A 28-year-old primigravida at 20 weeks of gestation attends her second ANC visit in a primary health center in rural India. During counseling on the antenatal care package, the health worker discusses various interventions. All of the following are components of the standard ANC package in India EXCEPT:

Explanation

## Antenatal Screening Package in India India's ANC guidelines include selective infectious disease screening and targeted metabolic screening. The key distinction is between **universal screening** (offered to all) and **risk-based screening** (offered based on risk factors). ### Universal Screening Components in ANC **Key Point:** All pregnant women in India should be screened for: 1. **Syphilis** — RPR/VDRL at first visit and repeat at third trimester - Prevents congenital syphilis and adverse pregnancy outcomes - Cost-effective and simple point-of-care test available 2. **HIV** — Rapid test at first contact; repeat at 32 weeks if initially negative - Prevents mother-to-child transmission (MTCT) - Allows early antiretroviral therapy initiation - Part of PPTCT (Prevention of Parent-to-Child Transmission) program 3. **Hepatitis B surface antigen (HBsAg)** — at first ANC visit - Identifies carrier mothers; allows neonatal immunoprophylaxis - Prevents vertical transmission - Mandatory under India's MCH guidelines ### Gestational Diabetes Mellitus (GDM) Screening — NOT Universal **High-Yield:** Routine OGTT (oral glucose tolerance test) screening for GDM in **all pregnant women** at 24–28 weeks is **NOT** part of India's standard ANC package for low-risk populations. **Clinical Pearl:** India's approach is **risk-based screening** for GDM: - **Risk factors for GDM screening:** age ≥25 years, BMI ≥25, family history of diabetes, previous GDM, glycosuria, recurrent pregnancy loss, or previous macrosomic baby - **Screening method:** Fasting blood sugar (FBS) or random blood sugar (RBS) in first trimester; if abnormal, proceed to OGTT - **Universal OGTT** is not recommended due to cost and resource constraints in low-resource settings **Warning:** Do not confuse "risk-based screening" with "no screening." GDM screening is performed, but selectively based on maternal risk factors, not universally in all pregnant women. ### Comparison: Universal vs. Risk-Based Screening in ANC | Condition | Screening Type | Method | Timing | | --- | --- | --- | --- | | **Syphilis** | Universal | RPR/VDRL | 1st visit + 3rd trimester | | **HIV** | Universal | Rapid test | 1st contact + 32 weeks | | **HBsAg** | Universal | Serology | 1st visit | | **GDM** | Risk-based | FBS/RBS → OGTT if abnormal | 1st trimester (risk assessment) | | **Anemia** | Universal | Hemoglobin | 1st + 3rd trimester | ### Mnemonic: Universal ANC Screening in India **"SHH" — Syphilis, HIV, Hepatitis B** (all universal) GDM is screened based on risk factors, not universally.