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Chakraborty A, Yadav S. Prevalence and determinants of gestational diabetes mellitus among pregnant women in India: an analysis of National Family Health Survey Data. BMC Womens Health 2024; 24:147. [PMID: 38424617 PMCID: PMC10902981 DOI: 10.1186/s12905-024-02936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a type of diabetes with its first recognition during pregnancy. GDM is a high-risk maternal and neonatal condition which increases the risk of Type 2 diabetes in mothers and their infants. It is essential to detect and treat GDM since its inception when mothers suffer from Type 1 diabetes while carrying the foetus during the gestational period. METHODS The study analysed individual data from the National Family Health Survey (NFHS) surveyed in 2015-2016 (4th round) and 2019-2021 (5th round) covering a total of approximately 6 lakhs and 7 lakhs women, respectively. Among them, 32,072 women in 2015-2016 and 28,187 in 2019-2021 were pregnant, of whom 180 women in 2014-2015 and 247 women in 2019-2021 had diabetes during their gestational periods, allowing the percentage prevalence calculation of GDM. The analysis of Poisson regression estimates examined the socioeconomic and demographic risk factors for GDM among pregnant women. RESULTS The overall prevalence of GDM in women showed an increase from 0.53% in 2015-16 to 0.80% in 2019-20 at the national level, and a similar increase in many states of India was witnessed, with a few exceptions. The GDM prevalence has shown a gradient over age, with a low prevalence in 15-19- and 25-29-year-olds and the highest prevalence in 40-44-year-olds. Concerning the rural and urban divide, its prevalence in both urban and rural areas has increased from 0.61 to 0.85% and 0.51 to 0.78% between 2015 and 16 and 2019-21. The results of the Poisson regression analysis reveal that older adults with high Body Mass Index (BMI), thyroid disorder, and heart disease have a greater risk of GDM among pregnant women in India. The states of Kerala, Meghalaya, and Goa show a high prevalence of GDM. CONCLUSION The low prevalence of GDM may not be clinically significant but has negative repercussions on the mother and her child cannot be overlooked. Thus, it is essential to curb GDM since its inception and save a generation ahead from the risk of diabetes and other diseases.
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Affiliation(s)
- Aditi Chakraborty
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India.
| | - Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
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Bunga PK, Balaga VS, Raju R, Suvvari TK, Sivaraj N, Narayan G, Ramadugu R, Arigapudi N, Kande MB, Panchanani A. Association of MTHFD1 G1958A Polymorphism with Gestational Diabetes Mellitus. Cureus 2024; 16:e53287. [PMID: 38435941 PMCID: PMC10905650 DOI: 10.7759/cureus.53287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The MTHFD1 G1958A polymorphism is a common variation in the gene encoding methylenetetrahydrofolate dehydrogenase 1 (MTHFD1), an enzyme crucial for folate metabolism. This study investigated the association between the MTHFD1 G1958A polymorphism, which is involved in folate metabolism, and gestational diabetes mellitus (GDM) risk. Methods A case-control study was conducted and 304 pregnant women (152 with gestational diabetes as cases and 152 healthy pregnant as controls) participated in the study. The polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP) techniques were used to determine the MTHFD1 1958G>A polymorphism genotypes. Results Analysis of genotype frequencies revealed a statistically significant difference (p-value < 0.05) between the GDM group and the control group, suggesting a potential association between this gene variant and the development of GDM. Interestingly, while allele frequencies alone did not show a significant association with GDM risk, analysis in a recessive model (both severe and mild forms) demonstrated a strong link between the homozygous AA genotype and increased susceptibility to GDM. Conclusion This study provides the first evidence linking the MTHFD1 G1958A polymorphism and GDM risk in an Indian setting. These findings warrant further investigation into the functional impact of the MTHFD1 G1958A polymorphism and its potential role in the pathogenesis of GDM.
