Evaluation of the prevalence of gestational diabetes mellitus in North Indians using the International Association of Diabetes and Pregnancy Study groups (IADPSG) criteria

Abstract

Objective:Currently, there is controversy regarding the diagnosis of gestational diabetes mellitus (GDM) as per the newer International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. We studied the prevalence and associations of GDM in North Indians, diagnosed by the IADPSG criteria.Patients and Methods:We conducted a cross-sectional study on 332 pregnant women, predominantly belonging to lower and middle socioeconomic strata. The women were screened for GDM between 24 weeks and 28 weeks of gestation by 75g oral glucose tolerance test (OGTT) and GDM diagnosed by the IADPSG criteria.Results:The prevalence of GDM was 41.9% [95% Confidence interval (CI) 36.6-47.2%]. Amongst the women diagnosed to have GDM, 91.4% had abnormal fasting plasma glucose (FPG), while 1-h and 2-h post-glucose (PG) levels were abnormal in 18.7% and 17.3% of women, respectively. No maternal factors were significantly associated with GDM. Birth weight of the neonates was similar in women with GDM as compared to those with normal glucose tolerance. In the entire group, fasting glucose levels were associated with the weight of the patient while 1-h PG levels were associated with weight, height, socioeconomic score, and parity.Conclusions:There is a very high prevalence rate of GDM using the IADPSG criteria in North Indian women of low and middle socioeconomic strata. Further studies are needed to assess the utility of applying these criteria in settings with limited resources.

Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis

“…Out of these, 19 studies (29%) had low risk of bias [16–34], 27 (42%) had medium risk of bias [11–13, 35–58], and 18 (28%) had high risk of bias [59–76]. A table showing the bias tool results for each study is given in Appendix S6.…”

“…The prevalence of GDM ranged from 0 to 41.9% (see Fig. 3) [12, 13]. Studies varied widely in population type, geography, as well as diagnostic method used.…”

“…Seven studies using the IADPSG criteria reported the percent of GDM cases diagnosed by the fasting plasma glucose criterion alone (fasting glucose > 92 g/dL), which ranged from 24.8 to 94%, with a median of 70% (see Appendix S8) [13, 25, 26, 31, 38, 49, 54]. …”

“…[13, 18, 31, 38, 44, 49, 50, 54, 71, 77] All ten studies reported a higher prevalence using the IADPSG criteria than the WHO99 criteria, with the difference between the two criteria ranging from 0.16 to 25.90% [13, 49]. …”

“…A previous study of 3674 patients across 7 cities in India estimated that the prevalence of GDM was 16.55% in India using the WHO 1999 method [11]. However, subsequent studies have shown high variability in the prevalence, from rates as low as 0% in Manipur to 42% in Lucknow, Uttar Pradesh [12, 13]. A variety of factors may contribute to this variability, including differences in the genetics and population across India, as well as differences in screening practices.…”