Antenatal Screening Compliance for Gestational Diabetes and Its Effect on Maternal-Fetal Outcomes: A Pre- and Post-Intervention Clinical Audit

Abstract

Gestational diabetes mellitus (GDM) is associated with hypertensive disorders of pregnancy, operative delivery, macrosomia, neonatal hypoglycaemia, and neonatal intensive care unit (NICU) admission. Current guidance recommends risk assessment at booking and glucose testing during pregnancy, particularly a 75 g oral glucose tolerance test (OGTT) for women at increased risk, with earlier testing in women with previous GDM. Objective: To assess compliance with antenatal GDM screening standards and examine the effect of improved compliance on maternal and neonatal outcomes at Hina Hospital, Lahore. Methods: A two-cycle clinical audit was designed in the Department of Obstetrics and Gynaecology at Hina Hospital, Lahore, from January 2025 to July 2025. Cycle 1 reviewed 180 antenatal records and delivery files before intervention. After identifying gaps, an intervention bundle was implemented comprising a mandatory booking risk-assessment checklist, staff education, patient counselling, OGTT tracking, and fast-track referral of women with abnormal results. Cycle 2 re-audited 190 records using the same indicators. Results: Documentation of booking risk assessment improved from 65.6% to 96.8%, OGTT offering among eligible women from 67.7% to 95.1%, and OGTT completion from 51.0% to 88.2% (all p<0.001). Early testing for women with previous GDM improved from 36.4% to 91.7% (p=0.009). Significant improvements were also observed in pre-eclampsia (8.9% vs 3.7%, p=0.038), polyhydramnios (7.2% vs 2.6%, p=0.040), emergency caesarean delivery (32.2% vs 20.0%, p=0.007), macrosomia (11.7% vs 4.2%, p=0.008), and neonatal hypoglycaemia (9.4% vs 3.7%, p=0.025). Conclusion: A structured screening and follow-up pathway for GDM was associated with marked improvement in antenatal screening compliance and with favorable trends in several maternal and neonatal outcomes. The audit supports continued use of standardized risk assessment, timely OGTT completion, and documented specialist follow-up.