CROSS SECTIONAL ANALYSIS OF RATE OF PRESENTATION OF PATIENTS WITH GESTATIONAL DIABETES (original) (raw)
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Factors Associated With Gestational Diabetes Mellitus: A Cross-Sectional Study
Cureus, 2021
The absence of tolerance in the levels of carbohydrates at the onset or at the time of pregnancy amongst females is known as gestational diabetes mellitus (GDM). This study is designed to determine the frequency of GDM and factors responsible for GDM to assess the actual magnitude of the outcome. Furthermore, it allows for developing strategies to minimize morbidities and improve the pregnancy outcome by early diagnosis and timely management, which can help reduce the frequency of GDM. The aim of the study was to determine the frequency of GDM and the factors responsible for GDM. Methods This was a cross-sectional study conducted in the Department of Obstetrics & Gynaecology Unit 2, Civil Hospital Karachi from the period starting from March 1, 2017, and ending on August 31, 2017, in order to determine the prevalence and associated risk factors of GDM. The study was carried out on 674 pregnant women. A total of 185 consecutive booked cases between the ages of 20 and 40 years, with parity 1 or more with gestational age greater than 24 weeks, were included in the study. Fasting plasma glucose levels 5.1-6.9 mmol/L (92-125mg/dl) and two hours plasma glucose levels of 8.5-11.0 mmol/L (153-199mg/dl) were set up as cutoff levels. GDM and factors were labeled on the basis of cutoff levels. Factors responsible for GDM included high maternal age when the age of the women was greater than 35 years and grand multiparity when women having a number of children greater than five, that is, women who have given birth five or more times. The collection forms were completed in the postpartum period. All information was obtained through the patient's clinical record and prenatal card. Initially, all variables were analyzed descriptively. To see the association of the groups, the chi-squared test (χ2 test) or Fisher's exact test was used. The level of significance used for the tests was 5%. Results The prevalence of gestational diabetes was 9.73% (95% CI: 8.53-12.64). The average age of the patients was 28.99 ± 4.34 years. The average pre-gestational BMI was 25.44 ± 2.74. Out of 185 women, 127 (68.65%) were less than or equal to 30 years of age. The average pre-gestational BMI was 25.44 ± 2.74, and average gestational age was 28.99 ± 2.34 years, respectively. A total of 161 (87.03%) of the women had a family monthly income of more than 10,000 PKR. There were 61 (32.97%) primiparous, 97 (52.43%) multiparous, and 27 (14.59%) grand multiparous women. Most of the women were illiterate numbering 36 (19.46%) or primary educated, numbering 30 (16.22%), and secondary educated or higher numbering 6 (3.24%). High maternal age (>30 years), high parity (>3), previous history of GDM, and family history of GDM were the significant factors of GDM. Conclusion The results of our study showed that the prevalence of gestational diabetes was 9.73% (95% CI: 8.53-12.64). Therefore, this study also showed that developing GDM was directly related to the following factors; such as the history of GDM in previous pregnancies with advanced maternal age, increased parity, and any medical history including a family history of GDM, along with the level of education of women. Hence, early detection and intervention are important because it improves pregnancy outcome.
International Journal of Endocrinology and Metabolism
Objectives: This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) based on two sets of criteria, namely the old criteria suggested in 2009 by the American Diabetes Association and new criteria of the International Association of Diabetes in Pregnancy Study Group. We also evaluated the predictive power of the risk factors of GDM. Methods: Pregnant women from three outpatient clinics in Tehran, Iran, participated in this cross-sectional observational study. During the first perinatal visit, demographic data, medical histories, weight, and height of mothers were recorded. The mother's fasting glucose and glycosylated hemoglobin were measured. An oral glucose tolerance test was also performed. The prevalence of GDM, based on the two criteria, was estimated and its predictive factors were investigated. Results: Of 1,117 pregnant women, 156 (15.6%) and 71 (7.1%) patients had GDM based on the new and old criteria, respectively. Multivariate analysis showed that older age at pregnancy (OR = 1.05; 95% CI: 1.006-1.107; P = 0.03), higher body mass index (OR = 1.2; 95% CI: 1.15-1.3; P < 0.001), family history of diabetes (OR = 1.97; 95% CI: 1.11-3.5; P = 0.02), and history of macrosomia (OR = 7.8; 95% CI: 1.96-30.9; P = 0.004) were independent predictive factors for GDM. Conclusions: Using the new criteria, the prevalence of GDM increases by 2.2 folds compared to the old criteria. Several factors can independently predict the occurrence of GDM.
