Antenatal Care for Gestational Diabetes in Primary Care: A Retrospective Study in Kazakhstan

Introduction

Gestational diabetes mellitus (GDM) remains a significant public health concern requiring effective screening and timely diagnosis at the primary healthcare level. The aim of this study was to estimate GDM prevalence and to evaluate the organization of antenatal care for pregnant women with GDM in primary healthcare settings.

Materials and Methods

A retrospective observational study was conducted using randomly selected medical records of pregnant women receiving care in public polyclinics in two cities of Kazakhstan (Aktobe and Uralsk). Inclusion criteria were gestational age ≥28 weeks, singleton pregnancy, and absence of severe comorbidities. The sample comprised 445 cases. Data were extracted from the DamuMed electronic health system, including clinical, laboratory, and visit records. Sociodemographic and clinical variables were assessed. All data were anonymized, coded, and analyzed in aggregated form. Statistical analysis was performed using IBM SPSS Statistics 26.0 with descriptive methods.

Results

The mean age of the study population was 30.08±5.94 years, while it was higher in the subgroup of women with gestational diabetes mellitus risk factors (32.86±6.15 years). Hyperglycemia (5.1–7.0 mmol/L) was detected in 23.6% (n = 105), whereas GDM was diagnosed in only 1% (n = 5), indicating substantial underdiagnosis. At least one risk factor was present in 51.5% (n = 229). Repeat glucose testing at 24–28 weeks was performed in 13.9% (n = 62), and endocrinologist consultation in 8.5% (n = 38).

Conclusions

The findings reveal deficiencies in the diagnosis and management of gestational diabetes mellitus at the primary healthcare level. A substantial proportion of women with identified risk factors did not undergo recommended follow-up procedures in accordance with established diagnostic and antenatal care guidelines, emphasizing the need to strengthen screening practices, optimize referral pathways, and improve adherence to clinical protocols.

Key messages

• A large gap exists between detected hyperglycemia (23.6%) and confirmed GDM diagnosis (1%), indicating substantial underdiagnosis in routine antenatal care.

• Low rates of repeat testing (13.9%) and endocrinologist referral (8.5%) highlight inadequate adherence to recommended screening and care pathways for women at risk of GDM.