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      Prevalence and predictors of gestational diabetes mellitus in rural Assam: a cross-sectional study using mobile medical units

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          Abstract

          Objective

          To determine the prevalence and predictors of gestational diabetes mellitus (GDM) in rural Assam, India using a network of Mobile Medical Units.

          Study design

          A field-based cross-sectional study.

          Settings

          Rural areas of Assam state, India.

          Participants

          A total of 1410 pregnant women in gestational age of 24–28 weeks

          Intervention

          Identification of pregnant women in 24–28 weeks of pregnancy from villages and administering them Government of India recommended oral glucose tolerance test for GDM confirmation.

          Primary and secondary outcome measures

          Presence of gestational diabetes among pregnant women, risk factors and predictors of GDM.

          Results

          A total of 1212 pregnant women underwent the oral glucose tolerance test. One hundred and ninety-eight women were ineligible due to existing chronic diseases or very high blood glucose level before the test. The overall GDM prevalence in Assam was 16.67% (95% CI 14.61% to 18.89%). Women aged 26–30 years (adjusted odds ratio, aOR 1.70; CI 1.14 to 2.52), who passed 10th class (aOR 1.58; CI 1.05 to 2.37), belonging to Muslim religion (aOR 1.52; 95% CI 1.05 to 2.21) and above poverty line (aOR 1.38; 95% CI 1.00 to 1.91) had significantly increased likelihood of developing GDM compared with respective baseline groups (p<0.05). Body mass index, gravida and being non-anaemic were non-significant risk factors for GDM. Family history of diabetes (aOR 1.82; 95% CI 1.08 to 3.06) and smoking (aOR 1.61; 95% CI 1.10 to 2.35) were significant and independent predictors of GDM.

          Conclusion

          The prevalence of GDM in rural Assam is high. The mobile medical units may play a significant role in the implementation of GDM screening, diagnosis, treatment to ensure better maternal and foetal health outcomes in rural Assam.

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          Effect of treatment of gestational diabetes mellitus on pregnancy outcomes.

          J. Moss, Caroline Crowther, Margaret S. Robinson … (2005)
          We conducted a randomized clinical trial to determine whether treatment of women with gestational diabetes mellitus reduced the risk of perinatal complications. We randomly assigned women between 24 and 34 weeks' gestation who had gestational diabetes to receive dietary advice, blood glucose monitoring, and insulin therapy as needed (the intervention group) or routine care. Primary outcomes included serious perinatal complications (defined as death, shoulder dystocia, bone fracture, and nerve palsy), admission to the neonatal nursery, jaundice requiring phototherapy, induction of labor, cesarean birth, and maternal anxiety, depression, and health status. The rate of serious perinatal complications was significantly lower among the infants of the 490 women in the intervention group than among the infants of the 510 women in the routine-care group (1 percent vs. 4 percent; relative risk adjusted for maternal age, race or ethnic group, and parity, 0.33; 95 percent confidence interval, 0.14 to 0.75; P=0.01). However, more infants of women in the intervention group were admitted to the neonatal nursery (71 percent vs. 61 percent; adjusted relative risk, 1.13; 95 percent confidence interval, 1.03 to 1.23; P=0.01). Women in the intervention group had a higher rate of induction of labor than the women in the routine-care group (39 percent vs. 29 percent; adjusted relative risk, 1.36; 95 percent confidence interval, 1.15 to 1.62; P<0.001), although the rates of cesarean delivery were similar (31 percent and 32 percent, respectively; adjusted relative risk, 0.97; 95 percent confidence interval, 0.81 to 1.16; P=0.73). At three months post partum, data on the women's mood and quality of life, available for 573 women, revealed lower rates of depression and higher scores, consistent with improved health status, in the intervention group. Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman's health-related quality of life.
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            The Hyperglycemia and Adverse Pregnancy Outcome Study

