Prevalence and risk factors of gestational diabetes mellitus in Yemen

Association of exposure to multiple heavy metals during pregnancy with the risk of gestational diabetes mellitus and insulin secretion phase after glucose stimulation

BACKGROUND

Epidemiological evidence for the association between heavy metals exposure during pregnancy and gestational diabetes mellitus (GDM) is still inconsistent. Additionally, that is poorly understood about the potential cause behind the association, for instance, whether heavy metal exposure is related to the change of insulin secretion phase is unknown.

OBJECTIVES

We aimed to explore the relationships of blood levels of arsenic (As), lead (Pb), thallium (Tl), nickel (Ni), cadmium (Cd), cobalt (Co), barium (Ba), chromium (Cr), mercury (Hg) and copper (Cu) during early pregnancy with the odds of GDM, either as an individual or a mixture, as well as the association of the metals with insulin secretion phase after glucose stimulation.

METHODS

We performed a nested case-control study consisting of 302 pregnant women with GDM and 302 controls at the First Affiliated Hospital of Anhui Medical University in Hefei, China. Around the 12th week of pregnancy, blood samples of pregnant women were collected and levels of As, Pb, Tl, Ni, Cd, Co, Ba, Cr, Hg and Cu in blood were measured. An oral glucose tolerance test (OGTT) was done in each pregnant woman during the 24-28th week of pregnancy to diagnose GDM and C-peptide (CP) levels during OGTT were measured simultaneously. The four metals (As, Pb, Tl and Ni) with the highest effect on odds of GDM were selected for the subsequent analyses via the random forest model. Conditional logistic regression models were performed to analyze the relationships of blood As, Pb, Tl and Ni levels with the odds of GDM. The weighted quantile sum (WQS) regression and bayesian kernel machine regression (BKMR) were used to assess the joint effects of levels of As, Pb, Tl and Ni on the odds of GDM as well as to evaluate which metal level contributed most to the association. Latent profile analysis (LPA) was conducted to identify profiles of glycemic and C-peptide levels at different time points. Multiple linear regression models were employed to explore the relationships of metals with glycaemia-related indices (fasting blood glucose (FBG), 1-hour blood glucose (1h BG), 2-hour blood glucose (2h BG), fasting C-peptide (FCP), 1-hour C-peptide (1h CP), 2-hour C-peptide (2h CP), FCP/FBG, 1h CP/1h BG, 2h CP/2h BG, area under the curve of C-peptide (AUCP), area under the curve of glucose (AUCG), AUCP/AUCG and profiles of BGs and CPs, respectively. Mixed-effects models with repeated measures data were used to explore the relationship between As (the ultimately selected metal) level and glucose-stimulated insulin secretion phase. The mediation effects of AUCP and AUCG on the association of As exposure with odds of GDM were investigated using mediation models.

RESULTS

The odds of GDM in pregnant women increased with every ln unit increase in blood As concentration (odds ratio (OR) = 1.46, 95% confidence interval (CI) = 1.04-2.05). The joint effects of As, Pb, Tl and Ni levels on the odds of GDM was statistically significant when blood levels of four metals were exceeded their 50th percentile, with As level being a major contributor. Blood As level was positively associated with AUCG and the category of glucose latent profile, the values of AUCG were much higher in GDM group than those in non-GDM group, which suggested that As exposure associated with the odds of GDM may be due to that As exposure was related to the impairment of glucose tolerance among pregnant women. The significant and positive relationships of As level with AUCP, CP latent profile category, 2h CP and 2h CP/2h BG were observed, respectively; and the values of 1h CP/1h BG and AUCP/AUCG were much lower in GDM group than those in non-GDM group, which suggested that As exposure may not relate to the impairment of insulin secretion (pancreatic β-cell function) among pregnant women. The relationships between As level and 2h CP as well as 2h CP/2h BG were positive and significant; additionally, the values of 2h CP/2h BG in GDM group were comparable with those in non-GDM group; the peak value of CP occurred at 2h in GDM group, as well as the values of 2h CP/2h BG in high As exposure group were much higher than those in low As exposure group, which suggested that As exposure associated with the increased odds of GDM may be due to that As exposure was related to the change of insulin secretion phase (delayment of the peak of insulin secretion) among pregnant women. In addition, AUCP mediated 11% (p < 0.05) and AUCG mediated 43% (p < 0.05) of the association between As exposure and the odds of GDM.

