A population-based screening for gestational diabetes mellitus in non-diabetic women in Bahrain

Evolution of Gestational Diabetes Mellitus across Continents in 21st Century

Over the last few decades, several definitions of gestational diabetes mellitus (GDM) have been described. There is currently not enough research to show which way is the best to diagnose GDM. Opinions differ in terms of the optimal screening and diagnostic measures, in part due to the differences in the population risks, the cost-effectiveness considerations, and the lack of an evidence base to support large national screening programs. The basic method for identifying the disease is the measurement of glucose plasma levels which may be determined when fasting, two hours after a meal, or simply at any random time. The currently increasing incidence of diabetes in the whole population, the altering demographics and the presence of lifestyle changes still require better methods of screening for hyperglycemia, especially during pregnancy. The main aim of this review is to focus on the prevalence and modifications to the screening criteria for GDM across all continents in the 21st century. We would like to show the differences in the above issues and correlate them with the geographical situation. Looking at the history of diabetes, we are sure that more than one evolution in GDM diagnosis will occur, due to the development of medicine, appearance of modern technologies, and the dynamic continuation of research.

Prevalence and risk factors of gestational diabetes mellitus among pregnant patients visiting National Guard primary health care centers in Saudi Arabia

Objectives:

To measure the prevalence of gestational diabetes mellitus (GDM) and its risk factors in Saudi Arabia, in comparison with developed and developing countries worldwide.

Methods:

We enrolled pregnant women aged 15-45 years who visited 3 National Guard-Health Affairs’ primary health care centers in Jeddah, Saudi Arabia between January 2017 and December 2017. We used stratified samples and computer-generated random numbers to collect data. This data includes demographics, obstetric history, blood pressure, non-fasting 1-hour glucose challenge test (GCT), 3-hour oral glucose tolerance test (OGTT), hemoglobin level, rubella immunization status, hepatitis B surface antigen status, urinalysis results, and labor, and delivery notes. We categorized the patients into 2 groups, GDM and non-GDM, based on GCT and OGTT.

Results:

We enrolled 347 women in the study (mean age, 28.8±6 years; range, 18-45 years). On GCT, 36.6% of women showed abnormal values and 6.9% exhibited diagnostic values. Oral glucose tolerance test indicated impairment in 18.7% of patients and a diagnostic finding in 15% of patients. Women diagnosed with GDM tended to be older and have greater body mass index (BMI) values.

Conclusion:

The prevalence of GDM in Saudi Arabia is high compared to other countries. Advanced maternal age and higher BMI values were associated with increased prevalence of GDM. Thus, early prevention and management of GDM is vital to minimize the risks to both the mother and fetus.

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

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

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018100629.

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

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

Maternal and birth cohort studies in the Gulf Cooperation Council countries: a systematic review and meta-analysis

BACKGROUND

We systematically reviewed and chronicled exposures and outcomes measured in the maternal and birth cohort studies in the Gulf Cooperation Council (GCC) countries and quantitatively summarized the weighted effect estimates between maternal obesity and (1) cesarean section (CS) and (2) fetal macrosomia.

METHODS

We searched MEDLINE-PubMed, Embase, Cochrane Library, Scopus, and Web of Science electronic databases up to 30 June 2019. We considered all maternal and birth cohort studies conducted in the six GCC countries (Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE)). We categorized cohort studies on the basis of the exposure(s) (anthropometric, environmental, medical, maternal/reproductive, perinatal, or socioeconomic) and outcome(s) (maternal or birth) being measured. Adjusted weighted effect estimates, in the form of relative risks, between maternal obesity and CS and fetal macrosomia were generated using a random-effects model.

RESULTS

Of 3502 citations, 81 published cohort studies were included. One cohort study was in Bahrain, eight in Kuwait, seven in Qatar, six in Oman, 52 in Saudi Arabia, and seven in the UAE. Majority of the exposures studied were maternal/reproductive (65.2%) or medical (39.5%). Birth and maternal outcomes were reported in 82.7% and in 74.1% of the cohort studies, respectively. In Saudi Arabia, babies born to obese women were at a higher risk of macrosomia (adjusted relative risk (aRR), 1.15; 95% confidence interval (CI), 1.10-1.20; I2 = 50%) or cesarean section (aRR, 1.21; 95% CI, 1.15-1.26; I2 = 62.0%). Several cohort studies were only descriptive without reporting the magnitude of the effect estimate between the assessed exposures and outcomes.

