Awareness of gestational diabetes mellitus among antenatal women in a primary health center in South India

Assessment of Women's Awareness of the Effects of Gestational Diabetes Mellitus on the Mother and Fetus in Saudi Arabia: A Cross-Sectional Study

Introduction Gestational diabetes mellitus (GDM) is a form of glucose intolerance that arises during pregnancy, affecting a significant portion of women. It has immediate and long-term effects on both the mother and fetus, including complications like preeclampsia, premature delivery, and an increased risk of cesarean sections. A cross-sectional study among Saudi Arabia's general population, which included 979 women aged between 18 and 60, found varying levels of awareness of GDM, emphasizing the need for more research on awareness levels regarding GDM in Saudi Arabia and more educational campaigns to improve awareness. Objectives The study evaluates the knowledge of pregnant women about GDM and its implications for the mother and fetus. It investigates the relationship between knowledge levels and demographic factors like age, education, and socioeconomic status, aiming to identify knowledge gaps regarding this health issue and develop targeted educational initiatives. Methodology This was a cross-sectional study that included 979 women and was conducted using a Google Forms (Google Inc., Mountainview, CA) questionnaire. The questionnaire covered demographics and explored the knowledge level of women about the impact of GDM on the mother and fetus. Statistical analysis was implemented by IBM SPSS software version 27.0 (IBM Corp., Armonk, NY), with a 5% significance level. Ethical approval was sought, emphasizing anonymous data collection. We did not collect any identifying or private information from participants, and all responses were kept confidential. Results A study of 979 women revealed that their knowledge of GDM was significantly influenced by their age, gestational age, and the number of prior deliveries (p-value < 0.05). The total mean knowledge score for women's correct responses stood at 7.62 (±4.49). The study found that a majority of women, exceeding 60%, accurately answered certain questions about GDM, such as its association with heightened risks, neonatal intensive care unit (NICU) admissions, cesarean section likelihood, high birth weight, and preeclampsia. However, less than 30% could answer yes to questions that indicated that GDM could increase the risk of shoulder dystocia, hypoglycemia at birth, premature rupture of membranes, postpartum hemorrhage, and vacuum delivery. Conclusion There is a need for targeted educational initiatives, particularly focusing on knowledge gaps that women are lacking regarding GDM. Age and prior deliveries were identified as significant determinants of knowledge levels.

Knowledge of Gestational Diabetes Mellitus Among Adult Females in Al Qassim Province, Saudi Arabia: A Cross-Sectional Study

Background Gestational diabetes mellitus (GDM) is a carbohydrate intolerance of variable severity with onset or first recognition during pregnancy; it does not include diabetics who become pregnant or women who become lactosuric. Knowledge of this problem among the public will promote its prevention, screening, and treatment strategies. This study aims to assess the knowledge of GDM regarding its risk factors, screening, treatment, and complications among women in the Al Qassim Province, Saudi Arabia. Method A cross-sectional study was conducted among 617 females aged 18 years and older through convenience sampling between October 2022 and January 2023. An online questionnaire was distributed using Google Forms (Google LLC, Mountain View, CA, USA) and WhatsApp (Meta, Menlo Park, CA, USA). Data was entered, cleaned, and analyzed using SPSS Statistics version 27 (IBM Corp., Armonk, NY, USA). Informed consent was obtained from every participant, and the participants' information was kept confidential. Results In this study, 52.4% of the women (323/617) had moderate knowledge, and 27.6% (170/617) had excellent knowledge about GDM. Only 13.3% (n = 82) knew the optimum time (24 to 28 weeks of gestational age) for gestational diabetes screening in the absence of risk factors. Moreover, 44.6% (n = 275) knew that insulin is one of the treatments for gestational diabetes, while 45.4% (n = 280) knew that gestational diabetes increases a baby's risk of obesity and type 2 diabetes mellitus (T2DM) later in life. A statistically significant association was found between the development of GDM with multigravida (19.5%), a BMI of >25 (15%), and age 31 to 45 years (17.8%), with corresponding p-values of 0.001, 0.0001, and 0.0001, respectively. Conclusion In this study, almost four-fifths of the study population had moderate to excellent knowledge regarding GDM. However, there is a need to enhance knowledge about optimum screening time and insulin use for gestational diabetes treatment. Therefore, encouraging the existing population to learn more about diabetes education programs and health promotional measures should be undertaken periodically. Further studies are required to support this study's findings.

Awareness of Gestational Diabetes Mellitus Among Women in the Al-Baha Region, Saudi Arabia

Background Gestational diabetes mellitus (GDM) is a condition characterized by impaired glucose tolerance that develops during pregnancy. The prevalence of GDM is increasing globally, including in the Al-Baha region of Saudi Arabia. However, there needs to be more data on the awareness of women in this region regarding GDM and its associated risks. This research aimed to evaluate the level of awareness among women in the Al-Baha region regarding GDM. Methodology This study followed an observational cross-sectional design conducted from April 2023 to December 2023. A simple random sampling technique was used to select 457 participants from the resident women of reproductive age in the Al-Baha region. Data were collected through a self-administered questionnaire that assessed knowledge and awareness of GDM risk factors, assessment, therapy, and implications. The questionnaire included a 12-item section evaluating GDM awareness, with correct answers receiving a score of 1. Descriptive statistics were used to analyze the data with Statistical Product and Service Solutions (SPSS, version 28) (IBM SPSS Statistics for Windows, Armonk, NY). Results The majority of participants fell into the age group of more than 36 years (n=207, 45.3%), with a significant proportion having completed university/diploma education (n=282, 61.7%), and most of them worked outside the health sector (n=283, 61.9%). Approximately 27.8% correctly identified that the number of pregnancies does not increase the chance of developing GDM. Only (n=48, 10.5%) accurately identified the usual time for diagnosing GDM in the absence of risk factors, which is between weeks 24 and 28 of pregnancy. Similarly, 26.0% (119 participants) correctly recognized a history of a previous pregnancy with a child weighing more than 4.5 kg as a factor that increases the suspicion of developing GDM in the future. However, it is important to note that the majority of participants (n=311, 68.1%) had a poor level of awareness regarding GDM. Conclusion The findings revealed that the overall level of knowledge about GDM was poor, with less than 10% of participants demonstrating adequate awareness. The study also highlighted that over 80% of the participants were unaware of GDM.