CONCLUSION

Our results suggested that joint exposure to As, Pb, Tl and Ni during early pregnancy was positively associated with the odds of GDM, As was a major contributor; and the association of environmental As exposure with the increased odds of GDM may be due to that As exposure was related to the impairment of glucose tolerance and change of insulin secretion phase after glucose stimulation (delayment of the peak of insulin secretion) among pregnant women.

Gestational diabetes mellitus and its associated factors in Ethiopia: a systematic review and meta-analysis

BACKGROUND

In Ethiopia, gestational diabetes mellitus (GDM) is a significant public health issue and a risk to maternal and child health. Understanding the prevalence and factors of GDM in Ethiopia may also help determine the best interventions. Therefore, we tried to review gestational diabetes and its factors in Ethiopia.AQ: Please check and confirm the edit made to the article title.yes i have checked and confirm METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) instrument was used to conduct the review. In order to report on the prevalence and contributing factors of gestational diabetes mellitus, the following databases were used: Google Scholar, PubMed, EMBASE, Scopus, Web of Sciences, and Grey literature. Pilo-tests were conducted using a standardized data gathering form in research using a random sample. All statistical analyses were performed using STATA version 16 software for Windows and the random-effects meta-analysis method. The results are presented using texts, tables, and forest plots, along with measure of effect and a 95% confidence interval.Affiliations: Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author Given name: [Fentahun Yenealem], Last name [Beyene], Given name: [Bekalu Getnet], Last name [Kassa], Given name: [Gedefaye Nibret], Last name [Mihretie], Given name: [Alemu Degu], Last name [Ayele].yes checked and corrected AQ: Is this word Pilo-tests spelled correctly throughout the article?Thank you the correction Affiliations: Please check and confirm whether the city name is correctly identified for the affiliation 2.yes checked and corrected  RESULTS: Out of 1755 records, 10 studies with 6525 participants that fully satisfy the inclusion criteria were included for the meta-analysis. The pooled prevalence of gestational diabetes mellitus in Ethiopia was 12.04% [95% CI (8.17%, 15.90%)]. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity, and previous history of GDM were statistically significant.AQ: Please note that the sentence Inadequate dietary diversity, high body mass index… is repeated under the below heading Conclusion.yes checked and corrected  CONCLUSION: The pooled prevalence of gestational diabetes mellitus is high in Ethiopia. Inadequate dietary diversity, high body mass index, having a family history of DM, history of having macrosomic neonate, low physical activity and previous history of GDM were statically significant variables. Emphasize on early screening, prenatal care and all women having risk factors and trying to get pregnant should get screens for diabetes to improve the maternal and child health at large.AQ: Please check the clarity of the sentence Emphasize on early screening, prenatal…it is clear and easly understand the readers.

Association of body composition in early pregnancy with gestational diabetes mellitus: A meta-analysis

INTRODUCTION

Body composition as dynamic indices constantly changes in pregnancy. The use of body composition indices in the early stages of pregnancy has recently been considered. Therefore, the current meta-analysis study was conducted to investigate the relationship between body composition in the early stages of pregnancy and gestational diabetes.

METHOD

Valid databases searched for papers published from 2010 to December 2021 were based on PRISMA guideline. Newcastle Ottawa was used to assess the quality of the studies. For all analyses, STATA 14.0 was used. Mean difference (MD) of anthropometric indices was calculated between the GDM and Non-GDM groups. Pooled MD was estimated by "Metan" command, and heterogeneity was defined using Cochran's Q test of heterogeneity, and I 2 index was used to quantify heterogeneity.

RESULTS

Finally, 29 studies with a sample size of 56438 met the criteria for entering the meta-analysis. Pooled MD of neck circumference, hip circumference, waist hip ratio, and visceral adipose tissue depth were, respectively, 1.00 cm (95% CI: 0.79 to 1.20) [N = 5; I^2: 0%; p: 0.709], 7.79 cm (95% CI: 2.27 to 13.31) [N = 5; I2: 84.3%; P<0.001], 0.03 (95% CI: 0.02 to 0.04) [N = 9; I2: 89.2%; P<0.001], and 7.74 cm (95% CI: 0.11 to 1.36) [N = 4; I^2: 95.8%; P<0.001].