CONCLUSIONS

Cohort studies in the GCC have predominantly focused on reproductive and medical exposures. Obese pregnant women are at an increased risk of undergoing CS delivery or macrosomic births. Longer-term studies that explore a wider range of environmental and biological exposures and outcomes relevant to the GCC region are needed.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017068910.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

The impact of diagnostic criteria for gestational diabetes on its prevalence: a systematic review and meta-analysis

BACKGROUND

The absence of universal gold standards for screening of gestational diabetes (GDM) has led to heterogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. We aimed to evaluate the effect of different diagnostic criteria for GDM on its prevalence among general populations of pregnant women worldwide, and also to investigate the prevalence of GDM based on various geographic regions.

METHODS

A comprehensive literature search was performed in PubMed, Scopus and Google-scholar databases for retrieving articles in English investigating the prevalence of GDM. All populations were classified to seven groups based-on their diagnostic criteria for GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed effect and random-effects inverse variance model for calculating the pooled effect. Publication bias was assessed by Begg's test. The Meta-prop method was used for the pooled estimation of the prevalence of GDM. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. Modified Newcastle-Ottawa Quality Assessment Scale for nonrandomized studies was used for quality assessment of the studies included; the ROBINS and the Cochrane Collaboration's risk of bias assessment tools were used to evaluate the risk of bias.

RESULTS

We used data from 51 population-based studies, i.e. a study population of 5,349,476 pregnant women. Worldwide, the pooled overall-prevalence of GDM, regardless of type of screening threshold categories was 4.4%, (95% CI 4.3-4.4%). The pooled overall prevalence of GDM in the diagnostic threshold used in IADPSG criteria was 10.6% (95% CI 10.5-10.6%), which was the highest pooled prevalence of GDM among studies included. Meta-regression showed that the prevalence of GDM among studies that used the IADPSG criteria was significantly higher (6-11 fold) than other subgroups. The highest and lowest prevalence of GDM, regardless of screening criteria were reported in East-Asia and Australia (Pooled-P = 11.4%, 95% CI 11.1-11.7%) and (Pooled-P = 3.6%, 95% CI 3.6-3.7%), respectively.

CONCLUSION

Over the past quarter century, the diagnosis of gestational diabetes has been changed several times; along with worldwide increasing trend of obesity and diabetes, reducing the threshold of GDM is associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women's psychological aspects, and health costs should be evaluated precisely.

Maternal and birth cohort studies in the Gulf Cooperation Council countries: protocol for a systematic review and narrative evaluation

INTRODUCTION

Cohort studies have revealed that genetic, socioeconomic, communicable and non-communicable diseases, and environmental exposures during pregnancy may influence the mother and her pregnancy, birth delivery and her offspring. Numerous studies have been conducted in the Gulf Cooperation Council (GCC) countries to examine maternal and birth health. The objectives of this protocol for a systematic review are to systematically review and characterise the exposures and outcomes that have been examined in the mother and birth cohort studies in the GCC region, and to summarise the strength of association between key maternal exposures during pregnancy (ie, body mass index) and different health-related outcomes (ie, mode of birth delivery). The review will then synthesise and characterise the consequent health implications and will serve as a platform to help identify areas that are overlooked, point out limitations of studies and provide recommendations for future cohort studies.

METHODS AND ANALYSIS

Medline, Embase, Cochrane Library and Web of Science electronic databases will be comprehensively searched. Two reviewers will independently screen each study for eligibility, and where discrepancies arise they will be discussed and resolved; otherwise a third reviewer will be consulted. The two reviewers will also independently extract data into a predefined Excel spreadsheet. The included studies will be categorised on the basis of whether the participant is a mother, infant or mother-infant dyad. Outcome variables will be divided along two distinctions: mother or infant. Exposure variables will be divided into six domains: psychosocial, biological, environmental, medical/medical services, maternal/reproductive and perinatal/child. Studies are expected to be of heterogeneous nature; therefore, quantitative syntheses might be limited.

ETHICS AND DISSEMINATION

There is no primary data collection; therefore, ethical review is not necessary. The findings of this review will be disseminated in a peer-reviewed journal and presented at relevant conferences.

PROSPERO REGISTRATION NUMBER

CRD42017068910.

The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review

BACKGROUND

Little is known about the burden of diabetes mellitus (DM) in pregnancy in low- and middle-income countries despite high prevalence and mortality rates being observed in these countries.

