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"This step will go a long way in providing multiple benefits. First, there will be a reduction in the number of stillbirths, and second, congenital abnormalities caused by gestational diabetes will come down, as will infant deaths caused by asphyxia during birth. Finally, complications caused during the delivery of large babies will come down as well," says Dr P. Padmanabhan, Tamil Nadu's Director of Public Health. Diabetes leads to large babies as the mother does not absorb sugar from food like a normal person would. Instead, the sugar crosses the placenta and enters the growing foetus. The foetus' pancreas produce large amounts of insulin, absorbing the sugar and accumulating fat, which leads to a condition called macrosomia. Severe complication occurs in the last trimester, when the baby dies suddenly due to placental insufficiency. The government has issued the necessary orders and has acquired auto analysers (equipment that analyses blood) at the rate of one machine per 100,000 people. Around 385 PHCs and all general and medical college hospitals in the state have been geared to take glucose challenge tests. While 1,75,000 expectant mothers will be tested at the PHCs, around 4,25,000 mothers will be covered through hospitals. This comes to roughly 55 per cent of the total 11,00,000 births per annum in the state, Dr Padmanabhan says. While some other states test urine for sugar, Tamil Nadu has become the first to introduce blood testing. The latter being more reliable, as many patients have a 'high renal threshold' where the sugar does not show up in the urine. A couple of years ago, several doctors with interest in the field of diabetes and pregnancy joined hands to set up the Diabetes in Pregnancy Study Group India (DIPSI) and with it, a framework for establishing practice guidelines for the diagnosis and treatment of GDM in the Indian environment was put in place. Dr V. Seshaiah, who is the Chairman of Diabetes Care and Research Institute as well as president of DIPSI, explains that GDM is a transient abnormality of glucose intolerance during pregnancy. Women with GDM are at increased risk of diabetes in future, as are their children and following generations. According to Dr Seshaiah, the success of a project for prevention of any disease en masse is dependent on the awareness about the disease among the general population. In India, there is little awareness about the possibility of glucose intolerance during pregnancy, or its consequences. Moreover, even though doctors and healthcare professionals are aware that GDM is one among the various complications that could occur during pregnancy, no statistically significant data was available to further study the problem in the Indian context. This led Dr Seshaiah to take up a baseline study to assess the knowledge, attitude and practice (KAP) in a sample population in Chennai. The city was divided into 424 health sub-units, with population ranging between 30,000 and 51,000. Multi-purpose health workers monitored the health of each unit. The study revealed that only 13.2 per cent of the population had knowledge and awareness of GDM. After this startling discovery, an intensive awareness campaign was launched and, a year later, another study was conducted to assess the impact: awareness had risen to 23.5 per cent. Thereafter, the group, with funding from the World Diabetic Foundation, decided to screen a number of antenatal women to determine the prevalence of GDM. When the team informed the government of the proposed study, the then Director of Public Heath, Mr Murugan, and, later, Dr Padmanabhan, showed tremendous interest and recommended that medical personnel team up with statisticians to help validate the data. As Dr Madhuri, one of the doctors involved, points out, the study would not have been quick and effective but for the cooperation and enthusiasm of the government. It was conducted on 4,300 pregnant women involving over 90 PHCs and some private practitioners. One of the important
aspects of the testing methodology was that it used a one-step
procedure where only one blood sample would have to be collected. To
their dismay, it was found that 17 per cent of 4,300 women tested had
gestational diabetes. Tests were conducted in all three trimesters of
pregnancy. In addition, around 3,000 women were The low prevalence could be attributed due to the less mechanised, agriculture-based lifestyle. The study concluded that early screening could go a long way in avoiding the dreaded complications of the disorder. To begin with, laboratory technicians in PHCs are being trained to operate auto analysers. Pregnant women will be given 75 gm glucose orally and their blood glucose level tested after two hours. All those who record a level of over 120 mg/dl will be deemed as patients with GDM. The primary mode of management will be diet and exercise, as medication may affect the foetus. Doctors attached to the PHCs are being trained in the standard treatment protocol for management of diabetes, says Dr Padmanabhan. Recently, at a
conference on diabetes and pregnancy in Istanbul, Turkey, the Tamil
Nadu government’s order was hailed as the first initiative for
universal screening for GDM in the world. To the government's credit,
a number of countries---such as Spain---took copies of the state's
order to set up a similar system. —
WFS First-born kids more brainy Elder siblings really are more intelligent than the younger ones. An analysis of more than a quarter of a million teenagers found that the first-born children have a noticeably higher IQ on an average than their second-born siblings. Scientists believe that although the difference in IQ between elder and younger siblings is small, it is still big enough to impart significant benefits to elder brothers and sisters during the course of their life. They also believe that the difference is not due to the birth order alone---caused for example by differences in nutrition in the womb---but rather it is due to the fact that elder siblings experience a different childhood upbringing than their younger family members. One theory, for instance, is that elder siblings take on the role of unofficial tutors to their younger relatives, which actually benefits the elder child by making them more mature and intelligent at an earlier age. Sir Francis Galton, the 19th century scientist and father of the eugenics movement, was the first person to seriously study the apparent superiority of first-born sons who, he had noticed, tended to be appointed to prominent positions in society. In the early 1970s, Dutch scientists showed more scientifically that birth order is associated with higher intelligence, with first-born tending to score better on IQ tests than second-born or third-born. But some scholars believed that the findings were simply phantom artefacts resulting from uncontrolled differences between families caused by such things as family size, socio-economic status, parental IQ and other confounding factors. However, the latest study by Petter Kristensen of the University of Oslo and Tor Bjerkedal of the Norwegian Armed Forces Medical Services suggests that there really is a statistically significant difference in the intelligence of first and second-born siblings. They studied the military records of 2.41,310 Norwegian conscripts aged between 18 and 19 to see if the birth order could be linked with intelligence as measured by the results of their IQ tests on enrolment. They also included in the study second-born children whose elder sibling had died when very young to see if these second-born had a higher IQ than other second-born who had remained the second eldest child in the family. — By arrangement
with The Independent
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