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Punnose J, Sukhija K, Rijhwani RM. Intermediate hyperglycemia in early pregnancy: A South Asian perspective. World J Diabetes 2023; 14:573-584. [PMID: 37273252 PMCID: PMC10236988 DOI: 10.4239/wjd.v14.i5.573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/28/2023] [Accepted: 04/07/2023] [Indexed: 05/15/2023] Open
Abstract
“Intermediate hyperglycemia in early pregnancy (IHEP)” refers to mild hyperglycemia detected before 24 gestational weeks (GW), satisfying the criteria for the diagnosis of gestational diabetes mellitus. Many professional bodies recommend routine screening for “overt diabetes” in early pregnancy, which identifies a significant number of women with mild hyperglycemia of undetermined significance. A literature search revealed that one-third of GDM women in South Asian countries are diagnosed before the conventional screening period of 24 GW to 28 GW; hence, they belong in the IHEP category. Most hospitals in this region diagnose IHEP by oral glucose tolerance test (OGTT) using the same criteria used for GDM diagnosis after 24 GW. There is some evidence to suggest that South Asian women with IHEP are more prone to adverse pregnancy events than women with a diagnosis of GDM after 24 GW, but this observation needs to be proven by randomized control trials. Fasting plasma glucose is a reliable screening test for GDM that can obviate the need for OGTT for GDM diagnosis among 50% of South Asian pregnant women. HbA1c in the first trimester predicts GDM in later pregnancy, but it is not a reliable test for IHEP diagnosis. There is evidence to suggest that HbA1c in the first trimester is an independent risk factor for several adverse pregnancy events. Further research to identify the patho-genetic mechanisms behind the fetal and maternal effects of IHEP is strongly recommended.
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Affiliation(s)
- John Punnose
- Department of Endocrinology and Metabolism, St. Stephen’s Hospital, Delhi 110054, India
| | - Komal Sukhija
- Department of Endocrinology, St.Stephen’s Hospital, Delhi 110054, India
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Muacevic A, Adler JR. World Health Organization Versus Diabetes in Pregnancy Study Group India Approaches in the Screening of Gestational Diabetes Among Pregnant Women With Risk Factors: A Study Among Rural Population of Telangana, South India. Cureus 2022; 14:e29799. [PMID: 36340523 PMCID: PMC9622028 DOI: 10.7759/cureus.29799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/12/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) represents a pathological condition wherein pregnant women (PW) suffer from glycemic dysregulation, which predisposes them to an increased risk of developing complications related to pregnancy and childbirth. The most commonly used guidelines to screen for GDM include those provided by the World Health Organization (WHO), the American Congress of Obstetricians and Gynecologists, the Canadian Diabetes Association, and the International Association of Diabetes and Pregnancy Study Group. The Diabetes in Pregnancy Study Group India (DIPSI) guidelines are national-level recommendations to screen for GDM in India. This study aimed to compare the efficacy of DIPSI criteria versus the WHO guidelines in screening for GDM among the rural population of Telangana, South India Methods A total of 300 PW aged 19-35 years with a gestational age of 24-28 weeks attending the antenatal clinic attached to Mahavir Institute of Medical Sciences (MIMS), Vikarabad, Telangana, India were included in the study. The study was approved by the Institutional Ethics Committee of MIMS, and informed consent was obtained from all the participants. Of the 300 subjects included, 75 PW were categorized as at-risk for GDM based on risk factors and were included for further analysis. The data relating to body mass index (BMI), oral glucose tolerance test, and the diagnosis of GDM based on DIPSI and the WHO criteria were collected. Results Out of the 75 PW included in the study, an overall GDM prevalence of 32% was noted among which 20 (26.7%) were diagnosed using the WHO criteria, 12 (16%) by DIPSI criteria, and the remaining 73.3% were non-GDM women. The mean gestational age and BMI among non-GDM and GDM patients were 24.74±4.15 weeks, 22.24±3.60 kg/m2, and 25.70±4.40, 24.48±3.37 kg/m2 (p<0.01), respectively. The activities of glucose at the second hour after a GTT among non-GDM and GDM cases were 113.70±20.4 mg/dL and 128.04±18.6 mg/dL (p=0.004), respectively. Conclusion DIPSI criteria could identify fewer numbers of GDM women as compared to the WHO criteria. Although the DIPSI criteria are convenient and prescribe less number of interventions, they could possibly miss many cases of GDM. Moreover, PW who remain undiagnosed could, in the future, be at risk of developing diabetes. Based on the study results and because risks should outweigh the benefits, we propose that DIPSI cannot be implemented as a single criterion to screen for GDM among PW in Indian settings.
