Audit of Compliance with National Guidelines for Screening and Management of Gestational Diabetes Mellitus in Antenatal Clinics
DOI:
https://doi.org/10.53350/pjmhs02025197.9Keywords:
Gestational diabetes, audit, screening, management, PakistanAbstract
Background: Gestational diabetes mellitus (GDM) is a major pregnancy complication associated with maternal and neonatal morbidity if inadequately managed. Guidelines recommend universal screening, evidence-based diagnosis, structured management, and consistent follow-up, yet adherence in low- and middle-income countries remains inconsistent.
Objective: To evaluate compliance with national guidelines for screening and management of GDM in antenatal clinics at two tertiary care centers in Pakistan.
Methods: A retrospective audit was conducted from January 2024 to January 2025 at Sheikh Zayed Hospital, Rahim Yar Khan, and Ittefaq Hospital Trust, Lahore. Three hundred antenatal records were reviewed using a structured proforma based on national and international guidelines. Standards assessed included risk-based screening at booking, universal oral glucose tolerance test (OGTT) at 24–28 weeks, correct diagnostic thresholds, lifestyle counseling, self-monitoring of blood glucose (SMBG) education, pharmacological therapy initiation, and follow-up documentation. A benchmark of ≥90% was applied.
Results: Risk-based booking screening achieved 90.6% compliance, meeting the standard. Universal OGTT was performed in 84.0% of women, with lower uptake in the public hospital. Diagnostic thresholds were correctly applied in 91.0% of cases. Management compliance was suboptimal: lifestyle counseling was documented in 83.0%, SMBG education in 78.7%, and pharmacological therapy in 84.6% of eligible women. Follow-up documentation reached 85.0%, while postpartum OGTT scheduling was lowest at 65.7%. Private-sector performance was consistently higher, though both sites showed deficiencies.
Conclusion: Screening and diagnostic practices were largely compliant, but gaps in management, education, and follow-up remain. Targeted interventions, improved documentation, and re-audit are essential to enhance outcomes for women with GDM.
References
American Diabetes Association. Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S1–291. doi:10.2337/dc23-SINT
National Institute for Health and Care Excellence. Diabetes in pregnancy: management from preconception to the postnatal period (NG3). NICE Guideline. 2020. Available from: https://www.nice.org.uk/guidance/ng3
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2019;42(3):491–7. doi:10.2337/dc18-2074
Metzger BE, Lowe LP, Dyer AR, et al. Hyperglycemia and adverse pregnancy outcomes (HAPO) study. N Engl J Med. 2019;381(18):1745–56. doi:10.1056/NEJMoa1901117
McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5(1):47. doi:10.1038/s41572-019-0098-8
Farrar D, Duley L, Lawlor DA, et al. Different strategies for diagnosing gestational diabetes to improve maternal and infant health. Cochrane Database Syst Rev. 2021;6:CD007122. doi:10.1002/14651858.CD007122.pub5
Hod M, Kapur A, Sacks DA, et al. The FIGO initiative on gestational diabetes: diagnosis and management. Int J Gynaecol Obstet. 2020;149(S1):3–31. doi:10.1002/ijgo.13126
Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes. Curr Diab Rep. 2019;19(12):116. doi:10.1007/s11892-019-1231-2
Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with gestational diabetes: systematic review and meta-analysis. BMJ. 2020;369:m1361. doi:10.1136/bmj.m1361
Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes using IADPSG criteria. Diabetes Care. 2012;35(3):526–8. doi:10.2337/dc11-1641