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Affiliation(s)
- Papa Kusuma Bunga
- Research and Development, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Vijaya Sirisha Balaga
- Obstetrics and Gynaecology, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Riya Raju
- Internal Medicine, Maharajah Institute of Medical Sciences, Vizianagaram, IND
| | - Tarun Kumar Suvvari
- General Medicine, Rangaraya Medical College, Kakinada, IND
- Research, Squad Medicine and Research (SMR), Visakhapatnam, IND
| | - Nagarjuna Sivaraj
- Research and Development, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Gaurang Narayan
- Obstetrics and Gynecology, Indira Gandhi Government Medical College & Hospital, Nagpur, IND
| | - Rithika Ramadugu
- Surgery, Kamineni Academy of Medical Science And Research Centre, Hyderabad, IND
| | - Nithya Arigapudi
- Genetics, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Vijayawada, IND
| | - Mahesh Babu Kande
- Internal Medicine, Great Eastern Medical School & Hospital, Srikakulam, IND
| | - Arun Panchanani
- Internal Medicine, Great Eastern Medical School & Hospital, Srikakulam, IND
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Kiran T, Junaid KP, Rajagopal V, Gupta M, Sharma D. Measurement and mapping of maternal health service coverage through a novel composite index: a sub-national level analysis in India. BMC Pregnancy Childbirth 2022; 22:761. [PMID: 36217107 PMCID: PMC9552458 DOI: 10.1186/s12884-022-05080-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 09/27/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Expansion of maternal health service coverage is crucial for the survival and wellbeing of both mother and child. To date, limited literature exists on the measurement of maternal health service coverage at the sub-national level in India. The prime objectives of the study were to comprehensively measure the maternal health service coverage by generating a composite index, map India by categorizing it into low, medium and high zones and examine its incremental changes over time. METHODS Utilising a nationally representative time series data of 15 key indicators spread across three domains of antenatal care, intranatal care and postnatal care, we constructed a novel 'Maternal Health Service Coverage Index' (MHSI) for 29 states and 5 union territories of India for the base (2017-18) and reference (2019-20) years. Following a rigorous procedure, MHSI scores were generated using both arithmetic mean and geometric mean approaches. We categorized India into low, medium and high maternal health service coverage zones and further generated geospatial maps to examine the extent and transition of maternal health service coverage from base to reference year. RESULTS India registered the highest mean percentage coverage (93.7%) for 'institutional delivery' and the lowest for 'treatment for obstetric complications' (9.3%) among all the indicators. Depending on the usage of arithmetic mean and geometric mean approaches, the maternal health service coverage index score for India exhibited marginal incremental change (between 0.015-0.019 index points) in the reference year. West zone exhibited an upward transition in the coverage of maternal health service indicators, while none of the zones recorded a downward movement. The states of Mizoram (east zone) and the Union Territory of Puducherry (south zone) showed a downward transition. Union territories of Dadra & Nagar Haveli (west zone) and Chandigarh (north zone), along with the states of Maharashtra (west zone), Assam, as well as Jharkhand (both from the east & north east zone), showed upward transition. CONCLUSION Overall, maternal health service coverage is increasing across India. Our study offers a novel summary measure to comprehensively quantify the coverage of maternal health services, which can momentously help India identify lagged indicators and low performing regions, thereby warranting the targeted interventions and concentrated programmatic efforts to bolster the maternal health service coverage at the sub-national level.
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Affiliation(s)
- Tanvi Kiran
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - K P Junaid
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Vineeth Rajagopal
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Madhu Gupta
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divya Sharma
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Rahnemaei FA, Abdi F, Kazemian E, Shaterian N, Shaterian N, Behesht Aeen F. Association between body mass index in the first half of pregnancy and gestational diabetes: A systematic review. SAGE Open Med 2022; 10:20503121221109911. [PMID: 35898952 PMCID: PMC9310335 DOI: 10.1177/20503121221109911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
Gestational diabetes mellitus is a more common complication in pregnancy and rising worldwide and screening for treating gestational diabetes mellitus is an opportunity for preventing its complications. Abnormal body mass index is the cause of many complications in pregnancy that is one of the major and modifiable risk factors in pregnancy too. This systematic review aimed to define the association between body mass index in the first half of pregnancy (before 20 weeks of gestation) and gestational diabetes mellitus. Web of Science, PubMed/Medline, Embase, Scopus, ProQuest, Cochrane library, and Google Scholar databases were systematically explored for articles published until April 31, 2022. Participation, exposure, comparators, outcomes, study design criteria include pregnant women (P), body mass index (E), healthy pregnant women (C), gestational diabetes mellitus (O), and study design (cohort, case–control, and cross-sectional). Newcastle–Ottawa scale checklists were used to report the quality of the studies. Eighteen quality studies were analyzed. A total of 41,017 pregnant women were in the gestational diabetes mellitus group and 285,351 pregnant women in the normal glucose tolerance group. Studies have reported an association between increased body mass index and gestational diabetes mellitus. Women who had a higher body mass index in the first half of pregnancy were at higher risk for gestational diabetes mellitus. In the first half of pregnancy, body mass index can be used as a reliable and available risk factor to assess gestational diabetes mellitus, especially in some situations where the pre-pregnancy body mass index is not available.