CONCLUSION

Increased neck circumference, waist circumference, hip circumference, arm circumference, waist to hip ratio, visceral fat depth, subcutaneous fat depth, and short stature increased the possibility of developing gestational diabetes. These indices can accurately, cost-effectively, and affordably assess the occurrence of gestational diabetes, thus preventing many consequences with early detection of gestational diabetes.

Association between body mass index in the first half of pregnancy and gestational diabetes: A systematic review

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.

Previous adverse pregnancy events as a predictor of gestational diabetes mellitus in Southern Ethiopia: a case control study

INTRODUCTION

Gestational diabetes mellitus is a type of glucose intolerance that first manifests itself during pregnancy. A pregnant woman and her unborn child are at an increased risk of pregnancy complications and poor neonatal outcomes. Pregnancy diabetes affects one out of every 200 women. Therefore, this study aims to identify the determinants of gestational diabetes mellitus among pregnant women attending an antenatal care service in Gedeo Zone, Ethiopia.

METHODS

A facility-based case-control study design was employed from 25 January 2020 through 25 April 2020. The study included 80 cases and 240 control groups of pregnant women. Face-to-face interviews with structured questionnaires were used to collect data. For analyses, data was entered into Epidata version 3.1 and exported to the Statistical Package for the Social Sciences (SPSS) version 23.0. Variables with p .25 or lower in bivariate analysis were fitted to multivariable analysis. A multivariable logistic regression model with a 95% confidence interval and a p-Value of .05 was used.

RESULTS

Family history of diabetes mellitus [AOR 1.837; 95% CI (1.06-3.18)], history of spontaneous abortion [AOR 2.39; 95% CI 1.33-4.31), history of still birth [AOR 2.240 (1.222-4.105)], and history of delivery of a macrocosmic baby in the previous pregnancy [AOR 1.99 (1.157-3.43)] were found to be predictors of GDM.

CONCLUSION

Previous adverse pregnancy outcomes were found to be the main predictors of GDM. Women with gestational diabetes mellitus should be followed after delivery in order to monitor hyper-glycemic status.

An age matched case-control study on the risk factors for the gestational diabetes mellitus among primiparous women

OBJECTIVES

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy. It is associated with a wide range of short and long term adverse health consequences for both mother and offspring. As we know, the risk factors of the GDM are complex and diverse, and the incidence of GDM is directly correlated with the age and the times of women delivery. In the process of exploring the risk factors of GDM, if the 2 known independent risk factors are unevenly distributed among groups, the effects of other risk factors may be concealed. To avoid the influence of the 2 factors on the research results, we collected primiparous women as the participants through the method of the case-control study of age 1꞉1 paired design. Through this way, we want to provide early intervention for the pregnant women with the high risk factors so as to reduce the possibility of the GDM during the pregnancy and promote the maternal and infant's health.

METHODS

This study was a retrospective study. A total of 2 425 pregnant women were collected as the participants, who accepted the regular prenatal examination or nutrition health guidance in the Department of Obstetrics or Nutrition in the Women and Children's Hospital, School of Medicine, Xiamen University from August 2018 to October 2019. According to the inclusion and exclusion criteria, 2 287 pregnant women were included in the study. Among them, 231 pregnant women with the complete information were collected as a case group because of the abnormal results of the oral glucose tolerance test (OGTT) that executed between the 24th and 28th weeks during the pregnancy. Meanwhile, among the participants with the normal results of the OGTT, 231 pregnant women with the complete information were selected randomly as a control group through the method of the age 1꞉1 paired with the case group. The age range of the all subjects was 22 to 45 (28.82±4.03) years old. We collected their clinical and basic data retrospectively, including the BMI before pregnancy, the level of uric acid, fasting blood glucose, serum lipid index, and glycosylated hemoglobin (HbA1c) in the early pregnancy, the body weight gain before the 13th and 24th weeks during the pregnancy, the times of the abortions, the positive of HBsAg, the family history of diabetes or hypertension etc. The differences in these indexes were compared between the 2 groups. The logistic regression analysis was used to explore the risk factors for GDM and the stratified analysis was used to explore the difference of the body weight gain before the 24th week during the pregnancy between the 2 groups.

