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Rohini HN, Punita P, Santhekadur PK, Ravishankar MV. Gestational Diabetes Mellitus - The Modern Indian Perspective. Indian J Endocrinol Metab 2023; 27:387-393. [PMID: 38107727 PMCID: PMC10723610 DOI: 10.4103/ijem.ijem_147_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/08/2023] [Accepted: 04/22/2023] [Indexed: 12/19/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a serious and most frequent health complication during pregnancy which is associated with a significant increase in the risk of maternal and neonatal outcomes. GDM is usually the result of β-cell dysfunction along with chronic insulin resistance during pregnancy. Seshiah et al. pioneer work led to the adoption of Diabetes in Pregnancy Study Group in India criteria as the norm to diagnose GDM, especially in the community setting. In 2014, the Maternal Health Division of the Ministry of Health and Family Welfare, Government of India, updated guidelines and stressed upon the proper use of guidelines such as using a glucometer for self-monitoring and the use of oral hypoglycaemic agents. The 2018 Government of India guidelines stress the importance of counselling about lifestyle modifications, weight control, exercise, and family planning.
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Affiliation(s)
- H N Rohini
- Department of Physiology, Meeankshi Medical College and Research Institute, Affiliated to Meenakshi Academy of Higher Education and Research, Mysore, India
| | - Pushpanathan Punita
- Department of Physiology, Meeankshi Medical College and Research Institute, Affiliated to Meenakshi Academy of Higher Education and Research, Mysore, India
| | - Prasanna Kumar Santhekadur
- Department of Biochemistry, Center of Excellence in Molecular Biology and Regenerative Medicine, JSS Medical College, Mysore, India
| | - MV Ravishankar
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
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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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Singh AK, Palepu S, Saharia GK, Patra S, Singh S, Taywade M, Bhatia V. Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study. Indian J Community Med 2023; 48:351-356. [PMID: 37323735 PMCID: PMC10263052 DOI: 10.4103/ijcm.ijcm_759_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/17/2022] [Indexed: 06/17/2023] Open
Abstract
Background The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India. Material and Methods Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD. Results Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35). Conclusion This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.
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Affiliation(s)
- Arvind Kumar Singh
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sarika Palepu
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Gautom Kumar Saharia
- Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Suravi Patra
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sweta Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Manish Taywade
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Vikas Bhatia
- Executive Director and CEO, All India Institute of Medical Sciences, Bibinagar, Telangana, India
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Mishra S, Semwal J, Srivastava A, Kumar Mishra S. Prevalence of Hyperglycemia in Pregnancy and Related Screening Practices in Rural Dehradun: The First Population-Based Study from Uttarakhand (PGDRD-1). Indian J Endocrinol Metab 2023; 27:145-153. [PMID: 37292078 PMCID: PMC10245310 DOI: 10.4103/ijem.ijem_459_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 06/10/2023] Open
Abstract
Aims Phase I of the Prevalence of Gestational Diabetes Mellitus in Rural Dehradun (PGDRD) project estimates hyperglycemia in pregnancy (HIP) prevalence and identifies gaps in the utilization of community-related services in rural areas of the Dehradun district (western Uttarakhand); a state where notably no prior population-based study has ever been conducted despite being an Empowered Action Group state for more than two decades. Methods Using a multistage random sampling technique, 1,223 pregnant women locally registered in the rural field practice area of a block were identified. Those requiring HIP screening were subjected to a 2-h 75 g oral glucose tolerance test during the house visit irrespective of their period-of-gestation and last meal timings, diagnosed using the Diabetes in Pregnancy Study Group India (DIPSI) criterion (when indicated). Data were collected by personal interviews using a pretested data collection tool. Statistical Package for Social Sciences version 20.0 was used for analysis. Results The overall HIP prevalence recorded was 9.7% (95% CI: 8.1-11.5%); the majority (95.8%) were GDM followed by overt DIP (4.2%). Less than 1% of the subjects (0.7%) self-reported pre-GDM. Despite this burden, more than three-fourths were never screened for HIP in their pregnancy. Of those tested, the majority availed secondary healthcare facilities. Few even had to bear expenses in private with a very handful being tested free-of-cost by ANM in the community; findings that altogether sharply contrast to those recommended by national protocols. Conclusion Despite the high HIP burden, beneficiaries are unable to utilize community-related universal screening protocols as desired.