Journal of Bioinformatics and Diabetes, 2016
Objective: To observe association of risk factors with gestational diabetes mellitus (GDM) in a tertiary care hospital of Bangladesh. Materials and methods: Risk factors of GDM were evaluated in pregnant subjects (n=385; age: 26.4±4.9 yrs; body mass index, BMI: 25.3±4.3 kg/m 2 ; mean ± SD) screened by 75 gram oral glucose tolerance test (OGTT) following WHO 1999 criterion irrespective of gestational age in the Department of Endocrinology, Bangabandhu Sheikh Mujib Medical University (BSMMU). BMI, maternal age, parity, trimester and family history of diabetes were considered as risk factors. Plasma glucose was measured by glucose-oxidase method on the same day. Results: GDM and normal glucose tolerance (NGT) showed significant difference for age (28.2±4.9 vs. 25.3±4.6 yrs, p<0.001), BMI (26.7±4.4 vs. 24.4±3.9 kg/m 2 , p˂0.001), family history of DM (55.5% vs. 43.0%, p=0.017) and number of gravida (p=0.048). There was no significant difference of frequencies of GDM among various trimesters (39.4% vs. 42.5% vs. 38.2%; χ2=0.653, p=0.721). OGTT performed before 24 weeks revealed GDM in about 44% (88/202). Multiple regression revealed age (p<0.001), BMI (p=0.007) and family history of DM (p=0.048) as independent predictors for GDM. Conclusion: It is concluded that age of mother, increased BMI, family history of diabetes as well as multigravidae are important predictors for GDM.
Thai Journal of Obstetrics and Gynaecology, 2013
To determine the prevalence and clinical outcomes of gestational diabetes mellitus (GDM), defined by IADPSG criteria, in pregnant women who are at risk of GDM. Study design: Descriptive study. Material and Method: We studied pregnant women who visited the antenatal clinics at Bhumibol Adulyadej Hospital between July 1, 2011 and December 31, 2012 and had risk factors of GDM. The diagnosis of GDM was defined using the IADPSG criteria. Primary outcome was the prevalence of GDM and the secondary outcomes were pregnancy related complications which included maternal and neonatal complications. Results: A total of 6,324 pregnancy women, 164 patients were diagnosed GDM. The prevalence of GDM was 2.6%. The most common clinical risk factor for GDM was age ≥30 years (75.4%). The most common maternal and neonatal complication were pregnancy induced hypertension (PIH) (12.7%) and hypoglycemia (47.6%). GDM women were significantly different from non-GDM women in PIH, primary cesarean section, hypoglycemia, Apgar <7, and NICU admission. Pregnancy outcomes between GDM A1 and A2 were significantly different. GDM A2 increased the rate of cesarean section, hypoglycemia, and NICU admission. Conclusion: Using the IADSP criteria, the prevalence of GDM was 2.6%. Compared to non-GDM regnant women, adversed pregnancy outcomes were significantly higher in GDM pregnant women.
2016
Objective: The study was aimed to observe the frequency of GDM among pregnant mothers attending at antenatal clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU). Methods: This cross-sectional study screened 385 pregnant subjects irrespective of gestational age and risk factors for GDM (age: 26.4±4.9 yrs, BMI: 25.3±4.3 kg/m2; mean ± SD) by 75g oral glucose tolerance test (OGTT) following WHO 1999 criterion. Subjects having normal glucose tolerance (NGT) before 24 weeks, were asked for repeat test during 24 to 28 weeks. 49 subjects out of 94 with NGT before 24 weeks of gestation repeated 75g OGTT while 31 did not respond and 14 were not mature for repeat test at endpoint. Glucose was measured by glucose-oxidase method on the same day of sampling. All data were processed by utilizing SPSS program (Version 22.0) and expressed as frequencies or percentages as well as mean (±SD/ SEM) as applicable. Results: Frequency for GDM was 36.6% (141/385) by WHO 1999 criterion and it reached to 40.3% (155/385) when repeat test results for those who were NGT before 24 weeks were included. GDM and NGT showed significant difference for age (28.0±4.9 vs. 24.9±4.5 yrs, p<0.001), BMI (26.5±4.2 vs. 24.3±4.0 kg/m2, pÂ0.001), family history of DM (56.1% vs. 37.9%, p<0.001) and number of gravida (p=0.027). There was no statistically significant difference for GDM among trimesters [1 st vs. 2 nd vs. 3 rd trimester: 40.9% (27/66) vs. 44.9% (75/167) vs. 48.7% (74/152); 2=1.198, p=0.549]. GDM frequency increased to 41.6% (160/385), 43.4% (167/385) and 52.2% (201/385) when the cutoff value of FPG was considered at 6.1 mmol/L, 5.6 mmol/L and 5.1 mmol/L respectively while 02HPG ≥ 7.8 mmol/L (as WHO 1999 criterion). Multiple regression showed age (p<0.001), family history of diabetes (p=0.048) and BMI (p=0.007) as independent predictors for GDM. Conclusion: It is concluded that frequency of GDM in our society is quite high and alarming. Observed increased efficiency with low set cutoff for FPG needs further studies in light of pregnancy outcome. Screening should be done as early as possible irrespective of trimester and weeks of gestation.
