Published: 2022-05-27

Health system determinants of gestational diabetes mellitus screening of pregnant patients in public health facilities of district Jhansi: a cross sectional study

Sudha Sharma, Anil K. Malhotra


Background: Worldwide, one in 10 pregnancies is associated with diabetes, 90% of which are gestational diabetes mellitus (GDM). Undiagnosed or inadequately treated GDM can lead to significant maternal and fetal complications. Due to this high prevalence, currently universal screening is being done for all pregnant women. The present study aims to assess the status of screening at these facilities and the factors which can improve this further.

Methods: The status of screening was determined by GDM reporting format for last six months preceding the study from April 2018 to September 2018 and 100 auxiliary nurse midwives (ANMs) were selected from 4 blocks were interviewed to assess the factors and challenges which are associated with GDM screening with the help of a predesigned questionnaire.

Results: Overall 40.05% (73.17-14.27%) antenatal women are being screened in Jhansi district at public health facilities. The percentage of screened women found positive for GDM were 4.71% (1.36-8.99%). The factors found to be associated with screening were factors like age, years of service and education, availability of logistics, distance of sub-center within 10 km of the Community Health Centre (CHC), having both Accredited Social Health Activist (ASHA) and Anganwadi worker (AWW) as motivators and doing screening at all sites (sub-center and out-reach). ANMs who had their own vehicle were found to do better screening.

Conclusions: To make screening for GDM universal at all public health facilities continuous monitoring of sub-centers and VHNDs, support to ANMs in the form of availability of logistics, and involving the ASHA and AWW in routine screening are essential.


Gestational diabetes mellitus, Pregnant women, Screening, DIPSI method

Full Text:



Coustan DR, Lowe LP, Metzger BE, Dyer AR. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study: paving the way for new diagnostic criteria for gestational diabetes mellitus. Am J Obstet Gynecol. 2010;202(6):654.

Seshiah V, Kapur A, Balaji V, Shah SN, Das AK, Diwakar H, et al. Targeting Glycemic Level in Gestational Diabetes Mellitus to that of Normal Pregnancy would result in a better Maternal-Fetal Outcome. J Assoc Physicians India. 2019;67(4):66-70.

Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. J Assoc Physicians India. 2004;52:707-11.

Anjana RM, Deepa M, Pradeepa R, Mahanta J, Narain K, Das HK, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5(8):585-96.

Siddiqui S, Waghdhare S, Panda M, Sinha S, Singh P, Dubey S, et al. Regional prevalence of gestational diabetes mellitus in North India. J Diabetol. 2022;10(1):25.

Govt of India. National guidellines for Diagnosis & Management of Gestational Diabetes Mellitus. Natl Guid Govt India. 2014;1(1):1-100.

Chudasama RK, Kadri AM, Ratnu A, Jain M, Kamariya CP. Magnitude of gestational diabetes mellitus, its influencing factors and diagnostic accuracy of capillary blood testing for its detection at a Tertiary Care Centre, Rajkot, Gujarat. Indian J Community Med. 2019;44(2):142-6.

Babu GR, Tejaswi B, Kalavathi M, Vatsala GM, Murthy GVS, Kinra S, et al. Assessment of screening practices for gestational hyperglycaemia in public health facilities: A descriptive study in Bangalore, India. J Public health Res. 2015;4(1):29-34.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu) - A community based study. J Assoc Physicians India. 2008;56:329-33.

Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, et al. Prevalence of Gestational Diabetes Mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016;2(1):1-11.

Chebrolu P, Kurbude R, Thakur M, Shah N, Jain R. Gestational diabetes in rural central India: low prevalence but absence of typical risk factors. Heliyon. 2021;7(7):e07431.

Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol. 2018;55(6):613-25.