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Affiliation(s)
- Surabhi Mishra
- Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, India
| | - Jayanti Semwal
- Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, India
| | - Abhay Srivastava
- Department of Community Medicine, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University (SRHU), Swami Ram Nagar, Jolly Grant, Dehradun, Uttarakhand, India
| | - Surendra Kumar Mishra
- Department of Water Resources Development and Management, Indian Institute of Technology Roorkee, Roorkee, Uttarakhand, India
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Bahl S, Dhabhai N, Taneja S, Mittal P, Dewan R, Kaur J, Chaudhary R, Bhandari N, Chowdhury R. Burden, risk factors and outcomes associated with gestational diabetes in a population-based cohort of pregnant women from North India. BMC Pregnancy Childbirth 2022; 22:32. [PMID: 35031013 PMCID: PMC8759176 DOI: 10.1186/s12884-022-04389-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background The burden of gestational diabetes mellitus (GDM) appears to be increasing in India and may be related to the double burden of malnutrition. The population-based incidence and risk factors of GDM, particularly in lower socio-economic populations, are not known. We conducted analyses on data from a population-based cohort of pregnant women in South Delhi, India, to determine the incidence of GDM, its risk factors and association with adverse pregnancy outcomes (stillbirth, preterm birth, large for gestational age babies) and need for caesarean section. Methods We analyzed data from the intervention group of the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. An oral glucose tolerance test (OGTT) was performed at the time of confirmation of pregnancy, and for those who had a normal test (≤140 mg), it was repeated at 24–28 and at 34–36 weeks. Logistic regression was performed to ascertain risk factors associated with GDM. Risk ratios (RR) were calculated to find association between GDM and adverse pregnancy outcomes and need for caesarean section. Results 19.2% (95% CI: 17.6 to 20.9) pregnant women who had at least one OGTT were diagnosed to have GDM. Women who had prediabetes at the time of confirmation of pregnancy had a significantly higher risk of developing GDM (RR 2.08, 95%CI 1.45 to 2.97). Other risk factors independently associated with GDM were woman’s age (adjusted OR (AOR) 1.10, 95% CI 1.06 to 1.15) and BMI (AOR 1.04, 95% CI 1.01 to 1.07). Higher maternal height was found to be protective factor for GDM (AOR 0.98, 95% CI 0.96 to 1.00). Women with GDM, received appropriate treatment did not have an increase in adverse outcomes and no increased need for caesarean section Conclusions A substantial proportion of pregnant women from a low to mid socio-economic population in Delhi had GDM, with older age, higher BMI and pre-diabetes as important risk factors. These findings highlight the need for interventions for prevention and provision of appropriate management of GDM in antenatal programmes. Clinical trial registration Clinical Trial Registry – India, #CTRI/2017/06/008908 (http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339&EncHid=&userName=society%20for%20applied%20studies). Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04389-5.
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Affiliation(s)
- Stuti Bahl
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.,Amrita Institute of Medical Sciences, Kochi, India
| | - Neeta Dhabhai
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Pratima Mittal
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rupali Dewan
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Jasmine Kaur
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ritu Chaudhary
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.
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Gupta S, Gupta A, Swarnakar CP, Rathore M, Beniwal R, Meena K, Simlot A, Gupta N. The Early Sonographic Prediction of Gestational Diabetes in Women From India. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793211029882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The purpose of this study was to look for the earliest, cost -effective method that can be added to the routine antenatal screening for identifying patients who might develop gestational diabetes mellitus (GDM) in a proactive manner, as opposed to the current reactive approach of screening and treating GDM, during the second trimester of pregnancy. Materials and Methods: 190 singleton pregnant women in the age group 18-35 years were selected for the study. On these women two step assessment was done. The current project was carried out to utilize sonography as an early, cost-effective method which could be added to routine antenatal screening for identifying patients, at risk for developing GDM. Results: Body mass index was found to have a significant association in those patients with GDM with a P < .001. There was a significant association between subcutaneous adipose tissue (SAT) depth and occurrence of GDM, with a P-value of <.001. Also, in the present study, the occurrence of GDM significantly increased with a rise in visceral adipose tissue (VAT), and there was a significant association between the two, with P < .001. It was noted that there were greater incidences of GDM as VAT depth increased. The existence of GDM greatly increased with a rise in total abdominal tissue (TAT), and there was a significant association between the two, with P < .001 Conclusion: The sonographic measurement of SAT, VAT, and TAT, could be potential marker to identify probable events for the development of GDM, among Asian Indian women who tend to have T2DM, due to differential distribution of fat.
