Developing a stepwise approach by integrating nutrition and lifestyle modifications in the management of diabetes amongst pregnant women in hospitals of urban Vadodara

Introduction: With estimated rates of Gestational Diabetes Mellitus being much higher in Indiathan West (10-14.3%) and an approximate of about 4 million women being affected nationwide at anygiven point in time has made Diabetes a major antenatal concern in India.Objective: To develop a stepwise approach by integrating nutrition and lifestyle modifications inmanagement of diabetes amongst pregnant womenMethods: The cross-sectional study comprised of situational analysis under Phase I wherein onetime in-depth interviews of doctors and pregnant women were conducted to identify screening, assessmentand management protocols being used. Six hundred pregnant women from government and privatehospitals across all four zones of Vadodara city were interviewed along with the doctors. Phase IIcomprised of an interactive session with doctors and nutritionists to discuss the issues faced whileimplementing routine screening, assessment and management protocols. Information was used to developstepwise approach.Results: Prevalence of Gestational Diabetes Mellitus and Diabetes in pregnancy were found to bedifferent as reported by the doctors versus what was observed by the researcher in the situational analysis.Majority (76%) women reported of being tested for diabetes using fasting or random blood sugar test.However, only 16% got Oral Glucose tolerance test done whereas 80% of the doctors reported of gettingOGTT done as an assessment method for these women. Almost all doctors (94.7) reported of dietcounselling being administered to the subjects however, only one hospital had a dietician. A stepwiseapproach was developed for screening and assessment of this pregnancy risk using the existing protocolsand including recommendations from Phase-II.Conclusion: A universal approach for integrated management with nutrition as the key componentfor efficient management and risk reduction for a safe pregnancy is the way forward which was the focalpoint of this study.