Mishra Surabhi, Semwal Jayanti, Srivastava Abhay, Kumar Mishra Surendra
Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, India.
Department of Water Resources Development and Management, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India.
Indian J Endocrinol Metab. 2023 Mar-Apr;27(2):145-153. doi: 10.4103/ijem.ijem_459_22. Epub 2023 Apr 14.
Phase I of the revalence of estational iabetes Mellitus in ural ehradun (PGDRD) project estimates hyperglycemia in pregnancy (HIP) prevalence and identifies gaps in the utilization of community-related services in rural areas of the Dehradun district (western Uttarakhand); a state where notably no prior population-based study has ever been conducted despite being an Empowered Action Group state for more than two decades.
Using a multistage random sampling technique, 1,223 pregnant women locally registered in the rural field practice area of a block were identified. Those requiring HIP screening were subjected to a 2-h 75 g oral glucose tolerance test during the house visit irrespective of their period-of-gestation and last meal timings, diagnosed using the Diabetes in Pregnancy Study Group India (DIPSI) criterion (when indicated). Data were collected by personal interviews using a pretested data collection tool. Statistical Package for Social Sciences version 20.0 was used for analysis.
The overall HIP prevalence recorded was 9.7% (95% CI: 8.1-11.5%); the majority (95.8%) were GDM followed by overt DIP (4.2%). Less than 1% of the subjects (0.7%) self-reported pre-GDM. Despite this burden, more than three-fourths were never screened for HIP in their pregnancy. Of those tested, the majority availed secondary healthcare facilities. Few even had to bear expenses in private with a very handful being tested free-of-cost by ANM in the community; findings that altogether sharply contrast to those recommended by national protocols.
Despite the high HIP burden, beneficiaries are unable to utilize community-related universal screening protocols as desired.
德拉敦农村地区妊娠期糖尿病患病率(PGDRD)项目的第一阶段估计妊娠期高血糖症(HIP)的患病率,并找出北阿坎德邦西部德拉敦地区农村社区相关服务利用方面的差距;该邦尽管作为增强型行动小组邦已有二十多年,但此前从未进行过基于人群的研究。
采用多阶段随机抽样技术,确定了在一个街区农村实地实践区域本地登记的1223名孕妇。无论妊娠周数和最后一餐时间如何,需要进行HIP筛查的孕妇在家庭访视期间接受2小时75克口服葡萄糖耐量试验,并根据印度妊娠糖尿病研究组(DIPSI)标准进行诊断(如有需要)。使用预先测试的数据收集工具通过个人访谈收集数据。使用社会科学统计软件包20.0进行分析。
记录的总体HIP患病率为9.7%(95%CI:8.1-11.5%);大多数(95.8%)为妊娠期糖尿病(GDM),其次是显性糖尿病(DIP,占比4.2%)。不到1%的受试者(0.7%)自我报告为妊娠前糖尿病(pre-GDM)。尽管有如此高的负担,但超过四分之三的孕妇在孕期从未接受过HIP筛查。在接受检测的孕妇中,大多数利用了二级医疗设施。很少有人甚至需要自费,只有极少数人在社区由辅助护士助产士(ANM)免费检测;这些结果与国家方案所建议的情况形成鲜明对比。
尽管HIP负担沉重,但受益者无法按预期利用社区相关的通用筛查方案。