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Affiliation(s)
- Shivani Gupta
- Department of Obstetrics and Gynecology, SMS Medical College & Attached Hospital, Jaipur, India
| | - Arjun Gupta
- Jawahar Lal Nehru Medical College, KLE University, Belagavi, India
| | - C. P. Swarnakar
- Department of Radiology, SMS Medical College & Attached Hospital, Jaipur, India
| | - Monika Rathore
- Department of Preventive and Social Medicine, SMS Medical College & Attached Hospital, Jaipur, India
| | - Ramesh Beniwal
- Department of Obstetrics and Gynecology, SMS Medical College & Attached Hospital, Jaipur, India
| | - Kiran Meena
- Department of Obstetrics and Gynecology, SMS Medical College & Attached Hospital, Jaipur, India
| | - Anita Simlot
- Department of Obstetrics and Gynecology, SMS Medical College & Attached Hospital, Jaipur, India
| | - Nidhi Gupta
- Research and Development Cell, IIS (Deemed to be University), Jaipur, India
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A study of serum growth differentiation factor 15 in Indian women with and without gestational diabetes mellitus in the third trimester of pregnancy and its association with pro-inflammatory markers and glucose metabolism. Diabetol Int 2021; 12:254-259. [PMID: 34150433 DOI: 10.1007/s13340-020-00478-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
The pathogenesis of gestational diabetes mellitus (GDM) is multifactorial and it shares many features with type 2 diabetes mellitus. Growth differentiation factor 15 (GDF-15), a member of transforming growth factor-β superfamily, is expressed in a high amount in the placenta in addition to other organs. This cross-sectional study was performed to assess the difference of GDF-15 and pro-inflammatory cytokines between pregnant women with or without GDM, and to explore the possible association of GDF-15 with the parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60 min, and 120 min post-75 gm oral glucose plasma glucose levels) and inflammation (IL-6 and TNF-α) in women with GDM at 24-28 weeks of gestation. Thirty-five women with GDM and 30 age-matched non-diabetic pregnant control (NDPC) subjects were recruited for the study. Mean serum GDF-15, IL-6, and TNF-α levels were significantly higher in GDM in comparison to the NDPC population. These differences persisted even after adjusting for the possible confounders like maternal age and BMI. GDF-15 level showed a positive correlation with parameters of dysglycemia (Serum insulin, HOMA-IR, fasting, 60 min, and 120 min post-75 gm oral glucose plasma glucose levels) but a variable correlation with the markers of inflammation. In conclusion, our study provides evidence that, in Indian women, serum GDF-15 level is higher in GDM in comparison to age-matched pregnant subjects without GDM in the early third trimester pregnancy. Moreover, in third trimester, GDF-15 level increases with increase in plasma glucose and insulin resistance.
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Ghosh A, Ghosh S, Dutta J, Sinha R, Mukherjee J, Chakravorty N. Understanding the awareness, perception and practices of community healthcare workers for high risk antenatal cases: A survey conducted in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Chanda S, Dogra V, Hazarika N, Bambrah H, Sudke AK, Vig A, Hegde SK. Prevalence and predictors of gestational diabetes mellitus in rural Assam: a cross-sectional study using mobile medical units. BMJ Open 2020; 10:e037836. [PMID: 33172942 PMCID: PMC7656912 DOI: 10.1136/bmjopen-2020-037836] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To determine the prevalence and predictors of gestational diabetes mellitus (GDM) in rural Assam, India using a network of Mobile Medical Units. STUDY DESIGN A field-based cross-sectional study. SETTINGS Rural areas of Assam state, India. PARTICIPANTS A total of 1410 pregnant women in gestational age of 24-28 weeks INTERVENTION: Identification of pregnant women in 24-28 weeks of pregnancy from villages and administering them Government of India recommended oral glucose tolerance test for GDM confirmation. PRIMARY AND SECONDARY OUTCOME MEASURES Presence of gestational diabetes among pregnant women, risk factors and predictors of GDM. RESULTS A total of 1212 pregnant women underwent the oral glucose tolerance test. One hundred and ninety-eight women were ineligible due to existing chronic diseases or very high blood glucose level before the test. The overall GDM prevalence in Assam was 16.67% (95% CI 14.61% to 18.89%). Women aged 26-30 years (adjusted odds ratio, aOR 1.70; CI 1.14 to 2.52), who passed 10th class (aOR 1.58; CI 1.05 to 2.37), belonging to Muslim religion (aOR 1.52; 95% CI 1.05 to 2.21) and above poverty line (aOR 1.38; 95% CI 1.00 to 1.91) had significantly increased likelihood of developing GDM compared with respective baseline groups (p<0.05). Body mass index, gravida and being non-anaemic were non-significant risk factors for GDM. Family history of diabetes (aOR 1.82; 95% CI 1.08 to 3.06) and smoking (aOR 1.61; 95% CI 1.10 to 2.35) were significant and independent predictors of GDM. CONCLUSION The prevalence of GDM in rural Assam is high. The mobile medical units may play a significant role in the implementation of GDM screening, diagnosis, treatment to ensure better maternal and foetal health outcomes in rural Assam.