RESULTS

The BMI before pregnancy, the uric acid, the fasting blood glucose, the body weight gain before the 13th and 24th weeks during the pregnancy in the GDM group were higher than those in the control group, and the differences were significant (all P<0.05). The LDL level in the early pregnancy of the GDM group was higher than that of the control group, however, the HDL level in the early pregnancy of the GDM group was lower than that of the control group, and the differences were significant (both P<0.05). The rates of the pregnant women in the GDM group with more than 2 abortions, obesity or overweight before pregnancy, the fasting blood glucose in the early pregnancy over 5.1 mmol/L were significantly higher than those in the control group (all P<0.05). With the uptrend of the cut-off point of the body weight gain before the 24th week during the pregnancy, the risk of the GDM was gradually increasing. When the cut-off point reached at 10 kg, the difference was significant (OR=1.988, P=0.004). The level of HDL in the early pregnancy over 1.6 mmol/L was the protective factor for GDM (OR=0.460, P=0.016). Meanwhile, the body weight gain over 10 kg before the 24th week during the pregnancy (OR=1.743, P=0.032), the fasting blood glucose in the early pregnancy over 5.1 mmol/L (OR=3.488, P=0.001), the LDL in the early pregnancy over 2.5 mmol/L (OR=2.179, P=0.032) were the risk factors for the GDM. Among them, the fasting blood glucose in the early pregnancy over 5.1 mmol/L had the greatest impact on the increase of risk for the GDM.

CONCLUSIONS

After excluding the influence of the age, for primiparous women, the higher level of the LDL and the fasting blood glucose in the early pregnancy, the higher possibility to be the GDM. Meanwhile, the pregnant women should control their diet as soon as possible to control the body weight gain within 10 kg before the 24th week during the pregnancy so as to reduce the possibility of being GDM.

Prevalence of Gestational Diabetes Mellitus and Its Associated Risk Factors in Boo-Ali Hospital, Tehran

Background:

Gestational diabetes mellitus (GDM) represents the most common metabolic complication during pregnancy. GDM is associated with maternal and fetal complications. Approximately 7% of all pregnancies are affected by GDM, resulting in more than 200,000 cases worldwide annually, and the prevalence may vary from 1% to 14% among all pregnancies. Accordingly, this study attempted to determine the prevalence and some risk factors of GDM.

Materials and Methods:

This hospital-based cross-sectional study was carried out at Boo-Ali hospital in Tehran, the capital of Iran. Four hundred non-diabetics pregnant women with a gestational age of 24-28 weeks who attended the Boo-Ali hospital outpatient department were included in our study. Demographic and anthropometric data including age, gravida, para, gestational age, family history of diabetes, history of GDM, weight, height, and body mass index (BMI) were collected. Blood samples were collected from the women at 24-28 weeks to diagnose GDM by oral glucose tolerance test (OGTT). We measured the 25-OH-D level in participants at 24-28 weeks.

Results:

Among the 400 pregnant women, 46 (11.5%) had GDM based on OGTT, and the mean age of GDM women were 30.78± 5.96 years. Among selected variables, BMI ≥25kg/m2, family history, and GDM history were associated with increased risks of GDM (odds ratio=2.49, 95% confidence interval [CI] 1.22–5.07;3.52, 95% CI 1.84–6.70; 19.57, and 95% CI 6.16–62.17, respectively). The association was more robust in the positive GDM history of women.

Conclusion:

High prevalence of GDM highlights more attention of health-care givers in screening pregnant women with risk factors. BMI as a modifiable risk factor for GDM needs more attention, and positive family history and previous GDM history should be considered in the core activities of pregnant women.

Risk of gestational diabetes mellitus by pre-pregnancy body mass index: A systematic review and meta-analysis

Gestational diabetes mellitus (GDM) is serious health challenges. This study aimed at determining the risk of GDM among pregnant women by pre-pregnancy BMI. Five electronic databases including Medline (PubMed), Scopus, Embase, Web of Science and Google Scholar were searched for literature published form 2015 to January 1, 2021. The pooled estimate risk of GDM among pregnant women was 16.8% (95% CI: 15.3-18.4). The risk of GDM in underweight/normal group and overweight/obese group were 10.7% (95% CI: 9.1-12.4) and 23% (95% CI: 20.2-25.9), respectively. The risk of GDM is high among overweight/obese pregnant women.

Prevalence and Risk Factors of Gestational Diabetes Mellitus among Women Attending Antenatal Care in Hadiya Zone Public Hospitals, Southern Nation Nationality People Region

Introduction

In low- and middle-income countries, gestational diabetes mellitus is increasing globally; it is also a double burden of illness for both mothers and children. While gestational diabetes mellitus is recognized in Ethiopia, according to recent diagnostic criteria, information regarding it remains scarce.

