g 2011

Addressing

Gestational Mellitus

A Reference Manual

Eds: Sridevi Seetharam, Anil Channakeshavamurthy,

Katherine Holbrook and Jennifer Toy

Developed by

Swami Vivekananda Youth Movement

With support from World Diabetes Foundation

This manual has been developed based on the experiences gained and information gathered during the implementation of the project Addressing Gestational Diabetes Mellitus in rural and tribal populations in South . This project was implemented by Swami Vivekananda Youth

Movement in H.D.Kote Taluk of Mysore District, State from March 2009 to October 2011, with support from World Diabetes Foundation*.

Swami Vivekananda Youth Movement (www.svym.org), established in 1984, is a development organization engaged in building a new civil society in India through its grassroots to policy-level

action in Health, Education and Community Development sectors. Acting as a key promoter- facilitator in the community's efforts towards self-reliance and empowerment, SVYM is developing local, innovative and cost-effective solutions to sustain community-driven progress.

World Diabetes Foundation (www.worlddiabetesfoundation.org) is dedicated to supporting prevention and treatment of diabetes in developing countries. WDF focuses on the following areas: Awareness of diabetes

Prevention of diabetes and its complications Education and training of patients and professionals Enhancement of detection, treatment and monitoring of diabetes

This work is licensed under a Creative Commons Attribution-

NonCommercial-ShareAlike 3.0 Unported License. To view a copy of the

license, visit http://creativecommons.org/licenses/by-nc-sa/3.0/

The contents of this manual may be used / reproduced with due credit to the authors. Citation is to be mentioned as: Addressing Gestational Diabetes Mellitus: A Reference Manual for the Grassroots. Eds: Sridevi Seetharam, Anil Channakeshavamurthy, Katherine Holbrook, Jennifer Toy. Swami Vivekananda Youth Movement. 2011. E-Version of this manual is available at www.svym.org/publications.html. .

Address for Correspondence Dr. Sridevi Seetharam Swami Vivekananda Youth Movement Hanchipura Road, Saragur, H.D.Kote Taluk Mysore District, Karnataka State, INDIA – 571121 Phone: +91.8228.265877 Email: [email protected], [email protected]

*Disclaimer: WDF has only funded the project. WDF was not involved with the writing or development of the contents of this manual and takes no responsibility of the authenticity or GDMotherwise Reference of the Man contents.ual 2

Table of Contents

A NOTE OF THANKS ...... 5 CONTRIBUTORS & REVIEWERS ...... 6 ABBREVIATIONS ...... 7 PREFACE ...... 8 A. INTRODUCTION ...... 10

ADDRESSING GESTATIONAL DIABETES MELLITUS ...... 11 WHY THIS MANUAL ...... 12 WHO SHOULD USE THIS MANUAL ...... 12 HOW TO USE THIS MANUAL ...... 13 NAVIGATING THIS MANUAL: ...... 14 B. KNOWING ABOUT DIABETES ...... 15 C. UNDERSTANDING GESTATIONAL DIABETES MELLITUS ...... 21 D. A PUBLIC HEALTH APPROACH TO GESTATIONAL DIABETES MELLITUS ...... 27

PRIMARY PREVENTION ...... 27 EARLY SCREENING AND DIAGNOSIS ...... 31 E. CLINICAL MANAGEMENT OF GESTATIONAL DIABETES MELLITUS ...... 36

CARE BEFORE DELIVERY ...... 36 TIMING AND MANAGEMENT OF DELIVERY AND IMMEDIATE POSTPARTUM ...... 46 CARE AFTER DELIVERY: POST PARTUM MANAGEMENT OF THE MOTHER AND THE BABY...... 50 ANNEXURE 1: STANDARD OPERATING PROCEDURES ...... 58

1A. MOTHERS’ MEETINGS ...... 58 1B. SELF HELP GROUP MEETINGS ...... 63 1C. PUBLIC MEETINGS & GATHERINGS ...... 67 1D. TORCH LIGHT PARADE ...... 69 1E. STREET PLAY ...... 72 1F. HEALTH EXHIBITION ...... 75 1G. HOUSE VISITS / ONE-TO-ONE DISCUSSIONS ...... 76 ANNEXURE 2: EDUCATIONAL TOOLS ...... 78

2A. HANDOUTS...... 78 2B