Knowledge and Attitude Regarding Gestational Diabetes Mellitus Among Pregnant Women in Tabuk City, Saudi Arabia: An Exploratory Study

INTRODUCTION

Gestational diabetes mellitus (GDM) refers to any stage of glucose intolerance that begins or is first noticed during pregnancy. GDM has long been an issue in Saudi Arabia. When a pregnant woman who does not already have diabetes is unable to produce enough insulin, GDM develops. GDM patients not only run the danger of developing a number of health issues for themselves but also for the health of their developing fetus. The first step in GDM screening during pregnancy is raising awareness of the condition.

METHODS

This was a cross-sectional study conducted to assess knowledge and attitudes with regard to GDM among pregnant women in Tabuk City, Saudi Arabia. The sample size was 539 females from obstetrics and gynaecology clinics in civil and military hospitals. Data collection was done using a valid questionnaire.

RESULTS

A total of 539 women were included in the study, spanning various age groups from under 20 to above 40 years, with pregnancy occurrences ranging from one to four times. Most participants exhibited strong understanding, with 410 (76.1%) demonstrating awareness of GDM, and 382 (70.9%) having a clear grasp of its definition. Additionally, a majority displayed positive attitudes toward managing GDM.

CONCLUSION

The Saudi women who participated in this study showed good knowledge of GDM and its risk factors, as well as a good attitude regarding the management of GDM and lifestyle modification to reduce its complications. The participants gave adequately logical answers about the sources of information about GDM and about the barriers to effective GDM management. A highly significant association was noticed between knowledge and attitude regarding GDM among the participants (p = <0.001).

Comprehension and Understanding of Gestational Diabetes Mellitus Among Pregnant Women Attending Primary Health Care Facilities in Jeddah, Saudi Arabia

Background and objective Gestational diabetes mellitus (GDM) is a form of diabetes that develops during pregnancy and can negatively affect both the mother and the fetus. This study aimed to assess the knowledge and awareness of GDM among pregnant women in primary care centers. By enhancing their understanding of the risks and symptoms of GDM, we can potentially mitigate adverse outcomes. Methods A cross-sectional study was conducted in the National Guard's primary healthcare facilities in Jeddah, Saudi Arabia. The study employed a validated 12-item questionnaire to collect data from 489 participants. The questionnaire items covered the identification of risk factors, diagnostic approach, treatment options, and complications related to GDM, considering maternal and fetal health implications. Results The study participants had a mean age of 30.9 years. Among these participants, 53.6% demonstrated a thorough understanding of GDM, 35.2% had moderate knowledge scores, and 11.2% had low knowledge scores. Higher levels of awareness were strongly associated with higher levels of education, gravidity, and prior knowledge of GDM. Conclusion The study highlights the importance of early detection and management strategies for GDM during pregnancy to minimize its negative impacts. The findings suggest the need for individually tailored antenatal education programs by healthcare professionals that address the needs of different populations. This is particularly relevant for women with lower education levels and those who are pregnant for the first time or have no prior knowledge of GDM.

Knowledge on gestational diabetes mellitus and associated factors among pregnant women attending antenatal care clinics of North Shewa zone public hospitals, Oromia region, Central Ethiopia: a cross-sectional study

BACKGROUND

Globally, the prevalence of gestational diabetes mellitus (GDM) is currently rising. Assessing GDM knowledge and taking various public health actions will help pregnant women know more about the condition, resulting in its prevention.

OBJECTIVE

To assess pregnant women's knowledge of GDM and associated factors at antenatal care clinics of public hospitals in the North Shewa zone, Oromia region, Central Ethiopia.

DESIGN

Cross-sectional study.

SETTING

Five public hospitals of North Shewa zone, Oromia regional state, Central Ethiopia.

PARTICIPANTS

A total of 417 pregnant women.

METHODS

A face-to-face interview was conducted. A 13-items tool was used to measure GDM knowledge. Multivariable binary logistic regression was fitted to identify factors associated with the knowledge of GDM. The adjusted OR (AOR) with 95% CI and a p<0.05 was used to determine statistical significance.

RESULTS

Overall, 48% (95% CI 43.4% to 52.8%) of pregnant women had sufficient knowledge about GDM. The level of sufficient knowledge for GDM risk factors, screening/treatment and its consequences were 48%, 54.4% and 99%, respectively. Age group 15-24 years (AOR 3.49, 95% CI 1.05 to 11.59), attending secondary and above education (AOR 4.27, 95% CI 1.29 to 14.070, women whose partners attended primary school (AOR 3.83, 95% CI 1.36 to 10.78), history of GDM (AOR 3.36, 95% CI 1.68 to 6.71), history of hypertension (AOR 2.42, 95% CI 1.21 to 4.84), receiving preconception care (AOR 3.02, 95% CI 1.74 to 5.22) and being multigravida (AOR 3.19, 95% CI 1.52 to 6.67) were factors significantly associated with sufficient knowledge about GDM.

CONCLUSION

Overall, more than half of pregnant women have insufficient knowledge about GDM. Significant association between GDM knowledge and women's age, women's and partners' educational status, preconception care, history of GDM and hypertension, and the number of pregnancies were detected. Therefore, to increase pregnant women's GDM knowledge, health education programmes in the community and healthcare facilities should target the identified factors.

Is maternal serum endocan level a novel marker in gestational diabetes mellitus?

AIM

To determine whether there was a significant difference between serum endocan levels of pregnant women with and without gestational diabetes mellitus (GDM).

METHODS

A total of 90 pregnant women, 45 with gestational diabetes and 45 healthy pregnant women, between 24 and 28 gestational weeks, were included in this prospective case-control study. The pregnant women were screened for gestational diabetes using a two-step protocol. Serum endocan levels were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. A p-value of <0.05 was considered statistically significant.

RESULTS

Serum endocan level was significantly higher in the GDM group than in healthy controls (168.46 ± 160.6 vs. 105.66 ± 26.52 pg/mL, respectively; p < 0.001). Serum endocan concentrations were positively correlated with the results of 50 g oral glucose challenge test (GCT) (p < 0.001). Receiver operating characteristic curve analysis showed that endocan with a cut-off point of 133.9 ng/dL indicated women with GDM with a sensitivity of 55.6% and specificity of 88.9% (area under the curve [AUC]: 0.737, 95% CI: 0.634-0.824). The overall differential performance of endocan according to the GDM groups was determined as 73.7% (p < 0.001). Maternal serum endocan level was positively correlated with fasting glucose, postprandial glucose, and glycated hemoglobin (HbA1c) (p < 0.001).