Objective

To assess the prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care in Hadiya Zone public Hospitals, Southern Ethiopia.

Methods

An institution-based cross-sectional research on a total of 470 pregnant mothers was conducted in the Hadiya Region from August 2019 to December 2020. Finally, via the systematic random sampling process, the study subjects were chosen. A two-hour oral glucose tolerance test of 75 g was used to conduct the universal one-step screening and diagnostic technique. Bivariate and multivariate analyses were used to identify factors associated with gestational diabetes mellitus.

Results

Gestational diabetes mellitus prevalence was 26.2% (95% CI, 21.8, 30.5). Urban residents (AOR: 2.181; 95% CI: 1.274, 3.733), primary education (AOR:2.286; 95% CI: 1.396, 3.745), without previous history of abortion (AOR: 0.097; 95% CI: 0.048, 0.196), with history of late gestational age in weeks (29-32) (AOR: 0.393; 95% CI: 0.213, 0.723), with no history of coffee drinking (AOR: 2.704; 95% CI: 1.044, 7.006), and adequate dietary diversity (AOR: 2.740; 95% CI: 1.585, 4.739) were significantly associated with gestational diabetes mellitus.

Conclusion

In Hadiya Zone public Hospitals, the prevalence of gestational diabetes mellitus among women attending antenatal treatment was higher compared to other studies conducted. The urban residents, primary schooling, no prior history of abortion, late gestational age, no history of coffee drinking, and sufficient dietary diversity were significantly linked with gestational diabetes mellitus. To enhance maternal and child health, reinforcing screening, treatment, and prevention strategies for gestational diabetes mellitus is essential.

The Effect of Solution-Oriented Counseling on Coping Strategies in Mental Health Issues in Women with Gestational Diabetes

This study aimed to investigate the effectiveness of solution-oriented intervention in patients with gestational diabetes, stress and anxiety on using coping strategies. This study was a randomized clinical trial with a control group. The population consisted of 56 diabetic women under treatment with insulin, who obtained higher score in one of the psychological disorders using DASS-21 (Depression, anxiety, stress scale). The participants were randomly assigned in two interventional (n = 28) and control (n = 28) groups after signing the written informed consent forms. The solution-oriented interventional program was conducted in six 60-min sessions for 6 weeks. Immediately after the final session and 6-8 weeks after the first session of the intervention, both groups completed coping inventory for stressful situations. The analytical statistic of t-test, chi-square, and variance analysis with repeated measurements using SPSS were used to analyze the data. solution-oriented counseling increased the problem-solving coping strategy in the intervention group (P = 0.001); the scores obtained by the subjects in the interventional group after adjusting the score before the intervention increased 2.68 units immediately after the intervention, which was not statistically significant (p-value = 0.44). However, it increased 11.5 scores six weeks after the intervention, which was statistically significant (P = 0.00). But, emotional and avoidance coping strategies were not significantly different between the two groups. This technique can be easily trained to all clients, and since it is focused on finding various solutions for psychological problems by clients, it can be used to reduce stress and anxiety in other chronic diseases as well.IRCT code: The code of this clinical trial study is IRCT20200202046339N1.

Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000-2019: A Systematic Review, Meta-Analysis, and Meta-Regression

Women in the Middle East and North Africa (MENA) region are burdened with several risk factors related to gestational diabetes mellitus (GDM) including overweight and high parity. We systematically reviewed the literature and quantified the weighted prevalence of GDM in MENA at the regional, subregional, and national levels. Studies published from 2000 to 2019 reporting the prevalence of GDM in the MENA region were retrieved and were assessed for their eligibility. Overall and subgroup pooled prevalence of GDM was quantified by random-effects meta-analysis. Sources of heterogeneity were investigated by meta-regression. The risk of bias (RoB) was assessed by the National Heart, Lung, and Blood Institute's tool. One hundred and two research articles with 279,202 tested pregnant women for GDM from 16 MENA countries were included. Most of the research reports sourced from Iran (36.3%) and Saudi Arabia (21.6%), with an overall low RoB. In the 16 countries, the pooled prevalence of GDM was 13.0% (95% confidence interval [CI], 11.5-14.6%, I² , 99.3%). Nationally, GDM was highest in Qatar (20.7%, 95% CI, 15.2-26.7% I² , 99.0%), whereas subregionally, GDM was highest in Gulf Cooperation Council (GCC) countries (14.7%, 95% CI, 13.0-16.5%, I² , 99.0%). The prevalence of GDM was high in pregnant women aged ≥30 years (21.9%, 95% CI, 18.5-25.5%, I² , 97.1%), in their third trimester (20.0%, 95% CI, 13.1-27.9%, I² , 98.8%), and who were obese (17.2%, 95% CI, 12.8-22.0%, I² , 93.8%). The prevalence of GDM was 10.6% (95% CI, 8.1-13.4%, I² , 98.9%) in studies conducted before 2009, whereas it was 14.0% (95% CI, 12.1-16.0%, I² , 99.3%) in studies conducted in or after 2010. Pregnant women in the MENA region are burdened with a substantial prevalence of GDM, particularly in GCC and North African countries. Findings have implications for maternal health in the MENA region and call for advocacy to unify GDM diagnostic criteria.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018100629.