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Affiliation(s)
- Fatemeh Alsadat Rahnemaei
- Reproductive Health Research Center, Department of Obstetrics & Gynecology, Al-Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Abdi
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Elham Kazemian
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Negar Shaterian
- Student Research Committee, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Negin Shaterian
- Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Behesht Aeen
- Student Research Committee, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Mazumder T, Akter E, Rahman SM, Islam MT, Talukder MR. Prevalence and Risk Factors of Gestational Diabetes Mellitus in Bangladesh: Findings from Demographic Health Survey 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052583. [PMID: 35270274 PMCID: PMC8909680 DOI: 10.3390/ijerph19052583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022]
Abstract
Gestational diabetes mellitus (GDM) has serious consequences for both maternal and neonatal health. The growing number of noncommunicable diseases and related risk factors as well as the introduction of new World Health Organization (WHO) diagnostic criteria for GDM are likely to impact the GDM prevalence in Bangladesh. Our study aimed to assess the national prevalence and identify the risk factors using the most recent WHO criteria. We used the secondary data of 272 pregnant women (weighted for sampling strategy) from the Bangladesh Demographic and Health Survey 2017–2018. Multivariate logistic regression was performed to determine the risk factors of GDM. The overall prevalence of GDM in Bangladesh was 35% (95/272). Increased odds of GDM were observed among women living in the urban areas (adjusted odds ratio (aOR) 2.74, 95% confidence interval (CI) 1.43–5.27) compared to rural areas and those aged ≥25 years (aOR 2.03, 95% CI 1.13–3.65). GDM rates were less prevalent in the later weeks of pregnancy compared to early weeks. Our study demonstrates that the national prevalence of GDM in Bangladesh is very high, which warrants immediate attention of policy makers, health practitioners, public health researchers, and the community. Context-specific and properly tailored interventions are needed for the prevention and early diagnosis of GDM.
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Affiliation(s)
- Tapas Mazumder
- Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia;
| | - Ema Akter
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (E.A.); (S.M.R.)
| | - Syed Moshfiqur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (E.A.); (S.M.R.)
- Department of Women’s and Children’s Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Md. Tauhidul Islam
- Health Administration, Policy and Leadership Program, Murdoch Business School, Murdoch University, Perth 6150, Australia;
| | - Mohammad Radwanur Talukder
- Wellbeing Preventable and Chronic Disease Division, Menzies School of Health Research, Darwin 0810, Australia
- Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Charles Darwin University, Darwin 0810, Australia
- Correspondence: ; Tel.: +61-889-466-857
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Chandrasekhar D, William AM, A A, Benny A, Karuppam A, Omar Ahmed R, KV Ahamedunni SA. Perceptions of essential obstetric care by rural pregnant women and safe motherhood approaches: An interventional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Risk factors associated with gestational diabetes mellitus: a retrospective case-control study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00947-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Objectives
The prevalence of gestational diabetes mellitus (GDM) has increased year-after-year globally, especially in low-income and developing countries. This study aims to identify the prevalence of GDM, the risk factors, and the effect on pregnancy outcome based on a retrospective case-control study.
Methods
Two hundred ninety-three parturients with GDM who delivered in a general hospital in Fujian province and met the inclusion criteria were selected as the case group from January to June 2018. Two hundred ninety-three parturients without GDM who delivered in the same period served as the control group. Risk factors for GDM were determined by univariate and binary logistic regression analysis. The prevalence of pregnancy outcomes was determined by a chi-square test.
Results
The prevalence of GDM was 15.69%. The percentages of 1, 2, and 3 abnormal OGTT values were 55.6%, 30.7%, and 13.7%, respectively. Gravidas with GDM have a higher risk of macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and gestational hypertension than gravidas without GDM (p < 0.05). Analysis of the factors influencing the development of GDM was advanced age, married, parents with a history of diabetes, gestational hypertension, and number of abortions.
