Prevalence and perinatal outcomes in GDM and non-GDM in a rural pregnancy cohort of Bangladesh

Abstract

Gestational diabetes mellitus (GDM) or hyperglycemia in pregnancy is associated with adverse perinatal outcomes such as large for gestational age (LGA), excess fetal adiposity and cesarean delivery. This study addressed the prevalence of diabetes in pregnancy and to compare the perinatal outcomes between GDM and non-GDM in a rural pregnancy cohort of Bangladesh. Ten villages were purposively selected in a rural area about 100 km off Dhaka City. A population census was conducted. A randomized sample of married women of age 15-45y was drawn from the census data. These women having either regular menstruation (non-regnant) or cessation of menstruation for ≥24weeks (pregnant) were considered eligible. Both the pregnant and non-pregnant women were invited to volunteer the study. Weight, height, waist-and hip-girth and blood pressure were taken. Fasting blood sample was collected for the estimation of plasma glucose (FPG), triglycerides (TG), cholesterol (chol), high-density lipoprotein (HDL). FPG >5.1 mmol/L was taken as cut-off for hyperglycemia in non-pregnant and gestational diabetes mellitus (GDM) for the pregnant women. The biophysical characteristics were compared between pregnant and non-pregnant; and then GDM and non-GDM. Only the pregnant women were taken as a pregnancy cohort. The cohort had followup from 24wks of pregnancy through 28 post-natal days. Results The census yielded 23545 (m / f=11896 / 11649) people of all ages. The married women of age 15-45y were 4526. Of them, 2100 were randomly selected for investigation and 1585 (75.5%) volunteered. The overall prevalence (95% CI) of hyperglycemia (FPG >5.1 mmol/L) was 18.5% (16.7 -20.3). The prevalence of GDM was 8.9% (7.0 -10.8) and non-GDM was 19. 8% (18.8 -20.8). The BMI and WHR were significantly higher in the pregnant than non-pregnant women; whereas, there was no significant difference between GDM and non-GDM group. The prevalence rates of abortions, stillbirths, hospital delivery, cesarean delivery, hospital stay ≥7days, puerperal sepsis and neonatal death did not differ between GDM and non-GDM subjects significantly. The prevalence of GDM in rural Bangladesh is comparable with any other population with higher prevalence of GDM. The prevalence of hyperglycemia was found significantly higher in the non-pregnant than the pregnant women. The anthropometric measures did not differ significantly between GDM and non-GDM though FPG was found significantly higher in the former. Compared with the non-GDM the GDM subjects had no significantly higher fetomaternal morbidity and mortality possibly due to non-sedentary habit, non-obesity, non-dyslipidemia or may be due to inherent genetic makeup. A well designed study in a larger sample may explain our findings.Ibrahim Med. Coll. J. 2013; 7(2): 21-27

Prevalence and Risk Factors of Gestational Diabetes Mellitus in Bangladesh: Findings from Demographic Health Survey 2017–2018

“…The prevalence reported in this study is also three times higher than the pooled overall prevalence of GDM reported in South Asian countries (Bangladesh, India, and Sri Lanka) (11.4%) [ 8 ]. An increased risk of GDM with higher age in this research is consistent with previous research [ 10 , 12 , 13 , 24 ].…”

“…Our study indicates that one third of pregnant women have GDM, a rate that is 3–4 times higher than most of the previous studies in Bangladesh. The prevalence of GDM in previous studies ranged between 7% and 14%, except the study that was conducted with women visiting antenatal clinics in an urban tertiary hospital, which reported a prevalence of 40.3% as per the WHO (1999) criteria [ 9 , 10 , 11 , 12 , 13 , 23 ]. The prevalence reported in this study is also three times higher than the pooled overall prevalence of GDM reported in South Asian countries (Bangladesh, India, and Sri Lanka) (11.4%) [ 8 ].…”

“…Few studies have reported the prevalence of GDM in Bangladesh, and most relied on the WHO (1999) criteria. The reported prevalence of GDM in these studies, largely from clinic or hospital settings, ranged between 6.8% and 40.3% [ 9 , 10 , 11 , 12 , 13 ]. The most recent estimate of GDM prevalence in Bangladesh is almost a decade old, and the prevalence was 9.7%, according to the WHO (1999) criteria.…”

“…Moreover, none of these studies used the most recent WHO (2013) criteria. Factors associated with GDM reported in Bangladesh studies were advanced age, high body mass index (BMI), family history of diabetes mellitus (DM), high parities, high household income, hypertension, total year of schooling, and history of ANC [ 9 , 10 , 11 , 12 , 13 ]. However, none of these studies adjusted for covariates [ 9 , 10 , 11 , 13 ] or provided sufficient information about adjusted models as they reported risk factors of GDM [ 12 ].…”

The Dhaka Declaration 2015

“…Affecting two lives at a time, it has an inter-generational impact as well. [ 7 8 ] The offspring of mothers with GDM have adverse cardiometabolic profiles and are at increased risk of diabetes and obesity, which further contributes to the epidemic of noncommunicable diseases. GDM lends itself to timely management and to prevention as well.…”