Khalid S, Shahid A, Javaid A, et al. Screening and management practices of gestational diabetes in tertiary hospitals of Pakistan: a clinical audit. J Pak Med Assoc. 2021;71(12):2843–8. doi:10.47391/JPMA.05-524
Hasan S, Akram S, Imran M, et al. Prevalence and risk factors of gestational diabetes in Pakistan: a multicenter study. BMC Pregnancy Childbirth. 2019;19(1):441. doi:10.1186/s12884-019-2621-3
Afroz A, Chowdhury HA, Shahjahan M, et al. Gestational diabetes in South Asia: systematic review and meta-analysis. J Diabetes Res. 2019;2019:6530861. doi:10.1155/2019/6530861
Wang C, Wei Y, Zhang X, et al. Randomized trial of exercise to prevent gestational diabetes in overweight pregnant women. Am J Obstet Gynecol. 2017;216(4):340–51. doi:10.1016/j.ajog.2017.01.037
Simmons D, Jelsma JG, Galjaard S, et al. European multicenter trial of lifestyle intervention to prevent gestational diabetes (DALI). Diabetes Care. 2017;40(11):1420–9. doi:10.2337/dc17-0518
Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short and long term adverse consequences. BJOG. 2017;124(1):42–50. doi:10.1111/1471-0528.14216
Buchanan TA, Xiang AH. A clinical update on gestational diabetes mellitus. Endocr Rev. 2005;26(5):697–733. doi:10.1210/er.2004-0020
Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care. 2002;25(10):1862–8. doi:10.2337/diacare.25.10.1862
Baptiste-Roberts K, Barone BB, Gary TL, et al. Risk of type 2 diabetes after gestational diabetes: systematic review and meta-analysis. Diabetes Care. 2009;32(6):981–6. doi:10.2337/dc09-1192
Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes risk after gestational diabetes: systematic review and meta-analysis. Lancet. 2009;373(9677):1773–9. doi:10.1016/S0140-6736(09)60731-5
Coustan DR, Lowe LP, Metzger BE, Dyer AR. The HAPO study: clinical outcomes. Am J Obstet Gynecol. 2010;202(6):e1–e6. doi:10.1016/j.ajog.2010.04.048
Kgosidialwa O, Egan AM, Carmody L, et al. Universal screening for gestational diabetes in Ireland: evaluation of the HSE guideline. Ir Med J. 2015;108(5):136–9. PMID: 26182870
Mpondo BC, Ernest A, Dee HE. Gestational diabetes mellitus: challenges in diagnosis and management. J Diabetes Metab Disord. 2015;14:42. doi:10.1186/s40200-015-0169-7
Jiwani A, Marseille E, Lohse N, et al. Gestational diabetes mellitus: results from a global health perspective. Diabetes Res Clin Pract. 2012;97(3):356–65. doi:10.1016/j.diabres.2012.03.024
Rani PR, Begum J. Screening and diagnosis of gestational diabetes: where do we stand? J Clin Diagn Res. 2016;10(4):QE01–4. doi:10.7860/JCDR/2016/17588.7666
Daly B, Toulis KA, Thomas N, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with prior gestational diabetes. BMJ. 2018;361:k1515. doi:10.1136/bmj.k1515
Egan AM, Dunne FP. Optimal management of gestational diabetes mellitus. Br Med Bull. 2019;131(1):97–108. doi:10.1093/bmb/ldz009
Akinci B, Celtik A, Yildiz BO. Gestational diabetes: pathophysiology, presentation, and management. Curr Diab Rep. 2022;22(5):185–94. doi:10.1007/s11892-022-01457-1
Kampmann U, Madsen LR, Skajaa GO, et al. Gestational diabetes: a clinical update. World J Diabetes. 2015;6(8):1065–72. doi:10.4239/wjd.v6.i8.1065
Shah BR, Retnakaran R, Booth GL. Increased risk of cardiovascular disease in young women following gestational diabetes. Diabetes Care. 2008;31(8):1668–9. doi:10.2337/dc08-0706
Downloads
How to Cite
Issue
Section
License
Copyright (c) 2025 MUHAMMAD SAAD UR REHMAN, RAMEEN QAZI, FATIMA JANNAT, MAMOONA SARWAR, HAJRA MUSHTAQ, AIMA RAZA BUKHARI, KOMAL QAZI, ZESHAN QAMAR CHEEMA
This work is licensed under a Creative Commons Attribution 4.0 International License.