Conclusions
The prevalence of GDM was 15.69% in this geographic region, and > 50% of the patients had one abnormal OGTT value. The risk factors for GDM were advanced age, parents with diabetes, gestational hypertension, and the number of abortions. Pregnancy outcomes of the two groups of patients were different with respect to macrosomia, polyhydramnios, pre-eclampsia, placenta previa, and hypertensive disorders of pregnancy.
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Zhang Y, Xiao CM, Zhang Y, Chen Q, Zhang XQ, Li XF, Shao RY, Gao YM. Factors Associated with Gestational Diabetes Mellitus: A Meta-Analysis. J Diabetes Res 2021; 2021:6692695. [PMID: 34046504 PMCID: PMC8128547 DOI: 10.1155/2021/6692695] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a major public health issue, and the aim of the present study was to identify the factors associated with GDM. Databases were searched for observational studies until August 20, 2020. Pooled odds ratios (ORs) were calculated using fixed- or random-effects models. 103 studies involving 1,826,454 pregnant women were identified. Results indicated that maternal age ≥ 25 years (OR: 2.466, 95% CI: (2.121, 2.866)), prepregnancy overweight or obese (OR: 2.637, 95% CI: (1.561, 4.453)), family history of diabetes (FHD) (OR: 2.326, 95% CI: (1.904, 2.843)), history of GDM (OR: 21.137, 95% CI: (8.785, 50.858)), macrosomia (OR: 2.539, 95% CI: (1.612, 4.000)), stillbirth (OR: 2.341, 95% CI: (1.435, 3.819)), premature delivery (OR: 3.013, 95% CI: (1.569, 5.787)), and pregestational smoking (OR: 2.322, 95% CI: (1.359, 3.967)) increased the risk of GDM with all P < 0.05, whereas history of congenital anomaly and abortion, and HIV status showed no correlation with GDM (P > 0.05). Being primigravida (OR: 0.752, 95% CI: (0.698, 0.810), P < 0.001) reduced the risk of GDM. The factors influencing GDM included maternal age ≥ 25, prepregnancy overweight or obese, FHD, history of GDM, macrosomia, stillbirth, premature delivery, pregestational smoking, and primigravida.
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Affiliation(s)
- Yu Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Chongqing Banan District, Chongqing 401320, China
| | - Cheng-Ming Xiao
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital and LiaochengClinical School of Shandong First Medical University, Liaocheng, Shandong 252000, China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital and LiaochengClinical School of Shandong First Medical University, Liaocheng, Shandong 252000, China
| | - Qiong Chen
- Department of Obstetrics and Gynecology, People's Hospital of Chongqing Banan District, Chongqing 401320, China
| | - Xiao-Qin Zhang
- Department of Obstetrics and Gynecology, People's Hospital of Chongqing Banan District, Chongqing 401320, China
| | - Xue-Feng Li
- Department of Obstetrics and Gynecology, People's Hospital of Chongqing Banan District, Chongqing 401320, China
| | - Ru-Yue Shao
- School of Clinical Medicine, Chongqing Medical and Pharmaceutical College; Chongqing Engineering Research Center of Pharmaceutical Sciences, Shapingba District, Chongqing, 401331, China
| | - Yi-Meng Gao
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital and LiaochengClinical School of Shandong First Medical University, Liaocheng, Shandong 252000, China
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Lotfi MH, Fallahzadeh H, Rahmanian M, Hosseinzadeh M, Lashkardoost H, Doaei S, Gholamalizadeh M, Hamedi A. Association of food groups intake and physical activity with gestational diabetes mellitus in Iranian women. J Matern Fetal Neonatal Med 2019; 33:3559-3564. [PMID: 30720376 DOI: 10.1080/14767058.2019.1579189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: It is suggested that combining a healthy diet with physical activity during and before pregnancy have a significant effect on insulin sensitivity. This study aimed to investigate the relationship between physical activity and diet before and during pregnancy with the risk of gestational diabetes mellitus (GDM).Methods: A case-control study was conducted on 173 women with GDM diagnosed during the pregnancy as the case group and 168 women with a negative test for GDM as controls. Weight and height were measured and BMI was calculated. Dietary intake and physical activity data during pregnancy were collected using 24-hour food recall questionnaire and international physical activity questionnaire (IPAQ).Results: Body mass index and the intake of refined sugars, high fat dairy products, and fried foods were significantly higher and the intake of fruit and animal oil intake were significantly lower in the case group compared to the control group (All p < .05). However, there was not any significant association between the level of physical activity, vegetable intake, and total energy intake with the risk of GDM.Conclusions: According to the results of this study, dietary intake before and during the pregnancy have a critical effect on the risk of GDM. Appropriate dietary planning for pregnant women can reduce the risk of GDM.
