Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA<sub>1c</sub> in an Indian cohort

Gupta, Yashdeep; Kapoor, Deksha; Desai, Ankush; Praveen, Devarsetty; Joshi, Rohina; Rozati, Roya; Bhatla, Neerja; Prabhakaran, Dorairaj; Reddy, Prasuna; Patel, Anushka; Tandon, Nikhil

doi:10.1111/dme.13102

Cited by 35 publications

(48 citation statements)

References 14 publications

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“…[9][10][11][12][13] Women with pre-eclampsia have an almost four-fold risk of developing chronic hypertension post-pregnancy, and approximately a two-fold increased risk of ischaemic heart disease and stroke. [14][15][16] Two-thirds of the Indian population live in rural areas. [14][15][16] Two-thirds of the Indian population live in rural areas.…”

Section: Introductionmentioning

confidence: 99%

“…9 Indian women are at increased risk of developing GDM; they are more likely to develop Type 2 diabetes (T2DM) at an earlier age and at a lower body mass index; and have a higher risk of coronary artery disease compared with Caucasians. [14][15][16] Two-thirds of the Indian population live in rural areas. 17 Women in rural settings are particularly vulnerable to complications due to limited awareness of the risk factors for cardiometabolic disorders, and limited healthcare access and quality.…”

Section: Introductionmentioning

confidence: 99%

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Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Nagraj

Hinton

Praveen

et al. 2019

BJOG

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Objectives A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long‐term risks. Design Qualitative study using modified grounded theory. Setting Two states in rural India: Haryana and Andhra Pradesh. Population Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. Methods In‐depth interviews and focus group discussions explored: (1) priorities for high‐risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long‐term sequelae of high‐risk conditions. A thematic analysis was undertaken. Results Seven focus group discussions and 11 in‐depth interviews (n = 71 participants) were performed. The key priority area for high‐risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long‐term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long‐term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. Conclusions There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. Funding SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. Tweetable abstract Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long‐term risks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Nagraj

Hinton

Praveen

et al. 2019

BJOG

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“…Cultural practices after birth, workforce shortages, particularly in rural areas, and a lack of health system infrastructure are additional barriers to providing lifelong care. Many women with hypertension and T2DM remain undiagnosed, although population-based screening for GDM shows high rates of conversion from GDM to T2DM in both urban and rural areas of LMICs (87). Further education and training of women and healthcare staff are needed to encourage postpartum follow-up and repeat testing of women at high risk of CMDs (84).…”

Section: The Need For Life-course Based Approaches To Women's Healthmentioning

confidence: 99%

Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings

Nagraj

Kennedy

Norton

et al. 2020

Front. Cardiovasc. Med.

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Cardiometabolic disorders (CMDs), including ischemic heart disease, stroke and type 2 diabetes are the leading causes of mortality and morbidity in women worldwide. The burden of CMDs falls disproportionately on low and middle-income countries (LMICs), placing substantial demands on already pressured health systems. Cardiometabolic disorders may present up to a decade earlier in some LMIC settings, and are associated with high-case fatality rates. Early identification and ongoing postpartum follow-up of women with pregnancy complications such as hypertensive disorders of pregnancy (HDPs), and gestational diabetes mellitus (GDM) may offer opportunities for prevention, or help delay onset of CMDs. This mini-review paper presents an overview of the key challenges faced in the early identification, referral and management of pregnant women at increased risk of CMDs, in low-resource settings worldwide. Evidence-based strategies, including novel diagnostics, technology and innovations for early detection, screening and management for pregnant women at high-risk of CMDs are presented. The review highlights the key research priorities for addressing cardiometabolic risk in pregnancy in low-resource settings.

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“…[12] Here, too, the concept of quaternary preventions needs to be invoked to protect patient well-being and outcomes.…”

Section: Pragmatic Approach For Quarternary Preventionmentioning

confidence: 99%

Quaternary prevention and gestational diabetes mellitus

Kalra¹,

Gupta²,

Kalra³

2017

Indian J Endocr Metab

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Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA_1c in an Indian cohort

Cited by 35 publications

References 14 publications

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings

Quaternary prevention and gestational diabetes mellitus

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Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA1c in an Indian cohort

Cited by 35 publications

References 14 publications

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Women's and healthcare providers’ perceptions of long‐term complications associated with hypertension and diabetes in pregnancy: a qualitative study

Cardiometabolic Risk Factors in Pregnancy and Implications for Long-Term Health: Identifying the Research Priorities for Low-Resource Settings

Quaternary prevention and gestational diabetes mellitus

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Conversion of gestational diabetes mellitus to future Type 2 diabetes mellitus and the predictive value of HbA_1c in an Indian cohort