Presenter: Guadalupe Canales Reñazco, Population Services International
Background: Adult prevalence of diabetes in Nicaragua is 12.4%, the second highest in South and Central America. The presence of gestational diabetes mellitus (GDM) incurs increased risk of complications during labor, poor birth outcomes, and later onset of diabetes in mothers and their children. Currently, screening and detection of GDM in Nicaragua is uncommon despite government guidelines on management of GDM. With the support of Novo Nordisk and the World Diabetes Foundation, the Pan American Social Marketing Organization (PASMO), a network member of Population Services International (PSI), is piloting an approach to build health worker capacity to manage GDM in antenatal care in four hospitals in Managua that primarily serve low income women.
Methodology: Women who present with known GDM risk factors (e.g., overweight, family history of diabetes) are screened at 24 weeks gestation with an oral glucose tolerance test. If positive, they are paired with a PASMO nutritionist who works with the primary provider to help them monitor their diets and identify pregnancy-safe exercises, reinforced using a food diary and motivational SMS messages. At every step, the active participation and decision making power of the women is emphasized.
Results: To date, 264 providers have been trained within the program. A total of 2,234 women have been screened and 398 have been diagnosed with GDM. Of the babies born to women with GDM, 4% have been born above average weight, compared with an estimated 42% risk of macrosomia for women with GDM who receive no treatment. Participating hospitals have begun hiring their own nutritionists to continue strengthening the program.
Conclusions: Building provider capacity to accurately screen, diagnose and manage GDM is a step towards improving antenatal care in Nicaragua. Successful integration of lifestyle interventions using the expertise of nutritionists along with primary care providers is a promising model of care.