Gestational Diabetes in the Arab Gulf Countries: Sitting on a Land-Mine

Type 2 diabetes mellitus (T2DM) has become a modern-day plague by reaching epidemic levels throughout the world. Due to its similar pathogenesis, gestational diabetes (GDM) increases in parallel to T2DM. The prevalence of T2DM (3.9–18.3%) and GDM (5.1–37.7%) in countries of the Arab Gulf are amongst the highest internationally, and they are still rising precipitously. This review traces the reasons among the Arab nations for (a) the surge of T2DM and GDM and (b) the failure to contain it. During the last five decades, the massive oil wealth in many Arab countries has led to the unhealthy lifestyle changes in physical activity and diet. The excess consumption of calories turned the advantageous genes, originally selected for the famine-like conditions, detrimental: fueling obesity and insulin resistance. Despite genetic differences in these populations, GDM—a marker for future obesity and T2DM—can overcome this scourge of T2DM through active follow-up and screening after delivery. However, the health policies of most Arab countries have fallen short. Neglecting this unique chance will miss an irreplaceable opportunity to turn the tide of the T2DM and obesity epidemic in the Middle Eastern Arab Gulf countries—as well as globally.

Risk factors associated with gestational diabetes mellitus: The role of pregnancy-induced hypertension and physical inactivity

BACKGROUND

Gestational diabetes mellitus (GDM) causes serious complications affecting the mother and fetus. Physical activity (PA) during pregnancy has positive effects on the mother and fetus. The objectives of this study were to assess GMD prevalence in Kuwait, identify its risk factors, and to evaluate its association with PA.

METHODS

A cross-sectional study was conducted among a randomly selected 653 post-partum women from all public maternal centers and five private centers. An anonymous self-administered questionnaire was used to collect participants' socio-demographic data, medical and obstetric history. Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess PA level.

RESULTS

Participants' mean age was 30.1 ± 5.3. GMD was diagnosed among 14.1% (95% CI: 11.6-17.0) of participants. Binary logistic regression revealed that poor income, having 2 + chronic diseases, past history of GDM, hypothyroidism, high systolic or diastolic blood pressure during pregnancy were independently correlated with developing GDM. For physical activity, the overall means of PPAQ total and sub-scores were below average and only PPAQ sub-score -Vigorous Intensity Activity- was significantly higher amid women without GMD than those with. However, PPAQ mean scores showed significant positive correlation with women's pre-pregnancy BMI and birth weight; and a significant negative association with gestational systolic and diastolic blood pressure.

CONCLUSIONS

GDM prevalence is relatively high in Kuwait, notably amid expatriates. Pregnancy-induced hypertension along with social and pre-pregnancy medical conditions correlated with developing GDM. PA helped mitigated pregnancy blood pressure, and fetal birth weight. Promoting additional medical monitoring and PA during pregnancy might aid reduce the prevalence of GDM.

Effect of ginger on the blood glucose level of women with gestational diabetes mellitus (GDM) with impaired glucose tolerance test (GTT): a randomized double-blind placebo-controlled trial

BACKGROUND

Gestational diabetes mellitus (GDM) is one the most common complications of pregnancy. The present work aimed at investigating the effect of ginger on the blood glucose level of GDM women with impaired glucose tolerance test (GTT).