CONCLUSIONS

Elevated endocan levels in gestational diabetes were correlated with fasting glucose, postprandial glucose, HbA1c, and oral glucose tolerance test (OGTT) results. Despite the low sensitivity of 55.6% and the high specificity of 88.9%, we found a high differential performance rate indicating that serum endocan levels were important for the pathophysiology of GDM and should be investigated for the possibility of being a novel marker in larger populations.

Respecting tribal voices in the development of a gestational diabetes risk reduction preconception counseling program for American Indian/Alaska Native adolescent females: a qualitative study

BACKGROUND

American Indians and Alaska Natives (AI/AN) are disproportionately affected by adolescent obesity, adolescent pregnancy and gestational diabetes mellitus (GDM). GDM is associated with increased risk for perinatal death, obesity, and subsequent type 2 diabetes (T2D) for the offspring. Moreover, mothers with GDM are also at increased risk for T2D post-partum. Yet few lifestyle interventions exist to reduce GDM risk prior to pregnancy. We describe the process of adapting an existing validated preconception counseling intervention for AI/AN adolescent girls at-risk for GDM and their mothers. Perspectives and recommendations were gathered from a diverse array of stakeholders to assure the new program called Stopping GDM was culturally responsive and developed with tribal voices and perspectives represented.

METHODS

We conducted focus groups and individual interviews with multiple AI/AN stakeholders (n = 55). Focus groups and interviews were digitally recorded, transcribed verbatim, and analyzed using a thematic content approach to construct cross-cutting themes across the focus groups and interviews.

RESULTS

Four key themes emerged reflecting issues important to planning a reproductive health intervention: 1) Limited awareness, knowledge, and health education resources about GDM; 2) The importance of acknowledging traditional AI/AN values and the diversity of traditions and culture among AI/AN tribes; 3) The need to cultivate healthy decision-making skills and empower girls to make safe and healthy choices; and 4) Lack of communication about reproductive health between AI/AN mothers and daughters and between AI/AN women and health care professionals.

CONCLUSION

Findings have been used to inform the cultural tailoring and adaptation of an existing preconception counseling program, originally designed for non-AI/AN adolescent girls with diabetes, for AI/AN adolescents at-risk for GDM in future pregnancies.

Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model

BACKGROUND

Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring's health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers' breastfeeding behaviors based on the health belief model (HBM).

METHODS

A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers' knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers' breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM.

RESULTS

The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF.

CONCLUSION

To promote EBF, physicians' education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

ANTENATAL FACTORS AFFECTING THE DECISION TO HAVE AN ORAL GLUCOSE TOLERANCE TEST

Aim We aimed to investigate the factors that may affect the pregnant’s decision to have an oral glucose tolerance test (OGTT) between 24-28 gestational weeks. Material and Methods This descriptive and cross-sectional study was conducted prospectively with 307 pregnant women. Demographic characteristics of the pregnant women, pregnancy follow-up findings, antenatal tests, and their decision for having an OGTT were questioned and recorded. All the factors were analyzed that may have a possible effect on the OGTT decision. Results Fifty-three percent of the participants had OGTT during pregnancy. The rate of positive OGTT was found to be 8.5%. Body mass index, gravida, history of abortion, miscarriage risk, weight gain during pregnancy, the rate of using antenatal folic acid and iron supplementation were similar between the groups that had and did not have OGTT (p &gt;0.05). In the univariate model, age, parity, planned pregnancy, regular follow-up, educational status and physical activity were found to have a significant effect on predicting patients who will have OGTT (p &lt;0.05). Also, antenatal screening tests and level 2 obstetrics ultrasonography were shown to have a significant independent effect in predicting patients who will have OGTT (p &lt;0.05). Conclusion By evaluating the factors that may affect the decision of pregnant about OGTT during pregnancy follow-up, we can predict the patients who tend not to have GDM screening and we can increase the screening rate by giving these pregnant women more detailed information. Thus, we have a chance to diagnose and treat more GDM and reduce related mortality and morbidity.

Gestational Diabetes Mellitus: A Cross-Sectional Survey of Its Knowledge and Associated Factors among United Arab Emirates University Students

Gestational diabetes mellitus (GDM) burden is burgeoning globally. Correct knowledge about GDM among young people is paramount for timely prevention. This study assesses GDM knowledge and identifies factors associated with it among United Arab Emirates (UAE) University students. A validated self-administered questionnaire collected data from the university students. We analyzed the data for GDM knowledge status (ever heard of GDM) and GDM knowledge levels (poor, fair, and good) and conducted ordinal logistic regressions to assess for associated factors. A total of 735 students were surveyed with a mean age of 21.0 years. Of these, 72.8% had heard of GDM, and 52.9% of males versus 20.3% of female students had never heard of the condition before. Higher age (p = 0.019) and being a postgraduate student (p = 0.026) were associated with higher GDM knowledge status in males. GDM knowledge level analysis showed that 24.0%, 58.5%, and 17.5% had poor, fair, and good knowledge. The mean GDM-knowledge score was 6.3 ± 2.4 (out of 12). Being married [aOR-1.82 (95%CI 1.10–3.03)] and knowing someone who had GDM [aOR-1.78 (95%CI 1.23–2.60)] were independently associated with higher GDM knowledge levels among students. Students’ primary source of GDM knowledge was family/friends. There is an observed knowledge gap related to GDM among the students, especially males. This study urges the need to accelerate targeted GDM awareness campaigns among university students and the general population in the UAE.

Translation and psychometric validation of the Arabic Gestational Diabetes Management Self-Efficacy Scale (GDMSES)

INTRODUCTION

The assessment of self-efficacy for adherence to healthy behaviours among women with gestational diabetes (GDM) is undermined by the unavailability of validated tools. Therefore, this study aimed at translating, culturally adapting and assessing the psychometric properties of the Arabic version of Gestational Diabetes Management Self-Efficacy Scale (GDMSES).

MATERIALS AND METHODS

This methodological study was conducted in the Antenatal Clinic at Sultan Qaboos University Hospital in Oman between October 2016 and January 2017. A total of 90 forms of the Arabic GDMSES tool were completed by Omani pregnant women with gestational diabetes. The study has a multiphase design: (1) cultural and linguistic validation; (2) content and face validity; (3) construct validity; (4) internal validity.

RESULTS

The Arabic GDMSES showed satisfactory content validity (CVI between .8 and 1), acceptable overall scale internal consistency reliability (Cronbach's alpha=0.85) and stability overtime (Pearson correlation coefficient>.6). Four factors emerged for construct validity using exploratory factor analysis: nutrition and body weight, adaptation to healthy eating, physical activity and treatment and blood sugar. Our sample size of 90 was considered adequate in determining these factors (Kaiser-Meyer-Olkin=.78).