OBJECTIVE

To investigate the prevalence and geographical patterns of DM in pregnancy up to 1 year post-delivery in low- and middle-income countries.

SEARCH STRATEGY

Medline, Embase, Cochrane (Central), Cinahl and CAB databases were searched with no date restrictions.

SELECTION CRITERIA

Articles assessing the prevalence of gestational diabetes mellitus (GDM), and types 1 and 2 DM were sought.

DATA COLLECTION AND ANALYSIS

Articles were independently screened by at least two reviewers. Forest plots were used to present prevalence rates and linear trends calculated by linear regression where appropriate.

MAIN RESULTS

A total of 45 articles were included. The prevalence of GDM varied. Diagnosis was made by the American Diabetes Association criteria (1.50-15.5%), the Australian Diabetes in Pregnancy Society criteria (20.8%), the Diabetes in Pregnancy Study Group India criteria (13.4%), the European Association for the Study of Diabetes criteria (1.6%), the International Association of Diabetes and Pregnancy Study Groups criteria (8.9-20.4%), the National Diabetes Data Group criteria (0.56-6.30%) and the World Health Organization criteria (0.4-24.3%). Vietnam, India and Cuba had the highest prevalence rates. Types 1 and 2 DM were less often reported. Reports of maternal mortality due to DM were not found. No geographical patterns of the prevalence of GDM could be confirmed but data from Africa is particularly limited.

CONCLUSION

Existing published data are insufficient to build a clear picture of the burden and distribution of DM in pregnancy in low- and middle-income countries. Consensus on a common diagnostic criterion for GDM is needed. Type 1 and 2 DM in pregnancy and postpartum DM are other neglected areas.

Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons

Background

The prevalence of gestational diabetes (GDM) is increasing all over the world. Hence, the impact of GDM on maternal and infant health is an important topic of research. No study has been conducted in Qatar to evaluate the outcome of pregnancies complicated by diabetes mellitus.

Objective

The aim of the study was to determine the prevalence of GDM, compare the maternal–neonatal complications among women with GDM and non-GDM pregnant women, and investigate the risk factors and potential outcomes associated with GDM.

Design

This is a prospective cohort study.

Setting

The survey was carried out at the antenatal clinics of the Women’s Hospital, Qatar.

Subjects and methods

A representative sample of 2056 pregnant women who attended the antenatal clinics of the Women’s Hospital were surveyed during the period from the first week of January 2010 to April 2011. From this sample, 1608 women (78.2%) expressed their consent to participate in the study. Questionnaires were administered to pregnant women who were seeking antenatal care at this urban hospital. The questionnaire covered variables related to sociodemographic factors, family history, medical history, maternal complications, and neonatal outcome.

Results

The prevalence of GDM in Qatar was 16.3%. Women with GDM were significantly higher in the age group of 35–45 years (45%; P = 0.001). Family history of diabetes (31.7%; P < 0.001), increased parity (55.3%; P = 0.004), and obesity (59.2%; P < 0.001) were determinants of GDM in pregnant women. Maternal complications like pregnancy-induced hypertension (19.1% vs 10.3%; P < 0.001), pre-eclampsia (7.3% vs 3.8%; P = 0.012), antepartum hemorrhage (19.2% vs 14.6%; P = 0.05), and cesarean (27.9% vs 12.4%; P < 0.001) were significantly higher in GDM women. Neonates were at increased risk of preterm birth (12.6% vs 8.3%; P = 0.03), macrosomia (10.3% vs 5.9%; P = 0.01), and birth trauma (8% vs 3%; P < 0.001).

Conclusion

The study findings revealed that GDM was higher in women in Qatar and that they were at increased risk of developing maternal and neonatal complications. Obesity emerged as an essential risk factor for subsequent GDM. The advanced maternal age, low monthly income, family history of diabetes, and obesity were the main significant risk factors for GDM.

