Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study

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Abstract

Objectives

The objectives of this study were to determine incidence and risk factors of glucose intolerance one year after delivery in a sub-cohort of Riy ad h Mother and B aby Cohort Study (RAHMA) study.

Methods

This is a follow-up study of a sub-cohort from RAHMA study from King Khalid University Hospital (KKUH). All women from RAHMA database who completed one year since delivery at KKUH were contacted by phone to participate in the study. Previously collected data from RAHMA registry for each participant were linked to this study data. Clinical data measured for each participant included current weight and height to calculate the BMI and waist circumference. Blood tests done for each participant were fasting blood glucose (FPG) and HbA1c. Based on the blood tests results, participants were classified into three groups; diabetic, pre-diabetic and normal. The incidence of diabetes and prediabetes was calculated for the whole cohort. Clinical, biochemical, and sociodemographic predictors of glucose intolerance were compared between the three groups. Risk factors with P-value less than 0.05 were tested in multivariate regression model with bootstrapping to calculate the relative risk (RR) and its 95% Bias corrected Confidence Interval (C.I.)

Results

From the sub-cohort, 407 women fulfilled the inclusion criteria and agreed to participate in the study. From the study participants; 250 (61.4%) women were normoglycemic, 142 (35%) women had prediabetes and 15 (3.6%) women were diabetic. Following multivariable regression analysis only history of gestational diabetes mellitus (GDM), (RR 1.74, 95% CI (1.06 to 2.84), P = 0.01), obesity (RR 1.69, 95% CI (1.01–3.11), P = 0.04) and diastolic blood pressure, (RR 1.04, 95% CI (1.01–1.09), P = 0.03) remained as predictors of postpartum glucose intolerance.

Conclusion

The incidence of postpartum glucose intolerance (diabetes and prediabetes) is very high in Saudi women. Both GDM and obesity are strong predictors of glucose intolerance.

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Most cited references 31

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Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline.

(2014)

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Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults.

M. Dalton, A J Cameron, P Zimmet … (2003)

To compare body mass index (BMI), waist circumference and waist-hip ratio (WHR) as indices of obesity and assess the respective associations with type 2 diabetes, hypertension and dyslipidaemia. A national sample of 11 247 Australians aged > or =25 years was examined in 2000 in a cross-sectional survey. The examination included a fasting blood sample, standard 2-h 75-g oral glucose tolerance test, blood pressure measurements and questionnaires to assess treatment for dyslipidaemia and hypertension. BMI, waist circumference and WHR were measured to assess overweight and obesity. The prevalence of obesity amongst Australian adults defined by BMI, waist circumference and WHR was 20.8, 30.5 and 15.8% respectively. The unadjusted odds ratio for the fourth vs. first quartile of each obesity measurement showed that WHR had the strongest relationship with type 2 diabetes, dyslipidaemia (women only) and hypertension. Following adjustment for age, however, there was little difference between the three measures of obesity, with the possible exceptions of hypertension in women, where BMI had a stronger association, and dyslipidaemia in women and type 2 diabetes in men, where WHR was marginally superior. Waist circumference, BMI and WHR identified different proportions of the population, as measured by both prevalence of obesity and cardiovascular disease (CVD) risk factors. Whilst WHR had the strongest correlations with CVD risk factors before adjustment for age, the three obesity measures performed similarly after adjustment for age. Given the difficulty of using age-adjusted associations in the clinical setting, these results suggest that given appropriate cut-off points, WHR is the most useful measure of obesity to use to identify individuals with CVD risk factors.

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Risk of development of diabetes mellitus after diagnosis of gestational diabetes.

D Feig, Janet E Hux, Bernard Zinman … (2008)

