India has more than 62 million diabetic individuals 1,2, and according to Wild et al 3. the prevalence of diabetes is predicted to double globally from 171 million in 2000 to 366 million in 2030, affecting up to 79.4 million individuals in India. As of 2010, there were approximately 22 million women in the age group of 20 – 39 living with diabetes & an additional 54 million women in this age group with impaired glucose tolerance (IGT) or pre-diabetes have a likelihood of developing Hyperglycemia in Pregnancy (HIP) if they become pregnant. HIP in India is estimated to be in the range of 10 -14.3%. A field study conducted under the aegis of the Diabetes in Pregnancy – Awareness and Prevention project in Tamil Nadu, it noted that of the 4151, 3960 and 3945 pregnant women screened in urban, semi urban and rural areas, respectively, the prevalence of HIP was 17.8% in the urban, 13.8% in the semi urban and 9.9% in the rural areas 4. The incidence of HIP is expected to increase to 20% i.e. one in every 5 pregnant women is likely to have HIP 4 . HIP, with its long term implications of obesity, diabetes and cardiovascular disease on the offspring will contribute to this epidemic as it has a major trans-generational impact to perpetuate diabetes.
Women develop high blood sugar because of the stress of pregnancy and their inability to increase insulin secretion to compensate for the high demand. This has harmful effects on the mother and the unborn baby resulting in worsening of maternal and newborn outcomes. Thus women with HIP are more prone to get pregnancy induced hypertension and preeclampsia a major cause of maternal deaths and preterm deliveries. Women with HIP have large babies leading to obstructed labor or shoulder dystocia requiring expert supervision of the delivery or cesarean delivery; prolonged labor and assisted delivery increases risk for postpartum hemorrhage (PPH) and high risk of infections the other major cause of maternal morbidity. There is also a high risk of abortions, still births and preterm births in women with HIP. Apart from birth injuries the babies born to women with HIP are at great risk of respiratory distress and hypoglycemia requiring intensive care for survival.
The initiative aims to work with the World Diabetes Foundation, International Federation of Gynecology and Obstetrics (FIGO), Avni Health Foundation, 11 medical colleges and district hospitals, Government of India (GoI) – Ministry of Health and Family Welfare (MOHFW) and the six State Governments – Ministry of health and Family Welfare to support its new broad strategic direction for improving maternal and newborn health by initiating and scaling up the implementation of Hyperglycemia in Pregnancy (HIP) program and contribute towards the improved maternal and infant outcomes (initiating, scaling up and improving equals framing the standard diagnosis and management guidelines, training, counseling, service delivery, monitoring, follow up and reporting). Increase in institutional deliveries in India offers tremendous opportunities, thus focusing on strengthening the competency of health care providers (ObsGyn, medical officers, staff nurses, lab technicians, ANMs and State program managers) in adhering to standard HIP management protocols for improving the pre, intra and postpartum care for women and their neonates will be a step in the right direction.
1 Joshi SR, Parikh RM. India - diabetes capital of the world: now heading towards hypertension. J Assoc Physicians India. 2007;55:323–4. [PubMed], 2 Kumar A, Goel MK, Jain RB, Khanna P, Chaudhary V. India towards diabetes control: Key issues. Australas Med J. 2013;6(10):524–31. [PMC free article] [PubMed], 3 Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes-estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(3):1047–53. [PubMed], 4 Health and family welfare statistics 2013, National family health survey 3, Government of India annual reports 2013, GoI guidelines on the diagnosis and management of diabetes mellitus, December 2014.