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Affiliation(s)
- Mohammad Hasan Lotfi
- School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Fallahzadeh
- School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Masoud Rahmanian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mahdieh Hosseinzadeh
- Department of Nutrition, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Lashkardoost
- Department of Public Health, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Saeid Doaei
- Research Center of Health and Environment, Guilan University of Medical Sciences, Rasht, Iran.,Natural Products and Medicinal Plants Research Center, North Khorasan University of Medical Sciences, Bojnurd, Iran.,Student Research Committee, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Gholamalizadeh
- Student Research Committee, Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Andishe Hamedi
- Shirvan Center of Higher Health Education, Imam Khomeini Hospital, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Ozgu-Erdinc AS, Sert UY, Buyuk GN, Engin-Ustun Y. Prevalence of gestational diabetes mellitus and results of the screening tests at a tertiary referral center: A cross-sectional study. Diabetes Metab Syndr 2019; 13:74-77. [PMID: 30641799 DOI: 10.1016/j.dsx.2018.08.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/21/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aimed to identify the gestational diabetes mellitus (GDM) prevalence of low risk pregnant population at a tertiary referral center by different approaches. MATERIAL AND METHODS A cross-sectional study using retrospective data between 2007-2017 was conducted. During this period 77227 patients underwent either two step or one step glucose tolerance tests. RESULTS The median age of the study population was 27 (15-49). Fasting plasma glucose (FPG) testing was evaluated in 144,113 women at the initial antenatal care visit which %21 of these were between 92-126 mg/dL. Of these women %1.25 had FPG>126 mg/dL which showed the prevalence of pregestational diabetes in our cohort. During the study period 74412 women underwent 50-g glucose challenge test where %18 were screen positive and % 2.9 was defined as gestational diabetic without need for further testing (>180 mg/dL). The screening positive patients were sent to 100-g oral glucose tolerance test and the prevalence of GDM with two-step screening was 5.5%. A total of 2815 patients were screened by 75-g glucose tolerance test and the prevalence of GDM with one-step screening was 21%. Overall 4684 patients have been diagnosed as gestational diabetes mellitus with the prevalence of 6.07%. CONCLUSION Fasting plasma glucose >92 mg/dL is challenging in our population due to improper fasting. The FPG dependent GDM prevalence is almost four times higher than two-step glucose screening test results (21.8% vs 5.5%). If FPG levels will be used for diagnosing GDM then the values must be checked in a second laboratory analysis.
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Affiliation(s)
- A Seval Ozgu-Erdinc
- University of Health Sciences Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey.
| | - Umit Yasemin Sert
- University of Health Sciences Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey.
| | - Gul Nihal Buyuk
- University of Health Sciences Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey.
| | - Yaprak Engin-Ustun
- University of Health Sciences Dr. Zekai Tahir Burak Women's Health Care, Education and Research Hospital, Ankara, Turkey.
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Lotfi MH, Fallahzadeh H, Rahmanian M, Lashkardoost H, Hamedi A. The role of clinical factors in the association of gestational diabetes amongst women aged 15-49 years residing in Yazd-Iran. Diabetes Metab Syndr 2018; 12:705-709. [PMID: 29693547 DOI: 10.1016/j.dsx.2018.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/09/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) has occurred in Fourteen percent of all pregnancies in the world. Epidemiological evidences about risk factors of GDM may be different from region to region and are unknown, exactly. This study examines the role of clinical factors in the association of gestational diabetes in Yazd, Iran. METHODS This study was carried out on 168 women with gestational diabetes and 168 women as controls after matching for age and place of residence. Each participant was interviewed about her pregnancy history and tobacco consumption. Information including BMI, weight before pregnancy and background of underlying diseases were recorded from information system in Health Centers. Finally, data were analyzed by using chi-square test, logistic regression and multiple correspondence analyze(MCA). RESULTS History of gestational diabetes in past pregnancy OR = 3.2[95%CI:1.1, 9.7], a family history of gestational diabetes OR = 3.7 [95%CI:1.1, 11.5], a history of hookah smoking OR = 3.6 [95%CI:1.06, 12.3], being obese before pregnancy OR = 1.9[95%CI:1.01, 3.5], and weight gain during pregnancy OR = 0.5[95%CI:0.2, 0.9], were the most important determinants of gestational diabetes. There were not significant relation between GDM and underlying diseases, history of stillbirth, abortion, twinning, cigarette smoking, alcohol and drug abuse. CONCLUSIONS In this research modifiable risk factors for gestational diabetes were high BMI before pregnancy, weight gain during pregnancy and history of hookah consumption. We advise that appropriate education, avoiding sedentary lifestyle, diet improvement and advertising which focus on tobacco consumption is playing as an important role in developing the chronic diseases, including GDM.