CONCLUSIONS

GDMSES is a valid and reliable tool, thus providing a quick and easy self-efficacy assessment tool for antenatal nurses dealing with pregnant women with GDM.

Awareness of gestational diabetes mellitus foetal-maternal risks: an Italian cohort study on pregnant women

Background

Gestational diabetes mellitus (GDM) incidence is increasing worldwide. It represents a major risk factor for adverse foetal-maternal outcomes. Awareness among women in regard to GDM-related risks (in particular foetus ones) has been proven to have an impact on compliance with recommendations. Therefore we aimed to evaluate the efficacy of our post-diagnosis counselling, that informs affected women of the GDM related risks for complications, in determining an adequate level of understanding.

Method

This is a cohort study involving 400 women undergoing the 24-28 weeks 75 g oral glucose tolerance test. Two hundred women diagnosed with GDM received the post-diagnosis counselling (treatment group) and two hundred women diagnosed without did not receive any counselling (control group). Both populations were surveyed with a 5 question questionnaire regarding their awareness about GDM foetal-maternal related risks. Their level of education about GDM foetal-maternal related risks, estimated according to the number of correct answers, was scored as: primary (score 0-1), secondary (score 2-3) or tertiary (score 4-5).

Results

Most of the women in the treatment group after receiving the post-diagnosis counselling have demonstrated a secondary level of education 132/200 (66%). Their mean level of awareness was higher in comparison to the control group 2.6 ± 1.8 (SD) versus 2.14 ± 1.8 (SD) p value = 0.012. In particular, they’ve demonstrated to be more aware of the risks for the foetus to become macrosomic (p = 0.004) or to die in utero (p = 0.0001). A high level of education and to have had previous pregnancies positively affected correct answers.

Conclusions

Our post-diagnosis counselling has played a role in improving women awareness about GDM foetal-maternal related risks. Future study will explore the impact of women’s level of awareness on glycaemic control.

Education and screening for obesity, hypertension, and diabetes (including gestational diabetes) "at the doorstep" of women from nine underprivileged urban areas in Delhi National Capital Region

BACKGROUND AND AIMS

Women in underprivileged urban areas have poor access to health and education, making them vulnerable to non-communicable diseases (NCDs), specifically diabetes. The current project has sought to focus on this group, to educate and screen this population to prevent and manage obesity and diabetes.

METHODS

The project was conducted in 9 underprivileged areas of Delhi NCR using a mobile van unit. Women from these areas were invited for health education (this included talks, lectures and distribution of Information, Education & Communication material), screening {anthropometric, blood glucose and blood pressure (BP) measurements} diet counselling sessions and referral of subjects with uncontrolled blood glucose.

RESULTS

Baseline survey on knowledge of diabetes and nutrition showed low awareness. Health education sessions (n, 46) included face-to-face discussion and problem solving and distribution of simple pictorial leaflets (n, 3000). The health education sessions were well accepted. In total, 4% women (n,3175/91000- total population, 3056 non-pregnant, 119 pregnant) participated in the research trial. Among non-pregnant women, an average weight gain of 11.8 kg between the ages of 20-40 years was observed. The average BMI and waist circumference (WC) was 26.8 ± 5.3 kg/m² and 91.1 ± 13.2 cm, respectively in non-pregnant women. Further, 75.3.0% (2207/2928) and 96.7% (2875/2971) of the non-pregnant women had overweight/obesity and abdominal obesity, respectively. In the non-pregnant women, 21.7% had known diabetes. Further, 7.4% non-pregnant women and 2.5% pregnant women were identified as having hyperglycaemic state. Hypertension was observed in 11.9% pregnant women and 49.9% of non-pregnant women.

CONCLUSION

Extremely high prevalence of obesity, along with diabetes and hypertension in underprivileged urban women requires intensive individualised and group health education, screening, and counselling "at the doorsteps", as has been shown in our model.

Behaviors of Turkish pregnant women towards gestational diabetes screening

OBJECTIVES

Although gestational diabetes is the most common metabolic disease in pregnancy some pregnant women still refuse to undergo oral glucose tolerance test (OGTT). The purpose of this study was to evaluate the behavior of pregnant women undergoing OGTT, and to compare perinatal results between women who undergo and refuse OGTT.

METHODS

This retrospective cohort study was performed by evaluating the data of Izmir Katip Celebi University Gynecology and Obstetrics outpatient clinic between 2012-2017. Data of 2079 pregnant were evaluated retrospectively. Among 373 women who refused OGTT were evaluated as the study group, while remaining 1706 women who underwent OGTT were considered as the control group. The groups were compared with regard to perinatal results.

RESULTS

Sixty-two point four percent of the group who refused OGTT had a C-section, while 56.3% of the control group had a C-section (p<0.05). Intrauterine growth retardation, fetal distress, amniotic fluid pathologies, macrosomia, gestational hypertension and perinatal death were slightly higher in pregnant women who did not undergo OGTT compared to the control group, however, the difference was not statistically significant.

CONCLUSION

Maternal complications and poor pregnancy results were found slightly higher in pregnant women who refused OGTT. These results might be explained by assuring glycemic control in pregnant women who refused OGTT by a series of fasting and postprandial blood sugar measurements in our center.

Level of and factors associated with awareness of gestational diabetes mellitus among pregnant women attending antenatal care at Kawempe National Referral Hospital: a cross sectional study

Background

The burden of Gestational diabetes mellitus (GDM) is significantly increasing worldwide and the disorder causes substantial short term and long-term adverse effects both to the mother and the unborn baby. Public health measures to increase awareness of GDM among pregnant women may aid in prevention of the disease through life style modification, screening, early diagnosis and management but very few studies have assessed awareness of GDM among pregnant women in sub Saharan Africa and none of these are from Uganda. This study therefore sought to evaluate the level of and factors associated with awareness of GDM among pregnant women attending antenatal care at Kawempe National Referral Hospital (KNRH), the busiest obstetric unit in Uganda, so as to assess their health sensitization needs.

Methods

This was a cross-sectional study. We recruited 403 participants at 30 weeks of gestation and above after giving written informed consent. Systematic sampling was used to select participants and data was collected using pretested interviewer-administered questionnaires. The collected data was entered in Epidata version 4.2 and exported to Stata for analysis. Continuous variables were summarized using mean and standard deviation. Categorical variables were summarized using frequencies and proportions. Factors associated with awareness were assessed at both bivariate and multivariate levels.

