Table 1.

Screening and management practices in identified publications.

Number	Author (ref.)	Year	Country	Setting	Design	Population	Screening	(Re)admission	Inpatient care	Follow-up	Outpatient care	Delivery	Newborn care	Postpartum
1	Sutton [13]	1977	Fiji	Referral hospital	Retrospective observational	21 pregnant diabetic women		32 weeks	Bed rest, diet, glycaemia 2x weekly. Amniotic fluid 1x weekly at ≥36 weeks; steroids 1 week prenatal			Planned delivery at 38 weeks: vaginal delivery but CS if complications or labor >18 hours; observed CS rate 57%
2	Fraser [14]	1982	Kenya	National hospital	Retrospective observational	51 pregnant diabetic women	50 g OGTT	After first visit (<32 weeks); Readmission 32 weeks	Initial stay: diet, glycaemia 3x/day 1-2/week; readmission: urine & blood pressure daily; weight & uterine height weekly; ≥37 weeks: amniotic fluid weekly	Weekly or fortnightly	Glucose and urine, blood pressure, weight, and abdominal examination	Induction; CS if no delivery within 12 hrs or if indication; observed CS rate 31% (half of them elective)	Pediatricians at delivery; observation of newborn for several days; early feeding
3	Otolorin et al. [15]	1985	Nigeria	University hospital	Retrospective observational	48 pregnant women diagnosed with diabetes		Initial admission first trimester/after booking; readmission between 32–34 weeks	Diet with 2000–2500 cal; twice weekly 4-point profile			Mode of delivery depending on several factors (e.g. age, diabetes control). Observed CS rate of 41%; 70% of patients delivered before 38 weeks	All newborn admitted to special newborn care unit and reviewed by pediatrician
4	Lutale et al. [16]	1991	Tanzania	University hospital	Prospective observational	47 pregnant diabetic women		No specific policy; decision on individual basis		Every 2-3 weeks; weekly if poorly controlled	Glucose and urine test, weight; no SMBG	Vaginal delivery; labor not routinely induced in uncomplicated pregnancies; induction only if shake test positive; observed CS rate 30%
5	Kadiki et al. [17]	1993	Libya	Urban diabetes clinic	Retrospective observational	988 pregnant diabetic patients		High risk patients admitted at 34-35 weeks; all others in week 37-38		Fortnightly until 24 weeks, weekly thereafter	Fasting and postprandial plasma glucose; no SMBG; ultrasound to monitor fetal growth	Vaginal delivery: induction of high risk patients in week 37-38; all others allowed to proceed to term; observed CS rate 36%
6	Djanhan et al. [18]	1995	Ivory Coast	University hospital	Prospective observational	109 pregnant women diagnosed with diabetes		Initially for 2 weeks; readmitted around term	Initial stay: glycaemia, blood, and urine tests, vaginal swab, ophthalmological check, ultrasound, and diet counselling. Readmission: FHB daily, every 2nd day fasting glucose	Weekly; obstetrician monthly		Observation: 95% delivered at term
7	Akhter et al. [19]	1996	Pakistan	University hospital	Retrospective observational	267 diabetic pregnancies	Universal screening: 50 g GCT weeks 20–28; women with RF/abnormal GCT: 75 g OGTT			Monthly; fortnightly in third trimester		Observed CS rate: 26%
8	Daponte et al. [20]	1999	South Africa	University hospital	Retrospective observational	142 pregnant women with diabetes	100 g OGTT	Admission for education on glucose monitoring and diet	6-point glucose profile daily, diet counselling (1800–2000 cal) & SMBG initiation	Weekly by multidisciplinary team		Women allowed to proceed to term if good glycemic control and no other obstetric complications; observed CS rate 49%; mean gestational age at delivery 38 weeks
9	Mirghani and Saeed [21]	2000	Sudan	Teaching hospital	Prospective observational	74 pregnant women with diabetes	75 g OGTT	Initial admission; readmission weeks 34–36	Initial admission: urine 6 hourly and glycaemia 2x/week; readmission: FBG 2x/weekly	Fortnightly ANC: FBG (no SMBG possible)		Delivery 38 weeks (induction or CS if not delivered within 12 hours), during labor glycosuria & glycaemia, prophylactic antibiotics. Observed CS rate 65%	Breast feeding 30 min after delivery and 4–6 hours after CS. Pediatrician present; newborn blood sugar 2 hours after birth
10	Randhawa et al. [22]	2003	Pakistan	Teaching hospital	Retrospective observational	50 women with GDM and diabetes in pregnancy	GCT followed by OGTT in weeks 28–32				Initial advice on diet and exercise; regular ultrasound for fetal growth, FHR 2x/weekly, biophysical profile weekly in high risk cases after 32 weeks	Induction at 38 weeks; CS if >4000 g; in labor FHB and 2-hourly glycaemia; 2nd stage assisted; prophylactic antibiotics. Observed CS rate 50%	No specific information provided, but 48% of newborns admitted to neonatal ward
11	Ozumba et al. [23]	2004	Nigeria	University hospital	Retrospective observational	207 pregnant women diagnosed with diabetes	Selective screening; 75 g OGTT; fasting glucose of women with known diabetes			Fortnightly until 32 weeks, weekly thereafter. Follow-up in ANC and by physician in diabetes clinic	Fasting and postprandial glucose, ultrasound, blood grouping, and rhesus factor, hemoglobin, and urine. No SMBG (only if women can purchase glucometer)	Induction at 38 weeks. Vaginal delivery in uncomplicated and well-controlled cases; induced if poorly controlled or complications; observed CS rate in GDM patients 20%		Women invited for repeat 75 g OGTT 6 weeks postpartum
12	Bouhsain et al. [24]	2009	Morocco	Teaching hospital	Retrospective observational	702 pregnant women consulting the gynecology department	If RF: screening at first ANC; universal screening at 24–28 weeks; screening with FBG alone or in combination with postprandial glycaemia or 50 g GCT followed by 100 g OGTT in case of GCT positivity
13	Dahana-yaka et al. [25]	2011	Sri Lanka	District facilities	Cross-sectional descriptive	223 pregnant women attending antenatal clinics	Selective screening at >24 weeks: 30.2% women with RF screened. 98% use urine dipstick, 27% postprandial glycaemia, 11% FBG or RBG, and 3% 75 g OGTT
14	Divakar & Manyonda [26]	2011	India	NA	Cross-sectional survey	584 specialists OBGY	Universal screening by 82% respondents; 65.5% test at first visit, 97.6% in weeks 24–28; as test 50g GCT done by 39.3%; 75 g OGTT by 26.2%; 14.3% test FBG.