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Affiliation(s)
- Mohammad Hasan Lotfi
- School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Hossein Fallahzadeh
- School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Masoud Rahmanian
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Hossein Lashkardoost
- Department of Public Health, School of Public Health, North Khorasan University of Medical Sciences, Bojnurd, Iran.
| | - Andishe Hamedi
- Shirvan Center of Higher Health Education, North Khorasan University of Medical Sciences, Shirvan, Iran.
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Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 2018; 55:613-625. [PMID: 29582160 PMCID: PMC5999405 DOI: 10.1007/s00592-018-1131-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
AIMS Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. METHODS We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. RESULTS We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit. CONCLUSIONS In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.
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Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
| | - Shilpa Naik
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Mallika Alexander
- Johns Hopkins University Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jyoti S Mathad
- Departments of Medicine and OB-GYN, Weill Cornell Medicine, New York, NY, USA
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Mathews E. Should pregnant women be excluded from a community-based lifestyle intervention trial? A case study. Reprod Health 2017; 14:165. [PMID: 29297356 PMCID: PMC5751519 DOI: 10.1186/s12978-017-0422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Kerala, the southernmost Indian state, is known as the diabetes capital of the country. A community-based lifestyle modification program was implemented in the rural areas of Kerala, India, to assess effectiveness in reducing the incidence of type 2 diabetes mellitus (T2DM) among individuals at high risk. High-risk individuals for T2DM were identified through home screening and enrolled into the program after an oral glucose tolerance test to rule out T2DM. Pregnant women were excluded from participation in the trial without justification. An analysis is offered to show that exclusion in this case compromised the ethical requirements of fairness and favorable risk-benefit ratio: specifically, pregnant women were deprived of the benefits of screening for high-risk status and subsequent potential involvement in the lifestyle modification intervention, an effective preventive strategy. Exclusion of pregnant women from translational and implementation research with known benefits over risk violates several ethical principles and further limits the exploration and advancement of research for future disease prevention in the population at large. Clearer guidelines on minimal risk and benefit need to be established in order to facilitate research that is beneficial to pregnant women and the developing fetus.
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Affiliation(s)
- Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India.
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Meththananda Herath HM, Weerarathna TP, Weerasinghe NP. Is Risk Factor-based Screening Good Enough to Detect Gestational Diabetes Mellitus in High-Risk Pregnant Women? A Sri Lankan Experience. Int J Prev Med 2016; 7:99. [PMID: 27625764 PMCID: PMC4995849 DOI: 10.4103/2008-7802.188084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 07/13/2016] [Indexed: 12/16/2022] Open
Abstract
Background: There is a long lasting dilemma over the ideal screening and diagnostic method in gestational diabetes mellitus (GDM). Even though universal screening is commonly practiced, selective screening based on risk factors is also practiced in some center. The aim of this study is to evaluate the most appropriate method to screen GDM in high-risk pregnant women in Sri Lanka. Methods: This study was a clinic-based, cross-sectional study conducted in a tertiary referral center, Sri Lanka. All women underwent 75 g oral glucose tolerance test at 24–28 weeks of gestation. Diagnosis of GDM was made according to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) and World Health Organization (WHO) criteria. Results: With universal screening using IADPSG criteria, 23.2% (105/452) were found to have GDM and with risk factor-based screening 20.1% (91/452) were detected to have GDM. The prevalence of GDM dropped to 18.1% when GDM was diagnosed using the WHO criteria with universal screening approach. It was further dropped to 15.7% when the WHO criteria were used along with risk factors-based screening approach. Conclusions: The IADPSG criteria labeled considerably higher number of women as having GDM compared to the WHO criteria. With regards to the screening methods, the risk-based screening had a lower detection rate of GDM; however, it reduced the necessity of screening of women by around 20%.
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