Results

Four hundred three pregnant women were recruited, majority (35.5 %) were between 20 and 24 years and their mean age was 26.6 years. Only 125 (31 %) participants were aware of GDM. Age and educational level were significantly associated with awareness of GDM. Women aged 35 years and above were more likely to be aware of GDM (OR = 2.34 (95 % CI = 1.14–4.81) p = 0.021. Women with primary education or no education were less likely to be aware (OR = 0.48 (CI 0.24–0.96) p = 0.038.

Conclusions

Awareness of GDM was poor among study participants. There is need to improve the health education programs in order to increase awareness of GDM among women attending ANC at KNRH. Women below 35 years of age and those with primary education or less should be specifically targeted when giving health education sessions so as to increase their awareness of GDM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03927-x.

Risk of Developing Type 2 Diabetes Mellitus in South Asian Women with History of Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis

BACKGROUND

Gestational diabetes mellitus (GDM) and type 2 diabetes mellitus (T2DM) represent two different components of the spectrum of diabetes mellitus (DM). Women with GDM have a high chance of developing T2DM in later life and this relative risk depends on a number of factors including ethnicity.

AIM

To compare and estimate the risk of developing T2DM in South Asian women with a history of GDM compared to those without a history of GDM.

METHODS

This is a systematic review of PubMed and MEDLINE articles reporting the progression of GDM to T2DM that were published in English from 2000 to 2020. We performed meta-analysis to calculate risk ratios (RR).

RESULTS

We selected 6 studies considering the inclusion and exclusion criteria after sorting 25 full-text articles. Of the 44165 South Asian women assessed, 3095 had GDM and 41070 were without GDM. 995 women in GDM group and 1525 women in non-GDM group had developed T2DM. The RR of women with GDM over non-GDM in developing T2DM was 10.81 (95% confidence interval (CI): 7.61-15.35) suggesting that women with GDM are at 10.81 times more risk of developing T2DM than non-GDM. The cumulative incidence of T2DM in GDM group was 17.34% at 5 years of follow-up and 33% at more than 10 years of follow-up.

CONCLUSION

The risk of developing T2DM in later life is higher in South Asian women with GDM than without GDM. Therefore, lifestyle and pharmacological interventions, patient communication, timely screening, and long-term follow-up of GDM patients are important to reduce the risk.

Gestational diabetes and determinants of adherence to healthy behaviors

BACKGROUND

Previous studies on (GDM) focused on finding new strategies to decrease the incidence of its complications; however, there is insufficient evidence that investigate the influencing factors of adherence to healthy behaviors. This study examined the influencing factors of adherence to healthy behaviors among pregnant women with gestational diabetes (GDM).

METHODS

Descriptive cross-sectional design was used among pregnant women with gestational diabetes. The study participants completed study instruments twice (pre-test & post-test), with a four-weeks gap. The measurement scales included summary of diabetes self-care activities measure (SDSCA), diabetes management self-efficacy scales (DMSES) and open-ended questions to assess barriers and motivators of adherence. The analytical tool was multiple linear regression.

RESULTS

The results from multiple regression indicated that 20.0 % of the total variation in the adherence to healthy behaviors was explained by women's perceived self-efficacy and the overall relationship was significant [F (1, 88) = 23.60, p < .000]. From the demographic variables, only, the gestational age at delivery was found to be a significant predictor of adherence to healthy behaviors (t= -3.1, p< .05), adjusted Rsquare=15.6. Physical limitation and time constraints (40%) were the most reported barriers for adherence. Participants' concern of GDM-related complications (94.4%) and family moral support (52.2%) were the main identified motivators for adherence.

CONCLUSIONS

The importance of assessing determinants, barriers and motivators of adherence to healthy behaviors should be considered before planning any antenatal health promotion interventions designed for women with GDM. The study findings have implications for research, practice, policy advisors and public health. For practice, maternal nurses should consider the identified barriers in this study in any health education intervention and provide solutions and resources to the pregnant women to overcome these barriers. Policy advisors need to take into considerations providing pregnant women with flexible working hours that could encourage them maintaining healthy lifestyle behaviors during the pregnancy period. Researchers interested in GDM should examine in the upcoming studies different self-efficacy enhancing strategies among pregnant women with GDM.

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.

Prevalence and predictors of gestational diabetes mellitus among pregnant women attending antenatal clinic in Dodoma region, Tanzania: an analytical cross-sectional study

INTRODUCTION

Gestational diabetes mellitus (GDM) is rapidly increasing worldwide. Globally, 18.4 million pregnancies are complicated by GDM. Despite its known effect, GDM screening is not part of routine antenatal services in Tanzania. There is paucity of data on the magnitude and risk factors for GDM. Therefore, this study sought to determine prevalence and predictors of GDM among pregnant women in Dodoma region, Tanzania from March to August 2018.

RESEARCH DESIGN AND METHODS

A cross-sectional study was carried out in Dodoma region, Tanzania between April and August of 2018. A total of 582 pregnant women were recruited from four local health facilities, where purposive sampling procedure was used to select the region, districts and health facilities. Simple random sampling was used to select study participants. Screening and diagnosis of GDM were performed using the 2013 WHO criteria. Descriptive and inferential analyses were performed using SPSS V.23 to determine prevalence and independent predictors of GDM.

RESULTS

Among 582 participants, 160 (27.5%) participants were diagnosed with GDM. GDM was more prevalent in urban areas than rural areas, among overweight participants, among participants with a history of a large for gestational age baby, among participants with a history of caesarean section, and among participants with college or university education. Multiple logistic regression analysis showed that maternal age above 35 years (adjusted OR (AOR) 3.115 (95% CI: 1.165 to 8.359)), pre-eclampsia (AOR 3.684 (95% CI: 1.202 to 5.293)), low physical activity level (AOR 4.758 (95% CI: 2.232 to 10.143)), lack of awareness of GDM (AOR 6.371 (95% CI: 1.944 to 13.919)), alcohol use (AOR 4.477 (95% CI: 1.642 to 12.202)) and family history of diabetes (AOR 2.344 (95% CI: 1.239 to 4.434)) were significantly associated with GDM.

CONCLUSIONS

Prevalence of GDM is relatively high in Dodoma region. Most pregnant women are unaware of the condition such that it leads to a high-risk lifestyle. Besides, GDM significantly contributes to the number of high-risk pregnancies that go undetected and suboptimally managed. The antenatal care centres offer an optimum platform for screening, preventing and treating GDM by prioritising high-risk women.

Prevalence, risk factors and morbidities of gestational diabetes among pregnant women attending a hospital in an urban area of Bhubaneswar, Odisha

Background

Gestational diabetes mellitus (GDM) causes several maternal and neonatal complications.

