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Primordial prevention: maternal health and diabetes

Veerasamy Seshiah & Vijayam Balaji

Women with gestational diabetes mellitus (GDM) are an ideal group for the primary prevention of diabetes as they are at increased risk of future diabetes, predominantly Type 2 diabetes mellitus, as are their children. This necessitates universal screening for GDM. The International Association of Diabetes and Pregnancy Study Group recommend three blood tests with 75‑g oral glucose load, although one value is adequate to diagnose GDM, whereas WHO recommends that GDM is diagnosed if 2‑h plasma glucose is ≥7.8 mmol/l with 75‑g oral glucose load, similar to impaired glucose tolerance outside of pregnancy. The Diabetes In Pregnancy Study Group India procedure is a modified WHO procedure in that it requires one blood test performed at 2 h with 75 g of oral glucose administered in the fasting or nonfasting state without considering the time of the last meal. This procedure serves both as a screening and diagnostic tool. This economical and evidence-based procedure is suitable for all socioeconomic populations, especially in resource-limited settings.