Table 2 Procedures for GDM screening and diagnosis synthesised based on observations, interviews, and available written information, versus instructions from government order on screening
| Â | Private urban centre | Government rural centre - performed by private-non-profit laboratory technician | Government rural centre -performed by government laboratory technician | Government order on screening for hyperglycaemia in pregnancy | |
|---|---|---|---|---|---|
Step 1: Attending the health centre for the test | Informed and referred for the test | Via the gynaecologist/obstetrician | Via the village health nurse | Via the village health nurse | Not mentioned |
Step 2: Initiating, completing and getting the report of the test | Attending days | Fasting on Mondays-Saturdays | Fasting on Tuesdays | No-fasting on Thursdays | 1) Irrespective of whether she has taken her breakfast or not |
Attending time | Morning | Morning | Morning | 2) Not mentioned | |
Gestational age at attendance | No specific gestational age required, but testing is recommended in each trimester | No specific gestational age required, but testing is recommended in each trimester | 4th, 6th and 8th month of pregnancy | 3) Gestational week 24–28 | |
Flow of the testing procedure | 1) Register 2) Consultation with doctor 3) Pay bill 4) Give fasting venous sample 5) Drink prepared glucose solution 6) Wait 1Â h 7) Give 1Â h venous sample 8) Wait 1Â h 9) Give 2Â h venous sample 10) Have breakfast and wait for results | 1) Register 2) Give fasting venous sample 3) Mix and drink glucose solution 4) Wait 1Â h 5) Give 1Â h capillary sample 6) Wait 1Â h 7) Give 2Â h venous sample 8) Go home or wait for regular ANC check-ups | 1) Register 2) Drink prepared glucose solution 3) Wait 2Â h 4) Give 2Â h venous sample 5) Go home | 4) Registration not mentioned 5) Drink 75Â g glucose solution 6) Wait 2Â h 7) Give 2Â h venous blood sample | |
Getting the test report | On the day of the test. Around 1.5–2 h after 2 h sample | Usually 1 week later | If plasma glucose value is 140 mg/dl or more laboratory technician informs village health nurse who informs woman to come back fasting for a second test | Not mentioned | |
Diagnosis | Steps of confirming test/s step to be completed | A second test not requested as diagnosis is based on first test | A second test not requested as diagnosis is based on first test | 1) Register 2) Fasting venous blood sample 3) Have breakfast consisting of 4 idlys (lentil and rice cakes). 4) Wait 1.5Â h 5) Give 1.5Â h venous sample 6) Go home | A second test not requested as diagnosis is based on first test |
Diagnostic cut-off levels used | 2 h plasma glucose value ≥140 mg/dl (7.8 mmol/l) | 2 h plasma glucose value ≥140 mg/dl (7.8 mmol/l) | Fasting plasma glucose value ≥110 mg/dl (6.1 mmol/l) 1.5 h plasma glucose value ≥140 mg/dl (7.8 mmol/l)) Both values have to be above the cut-off | 2 h plasma glucose value ≥140 mg/dl (7.8 mmol/l) | |