It is generally appreciated that gestational diabetes is a risk factor for type 2 diabetes. However, the precise relation between these 2 conditions remains unknown. We sought to determine the incidence of diabetes mellitus after diagnosis of gestational diabetes. We used a population-based database to identify all deliveries in the province of Ontario over the 7-year period from Apr. 1, 1995, to Mar. 31, 2002. We linked these births to mothers who had been given a diagnosis of gestational diabetes through another administrative database that records people with diabetes on the basis of either physician service claims or hospital admission records. We examined database records for these women from the time of delivery until Mar. 31, 2004, a total of 9 years. We determined the presence of diabetes mellitus according to a validated administrative database definition for this condition. We identified 659 164 pregnant women who had no pre-existing diabetes. Of these, 21 823 women (3.3%) had a diagnosis of gestational diabetes. The incidence of gestational diabetes rose significantly over the 9-year study period, from 3.2% in 1995 to 3.6% in 2001 (p < 0.001). The probability of diabetes developing after gestational diabetes was 3.7% at 9 months after delivery and 18.9% at 9 years after delivery. After adjustment for age, urban or rural residence, neighbourhood income quintile, whether the woman had a previous pregnancy, whether the woman had hypertension after the index delivery, and primary care level before the index delivery, the most significant risk factor for diabetes was having had gestational diabetes during the index pregnancy (hazard ratio 37.28, 95% confidence interval 34.99-40.88; p < 0.001). Age, urban residence and lower income were also important factors. When analyzed by year of delivery, the rate of development of diabetes was higher among the latest subcohort of women with gestational diabetes (delivery during 1999-2001) than among the earliest subcohort (delivery during 1995 or 1996) (16% by 4.7 years after delivery v. 16% by 9.0 years). In this large population-based study, the rate of development of diabetes after gestational diabetes increased over time and was almost 20% by 9 years. This estimate should be used by clinicians to assist in their counselling of pregnant women and by policy-makers to target these women for screening and prevention.

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Author and article information

Contributors

Hayfaa Wahabi: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Amel Fayed:

ORCID: http://orcid.org/0000-0003-3395-0486

Role: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Writing – review & editing

Safaa M. S. Tunkar: Role: Data curation

Hanadi Bakhsh: Role: Funding acquisitionRole: ValidationRole: Writing – review & editing

Ali M. Al-Hazmi: Role: Data curation

Samia Esmaeil: Role: Data curationRole: Project administrationRole: Supervision

Amna R. Siddiqui: Role: ConceptualizationRole: SupervisionRole: Writing – review & editing

Rhonda D. Szczesniak: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 7 January 2019

Publication date Collection: 2019

Volume: 14

Issue: 1

Electronic Location Identifier: e0210024

Affiliations

[1 ] Chair of Evidence-Based Healthcare and Knowledge Translation, College of Medicine, King Saud University, Riyadh, Saudi Arabia

[2 ] Clinical Department, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia

[3 ] Department of Biostatistics, High Institute of Public Health, Alexandria University, Alexandria, Egypt

[4 ] Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia

[5 ] Prince Sattam Bin Abdul Aziz Research Chair for Epidemiology and Public Health, College of Medicine, King Saud University, Riyadh, Saudi Arabia

[6 ] Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Cincinnati Children's Hospital Medical Center, UNITED STATES

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: fayedam_200@ 123456hotmail.com

Author information

Amel Fayed http://orcid.org/0000-0003-3395-0486

Article

Publisher ID: PONE-D-18-21277

DOI: 10.1371/journal.pone.0210024

PMC ID: 6322762

PubMed ID: 30615670

SO-VID: cc8cbeee-58a4-438b-ab02-3d605dabf336

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 18 July 2018

Date accepted : 14 December 2018

Page count

Figures: 2, Tables: 3, Pages: 13

Funding

Funded by: The Deanship of Scientific Research at Princess Nourah Bint Abdulrahman University

Award Recipient :

ORCID: http://orcid.org/0000-0003-3395-0486

Amel Fayed

This study is funded by The Deanship of Scientific Research at Princess Nourah Bint Abdulrahman University (Grant number 225-X-38). The funders had no role in study design, data collection, data analysis, decision to publish or preparation of the manuscript.

Custom metadata

Data Availability Most of the data needed is included in the published article. However, more data are available from the King Saud University Ethics Committee for researchers who meet the criteria for access to confidential data. The ethics committee contact details for data requests are: irb@ 123456ksu.edu.sa . This contact point is completely independent of all researchers.

Incidence and contributing factors of glucose intolerance in Saudi postpartum women: Sub-group analysis from RAHMA study

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Conclusion

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PLOS Climate

Most cited references 31

Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline.

Waist circumference, waist-hip ratio and body mass index and their correlation with cardiovascular disease risk factors in Australian adults.

Risk of development of diabetes mellitus after diagnosis of gestational diabetes.

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