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Nayak H, Gadhavi R, Solanki B, Aroor B, Gameti H, Shringarpure KS, Joshi J, Kazi Z. Screening for gestational diabetes, Ahmedabad, India. Bull World Health Organ 2022; 100:484-490. [PMID: 35923278 PMCID: PMC9306388 DOI: 10.2471/blt.22.288045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To implement a community-based screening and awareness-raising project for gestational diabetes in Ahmedabad, India. Methods The project took place between April 2016 and August 2019 in Ahmedabad. Medical college faculty members and medical officers trained 3582 paramedical staff on screening for gestational diabetes. These paramedical staff tested all pregnant women 24–28 weeks gestation, who were attending village health and nutrition days – also called mamta days – in urban and rural health centres for routine antenatal care, for gestational diabetes. An oral glucose tolerance test was used and blood sugar ≥ 7.8 mmol/L was the cut-off for gestational diabetes. Women with gestational diabetes were referred for counselling and treatment and all women were followed until 6 weeks after delivery. Findings Of 53 522 pregnant women screened, 6786 (12.7%) had gestational diabetes and were referred for nutritional therapy or medication; 836 (12.3%) of these women started medication. There was no significant difference in the prevalence of stillbirths between women with gestational diabetes (0.8%; 54/6786) and women without (0.7%; 338/46 736; P-value: 0.51). Of the women on treatment, 38 had abnormal blood glucose after delivery and continued with the medication. Two women with gestational diabetes died; they had other associated co-morbidities – pre-eclampsia and anaemia. Conclusion We found a high prevalence of gestational diabetes, indicating the need for gestational diabetes screening and implementation of this project on a larger scale. Gestational diabetes screening at the community level is operationally feasible using the existing human resources and infrastructure of the reproductive health programmes.
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Affiliation(s)
- Himanshu Nayak
- Department of Preventive and Social Medicine, Medical Education Trust Medical College, Ahmedabad, India
| | - Rajendra Gadhavi
- Department of Preventive and Social Medicine, Byramjee Jeejabhoy Medical College, Ahmedabad, India
| | | | - Bhagyalaxmi Aroor
- Department of Preventive and Social Medicine, Byramjee Jeejabhoy Medical College, Ahmedabad, India
| | - Hemant Gameti
- Department of Preventive and Social Medicine, Medical Education Trust Medical College, Ahmedabad, India
| | - Kalpita S Shringarpure
- Department of Preventive and Social Medicine, Medical College Baroda, Anandpura, Raopura, Baroda, Gujarat, 390001, India
| | - Jayun Joshi
- Department of Obstetrics and Gynecology, Medical Education Trust Medical College, Ahmedabad, India
| | - Zuveriya Kazi
- Gestational Diabetes Mellitus Project, Ahmedabad, India
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Thanawala U, Divakar H, Jain R, Agarwal MM. Negotiating Gestational Diabetes Mellitus in India: A National Approach. ACTA ACUST UNITED AC 2021; 57:medicina57090942. [PMID: 34577865 PMCID: PMC8467131 DOI: 10.3390/medicina57090942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022]
Abstract
The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.
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Affiliation(s)
| | - Hema Divakar
- Divakar Specialty Hospital, Bengaluru 560078, India;
| | | | - Mukesh M. Agarwal
- Department of Pathology, California University of Science and Medicine, Colton, CA 92324, USA
- Correspondence:
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Masood SN, Lakho N, Saeed S, Masood Y. Non-fasting OGTT versus Fasting OGTT for screening of Hyperglycaemia in Pregnancy (HIP). Pak J Med Sci 2021; 37:1008-1013. [PMID: 34290774 PMCID: PMC8281142 DOI: 10.12669/pjms.37.4.3979] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 04/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the reliability of non-fasting oral glucose tolerance test (OGTT) versus fasting OGTT for screening of hyperglycaemia in pregnancy (HIP). METHODS This cross sectional analytic study was conducted by the Department of Obstetrics & Gynaecology, Isra University Karachi Campus from October 2016 to April 2017. A total of 225 pregnant women irrespective of gestational age were included in the study. They underwent non fasting 75 grams OGTT. Venous plasma glucose was done 02 hours after the glucose load. Same women were advised to come again within three to seven days for fasting OGTT. Venous plasma glucose (VPG) was estimated in fasting and 2 hours post glucose load. RESULTS Using the non-fasting OGTT, out of 204 women, 32 were diagnosed with hyperglycemia. All these 204 women were again called for fasting OGTT three to seven days after the initial non-fasting OGTT. Only nine were diagnosed with hyperglycemia, out of these nine women, seven women who were screen positive on non-fasting OGTT were found to be screen positive on fasting OGTT as well. However, only two women were additionally diagnosed with hyperglycemia who were initially screen negative on non-fasting OGTT. The non-fasting OGTT has diagnosed HIP with sensitivity of 77.7%, specificity of 87.1%, positive predictive value of 21.8% and negative predictive value of 98.8%. CONCLUSION The use of the non-fasting OGTT at first antenatal visit may be a practical approach to detect the HIP as screening and diagnostic tool in the resource constrained settings.