Aims

This exploratory study was conducted to estimate the prevalence, determine the risk factors and morbidities among pregnant women.

Methods

In this prospective study, 1557 pregnant women attending the Gyn. & Obs. clinic of a hospital in an urban area of Bhubaneswar were enrolled. Various socio-demographic factors and clinical profiles were assessed. We used a Glucometer for the diagnosis of GDM.

Results

More younger pregnant women residing in slums, sedentary and overweight were having diabetes. A large percentage of pregnant women living in rural areas and slums visit the government hospitals as they are benefitted by the State govt.'s scheme, Mamata. Pregnant women residing in the urban areas prefer to go for ante-natal check-ups in private Nursing homes/Clinics owing to the crowd and prolonged waiting hours. In this study, body mass index (BMI) and family history of the pregnant women appeared to be the significant risk factors for the gestational diabetes. Out of 1557 pregnant women, 154 were having diabetes, the prevalence being 9.89%. This is low when compared to the studies reported from other regions of the country.

Conclusions

Gluco-One is suitable for screening gestational diabetes using the optimal threshold capillary glucose level of 140 mg/dl. As the pregnant women find it difficult to come the next day just to collect the results, this facilitated in getting the test results promptly and appropriate consultation by Doctor the same day. Glucometer can be used for accurate screening of gestational diabetes mellitus. Pregnant women with screening values not normal were identified on the spot and followed up at regular intervals. Screening for diabetes among pregnant women would result in early case detection indirectly resulting in better outcomes of treatment and prevention of complications.

Feasibility of a Lifestyle Intervention Program for Prevention of Diabetes Among Women With Prior Gestational Diabetes Mellitus (LIVING Study) in South Asia: A Formative Research Study

Aim: To refine and contextually adapt a postpartum lifestyle intervention for prevention of type 2 diabetes mellitus (T2DM) in women with prior gestational diabetes mellitus (GDM) in Bangladesh, India, and Sri Lanka. Materials and Methods: In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with women with current diagnosis of GDM, and health care professionals involved in their management, to understand relevant local contextual factors for intervention optimization and implementation. This paper describes facilitators and barriers as well as feedback from participants on how to improve the proposed intervention. These factors were grouped and interpreted along the axes of the three main determinants of behavior-capability, opportunity, and motivation. IDIs and FGDs were digitally recorded, transcribed, and translated. Data-driven inductive thematic analysis was undertaken to identify and analyze patterns and themes. Results: Two interrelated themes emerged from the IDIs and FGDs: (i) The lifestyle intervention was acceptable and considered to have the potential to improve the existing model of care for women with GDM; and (ii) Certain barriers such as reduced priority of self-care, and adverse societal influences postpartum need to be addressed for the improvement of GDM care. Based on the feedback, the intervention was optimized by including messages for family members in the content of the intervention, providing options for both text and voice messages as reminders, and finalizing the format of the intervention session delivery. Conclusion: This study highlights the importance of contextual factors in influencing postpartum care and support for women diagnosed with GDM in three South Asian countries. It indicates that although provision of postpartum care is complex, a group lifestyle intervention program is highly acceptable to women with GDM, as well as to health care professionals, at urban hospitals.

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women.

Methods

A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75 g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent.

Results

Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75 g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.9%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p: < 0.05).

Conclusions

Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.

Knowledge regarding teratogens among women of childbearing age at a large tertiary care center in Saudi Arabia

AIM

To investigate the knowledge of Saudi women regarding the teratogenic effects of environmental agents such as fever, some chronic conditions and medications and its association with certain socio-demographic factors.

MATERIALS AND METHODS

A survey based cross-sectional study was conducted on 315 Saudi women of childbearing age visiting OB/GYN clinics at a large tertiary care centre in Riyadh, Saudi Arabia. Knowledge of subjects on teratogenic risk of common entities was measured and nonparametric Mann-Whitney and Kruskal-Wallis tests were used to associate knowledge score with various predictors.

RESULTS

The response rate was 75%. Most of the participants were between 28 and 37 years. Knowledge on teratogenic risk was generally poor with specifically higher knowledge regarding insulin intake and isotretinoin. Older age, higher education, being employed, and having a high monthly income were significantly associated with a higher knowledge score (P < 0.05).

CONCLUSION

Women's knowledge regarding teratogenic risks is crucial in ensuring a safe pregnancy and a healthy fetus. Our study revealed inadequate knowledge of teratogens among the participants which implies an urgent need to increase awareness of mothers regarding the harmful effects of common teratogens.

Awareness and knowledge about gestational diabetes mellitus among antenatal women

Aim

The study examined the awareness and knowledge about gestational-diabetes-mellitus (GDM) among antenatal-women and found its influential factors through three phases.

Method

The sample for phase I was 523 antenatal women. In phases II and III, 33 participants who were identified to be aware of GDM from Phase I were included. Measures used were Gestational-Diabetes-Knowledge-Questionnaire (GDKQ) and an open-ended questionnaire.

Results

Age and “number of Pregnancies to date” significantly predicted awareness. Kruskal-Wallis H test indicated that antenatal-women differed in their ‘knowledge' across the trimesters. Mann-Whitney U showed a difference in ‘knowledge' among participants, ‘with' and ‘without' a history of diabetes. Electronic and print-media were identified to be the significant sources of knowledge.

Conclusion

The study highlights the importance of implementing methods that enhance the awareness and knowledge of GDM among the antenatal women.

Gestational Diabetes: Exploring the Perceptions, Practices and Barriers of the Community and Healthcare Providers in Rural Bangladesh: A Qualitative Study

BACKGROUND AND OBJECTIVE

Gestational Diabetes Mellitus (GDM) is a prevalent and important disease during pregnancy and has detrimental effects on both the mother and the baby. The current study explored the perception and attitude of the community people about GDM and describes the challenges and gaps in knowledge, availability and accessibility of services for GDM screening and management at a rural community in Bangladesh.

METHODS

We performed a qualitative study including seven Focus Group Discussions (FGDs) and eight Key Informant Interviews (KIIs) from November 2017 to January 2018 at randomly selected areas of Tangail district. A highly trained team including two anthropologists conducted the qualitative studies (FGDs and KIIs) under the guidance of experienced researchers. Thematic analysis was performed.