METHODS

This randomized double-blind placebo-controlled clinical trial was performed on the total of 70 women with GDM, who were in 24-28 weeks of pregnancy with impaired GTT from 2015 to 2016. For this purpose, the women were assigned to two groups of ginger or placebo. The ginger group received 126 tablets of ginger, and the placebo group received 126 tablets of placebo for six weeks. The serum Blood Sugar 2 h post-prandial (BS2hpp), Fast Blood Sugar (FBS) and insulin, as well as Homeostasis Model Assessment (HOMA) index were analyzed before and six weeks after intervention.

RESULTS

The mean of FBS (P = 0.04), fasting insulin (P = 0.01), and HOMA index (P = 0.05) was reduced significantly in the ginger group six weeks after intervention in comparison to the placebo group. But the mean of BS2hpp did not show any significant reduction in the two groups (P > 0.05(.

CONCLUSIONS

Oral administration of ginger tablet improved FBS, serum insulin and HOMA index in the women with GDM; however, it could not reduce their BS2hpp level. The trial has been registered in the Iranian Registry of Clinical Trials (IRCT2015090523897N1).

Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis

PURPOSE

Gestational diabetes mellitus (GDM) is one of the costly challenges in the health field. Despite the individual studies in the Eastern Mediterranean, there is no comprehensive study in this regard. The aim of this study was to determine the prevalence of GDM in the Eastern Mediterranean region.

METHODS

In this meta-analysis and systematic review, three international databases (PubMed, Web of science and Scopus) were searched from inception until 30 December 2018. The Hui tool was used to assess the quality of the included studies.

RESULTS

Thirty-three studies performed on 887166 participants were included in the meta-analysis. Based on the results of random effect method, the overall prevalence of GDM was 11.7%. Between six country with have three or more study, pooled prevalence for Saudi Arabi it was 3.6 times more than Israel (17.6 vs. 4.9%), and for Pakistan, Qatar, Bahrain and Iran were 15.3%, 14.7%, 12.2%, and 8.6%, respectively.

CONCLUSION

Despite the high diversity of methods, the results of the present study indicate a high prevalence of GDM in the Eastern Mediterranean region, indicating more policymakers' interest in timely screening and proper management.

Maternal height and risk of gestational diabetes: a systematic review and meta-analysis

AIMS

Identifying women at high risk of developing gestational diabetes mellitus (GDM) is a public health interest. This study aims to investigate the association between maternal height and risk of GDM through meta-analysis.

METHODS

We retrieved the studies that assessed maternal height in relation to GDM. Pooled risk estimates of the included articles and their 95% confidence intervals (95% CIs) were calculated using a fixed- or random-effects model. Subgroup analyses were conducted according to study design and study location. Quality of studies was determined using the Newcastle-Ottawa Scale. Publication bias was detected using the Egger's and Begg's tests.

RESULTS

A total of 10 studies including 7 cohort and 3 cross-sectional studies with a total of 126,094 women were included for meta-analysis. Combined, each 5-cm increase in height was associated with about 20% reduction in risk of GDM [pooled odds ratio = 0.80, (95% CI 0.76, 0.85)]. The analysis revealed high heterogeneity between studies which dissolved after subgroup analysis by study design. This significant association did not differ between Asian and non-Asian populations. Egger's and Begg's tests showed little evidence of publication bias.

CONCLUSIONS

The present meta-analysis supports the conception that short stature is associated with GDM. Further studies of high quality are needed to confirm the findings.

Global Inequality in Maternal Health Care Service Utilization: Implications for Sustainable Development Goals

