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Effect of Preconception Diabetes Screening on Diabetes Detection among Women Planning Pregnancy in Nigeria

Abstract

Diabetes is an important public health concern among women of reproductive age and may have serious implications for maternal and fetal health when it remains undiagnosed before conception. Women with previously undetected diabetes may enter pregnancy without appropriate medical assessment, blood glucose management, lifestyle counselling, and preconception care. Preconception diabetes screening provides an opportunity to identify women with previously undiagnosed diabetes or abnormal blood glucose levels before pregnancy occurs, allowing for timely clinical assessment, appropriate management, and referral. In Nigeria, however, access to preconception screening services remains limited in many communities because of inadequate awareness, financial constraints, geographical barriers, limited laboratory capacity, shortage of trained healthcare personnel, and insufficient integration of non-communicable disease screening into reproductive health services. Against this background, this study investigates the effect of preconception diabetes screening on diabetes detection among women planning pregnancy in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Health Promotion Model. The Health Belief Model explains how women's perceptions of their susceptibility to diabetes, perceived severity of diabetes-related complications, perceived benefits of screening, perceived barriers, and cues to action may influence participation in preconception diabetes screening. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and healthcare needs influence women's utilization of preconception and screening services. The Health Promotion Model emphasizes individual experiences, perceived benefits and barriers, interpersonal influences, and behavioural factors that influence participation in preventive health services. Collectively, these theoretical perspectives provide a suitable framework for explaining how preconception diabetes screening may influence diabetes detection among women planning pregnancy in Nigeria. The study will adopt a quantitative analytical cross-sectional or quasi-experimental research design. The study population will comprise women of reproductive age who are planning pregnancy and attending selected primary healthcare centres, hospitals, family planning clinics, preconception care clinics, and community health programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, clinics, and eligible women. Preconception diabetes screening will be assessed using indicators such as availability of screening services, screening participation, blood glucose testing, fasting plasma glucose assessment, glycated haemoglobin testing where clinically appropriate, diabetes risk assessment, availability of trained healthcare personnel, laboratory capacity, screening procedures, counselling, referral arrangements, and follow-up of abnormal results. Diabetes detection will be assessed using indicators such as newly identified diabetes cases, abnormal blood glucose results, identification of previously undiagnosed diabetes, confirmation through appropriate diagnostic testing, referral for further clinical assessment, and linkage to diabetes management services. Data will be collected using structured questionnaires, laboratory screening records, preconception clinic registers, medical records, referral registers, and relevant non-communicable disease and reproductive health programme documents. Descriptive statistics will be used to summarize participants' characteristics, screening coverage, screening findings, and diabetes detection patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of preconception diabetes screening on diabetes detection. Where a quasi-experimental design is adopted, diabetes detection outcomes before and after implementation of structured preconception screening may be compared, while relevant demographic, socioeconomic, family history, lifestyle, and healthcare-access factors are appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that preconception diabetes screening has a significant positive effect on diabetes detection among women planning pregnancy in Nigeria. Women who participate in preconception diabetes screening are expected to have a higher likelihood of previously undiagnosed diabetes or abnormal blood glucose levels being identified than women without access to routine screening. Early detection may allow women to receive appropriate clinical assessment, lifestyle counselling, medical management where indicated, and preconception guidance before pregnancy occurs. Integrating diabetes screening into preconception, family planning, and primary healthcare services may also improve access to screening and create additional opportunities for identifying women who may not otherwise seek diabetes testing. However, limited awareness, the cost of laboratory investigations, inadequate screening equipment, shortage of trained healthcare personnel, geographical barriers, and weak referral and follow-up systems may reduce screening coverage and the benefits of early detection. The study therefore expects accessible, affordable, appropriately targeted, and well-integrated preconception diabetes screening services to contribute significantly to improved diabetes detection among women planning pregnancy in Nigeria. The study is expected to contribute to the literature on preconception diabetes screening, diabetes detection, preconception care, reproductive health, maternal health, non-communicable disease prevention, diabetes screening, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, family planning clinics, healthcare professionals, diabetes programmes, reproductive health programmes, development partners, and policymakers regarding strategies for strengthening preconception healthcare. The study will also provide evidence-based recommendations for integrating diabetes screening into routine preconception and reproductive health services, improving access to affordable laboratory testing, strengthening healthcare-worker capacity, increasing awareness of preconception diabetes screening, establishing effective referral and follow-up systems, and linking women with appropriate diabetes management and preconception services across Nigeria.

Keywords: Preconception diabetes screening, diabetes detection, women planning pregnancy, preconception care, diabetes screening, reproductive health, maternal health, non-communicable diseases, preventive healthcare, Nigeria, public health.