RESULTS

GDM is not a known term for pregnant women, their husbands, mothers, and mothers-in-law. Most of the participants (78.7%) did not even hear the term. Some of them (25.5%) perceived that GDM will persist for whole life and transmit from husband to wife and mother to baby. Some people (21.3%) thought that GDM entirely depends on the wish of the God. Most of the participants (68.1%) perceived that symptoms of other types of diabetes and GDM are almost the same. Some participants (19.1%) thought that GDM patients need to intake some medicines that might affect the fetus. The majority of the respondents (83%) had no idea when a pregnant woman should test her diabetes during pregnancy. If GDM diagnosed, pregnant women decided to follow the advice of the doctors. The results from KII with health managers found that they lack in-depth knowledge of GDM. There is no structured guideline or protocol at their facilities for GDM management.

CONCLUSION

The existing barriers at the communities for adequate detection and management of GDM are identified properly. The findings of this study will be helpful for the decision-makers in taking necessary actions to control the GDM.

Non-Medical Strategies to Improve Pregnancy Outcomes of Women with Gestational Diabetes Mellitus: A literature review

This review aimed to examine the literature related to non-medical strategies used to improve pregnancy outcomes of women with gestational diabetes mellitus (GDM) and to determine the risk of bias of the selected studies. Treatment for GDM is changing due to the increased prevalence of GDM-related maternal and neonatal complications. A growing body of evidence suggests that early detection, aggressive monitoring and management of GDM using non-medical strategies can greatly improve outcomes for pregnant women and their babies. PubMed^® (National Library of Medicine, Bethesda, Maryland, USA), Cumulative Index to Nursing and Allied Health Literature^® (EBSCO Information Services, Ipswich, Massachusetts, USA), SCOPUS^® (Elsevier, Amsterdam, Netherlands) and other electronic databases were searched for relevant literature published between 2005-2015. A total of 15 studies on women with GDM that met the inclusion criteria were included in this review and assessment of risk of bias was performed for each study. The results of the studies were consistent with findings of significant improvement in maternal and neonatal outcomes when diet was combined with moderate exercise, self-monitoring of blood glucose and individualised health education. Future intervention studies in this area should be focussed on identifying and implementing factors that enhance and encourage adherence to the healthy behaviours mentioned above.

Why some pregnant women refuse glucose challenge test? Turkish pregnant women's perspectives for gestational diabetes mellitus screening

OBJECTIVE:

Diabetes in pregnancy is associated with several adverse outcomes for both mother and baby. Awareness is the first step toward identifying pregnant women with diabetes. The purpose of this study was to assess Turkish pregnant women’s opinion and practice about 50-g glucose challenge test (GCT) and to assess the reasons why some of them refuse the test.

METHODS:

This study was conducted on 312 patients at any age and gestational week in Istanbul, Turkey, by a personal interview using self-created questionnaire. Women were asked about their opinion and practice about 50-g GCT.

RESULTS:

Among women who were ≤28 weeks of gestation, 42.5% (n=82/193) exhibited their desire to have a GCT in their ongoing pregnancy, 40.9% (n=79/193) pointed out their reluctance, and 16.6% (n=32/193) indicated that they had no opinion about the subject. Women who were ≤28 weeks of gestation and did not want to have GCT, were asked to explain the reasons of their reluctance. The most frequently indicated reason was the belief that GCT is harmful for their babies and themselves (n=62/79, 78.5%). Of the women who were >28 weeks of gestation, 37.8% (n=45/119) had GCT in the ongoing pregnancy, while 62.2% (n=74/119) did not have GCT. The most frequently indicated reason why women did not have a GCT was the belief that GCT is harmful for themselves and the baby (n=37/74, 50%).

CONCLUSION:

This study exposes an important problem - misinformation about 50-g GCT - that carries a dangerous potential for missing the diagnosis of gestational diabetes. Study findings put forth the need for raising awareness among pregnant women and training health-care professionals about the subject.

Gestational Diabetes Mellitus Knowledge Assessment among Saudi Women

BACKGROUND

IDF estimates that 16.2% of women giving live births in 2015 had some form of hyperglycemia during pregnancy. In Saudi, a study estimated that the prevalence of gestational diabetes mellitus (GDM) is 39.4%.

AIM

We aimed to assess Saudi women's GDM knowledge and awareness.

METHODS

A cross-sectional study was conducted between August and December 2016 in Saudi Arabia using a validated questionnaire that included 12 questions focused on awareness and knowledge about GDM. Their responses were scored, and participants were divided poor knowledge (≤ 4/12) fair/good knowledge (≥ 5/12).

RESULTS

A total of 9002 adult female participated. Mean age was 27.8 ± 7.9, and they were mainly married urban residents with bachelor's degrees or higher. The mean overall score was 5.5 ± 2.5 with most of them in the fair GDM knowledge category. Participants were mostly aware of the GDM risk factors (54%) while they were least aware of the GDM diagnosis (15.9%). Multigravida and a prior history of GDM were the two risk factors about which participants were most aware (67.7%). Compared to those with poor knowledge, those with fair/good knowledge were more likely to live in urban areas, live in the central region of Saudi Arabia, work in medical fields, and be married, educated, and have personal and/or family histories of chronic diseases (all P values < 0.001).

CONCLUSION

Our study showed a high prevalence of poor awareness and knowledge, mainly in those areas relating to GDM diagnosis.

Evaluation of knowledge regarding gestational diabetes mellitus: a Bangladeshi study

OBJECTIVE

The aim of this study was to evaluate the level of knowledge about gestational diabetes mellitus (GDM) in Bangladeshi people.

STUDY DESIGN

Cross-sectional study.

METHODS

This study involving 1374 participants was conducted in 15 outpatient clinics of Diabetic Association of Bangladesh and its affiliated associations, Bangabandhu Sheikh Mujib Medical University and four medical college hospitals in Bangladesh from August 2015 to December 2015. A pretested interviewer-administered questionnaire was used to obtain information related to sociodemographic status, level of education, types of profession, and medical history. The questionnaire included eight questions on GDM. Level of knowledge (mean ± 1 standard deviation [SD]) was categorized as poor, average, and good. Descriptive, Chi-squared, and regression analysis were performed to express the results.

RESULTS

Of total knowledge score of 8, participants' mean knowledge score (±SD) was 2.7 ± 1.5. The levels of good, average, and poor knowledge were 26.3%, 63.1%, and 10.6%, respectively. In multivariate analysis, participants aged below 30 years (P < 0.001), male gender (P < 0.001), high-income group (P < 0.001), having university education (P < 0.001), health professionals (P < 0.001), capital Dhaka city residents (P < 0.001), those with family history of diabetes (P = 0.007), and participants with diabetes (P = 0.007) were found to be significantly associated with the good knowledge score.

