Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised.

In 2014, chronic, non-communicable diseases (NCDs) represent the leading causes of global mortality and disability. Government-level concern, and resulting policy changes, are manifesting. However, there continues to be a paucity of guiding frameworks for legislative measures. The surge of NCDs will require strong and effective governance responses, particularly in low and middle-income countries. Simultaneously following the 2008 World Health Report, there has recently been renewed interest in Primary Health Care (PHC) and its core principles. With this, has come strengthened support for revitalizing this approach, which aims for equitable and cost-effective population-health attainment. In this light and reflecting recent major global reports, declarations and events, we propose and critique a PHC approach to NCDs, highlighting PHC, with its core themes, as a valuable guiding framework for health promotion and policy addressing this group of diseases.

Background: Bullying among children is associated with high symptom load and depression. There is little knowledge about long-term consequences of bullying. The aim of the present study is to examine the association between recall of bullying at school and depression in midlife controlling for adult social class and parents’ mental health. Methods: The analyses were based on the 2004 survey among men from the Metropolit 1953 Danish Male Birth Cohort (n = 6094). Information on depression was retrieved by the Major Depression Inventory (MDI) (prevalent depression) and by a measure of first doctor diagnosed depression between the ages 31–51 years (DD). Information on bullying was based on a recall measure of bullying in school categorized into three dimensions: occurrence; intensity; and duration. Results: Compared to subjects who had never been bullied, those exposed to bullying in school were at a significantly increased risk of having been diagnosed with depression between the ages 31–51 years. Long duration and high intensity of bullying were risk factors for both MDI and DD. Inclusion of the possible confounders (SES, parental mental illness) attenuated the associations somewhat, but the associations remained statistically significant. Conclusion: The present comparisons of the long-term incidence of depression among middle-aged men who experienced high and low levels of bullying at school might indicate that being bullied at school is a contributing factor in the development of depression. Prospective longitudinal studies are needed to confirm the effect of bullying in school on adult depression.

Gestational diabetes mellitus (GDM) affects an increasing number of pregnant women globally. Although studies have identified psychosocial ramifications associated with GDM, stigma in the form of experienced discrimination and self-blame and its consequences have received limited attention. Our objective was to examine the current evidence on stigma, as experienced among women with GDM, including the potential adverse consequences hereof. A scoping review was conducted with citations retrieved from the databases MEDLINE, CINAHL, EMBASE and, PsycINFO. Studies published before 15 June 2022, when the search was conducted, were included. We identified 1388 citations and included 44 in the review. We found that women with GDM may experience stigma in the form of overt discrimination from healthcare personnel and relatives, and in the form of internalised stigma, such as guilt and shame. Identified consequences include avoidance of screening, not following dietary recommendations nor reporting blood glucose readings, social isolation, and poor mental wellbeing. No estimates of stigma prevalence were identified. Existing evidence shows that women with GDM report stigma, which may affect both their mental and physical health. Further investigations into the prevalence of stigma and long-term consequences of stigma are much needed. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Background : To address the risks of adverse pregnancy outcomes and future type 2 diabetes associated with gestational diabetes mellitus (GDM), its early detection and timely treatment is essential. In the absence of an international consensus, multiple different guidelines on screening and diagnosis of GDM have existed for a long time. This may be changing with the publication of the recommendations by the International Association of Diabetes and Pregnancy Study Groups. However, none of these guidelines take into account evidence from or ground realities of resource-poor settings. Objective : This study aimed to investigate whether GDM projects supported by the World Diabetes Foundation in developing countries utilize any of the internationally recommended guidelines for screening and diagnosis of GDM, explore experiences on applicability and usefulness of the guidelines and barriers if any, in implementing the guidelines. These projects have reached out to thousands of pregnant women through capacity building and improvement of access to GDM screening and diagnosis in the developing world and therefore provide a rich field experience on the applicability of the guidelines in resource-poor settings. Design : A mixed methods approach using questionnaires and interviews was utilised to review 11 GDM projects. Two projects were conducted by the same partner; interviews were conducted in person or via phone by the first author with nine project partners and one responded via email. The interviews were analysed using content analysis. Results : The projects use seven different screening procedures and diagnostic criteria and many do not completely adhere to one guideline alone. Various challenges in adhering to the recommendations emerged in the interviews, including problems with screening women during the recommended time period, applicability of some of the listed risk factors used for (pre-)screening, difficulties with reaching women for testing in the fasting state, time consuming nature of the tests, intolerance to high glucose load due to nausea, need for repeat tests, issues with scarcity of test consumables and lack of equipment making some procedures impossible to follow. Conclusion : Though an international consensus on screening and diagnosis for GDM is welcome, it should ensure that the recommendations take into account feasibility and applicability in low resource settings to ensure wider usage. We need to move away from purely academic discussions focusing on sensitivity and specificity to also include what can actually be done at the basic care level.

Maternal mortality and morbidity remains high in many low- and middle-income countries (LMIC). Gestational Diabetes Mellitus (GDM) represents an underestimated and unrecognised impediment to optimal maternal health in LMIC; left untreated – it also has severe consequences for the offspring. A better understanding of the barriers hindering detection and treatment of GDM is needed. Based on experiences from World Diabetes Foundation (WDF) supported GDM projects this paper seeks to investigate societal and health system barriers to such efforts. Questionnaires were filled out by 10 WDF supported GDM project partners implementing projects in eight different LMIC. In addition, interviews were conducted with the project partners. The interviews were analysed using content analysis. Barriers to improving maternal health related to GDM nominated by project implementers included lack of trained health care providers - especially female doctors; high staff turnover; lack of standard protocols, consumables and equipment; financing of health services and treatment; lack of or poor referral systems, feedback mechanisms and follow-up systems; distance to health facility; perceptions of female body size and weight gain/loss in relation to pregnancy; practices related to pregnant women’s diet; societal negligence of women’s health; lack of decision-making power among women regarding their own health; stigmatisation; role of women in society and expectations that the pregnant woman move to her maternal home for delivery. A number of barriers within the health system and society exist. Programmes need to consider and address these barriers in order to improve GDM care and thereby maternal health in LMIC.