A study of modifiable risk factors of GDM in Delhi
IP Innovative Publication pvt. ltd., 2017
Introduction: Gestational diabetes mellitus (GDM) has been observed to be associated with increased perinatal morbidity and mortality. GDM is becoming a public health concern globally as well as in India with fast increasing trend. It affects approximately 14% of all pregnancies. Most of the literature available has focused on traditional risk factors while this article has thrown light on modifiable ones. Objective: To study the modifiable risk factors for developing GDM in pregnant women based on physical examination and personal history. Materials and Methods: A hospital based case control study was conducted in Lady Hardinge Medical College and associated hospital with a sample size of 104 (52 cases & 52 controls). Pregnant women with gestational diabetes mellitus as diagnosed by abnormal oral Glucose Tolerance Test (OGTT) were taken as cases and Pregnant women who have completed 24 weeks of gestation and who tested negative on Glucose Challenge test (GCT) were selected as controls.bThe data was compiled and analysed in SPSS version 12. Results: Pre pregnancy BMI >23kg/m² (OR-12.96), Skinfold thickness >13mm (OR-5.30). OCPs use for more than 5 years (OR-4.71), Physical activity sedentary vs moderate (OR=1.40), consumption of food item with high GI (OR=2.86). Conclusions: The information found in the study regarding the risk factors may contribute heavily to the policy makers to develop strategies to combat the problem of GDM in the community.
International Journal of Research in Pharmaceutical Sciences, 2020
GDM is a condition in which high blood glucose level is exhibited in a women during pregnancy without a previous diagnosis of Diabetes Mellitus. Indian women are considered to be more prone for developing GDM. The increasing prevalence of GDM may be due to obesity, family history of Diabetes Mellitus, sedentary lifestyle, genetic predisposition and dietary habits. The screening and management of GDM in the general population remain controversial with conflicting guidelines and treatment protocols. Adequate blood sugar control in GDM women might reduce various maternal, foetal and neonatal complications. Prospective Observational study was done to find out the prevalence and risk factors of GDM. The study was conducted in the OBG department of the study center and pregnant women with 24-28 weeks of gestation attending for antenatal care were included. The results obtained from the study says the prevalence of GDM was found to be 16% in the study center, which is at par with South Ind...
Cureus
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/m 2 , and 25.70±4.40, 24.48±3.37 kg/m 2 (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.
PROSPECTIVE STUDY WITH OUTCOME ON GESTATIONAL DIABETES MELLITUS
BACKGROUND: In India; the high rate of infant and maternal mortality, may be attributable to rising trend of GDM across Pregnant women. Therefore the study of management of GDM by existing health facilities and Community camps in government and private sector becomes crucial for managing such cases. The present study by prospective evaluation method saught to find out the management of GDM for implementing GDM screening in Kanpur. METHODS: A prospective evaluation based study was done from October, 2012 to September, 2014 at 198 healthcare facilities and 454 screening camps in Kanpur Nagar on 57,018 pregnant women, who were screened between 24th-28th weeks of pregnancy as per DIPSI & FOGSI guidelines. RESULTS: The total pregnant women who were Diagnosed as GDM were 7641 (13.4%) and this prevalence of GDM was more in urban area(16%) as compared to rural area(9.8%). The health facilities in combined more were more efficient in diagnosing GDM(86%) as compared to Commmunity camps(14%)(p<0.0001), but facilities were least interested in follow-up of Blood glucose Monitoring and further counselling (10%). In public health facilities howver-21% Pregnant women attending OPD were under gone OGTT as compared to 7% in Private health facilities and they tested OGTT more than the private health facilities. CONCLUSION: Public health system role is management of GDM is more significant as compared to Community level camps. There are potential benefits of actively involving Public health facilities in GDM Management among pregnant women, which needs to be taken care by Government on priority basis.