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Affiliation(s)
- Subrata Chanda
- Clinical Domain, Piramal Swasthya Management and Reseach Institute, Guwahati, Assam, India
| | - Vishal Dogra
- Research and Analysis Wing, Piramal Swasthya Management and Reseach Institute, Hyderabad, Telangana, India
| | - Najeeb Hazarika
- Assam and North East State Office, Piramal Swasthya Management and Reseach Institute, Guwahati, Assam, India
| | - Hardeep Bambrah
- Assam and North East State Office, Piramal Swasthya Management and Reseach Institute, Guwahati, Assam, India
| | - Ajit Kisanrao Sudke
- Clinical Domain, Piramal Swasthya Management and Reseach Institute, Hyderabad, Telangana, India
| | - Anupa Vig
- Clinical Domain, Piramal Swasthya Management and Reseach Institute, Hyderabad, Telangana, India
| | - Shailendra Kumar Hegde
- Innovations, Piramal Swasthya Management and Reseach Institute, Hyderabad, Telangana, India
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Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, Wan Sulaiman WA, Suppiah S, Mohamed MH, Veettil SK. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:494. [PMID: 30547769 PMCID: PMC6295048 DOI: 10.1186/s12884-018-2131-4] [Citation(s) in RCA: 243] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 11/30/2018] [Indexed: 01/13/2023] Open
Abstract
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 ).
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Affiliation(s)
- Kai Wei Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Siew Mooi Ching
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Vasudevan Ramachandran
- Malaysian Research Institute on Ageing, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Anne Yee
- Department of Psychological Medicine, University of Malaya Center for Addiction Sciences (UMCAS), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Fan Kee Hoo
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Yook Chin Chia
- Department of Medical Sciences, School of Healthcare and Medical Sciences, Sunway University, 47500 Bandar Sunway, Selangor Malaysia
| | - Wan Aliaa Wan Sulaiman
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Subapriya Suppiah
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Mohd Hazmi Mohamed
- Department of Surgery, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Malaysia
| | - Sajesh K. Veettil
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, 57000 Kuala Lumpur, Malaysia
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Li KT, Naik S, Alexander M, Mathad JS. Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol 2018; 55:613-625. [PMID: 29582160 PMCID: PMC5999405 DOI: 10.1007/s00592-018-1131-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023]
Abstract
AIMS Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. METHODS We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. RESULTS We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33-79%). Studies specifying time of GDM diagnosis showed that patients (11-60%) develop GDM as early as the first trimester, but many GDM cases (16-40%) are missed if screened only at first visit. CONCLUSIONS In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.
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Affiliation(s)
- Katherine T Li
- Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA.
| | - Shilpa Naik
- Department of OB-GYN, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Mallika Alexander
- Johns Hopkins University Clinical Trials Unit, Byramjee Jeejeebhoy Government Medical College, Pune, Maharashtra, India
| | - Jyoti S Mathad
- Departments of Medicine and OB-GYN, Weill Cornell Medicine, New York, NY, USA
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12
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Affiliation(s)
- Ambrish Mithal
- Division of Endocrinology and Metabolism, Medanta, The Medicity, Gurgaon, India
| | - Beena Bansal
- Division of Endocrinology and Metabolism, Medanta, The Medicity, Gurgaon, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Research Institute of Diabetes and Endocrinology, Bharti Hospital, Karnal, Haryana, India
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