Abstract

Gestational diabetes mellitus (GDM) is glucose intolerance first recognized during pregnancy and is associated with short- and long-term adverse outcomes for both mother and child. Knowledge about GDM influences screening uptake, self-management, and postpartum follow-up. This study assessed prevalence indicators of GDM and evaluated knowledge regarding GDM among antenatal clinic attendees at District General Hospital (DGH), Kilinochchi. A descriptive cross-sectional study was conducted among 423 pregnant women. Data were collected using a structured questionnaire and recorded plasma glucose readings. Descriptive statistics were used. Fasting plasma glucose >95 mg/dL was observed in 35% of participants and 2-hour plasma glucose >140 mg/dL in 68%. Only 33% had ever heard of GDM, and family was the main source of information. Knowledge about screening, risk factors, complications, postpartum testing, and long-term child outcomes was generally poor. The findings highlight the need for structured antenatal education and strengthened health-worker counselling to improve GDM awareness and management in this setting.

Introduction

Gestational diabetes mellitus (GDM) is defined as glucose intolerance first recognized during pregnancy. It is associated with maternal and fetal complications including macrosomia, polyhydramnios, intrauterine fetal death, preeclampsia, preterm birth, and increased caesarean section rate. Women with GDM are at increased risk of developing type 2 diabetes mellitus later in life, and their offspring are at increased risk of obesity and glucose intolerance. Early detection through screening and appropriate management including lifestyle modification and pharmacotherapy can reduce adverse outcomes.

Understanding the burden of GDM and the knowledge level among antenatal clinic attendees is essential to improve screening uptake, timely diagnosis, adherence to dietary and lifestyle advice, and postpartum follow-up. There is limited local data from Kilinochchi describing both glucose abnormalities and patient knowledge regarding GDM. Findings from this study can inform targeted education strategies and strengthen clinical services at DGH Kilinochchi.
GDM prevalence varies globally depending on diagnostic criteria, population characteristics, and screening strategies. The Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study demonstrated a continuous relationship between maternal glucose levels and adverse pregnancy outcomes, which contributed to international diagnostic recommendations. International Association of Diabetes and Pregnancy Study Groups (IADPSG) and WHO criteria have influenced many national guidelines, while organizations such as ACOG, RCOG, RANZCOG, and SLCOG provide clinical recommendations on screening and management. Regional studies report increasing prevalence in South Asia and the Middle East, commonly associated with higher maternal age, obesity, and family history of diabetes. Evidence also indicates that patient knowledge is often insufficient, particularly regarding risk factors, screening timing, postpartum follow-up, and long-term consequences. Sri Lankan evidence suggests knowledge gaps among antenatal clinic attendees, emphasizing the need for structured counselling and culturally appropriate educational interventions.

Methodology

Descriptive cross-sectional study was conducted at antenatal clinic, District General Hospital (DGH), Kilinochchi, Sri Lanka. Pregnant women attending the antenatal clinic were considered as study population. Health care workers who were among study population were excluded from the study. Sample size was 423 which were recruited through consecutive sampling of eligible antenatal clinic attendees during the study period. A structured questionnaire assessed socio-demographic factors, obstetric characteristics, awareness and knowledge about GDM, and management knowledge. Plasma glucose readings (fasting and 2-hour) were recorded from available tests was used as study instrument. Relevant descriptive statistical techniques were used for data analysis.

Results

A total of 423 antenatal clinic attendees participated in the study. Results are presented according to the study objectives. Fasting plasma glucose values above 95 mg/dL were observed in 148 (35%) participants. Two-hour plasma glucose values above 140 mg/dL were observed in 288 (68%) participants. The 1-hour OGTT value was not performed.

The majority of the study participants believed that there is a higher risk of developing GDM when there’s a history of GDM during previous pregnancies. However, the majority refused to accept the risk of experiencing GDM when there is a family history of Diabetes Mellitus. The majority of the study participants believed that GDM does not create any risk of having preterm childbirth or increase the risk of pre eclampsia.

The majority of the participants were not aware of the association between GDM and occurring congenital abnormalities, unexplained fetal dismissal or macrosomia newborns (Table 2). A significant number of pregnant mothers refused to accept the relationship between onset of GDM and presence of pre pregnancy obesity.

The majority of the participants did not have any knowledge regarding the association between GDM and experiencing rapid weight gain during the pregnancy period (Table1). According to the majority of the study participants, having childbirth through LSCS is decided due to the presence of GDM.

According to the majority of the study participants, screening for GDM should be done during the first trimester. However, 19.8%(n=84) of the study participants were not aware of any screening procedures related to GDM(Figure: II).

The majority of the study participants were not aware of any postpartum blood sugar testing procedures (n=204). According to the majority of the mothers who were aware of the postpartum blood sugar testing procedure, it should be done six months after the childbirth process (Figure: III).

Discussion

This study assessed the prevalence indicators of gestational diabetes mellitus (GDM) and the level of knowledge regarding GDM among antenatal clinic attendees at DGH Kilinochchi. The discussion is presented according to the study objectives.
The findings suggest a considerable burden of abnormal glucose readings among antenatal clinic attendees. More than one-third (35%) had fasting plasma glucose values above 95 mg/dL and over two-thirds (68%) had 2-hour plasma glucose values above 140 mg/dL. However, interpretation of true prevalence must be cautious because the 1-hour OGTT value was not performed, and complete OGTT testing is typically required for diagnosis. Awareness of GDM was low, with only one-third reporting they had heard of the condition. Among those who had heard, family was the most common source of information. Knowledge of screening, risk factors, complications, postpartum testing, and long-term child outcomes was generally poor, although most women understood that good blood sugar control is important.
This study used summarized questionnaire data, which limited the ability to compute individual knowledge scores and perform inferential statistics. The 1-hour OGTT reading was not performed, which may affect diagnostic classification. Knowledge was assessed using close-ended questions, which may not fully capture depth of understanding.

Conclusion/Recommendations

Abnormal fasting and 2-hour plasma glucose values were common among antenatal clinic attendees at DGH Kilinochchi, suggesting a high burden of glucose intolerance during pregnancy. However, awareness and knowledge regarding GDM were poor across most domains. Strengthening antenatal education, standardized screening, and postpartum follow-up is required.
Structured antenatal education sessions on GDM should be implemented at clinic level, with emphasis on screening timing, risk factors, complications, postpartum testing, and long-term effects. Health workers should provide consistent counselling and culturally appropriate materials. Standardized screening protocols and postpartum follow-up pathways should be strengthened.

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