Behind the blue skies, sparkling seas, and rolling golden beaches of Trinidad and Tobago, the population faces a harsh reality: Chronic noncommunicable diseases (or NCDs), such as heart disease, stroke, cancer, diabetes, and lung disease, are affecting the health of individuals and negatively impacting families and communities. In particular, diabetes and its associated complications are at epidemic proportions, and this rise in diabetes prevalence extends to pregnant women as well.
Each year, there are approximately 20,000 pregnancies in Trinidad and Tobago. Of these pregnancies, there are 1,000 cases of pre-gestational diabetes, and estimates of gestational diabetes are expected to be even higher, given the high prevalence of obesity and other susceptibility characteristics of the population.
How has Trinidad and Tobago addressed this pressing national health issue?
The Risks of Diabetes in Pregnancy
Expectant mothers with Diabetes in Pregnancy (DIP) face significant risks, which can lead to adverse outcomes. Maternal complications include preeclampsia, a higher likelihood of cesarean delivery, maternal mortality, and an increased risk of developing type 2 diabetes and cardiovascular diseases later in life. Fetal and neonatal complications might involve a larger-sized baby at birth, hypoglycemia, respiratory distress syndrome, jaundice, preterm birth, stillbirth, congenital disabilities, and the risk of obesity later in life.
A Program to Help Address Diabetes-Related Pregnancy Complications
Recognizing the urgent need to address these major risks, in 2018 the Ministry of Health (MoH) established the National Diabetes Mellitus and Pregnancy Clinical Guidelines. The Inter-American Development Bank (IDB) funded the Health Services Support Program, the National Screening and Management Programme for Diabetes in Pregnancy in Trinidad and Tobago initiative was undertaken as part of this effort to implement the guidelines.
This initiative aimed not only to identify pregnant women at risk but also to provide them with comprehensive care and support throughout their pregnancy journey. In the words of Dr. Adesh Sirjusingh, Director of Women Health at the MoH, “Every single patient will be tested for diabetes at the start and at the end of pregnancy so that we can intervene earlier, we can manage better and have better patient outcomes.”
The program focused on accessibility, offering screening services at all public healthcare facilities nationwide, including remote areas. Additionally, it emphasized education, empowering women with knowledge about diabetes management, healthy lifestyle choices, and the importance of regular prenatal care.
Providing equipment and medical technology created an enabling environment, and healthcare providers were trained to conduct screenings and approach each interaction with sensitivity and understanding. They recognized the anxieties and fears that expectant mothers might have and worked to create a supportive environment where women felt comfortable seeking help and guidance.
Interventions and Results
The specific interventions that the program involved consisted of:
- The implementation of universal screening.
- The improvement of screening in rural health facilities.
- The procurement of 3,218 hand-held glucometers for improved self-management at home.
- The provision of training to health care workers.
- And the provision of equipment across all Regional Health Authorities.
Managing diabetes during pregnancy can present many challenges in a developing country, where healthcare resources are not as readily available and accessible to vulnerable populations. However, the learning is clear: a proactive approach can provide practical and strategic solutions to this complex public health problem. Investments in early detection and comprehensive care can help reduce the burden of Diabetes in Pregnancy and ensure healthier outcomes for mothers and their babies.
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