International migration and gestational diabetes mellitus: a systematic review of the literature and meta-analysis

Influxes of migrant women of childbearing age to receiving countries have made their perinatal health status a key priority for many governments. The international research collaboration Reproductive Outcomes And Migration (ROAM) reviewed published studies to assess whether migrants in countries of resettlement have a greater risk of gestational diabetes mellitus (GDM) than women in receiving countries. A systematic review of the literature from Medline, Embase, PsychInfo and CINAHL from 1990 to 2009 included studies of migrant women and GDM. Studies were excluded if there was no cross-border movement or comparison group or if the receiving country was not the country of resettlement. Studies were assessed for quality, analysed descriptively and meta-analysed. Twenty-four reports (representing >120,000 migrants) met our inclusion criteria. Migrants were described primarily by geographic origin; other relevant aspects (e.g. time in country, language fluency) were rarely studied. Migrants' results for GDM were worse than those for receiving-country women in 79% of all studies. Meta-analyses showed that, compared with receiving-country women, Caribbean, African, European and Northern European women were at greater risk of GDM, while North Africans and North Americans had risks similar to receiving-country women. Although results of the 31 comparisons of Asians, East Africans or non-Australian Oceanians were too heterogeneous to provide a single GDM risk estimate for migrant women, only one comparison was below the receiving-country comparison group, all others presented a higher risk estimate. The majority of women migrants to resettlement countries are at greater risk for GDM than women resident in receiving countries. Research using clear, specific migrant definitions, adjusting for relevant risk factors and including other aspects of migration experiences is needed to confirm and understand these findings.

Gestational diabetes: comparision of the carpenter and the coustan thresholds with the new thresholds of Turkish women and implications of variations in diagnostic criteria

OBJECTIVE

To find optimal 100-g 3-h oral glucose tolerance test (OGTT) threshold levels for diagnosis of gestational diabetes (GDM) in Turkish pregnant women.

METHODS

This study was conducted with 808 women screened for GDM between 24-28 weeks of gestation using the 1-h 50-g glucose challenge test (GCT) with a subsequent 3-h 100-g OGTT for confirmation if screen was positive. The glucose values obtained were analysed by both the Carpenter and Coustan (C&C criteria) and National Diabetes Data Group (NDDG) criteria for the diagnosis of GDM and IGT. Optimal OGTT cutoff values for Turkish population were calculated by ROC curve analysis.

RESULTS

The new diagnostic criteria, based on the result of the 100-g OGTT obtained from the healthy pregnant women, were 82.5, 171.5, 151.5, and 111.5 mg/dl at 0, 1, 2, and 3 h. The prevalence of GDM was 15.7% by the new criteria, 8.1% by C&C criteria, and 5.6% by the NDDG criteria. According to new criteria, 7.7% of infants of diabetic mothers had macrosomia. This ratio was 2.6% for non diabetic women.

CONCLUSIONS

Ethnic differences, enviromental factors and nutritional habits may effect development of GDM. Application of some pre-determined nomograms to all races and ethnic groups can lead errors.

Definition, epidemiology, risk factors

Gestational diabetes mellitus is defined as glucose intolerance that begins or is first recognized during pregnancy. Its prevalence, generally situated between 2-6%, may reach 10-20% in high-risk populations, with an increasing trend across most racial/ethnic groups studied. Among traditional risk factors, previous gestational diabetes, advanced maternal age and obesity have the highest impact on gestational diabetes risk. Racial/ethnic origin and family history of type 2 diabetes have a significant but moderate impact (except for type 2 diabetes in siblings). Several non traditional factors have been recently characterized, either physiological (low birthweight and short maternal height) or pathological (polycystic ovaries). The multiplicity of risk factors and their interactions results in a low reliability of risk prediction on an individual basis.

Universal versus selective screening for detection of gestational diabetes mellitus in a malaysian population

OBJECTIVES

To compare the efficacy of two screenings methods for gestational diabetes mellitus, namely the universal screening using 50g Glucose Challenge Test to that of selective screening based on risk factors.

METHODOLOGY

A cross-sectional study involving 366 women between 24 weeks to 28 weeks gestation who attended a community health clinic for their antenatal care between January to May 2003. All women had their risk factors for gestational diabetes identified at the beginning of the study, after which they underwent a 50g Glucose Challenge Test and subsequently the 75g Oral Glucose Tolerance Test.

RESULTS

The prevalence of gestational diabetes mellitus in this population was 18.3%. The universal screening had a sensitivity of 83.5% and specificity of 82.6% compared to that of selective screening, 76.1% and 60.9% respectively. Of all patients diagnosed to have gestational diabetes mellitus, 23.8% were without risk factors.

CONCLUSION

Universal screening strategy using 50g glucose challenge test is a better predictor of gestational diabetes mellitus compared to risk-based selective screening.

Screening for gestational diabetes at antenatal booking in a Malaysian university hospital: the role of risk factors and threshold value for the 50-g glucose challenge test

BACKGROUND

The best method of screening for gestational diabetes (GDM) remains unsettled. The 50-g glucose challenge test (GCT) is used in a two-stage screening process but its best threshold value can vary according to population.

