Healthy Mothers and Babies through Screening and Management of Gestational Diabetes Mellitus in Nicaragua

By Guadalupe Canales Reñazco, Executive Director PASMO Nicaragua, and Rebecca Firestone, Senior Research Advisor PSI

“When I realized I was pregnant, I was so happy,” says Yahaira, a first-time mother in Managua, Nicaragua. “I said, ‘At last I will be a mom.” At the beginning of pregnancy, Yahaira learned that she had maternity-induced hypertension and gestational diabetes mellitus (GDM), which could result in the death of her unborn child, if not appropriately managed. “I panicked because my son was at risk,” she says. “I could lose my son.”

Diabetes during pregnancy is a serious complication that all too often goes undiagnosed. One in six live births occur to women with some form of hyperglycemia (high blood sugar), and 84% of those cases are due to GDM. If not diagnosed and adequately managed, GDM can lead to more severe pregnancy complications and even to maternal deaths. Children born to women with GDM can have dangerously high birthweights, and GDM greatly increases the risk that women and their children will develop type 2 diabetes later in life. What’s even more troubling – the occurrence of GDM seems to be on the rise globally, tied to the global obesity epidemic and the rise of non-communicable diseases.

Despite the grave health risks of GDM, there’s been little action until recently to address the condition in the developing world. This is in part due to incomplete data as well as perceptions that managing diabetes is complex and expensive. Women outside of high-income countries are rarely screened for GDM during routine antenatal care, despite the fact that the vast majority of pregnancy complications and deaths occur in these countries.

Recognizing this major gap in care, the Pan American Social Marketing Organization (PASMO) in Nicaragua, a network member of Population Services International (PSI), has been working to improve diabetes management in pregnancy since 2012, with the support of Novo Nordisk and the World Diabetes Foundation. Comparative adult prevalence of diabetes in Nicaragua is 12.4%, the second highest in South and Central America. While national guidelines for managing GDM are available, these were rarely implemented in practice.

PASMO works with four private hospitals that are members of its Red Segura social franchise network. If the pregnant woman is found to have elevated blood sugar levels, she is paired with a PASMO nutritionist who works with the woman’s primary provider to help her monitor her diet and identify pregnancy-safe exercises. The nutritionist provides each woman with cooking and shopping advice, which the patient tracks with a food diary. She also receives motivational SMS messages on the CommCare network.

Yahaira was one of those women. When she received her diagnosis, her doctor referred her to a nutritionist who encouraged her change in eating habits and level of physical activity. Yahaira shared that advice with family members and soon she was purchasing more fresh fruit and vegetables while her mother cooked nutritious meals and her husband began encouraging her to complete the exercise program. The whole family began to make changes for their health.

At every step, PASMO encourages a woman’s active participation in her own health and lays the groundwork for her to use her own decision-making power. To date, 381 health care providers have been trained. Of the 4,159 women who have been screened, 648 were found to be positive, which corresponds to 15%. They are each receiving individualized nutritional counseling. The program has also seen improved coordination between the various providers delivering care to pregnant women, including OB/GYNs, internists, and nutritionists, so that women are receiving improved, more holistic care, including continued follow-up care in the post-partum period.

At a global level, the International Federation of Gynecology and Obstetrics (FIGO) just launched new global guidelines on GDM, making GDM care simpler and easier to take to scale.

“It’s exciting when the doctors say ‘You’ve improved,” says Yahaira. “There are things as a mom [that] make you say, ‘I am doing good things for my son.’” Yahaira’s son was born healthy five days after the interview was made.

Watch this video to meet Yahaira and learn more about PASMO’s GDM program in Nicauragua.

PSI and PASMO will be sharing successes and lessons learned from Nicaragua at the Global Maternal and Neonatal Health Conference in Mexico City this October as part of a conversation with colleagues from FHI360 and Jhpiego on improving health systems by integrating non-communicable diseases into maternal care with the Taskforce on Women and NCDs.