Purpose: Globally, low-middle-income countries continue to account for almost all of the pregnancy-related mortalities that are largely preventable through adequate utilization of essential maternal health care services such as antenatal care (ANC) and skilled birth assistance (SBA). Promoting the use of ANC and SBA services are hindered by numerous policy- and capacity-related barriers along with widespread inequality in utilization of the existing services that further exacerbates the scenario. In an attempt to better understand the geography of inequality in service utilization, we conducted this brief descriptive study by using World Health Organization (WHO) data on ANC and SBA utilization among the member states. Methods: This was a descriptive study based on open access data on ANC and SBA use between 2012 and 2015 available through the Global Health Observatory of WHO. Country-level data were collected for Asia (41 countries), Africa (35 countries), Europe (35 countries), North America (10 countries), Latin America and the Caribbean (25 countries), and Oceania (16 countries). Cross-country and continent comparisons were made using dot and bar charts. Results: The overall prevalence of ANC and SBA use were, respectively, 78.17% and 88.33%. Considerable disparities were found in terms of ANC and SBA use across the continents, especially in Asia and Africa. Globally, the poorest performing countries included Afghanistan, Somalia, and South Sudan where more than three-quarters of the women remain deprived of ANC and SBA services during the period of 2012 and 2015. The greatest inequality in ANC use was observed in Africa (9.4% in Somalia and 99.9% in Libya), whereas that of SBA use was observed in Asia (17.8% in Afghanistan vs. 100% in Bahrain). Europe was the most equal of all regions in terms of both ANC (66.8% in Albania vs. 99.7% in Belarus) and SBA (94.4% in Denmark vs. 100% in Lithuania) use. Conclusion: Although in the majority of countries more than three-quarters of the women receive ANC and SBA services, the extent of intraregional inequality remains overwhelming especially for Asia and Africa. Progress toward maternal health-related targets should be interpreted in terms of the disparities to ensure a more even and sustainable outcome at both national and global level.

Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis

BACKGROUND

Gestational diabetes mellitus (GDM) is a of the major public health issues in Asia. The present study aimed to determine the prevalence of, and risk factors for GDM in Asia via a systematic review and meta-analysis.

METHODS

We systematically searched PubMed, Ovid, Scopus and ScienceDirect for observational studies in Asia from inception to August 2017. We selected cross sectional studies reporting the prevalence and risk factors for GDM. A random effects model was used to estimate the pooled prevalence of GDM and odds ratio (OR) with 95% confidence interval (CI).

RESULTS

Eighty-four studies with STROBE score ≥ 14 were included in our analysis. The pooled prevalence of GDM in Asia was 11.5% (95% CI 10.9-12.1). There was considerable heterogeneity (I2 > 95%) in the prevalence of GDM in Asia, which is likely due to differences in diagnostic criteria, screening methods and study setting. Meta-analysis demonstrated that the risk factors of GDM include history of previous GDM (OR 8.42, 95% CI 5.35-13.23); macrosomia (OR 4.41, 95% CI 3.09-6.31); and congenital anomalies (OR 4.25, 95% CI 1.52-11.88). Other risk factors include a BMI ≥25 kg/m2 (OR 3.27, 95% CI 2.81-3.80); pregnancy-induced hypertension (OR 3.20, 95% CI 2.19-4.68); family history of diabetes (OR 2.77, 2.22-3.47); history of stillbirth (OR 2.39, 95% CI 1.68-3.40); polycystic ovary syndrome (OR 2.33, 95% CI1.72-3.17); history of abortion (OR 2.25, 95% CI 1.54-3.29); age ≥ 25 (OR 2.17, 95% CI 1.96-2.41); multiparity ≥2 (OR 1.37, 95% CI 1.24-1.52); and history of preterm delivery (OR 1.93, 95% CI 1.21-3.07).

CONCLUSION

We found a high prevalence of GDM among the Asian population. Asian women with common risk factors especially among those with history of previous GDM, congenital anomalies or macrosomia should receive additional attention from physician as high-risk cases for GDM in pregnancy.

TRIAL REGISTRATION

PROSPERO (2017: CRD42017070104 ).

Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis

OBJECTIVE

Gestational diabetes is the most prevalent metabolic disorder being firstly diagnosed during pregnancy. The relationship between the family history of diabetes and the gestational diabetes mellitus (GDM) has been investigated in several primary studies with a number of contradictions in the results. Hence, the purpose of the present study is to determine the relationship between the GDM and the family history of diabetes using the meta-analysis method.

METHOD

All published papers in main national and international databases were systematically searched with some specific keywords to find the related studies between 2000 and 2016. We calculated the odds ratio (OR) with 95% confidence interval (CI) in analysis for each study using a random-effect and Mantel-Haenzel method. We also determined heterogeneity among these 33 articles and their publication bias.

RESULTS

We entered 33 relevant studies of 2516 articles into the meta-analysis process including 2697 women with family history of diabetes mellitus as well as 29134 women without. Of them, 954 and 4372 subjects developed GDM respectively. Combining the results of the primary studies using the meta-analysis method, the overall odds ratio of family history for developing GDM was estimated as of 3.46 (95% CI: 2.80-4.27).

CONCLUSION

This meta-analysis study revealed that the family history of diabetes is an important risk factor for the gestational diabetes mellitus.