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’.