Diagnosis and management of women with hyperglycaemia in
pregnancy
HIP was diagnosed according to WHO 2013 criteria as GDM: fasting glucose
≥5.1 and <6.9 mmol/L or 1-hour glucose ≥10.0mmol/L or 2-hour
glucose ≥8.5 and <11.0mmol/L; and, DIP: fasting glucose
≥7.0mmol/L or 2-hour glucose ≥11.1mmol/L. Women with hyperglycaemia in
pregnancy were notified and invited to meet the local obstetric team for
further management. A summary of local management practices conducted
prior to the study is provided in the Supplementary Appendix (Table S1).
Clinicians were provided with a basic treatment protocol based on the
FIGO pragmatic guide for diabetes antenatal care in the resource-limited
setting.15 Antenatal management was recorded with a
standardised proforma by the obstetric team at each study site including
the number of antenatal visits, fasting capillary glucose values,
treatment administered, and third trimester ultrasound scan results.
This study was aimed at examining the association of GDM, specifically,
and pregnancy outcomes; women with DIP were therefore excluded from
subsequent analyses. For this study, we considered GDM as ‘controlled’,
‘partially controlled’ or ‘uncontrolled’ if the mean of the two fasting
capillary blood glucose values prior to delivery were <5.1
mmol/L, 5.1-7.0 mmol/L, or >7.0 mmol/L respectively. If
cases were not seen in the antenatal clinic or only had one fasting
capillary glucose result, they were coded as ‘unknown’.