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Affiliation(s)
- Shabeen Naz Masood
- Dr. Shabeen Naz Masood, MBBS, MCPS, FCPS, PhD, DCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Nusrat Lakho
- Dr. Nusrat Lakho, MBBS, FCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Saira Saeed
- Dr. Saira Saeed, MBBS, FCPS. Department of Obstetrics & Gynaecology, Isra University, Karachi, Pakistan
| | - Yasir Masood
- Dr. Yasir Masood, MD, MPH. Department of Public Health, Brown School, Washington University in St. Louis, Missouri, USA
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Chebrolu P, Kurbude R, Thakur M, Shah N, Jain R. Gestational diabetes in rural central India: low prevalence but absence of typical risk factors. Heliyon 2021; 7:e07431. [PMID: 34286121 PMCID: PMC8273204 DOI: 10.1016/j.heliyon.2021.e07431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction The reported prevalence of gestational diabetes mellitus (GDM) varies widely across India. Given the short-term, long-term, and multigenerational health impacts of GDM, understanding its frequency and risk factors is important for population screening strategies. We estimated the prevalence of GDM and determined associated risk factors in rural, central India, where data is sparse. Methods We conducted a cross-sectional study of a convenience sample of 575 pregnant women attending antenatal care (ANC) clinics at Jan Swasthya Sahyog's (JSS) outreach clinics in rural Chhattisgarh, India. Study participants underwent a non-fasting 75g oral glucose tolerance test (OGTT) between 24-28 weeks gestation. Using Diabetes in Pregnancy Study Group of India (DIPSI) criteria, a 2-hour post-OGTT glucose ≥140 mg/dL was used to diagnose GDM. Results We found 11 patients (1.9%) who met diagnostic criteria for GDM. Median age, systolic blood pressure, and diastolic blood pressure were higher in those with GDM (26 vs 23 years, p = 0.02; 117 vs 106 mmHg, p = 0.04, 77 vs 68 mmHg, p < 0.01, respectively). Pre-hypertension was associated with increased odds of GDM on multivariate analysis (OR 4.0, 95% CI: 1.1, 14.8). BMI was not associated with GDM. With appropriate management there were no differences in fetal complications between GDM and normal glucose tolerance (NGT) groups. Conclusions In rural, central India the prevalence of GDM was 1.9% in the absence of traditional risk factors such as increased BMI. Further research is needed to define the applicability of optimal screening strategies in such settings.
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Khan S, Bal H, Khan ID, Paul D. Evaluation of the diabetes in pregnancy study group of India criteria and Carpenter-Coustan criteria in the diagnosis of gestational diabetes mellitus. Turk J Obstet Gynecol 2018; 15:75-79. [PMID: 29971182 PMCID: PMC6022420 DOI: 10.4274/tjod.57255] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/18/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance that is diagnosed for the first time during pregnancy. This prospective study was undertaken to validate the single-step non-fasting 75 gm Diabetes in Pregnancy Study Group of India (DIPSI) criteria of GDM in Indian patients in comparison with the two-step fasting 100 gm glucose challenge through the Carpenter Coustan criteria (CCC). MATERIALS AND METHODS Two hundred patients underwent comparative testing using the DIPSI criteria and CCC. Plasma venous blood glucose levels were estimated using the hexokinase method; values ≥140 mg/dL at 2 hours were considered positive according to the DIPSI criteria. Any two values from ≥95 mg/dL for fasting, ≥180 mg/dL at 1 hour, ≥155 mg/dL at 2 hours, and ≥140 mg/dL at 3 hours were considered positive with the CCC. RESULTS The mean age and body mass index were 24.26±3.75 years and 20.7±3.07 kg/m2. The sensitivity, specificity, and positive and negative predictive values of the DIPSI guidelines were found as 100%, 97.14%, 83.87%, and 100%, respectively. The positive and negative likelihood ratios were 35.8 and zero. Diagnostic accuracy was found as 97.56%. CONCLUSION DIPSI having high sensitivity, specificity, negative predictive value and diagnostic accuracy. DIPSI offers simplicity, feasibility, convenience, and repeatability while economizing universal screening and diagnosis of GDM on a mass-scale. The DIPSI procedure has the potential to be applied to the entire obstetric population, in the implementation of public health programs to diagnose GDM in the community, thus reaching the needs of the developing world.
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Affiliation(s)
- Shazia Khan
- INHS Kalyani Hospital, Clinic of Obstetrics and Gynecology, Visakhapatnam, India
| | - Himadri Bal
- Dr. DY. Patil Medical College Hospital and Research Centre, Clinic of Obstetrics and Gynecology, Pune, India
| | - Inam Danish Khan
- Army College of Medical Sciences and Base Hospital, Clinic of Microbiology, New Delhi, India
| | - Debashish Paul
- Armed Forces Medical College, Clinic of Obstetrics and Gynecology, Pune, India
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