A Mass Media Campaign for Screening of Hyperglycemia in Pregnancy and Postpartum Follow-up: A Major Challenge in Resource-Constrained Settings, WDF-GDM Project, Pakistan

Abstract Background: Pakistan’s collaboration with the World Diabetes Foundation (WDF) introduced a pioneering and unparalleled initiative to enhance maternal and child healthcare. The mass media campaign for the detection of hyperglycemia in pregnancy (HIP) via screening, management, and prevention is a significant component of this collaboration to reduce the impact of hyperglycemia on maternal-fetal health and have insight on postpartum follow-up (PPFU) trends. Materials and Methods: WDF-GDM Project encompassed an extensive mass media campaign across 29 cities in 10 regions of Pakistan. The primary objective was to establish a national standard for screening and diagnostic standards of HIP, training healthcare providers in blood glucose (BG) screening, treatment, PPFU, as well as disseminating information about pre-conception counseling. The DIPSI method, which is a single-step, non-fasting oral glucose tolerance test with a diagnostic threshold of 140 mg/dL (7.8 mmol/L), was employed as a screening and diagnostic test. Results: A total of 17,392 pregnant women of diverse ethnic backgrounds attended antenatal visits; 77.2% ( n = 13,417) underwent BG screening based on DIPSI criteria, irrespective of the period of gestation. The overall prevalence of HIP was 35.7% with gestationally impaired glucose tolerance at 25.7%, and gestational diabetes mellitus (GDM) at 9.97% postpartum, approximately 4767 women were eligible for PPFU. Among these, 7% experienced fetal loss. Of the 2376 women who completed PPFU, 81% were normoglycemic, 9% had impaired fasting glucose, 8% had impaired glucose tolerance, and 2% were diagnosed with diabetes. About 75% of women who had hyperglycemia during pregnancy reverted to normoglycemia postpartum, while a small percentage continued to have persistent diabetes. Conclusion: This study highlights a GDM prevalence of 9.97% in Pakistan and depicts the positive outcome where many women returned to normoglycemia after childbirth. Factors such as previous pregnancies, body mass index, and history of fetal loss were identified as contributors to the development of hyperglycemia during pregnancy. The WDF-GDM initiative’s approach and comprehensive methodology provide better insights for future maternal healthcare strategies in similar settings nationally and globally.