Factors influencing utilization of universal Gestational Diabetes Mellitus screening services among mothers in Sri Lanka: A cross sectional study

Abstract

Abstract Background: Gestational Diabetes Mellitus (GDM) is associated with adverse maternal and perinatal outcomes and increased risk of developing diabetes in later life for both child and mother. Early detection of mothers with risk of GDM is pivotal in preventing such adverse outcomes. Sri Lanka adopted universal GDM screening at two time points in pregnancy (before 12 weeks and between 24 to 28 weeks) since 2014 and its utilization has not been assessed. This study aimed to assess utilization of GDM screening services and associated factors among antenatal mothers in Southern Sri Lanka. Methods: A cross-sectional study was carried out in a convenient sample of 420 postpartum mothers delivered at three hospitals in Matara district, Sri Lanka. Data were collected using an interviewer-administered questionnaire. A data record sheet was used to collect information on availability of screening services and the logistics to provide services. Data were analysed using SPSS software and Chi square test was used to assess the association between variables. Results: Mean age (SD) of the mothers in the sample was 29 (5.2) and the majority were in their first or second pregnancy. The coverage of first and second screening tests were 91.4% and 94.5% and timeliness were 72.4% and 59.5%, respectively. Median period of amenorrhoea at first and second screening were 10.0 (inter-quartile range: 7.5-12.5) weeks and 28.0 (inter-quartile range: 26.5-29.5) weeks. A higher utilization was associated with higher maternal education for both screening tests (p=0.021 and p=0.025). Primiparity (p=0.033), nulliparity (p=0.03), planned pregnancy (p=0.00), proximity of nearest laboratory (p=0.02) and having family support (p=0.025) were positively associated with having at least one screening test. Timeliness of screening was associated with performing the test at field clinics for both screening tests (p<0.001 and p=0.007). Being unemployed (p=0.005), planned pregnancy (p=0.023) and availability of logistics at field clinics (p=0.007) were associated with timely performance of at least one screening test. Conclusions: Though a high utilization of GDM screening was observed among antenatal mothers, measures should be taken to ensure timeliness of screening through improved availability and accessibility of screening facilities. Further studies are recommended to assess service provider’s perspective.