            Patrick Catalano, H McIntyre, J. Kennedy Cruickshank … (2012)
            OBJECTIVE To determine associations of gestational diabetes mellitus (GDM) and obesity with adverse pregnancy outcomes in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. RESEARCH DESIGN AND METHODS Participants underwent a 75-g oral glucose tolerance test (OGTT) between 24 and 32 weeks. GDM was diagnosed post hoc using International Association of Diabetes and Pregnancy Study Groups criteria. Neonatal anthropometrics and cord serum C-peptide were measured. Adverse pregnancy outcomes included birth weight, newborn percent body fat, and cord C-peptide >90th percentiles, primary cesarean delivery, preeclampsia, and shoulder dystocia/birth injury. BMI was determined at the OGTT. Multiple logistic regression was used to examine associations of GDM and obesity with outcomes. RESULTS Mean maternal BMI was 27.7, 13.7% were obese (BMI ≥33.0 kg/m2), and GDM was diagnosed in 16.1%. Relative to non-GDM and nonobese women, odds ratio for birth weight >90th percentile for GDM alone was 2.19 (1.93–2.47), for obesity alone 1.73 (1.50–2.00), and for both GDM and obesity 3.62 (3.04–4.32). Results for primary cesarean delivery and preeclampsia and for cord C-peptide and newborn percent body fat >90th percentiles were similar. Odds for birth weight >90th percentile were progressively greater with both higher OGTT glucose and higher maternal BMI. There was a 339-g difference in birth weight for babies of obese GDM women, compared with babies of normal/underweight women (64.2% of all women) with normal glucose based on a composite OGTT measure of fasting plasma glucose and 1- and 2-h plasma glucose values (61.8% of all women). CONCLUSIONS Both maternal GDM and obesity are independently associated with adverse pregnancy outcomes. Their combination has a greater impact than either one alone.
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              Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR–INDIAB population-based cross-sectional study

              Ranjit Mohan Anjana, Mohan Deepa, Rajendra Pradeepa … (2017)
              Previous studies have not adequately captured the heterogeneous nature of the diabetes epidemic in India. The aim of the ongoing national Indian Council of Medical Research-INdia DIABetes study is to estimate the national prevalence of diabetes and prediabetes in India by estimating the prevalence by state.
              Article 0 comments Cited 284 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): BMJ Open
                Journal ID (iso-abbrev): BMJ Open
                Journal ID (hwp): bmjopen
                Journal ID (publisher-id): bmjopen
                Title: BMJ Open
                Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                ISSN (Electronic): 2044-6055
                Publication date Collection: 2020
                Publication date (Electronic): 10 November 2020
                Volume: 10
                Issue: 11
                Electronic Location Identifier: e037836
                Affiliations
                [1 ]departmentClinical Domain , Piramal Swasthya Management and Reseach Institute , Guwahati, Assam, India
                [2 ]departmentResearch and Analysis Wing , Piramal Swasthya Management and Reseach Institute , Hyderabad, Telangana, India
                [3 ]departmentAssam and North East State Office , Piramal Swasthya Management and Reseach Institute , Guwahati, Assam, India
                [4 ]departmentClinical Domain , Piramal Swasthya Management and Reseach Institute , Hyderabad, Telangana, India
                [5 ]departmentInnovations , Piramal Swasthya Management and Reseach Institute , Hyderabad, Telangana, India
                Author notes
                [Correspondence to ] Vishal Dogra; vani1825@ 123456gmail.com
                Author information
                http://orcid.org/0000-0001-9725-5699
                Article
                Publisher ID: bmjopen-2020-037836
                DOI: 10.1136/bmjopen-2020-037836
                PMC ID: 7656912
                PubMed ID: 33172942
                SO-VID: 22559e43-b763-44a8-a1de-75b88bdf2a61
                Copyright © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
                License:

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                Date received : 19 February 2020
                Date revision received : 09 August 2020
                Date accepted : 28 September 2020
                Funding
                Funded by: World Diabetes Foundation;
                Award ID: Project-number WDF 15-956
                Categories
                Subject: Epidemiology
                Subject: 1506
                Subject: 1692
                Series title: Original research
                Custom metadata
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                ScienceOpen disciplines: Medicine
                Keywords: epidemiology,primary care,diabetes in pregnancy
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: epidemiology, primary care, diabetes in pregnancy

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