Article

Gestational diabetes mellitus in India

Apollo Hospitals, Chennai.
The Journal of the Association of Physicians of India 09/2004; 52:707-11.
Source: PubMed

ABSTRACT Glucose intolerance during pregnancy predisposes the offspring for increased risk of developing glucose intolerance in the future. This vicious cycle is likely to influence and perpetuate the incidence and prevalence of glucose intolerance in any population.
No data is available about the prevalence of glucose intolerance during pregnancy in our country and hence a study was undertaken on this aspect.
This study was performed in the antenatal clinic of Government Maternity Hospital, Chennai, India. As a pregnant woman in second or third trimester checks into the antenatal clinic, she was given 50 gm oral glucose load and blood sample was collected after one hour. This test was performed on 1251 pregnant women. They were requested to come after 72 hours for the 75 gm OGTT recommended by WHO. Among the 1251 women, 891 responded. The blood sample was taken in the fasting state and at 2 hours after 75 gm of oral glucose. Diagnosis was based on the WHO criteria for gestational diabetes mellitus (GDM).
The mean age of these pregnant women was 23+/-4 years. There was a significant increase in the prevalence of GDM in relation to gravida. The effect of BMI did not quite reach statistical significance (chi2 (df=1) = 3.659, P = 0.055), but a model of linear trend was significant. Of the 1251 women who underwent the 50 gm oral glucose challenge test, 670 (53.55%) had one hour plasma glucose > or = 130 mg/dl. Among the 891 pregnant women who had 75 gms OGTT, 168 (18.9%) were diagnosed as GDM, taking both FPG > or = 126 mg/dl and/or 2 hr PPG > or = 140 mg/dl as cut-off values. Taking only 2 hr plasma glucose for analysis, 144 (16.2%) had a value > or = 140 mg/dl. A similar study was conducted in different parts of the country taking only the 2 hr 75 gm post-glucose value of > or = 140 mg/dl as diagnostic criteria for GDM. Of the total number of pregnant women (n = 3674) screened, 16.55% of them found to have GDM.
Our study has documented the increased prevalence of GDM in our population necessitating universal screening for glucose intolerance in pregnancy. Using 2 hr plasma glucose > or = 140 mg/dl as a one step procedure is simple and economical, particularly for the countries ethnically more prone to high prevalence of diabetes.

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    • "The prevalence ranges between 1 and 14 % of all pregnancies [1]. But studies conducted in different parts of the country averages the incidence of GDM in Indian population to be 16.55% [3]. Highest frequency of GDM among Indian women necessitates early diagnosis of GDM using glucose tolerance tests between 24 and 28 week of gestational age, though reports claim that about 40 to 66% of women with GDM can be diagnosed even earlier during pregnancy [4] [5]. "
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    ABSTRACT: Early intervention and appropriate treatment in patients with GDM will help in preventing the adverse maternal and fetal outcome and protect them from long term complications. Several studies have shown the association of hyperuricemia with GDM. This study was undertaken to find out the association of elevated first trimester uric acid with development of GDM. This prospective observational study was conducted in Mahatma Gandhi Medical Collage and Research Institute, Pondicherry, India, between November 2010 and May 2012. A total of 70 pregnant women were included and parameters like age, parity, BMI, history of DM, serum uric acid at <15 weeks and at 24 to 28 weeks and one step test at 24 to 28 weeks were noted and compared. There was no significant correlation between the demographic variables and GDM, but a moderate significance noted between the family history of DM and one step test (p=0.048). Though there is a proportional increase in the serum uric acid with increase in the BMI, it was not statistically significant. A significant correlation was seen between BMI and risk of development of GDM (p= 0.001). Though there is a significant correlation between serum uric acid at <15 weeks and at 24 to 28 weeks, serum uric acid at <15 weeks of gestation is a better predictor of GGI and GDM (Pearson's correlation = 0.735). There is increase in the risk of development of GDM with increased levels of serum uric acid in the first trimester. Uric acid levels at <15 weeks of gestation is more significantly associated with risk of development of GDM than it's levels at 24 to 28 weeks of gestation.
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    • "In general, studies varied from reporting on prevalence only to reporting on prevalence, risk factors, pregnancy outcomes and interventions (data not shown). Fifteen studies reported on prevalence only (24, 25, 28–31, 34, 35, 37, 49, 53, 60, 61, 66, 67), 10 studies on prevalence and risk factors only (38, 40, 41, 46, 47, 50, 52, 54, 57, 62), 12 studies on prevalence, risk factors and pregnancy outcomes/obstetric complications (21, 25, 26, 35, 41–44, 54, 57, 62–64), and eight studies on prevalence, pregnancy outcomes/complications and some form of intervention (22, 31, 32, 38, 47, 50, 58, 59). The interventions in the latter group included diet/medical nutrition therapy only, insulin only or combined diet and insulin therapy. "
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    ABSTRACT: 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.
    Global Health Action 07/2014; 7:23987. DOI:10.3402/gha.v7.23987 · 1.65 Impact Factor
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    • "Overall, prevalence of GDM was 16.55% among urban women using WHO criteria. This study documented a definite increasing trend in prevalence of GDM.[7] Still no data is available from Haryana with regard to prevalence of GDM in rural population. Therefore, we have assessed the prevalence and associated risk factors of GDM in the rural block. "
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    ABSTRACT: Background and Objectives: Gestational diabetes mellitus (GDM) is a global health concern as it affects health status of both mother and fetus. In India, prevalence of GDM varies in different populations and no data is available from rural Haryana. This study was undertaken to determine the prevalence of GDM and risk factors associated with it in rural women of Haryana. Materials and Methods: Nine hundred and thirteen women, with estimated gestational age above 24 weeks from a rural block of Haryana who consented to participate were given a standardized 2-h 75-g oral glucose tolerance test (OGTT). Pro forma containing general information on demographic characteristics, educational level, gravida, family history of diabetes, and past history of GDM was filled-up. A World Health Organization (WHO) criterion for 2-h 75-g OGTT was used for diagnosing GDM. Results: GDM was diagnosed in 127/913 (13.9%) women with higher mean age as compared to non-GDM women. Majority (78.4%) of the women were housewives, rest engaged in agriculture (9.2%) and labor (5.5%). Women with gravida ≥3 and positive family history of diabetes had significantly higher prevalence of GDM. History of macrosomia (birth weight ≥4 kg) was significantly associated with prevalence of GDM (P = 0.002). On multiple logistic regression analysis, risk factors found to be significantly associated with GDM were maternal age >25 years, gravida >3, history of macrosomic baby, and family history of diabetes. Conclusion: The prevalence of GDM has been found quite high in rural Haryana. Appropriate interventions are required for control and risk factor modifications.
    05/2014; 18(3):350-4. DOI:10.4103/2230-8210.131176
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