Incidence of gestational diabetes mellitus in the United Arab Emirates; comparison of six diagnostic criteria: The Mutaba’ah Study

Abstract

BackgroundFor more than half a century, there has been much research and controversies on how to accurately screen for and diagnose gestational diabetes mellitus (GDM). There is a paucity of updated research among the Emirati population in the United Arab Emirates (UAE). The lack of a uniform GDM diagnostic criteria results in the inability to accurately combine or compare the disease burden worldwide and locally. This study aimed to compare the incidence of GDM in the Emirati population using six diagnostic criteria for GDM.MethodsThe Mutaba’ah study is the largest multi-center mother and child cohort study in the UAE with an 18-year follow-up. We included singleton pregnancies from the Mutaba’ah cohort screened with the oral glucose tolerance test (OGTT) at 24–32 weeks from May 2017 to March 2021. We excluded patients with known diabetes and with newly diagnosed diabetes. GDM cumulative incidence was determined using the six specified criteria. GDM risk factors were compared using chi-square and t-tests. Agreements among the six criteria were assessed using kappa statistics.ResultsA total of 2,546 women were included with a mean age of 30.5 ± 6.0 years. Mean gravidity was 3.5 ± 2.1, and mean body mass index (BMI) at booking was 27.7 ± 5.6 kg/m2. GDM incidence as diagnosed by any of the six criteria collectively was 27.1%. It ranged from 8.4% according to the EASD 1996 criteria to 21.5% according to the NICE 2015 criteria. The two most inclusive criteria were the NICE 2015 and the IADPSG criteria with GDM incidence rates of 21.5% (95% CI: 19.9, 23.1) and 21.3% (95% CI: 19.8, 23.0), respectively. Agreement between the two criteria was moderate (k = 0.66; p < 0.001). The least inclusive was the EASD 1996 criteria [8.4% (95% CI: 7.3, 9.6)]. The locally recommended IADPSG/WHO 2013 criteria had weak to moderate agreement with the other criteria, with Cohen’s kappa coefficient ranging from (k = 0.51; p < 0.001) to (k = 0.71; p < 0.001). Most of the GDM risk factors assessed were significantly higher among those with GDM (p < 0.005) identified by all criteria.ConclusionsThe findings indicate discrepancies among the diagnostic criteria in identifying GDM cases. This emphasizes the need to unify GDM diagnostic criteria in this population to provide accurate and reliable incidence estimates for healthcare planning, especially because the agreement with the recommended criteria was not optimal.

Epidemiology, Technology, and Professional Perspectives on Diabetes in the United Arab Emirate: A Focused Review

“…21,22 However, more recent studies are larger and include the epidemiology of diabetes in pregnancy in the UAE, the applicability of several diagnostic guidelines, and the impact of lifestyle management. [23][24][25][26][27][28][29] The Mutaba'ah study is the largest multicenter mother and child cohort study in the UAE with an 18-year follow-up. Discrepancies among the diagnostic criteria in identifying gestational diabetes mellitus (GDM) cases were evident emphasizing the need to unify diagnostic criteria to provide accurate and reliable incidence estimates for health care planning, particularly as the agreement with the recommended criteria was not optimal.…”

“…Discrepancies among the diagnostic criteria in identifying gestational diabetes mellitus (GDM) cases were evident emphasizing the need to unify diagnostic criteria to provide accurate and reliable incidence estimates for health care planning, particularly as the agreement with the recommended criteria was not optimal. 23 The pregnant women's perception and knowledge of the impact of obesity on prenatal outcomes was evaluated in a cross-sectional study using 526 self-administered questionnaires, with a response rate of 72%. Most (81.8%, n ¼ 429) entered pregnancy as overweight or obese.…”

“…Discrepancies among the diagnostic criteria in identifying gestational diabetes mellitus (GDM) cases were evident emphasizing the need to unify diagnostic criteria to provide accurate and reliable incidence estimates for health care planning, particularly as the agreement with the recommended criteria was not optimal. 23…”

"A Mini-Review: Investigating the Interplay of Maternal Diet, Fasting in Ramadan, and Their Collective Impact on Pregnancy and Fetal Outcomes"

“…Maternal complications, such as pregnancy-induced hypertension and postpartum hemorrhage, are linked to GDM, along with an increased likelihood of needing a C-section according to a study in Ethiopia [8]. In the United Arab Emirates, where GDM prevalence ranges from 8.4% to 27.1%, the condition has a notable impact on maternal and newborn outcomes [9]. Dietary food changes as well as fasting have been seen to significantly affect the predisposition of the pregnant mother to GDM.…”