AIMS

To evaluate the role of risk factors in conjunction with GCT and to determine an appropriate threshold for the one-hour venous plasma glucose with the GCT.

METHOD

In a prospective study, 1600 women at antenatal booking without a history of diabetes mellitus or GDM filled a form on risk factors before GCT. Women who had GCT >or= 7.2 mmol/L underwent the 75-g oral glucose tolerance test (OGTT). GDM was diagnosed according to WHO (1999) criteria.

RESULT

Thirty-five per cent had GCT >or= 7.2 mmol/L, 32.6% underwent OGTT and 34.5% of OGTT confirmed GDM. The GDM rate in our population was at least 11.4%. Examination of the receiver operator characteristic curve suggested that the best threshold value for the GCT in our population was >or= 7.6 mmol/L. Multivariable logistic regression demonstrated that only GCT >or= 7.6 mmol/L was an independent predictor for GDM (adjusted odds ratio 3.7: P < 0.001). After GCT, maternal age and anthropometry, OGTT during the third trimester, family history, obstetric history and glycosuria were not independent predictors of GDM.

CONCLUSIONS

Risk factors were not independent predictors of GDM in women with GCT >or= 7.2 mmol/L. GCT threshold value >or= 7.6 mmol is appropriate for the Malaysian population at high risk of GDM.

The increasing prevalence of diabetes in pregnancy

The authors review studies published in the past 10 years that examine the prevalence and trends in the prevalence of gestational diabetes mellitus (GDM). The prevalence of GDM in a population is reflective of the prevalence of type 2 diabetes within that population. In low-risk populations, such as those found in Sweden, the prevalence in population-based studies is lower than 2% even when universal testing is offered, whereas studies in high-risk populations, such as the Native American Cree, Northern Californian Hispanics, and Northern Californian Asians, reported prevalence rates ranging from 4.9% to 12.8%. Prevalence rates for GDM obtained from hospital-based studies similarly reflect the risk of type 2 diabetes in a population with a single hospital-based study in Australia reporting prevalences ranging from 3.0% in Anglo-Celtic women to 17.0% in Indian women. Finally, of the eight studies published that report on trends in the prevalence of GDM, six report an increase in the prevalence of GDM across most racial/ethnic groups studied. In summary, diabetes during pregnancy is a common and increasing complication of pregnancy.

The increasing prevalence of diabetes in pregnancy

The authors review studies published in the past 10 years that examine the prevalence and trends in the prevalence of gestational diabetes mellitus (GDM). The prevalence of GDM in a population is reflective of the prevalence of type 2 diabetes within that population. In low-risk populations, such as those found in Sweden, the prevalence in population-based studies is lower than 2% even when universal testing is offered, whereas studies in high-risk populations, such as the Native American Cree, Northern Californian Hispanics, and Northern Californian Asians, reported prevalence rates ranging from 4.9% to 12.8%. Prevalence rates for GDM obtained from hospital-based studies similarly reflect the risk of type 2 diabetes in a population with a single hospital-based study in Australia reporting prevalences ranging from 3.0% in Anglo-Celtic women to 17.0% in Indian women. Finally, of the eight studies published that report on trends in the prevalence of GDM, six report an increase in the prevalence of GDM across most racial/ethnic groups studied. In summary, diabetes during pregnancy is a common and increasing complication of pregnancy.

The increasing prevalence of diabetes in pregnancy

The authors review studies published in the past 10 years that examine the prevalence and trends in the prevalence of gestational diabetes mellitus (GDM). The prevalence of GDM in a population is reflective of the prevalence of type 2 diabetes within that population. In low-risk populations, such as those found in Sweden, the prevalence in population-based studies is lower than 2% even when universal testing is offered, whereas studies in high-risk populations, such as the Native American Cree, Northern Californian Hispanics, and Northern Californian Asians, reported prevalence rates ranging from 4.9% to 12.8%. Prevalence rates for GDM obtained from hospital-based studies similarly reflect the risk of type 2 diabetes in a population with a single hospital-based study in Australia reporting prevalences ranging from 3.0% in Anglo-Celtic women to 17.0% in Indian women. Finally, of the eight studies published that report on trends in the prevalence of GDM, six report an increase in the prevalence of GDM across most racial/ethnic groups studied. In summary, diabetes during pregnancy is a common and increasing complication of pregnancy.