CONCLUSIONS

Participants in this study had average knowledge about GDM. New innovative strategies should be developed to improve the knowledge of GDM among health professionals and general population.

Awareness of Gestational Diabetes and its Risk Factors among Pregnant Women in Samoa

Gestational diabetes mellitus (GDM) is a subtype of diabetes mellitus defined as the development, or first recognition, of glucose intolerance during pregnancy. The risk of developing type 2 diabetes mellitus (T2DM) is greater in mothers with GDM compared to the general population. Preventing the development of GDM could help lower the prevalence of T2DM and long-term morbidity in children of affected mothers. The purpose of this study was to investigate the awareness of GDM and its risk factors among pregnant women in Samoa, exploring where participants obtained information, and understanding their attitudes towards diet and physical activity. A quantitative cross-sectional study of 141 women attending Tupua Tamasese Meaole (TTM) hospital in Apia, Samoa in May 2015 was performed. Fifty-eight percent women were aware diabetes can occur for the first time during pregnancy. The greatest information source was from doctors (37%, n=44) followed by family members (22%, n=28), based on 118 respondents. Only one woman correctly identified all four risk factors for GDM. Most women recognized eating a healthy diet (79%) and regular physical activity (78%) to be appropriate lifestyle changes to help prevent GDM. These findings suggest awareness of GDM among pregnant women in Samoa is mixed, with a very small proportion having good knowledge (based on the number of risk factors identified). We conclude that increased education about GDM is necessary, both in hospital clinics and within the community. By increasing awareness of GDM, it may be possible to decrease the prevalence of T2DM in Samoa.

The Challenges and Recommendations for Gestational Diabetes Mellitus Care in India: A Review

Gestational diabetes mellitus (GDM) is a primary concern in India affecting approximately five million women each year. Existing literature indicate that prediabetes and diabetes affect approximately six million births in India alone, of which 90% are due to GDM. Studies reveal that there is no consensus among physicians and health-care providers in India regarding management of GDM prepartum and postpartum despite available guidelines. Also, there is no consensus among physicians as to when a woman should undergo oral glucose tolerance test after delivery. This clearly shows that management of GDM is challenging and controversial in India due to conflicting guidelines and treatment protocols, despite availability of straightforward protocols for screening and management. Also, a collaborative approach remains a key for GDM management, as patient compliance and proper educational interventions promote better pregnancy outcomes. Management of GDM plays a pivotal role, as women with GDM have an increased chance of developing diabetes mellitus 5-10 years after pregnancy. Also, children born in GDM pregnancies face an increased risk for obesity and type 2 diabetes. The cornerstone for the management of GDM is glycemic control and quality nutritional intake. GDM management is complex in India, and existing challenges are multifactorial. However, there are little published data outlining these challenges. This review gives an account of some of the key challenges from self-management and health-care provider perspective. The recommendations in this review provide insights for building a more structured model for GDM care in India. This research has several practical applications. First, it points out to reaching a consensus on approaches for screening, diagnosis, and treatment of care across clinical practices in the nation that can aid in overcoming certain challenges observed. Second, it highlights the importance to build capacities and capabilities, especially in resource-limited settings. Health education among pregnant women remains a priority to resolve issues related to self-management. More broadly, further research, specifically qualitative is vital to determine forthcoming challenges with respect to patients, caregivers, providers, and policy makers and to provide solutions fitted to practice setting and demographic background.

Trends in the Diagnosis of Gestational Diabetes Mellitus

Introduction. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable degree with onset or recognition during pregnancy. As prevalence of diabetes is linked to impaired glucose tolerance during antenatal period, routine antenatal screening of GDM is required. However, screening tests for GDM remain controversial. Objective. To review different diagnostic criteria for GDM. Materials and Methods. Freely accessible, full-text articles from 1964 to 2015, available in PubMed in English language, pertaining to screening of GDM were reviewed. Results. First diagnostic criteria for GDM in 1964 by O'Sullivan and Mahan, modified by the National Diabetes Data Group (NDDG) in 1979 and Carpenter in 1982. The cut-off value as per WHO definition of GDM was 140 mg/dL, 2 hours after 75 g glucose intake. Diabetes in Pregnancy Study Group India (DIPSI), in 2006, endorsed WHO criteria but irrespective of the last meal timings. Being cost-effective, it formed the basis of national guidelines for Indians in 2014. Conclusions. As typical clinical scenarios are usually varied, practical guidelines that meet the constraints of low-resource settings like India are required.

Global estimates of the prevalence of hyperglycaemia in pregnancy

AIMS

We estimated the number of live births worldwide and by IDF Region who developed hyperglycaemia in pregnancy in 2013, including total diabetes in pregnancy (known and previously undiagnosed diabetes) and gestational diabetes.

METHODS

Studies reporting prevalence of hyperglycaemia first-detected in pregnancy (formerly termed gestational diabetes) were identified using PubMed and through a review of cited literature. A simple scoring system was developed to characterise studies on diagnostic criteria, year study was conducted, study design, and representation. The highest scoring studies by country with sufficient detail on methodology for characterisation and reporting at least three age-groups were selected for inclusion. Forty-seven studies from 34 countries were used to calculate age-specific prevalence of hyperglycaemia first-detected in pregnancy in women 20-49 years. Adjustments were then made to account for heterogeneity in screening method and blood glucose diagnostic threshold in studies and also to align with recently published diagnostic criteria as defined by the WHO for hyperglycaemia first detected in pregnancy. Prevalence rates were applied to fertility and population estimates to determine regional and global prevalence of hyperglycaemia in pregnancy for 2013. An estimate of the proportion of cases of hyperglycaemia in pregnancy due to total diabetes in pregnancy was calculated using age- and sex-specific estimates of diabetes from the IDF Diabetes Atlas and applied to age-specific fertility rates.

RESULTS

The global prevalence of hyperglycaemia in pregnancy in women (20-49 years) is 16.9%, or 21.4 million live births in 2013. An estimated 16.0% of those cases may be due to total diabetes in pregnancy. The highest prevalence was found in the South-East Asia Region at 25.0% compared with 10.4% in the North America and Caribbean Region. More than 90% of cases of hyperglycaemia in pregnancy are estimated to occur in low- and middle-income countries.

CONCLUSION

These are the first global estimates of hyperglycaemia in pregnancy and conform to the new WHO recommendations regarding diagnosis and also include estimates of live births in women with known diabetes. They indicate the importance of the disease from a public health and maternal and child health perspective, particularly in developing countries.