15	Divakar & Manyonda [27]	2012	India	NA	Cross-sectional survey	584 specialists OBGY				Fortnightly glucose; 47.6% respondents advise daily home monitoring combined with follow-up visits 2x/month	69.1% of clinicians refer women with GDM to specialists	64.3% of obstetricians deliver women with GDM ≤ 38 weeks; 35.7% await spontaneous labor but 54.8% wait no longer than 39 weeks	57.1% of clinicians refer 10% and 33.3% refer 50% of newborns of mothers with GDM to NICU	93% of doctors advise testing 6 weeks postpartum: 56% advise random glucose tests
16	Maiti et al. [28]	2012	India	Urban hospital	Prospective observational	50 women with GDM	75 g OGTT			Women or relatives present results of fortnightly glucose test at clinic every 2 weeks	Nutritional advice; 3-point profile fortnightly at laboratories close to patient's home (no SMBG)	Observed CS rate (GDM): 84%; 82% delivered at term
17	Hirst et al. [29]	2012	Vietnam	Referral hospital	Qualitative study on perceptions & experiences of pregnant women with GDM management	4 FGD with 34 women having gestational diabetes	Universal screening; 75 g OGTT in week 28	Admission of noncontrollable cases	Glucose monitoring up to 6x daily	Weekly follow-up; glucose checks once or twice weekly at OPD if no SMBG	Women with GDM referred to high risk antenatal clinic: physician provides advice on nutrition. Glucose-surveillance recommended by SMBG or 1-2x/week at OPD
18	Nielsen et al. [30]	2012	Cameroon, China, Cuba, India, Kenya, and Sudan		Retrospective descriptive; review of screening practices of 9 GDM projects and qualitative assessment of barriers		Universal screening in 78% of 9 GDM projects by random glucose testing (Sudan), fasting glucose followed by OGTT (Cuba, Cameroon, and China); GCT followed by OGTT (Karnataka, India); or OGTT alone (Kenya & 2 states of India)
19	Rajagopalan et al. [31]	2013	India	Private hospital	Retrospective observational	Screening practices of 753 women booked in ANC; 105 with GDM	Universal screening; 2010–2012: single step at 24 weeks; 2013: screening in each trimester at booking, 26 and 34 weeks				After diagnosis advise on diet, exercise (and medication)	Induction of labor between 38 and 39 weeks; observed CS rate 38%
20	Thomas et al. [32]	2013	India	University hospital	Prospective observational	281 women with GDM requiring medication			Glycaemia 3–7 days after diet initiation			Observed CS rate: 43%; mean gestational age at delivery 37.5 weeks	Referral to nursing care: hourly feeding first 6 hours, then 2-hourly; glucose test after 1, 3, 5, 9, and 12 hours; if hypoglycemia iv dextrose
21	Gupta et al. [33]	2014	India	NA	Cross-sectional survey	134 health care providers (56 OBGY, 78 physicians)	59.7% of providers screen selectively based on RF and 30% screen universally; 88.8% respondents screen at first ANC visit: 77.6% of professionals by FBG, 18.6% by RBG, and 3.8% use 75 g OGTT			62.7% providers advise glucose test once every 2 weeks, 28.4% weekly
22	John et al. [34]	2015	Nigeria	University hospital	Retrospective observational	122 pregnant women with diabetes and 101 with GDM	Selective screening at booking with 75 g OGTT; repeated at 28 weeks					Mode of delivery assessed on individual basis depending on glycemic control; observed CS rate 89%	49% of newborns admitted to NICU
23	Babu et al. [35]	2015	India	70 public health facilities	Cross-sectional survey	50 doctors	Universal screening by 82% doctors: 52% in weeks 16–24. Screening by RBG done by 46% of respondents; GDM diagnosis with 75 g OGTT by 96% respondents							54% doctors test sugar postpartum and 36% use FBG; 80% counsel on diet; 82% on exercise; 96% advise follow-up of glycaemia