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

Abstract

Aims Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India. Methods We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias. Results We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33–79%). Studies specifying time of GDM diagnosis showed that patients (11–60%) develop GDM as early as the first trimester, but many GDM cases (16–40%) are missed if screened only at first visit. Conclusions In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients' needs and correlate screening criteria with pregnancy outcomes.

Prevalence of Gestational Diabetes in India by Individual Socioeconomic, Demographic, and Clinical Factors

“…16 Second, although no specific guidelines exist for assessing GD status in population-based and epidemiological surveys, there has been much debate regarding the optimal cutoffs to be used for screening and diagnosis of GD and the implications for pregnancy and neonatal outcomes. [39][40][41][42] weeks, and we had a roughly even distribution of women across trimesters of pregnancy. Our findings suggested that we were able to capture a similar proportion of women with elevated glucose in each trimester.…”

Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition

“…Interestingly, Li et al found a large variation of Indian GDM estimates (0.0-41.9%) depending on the diagnostic criteria use. They conducted a meta-analysis of 64 studies reporting 90 prevalence estimates in India, and found using the IADPSG criteria resulted in significantly higher prevalence of 19.2% compared with WHO 1999 of 10.13% or DIPSI of 7.4% [36]. Similarly, Macaulay's systematic review published in 2014 of 6 countries in Africa estimated that the prevalence varied between 0% for Tanzania to 13.9% in Nigeria [18].…”

Prevalence of pregnancy induced thyroid disorders, diabetes and hypertension in a tertiary care teaching hospital: an observational study

“…Gestational diabetes [6][7][8][9][10][11][12][13][14][15] For the diagnosis of gestational diabetes, oral glucose tolerance test (OGTT) was performed in several steps.…”

“…Fetal complications are premature birth, macrosomia, trauma during the birth, neonatal hypoglycaemia, perinatal death. 6,7 Gestational hypertension also referred to as pregnancy induced hypertension (PIH) is a condition characterized by high blood pressure during pregnancy. Hypertension during pregnancy affects about 6-8% of pregnant women.…”