Exploring Diabetes screening in pregnancy: a comprehensive study at two teaching hospitals in Khyber Pakhtunkhwa, Pakistan
Article Sidebar
Main Article Content
Abstract
OBJECTIVE: to determine frequency of Gestational Diabetes Mellitus (GDM) among antenatal women visiting two teaching hospitals of Kohat & Peshawar Pakistan.
METHODS: This cross-sectional study was conducted at Liaqat Memorial Hospital, Kohat and Hayatabad Medical Complex, Peshawar, Pakistan, from December 2022 to May 2023. Participants were selected through non-probability convenient sampling, and antenatal women were included after written informed consent. Oral glucose tolerance test (OGTT) was, and GDM was diagnosed, based on International Association of Diabetes and Pregnancy Study Groups criteria. Demographic details and OGTT results were recorded.
RESULTS: In a cohort of 244 antenatal patients (mean age 28.80±5.76 years, 44.3% multigravida), GDM was diagnosed in 27.5%, 18.4%, and 16.4% based on FBS, one-hour OGTT, and two-hour OGTT, respectively. Significant associations were found between GDM and positive family history of DM, and maternal DM across all diagnostic criteria. However, no significant associations were observed with paternal DM, first-degree relatives, or siblings. A previous history of GDM showed a significant association with GDM in current pregnancy. Hypertension exhibited a significant association with GDM across all criteria, while no significant associations were found for BMI, polyhydramnios, or gravidity.
CONCLUSION: GDM frequency was 27.5%, 18.4%, and 16.4% based on FBS, one-hour, and two-hour OGTT. Significantly associated factors included positive family history of DM, maternal DM, hypertension, and a previous GDM history. No significant associations were found with paternal DM, first-degree relatives, siblings, BMI, polyhydramnios, or gravidity. These findings contribute to refining GDM screening and management guidelines in primary and secondary care settings.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Work published in KMUJ is licensed under a
Creative Commons Attribution 4.0 License
Authors are permitted and encouraged to post their work online
(e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
References
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022;183:109119. https://doi.org/10.1016/j.diabres.2021.109119.
Hod M, Kapur A, Sacks DA, Hadar E, Agarwal M, Di Renzo GC, et al. The International Federation of Gynecology and Obstetrics (FIGO) Initiative on gestational diabetes mellitus: A pragmatic guide for diagnosis, management, and care. Int J Gynaecol Obstet 2015;131 (Suppl 3):S173-211. https://doi.org/10.1016/S0020-7292(15)30033-3.
International Diabetes Federation. What is Diabetes? in: IDF Diabetes Atlas 10th ed 2021. (Online): Accessed On June 06, 2023. Available from URL: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf
Wang H, Li N, Chivese T, Werfalli M, Sun H, Yuen L, et al. IDF Diabetes Atlas: Estimation of Global and Regional Gestational Diabetes Mellitus Prevalence for 2021 by International Association of Diabetes in Pregnancy Study Group’s Criteria. Diabetes Res Clin Pract 2022;183:109050. https://doi.org/10.1016/j.diabres.2021.109050.
Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358(19):1991-2002. https://doi.org/10.1056/NEJMoa0707943
Vounzoulaki E, Khunti K, Abner SC, Tan BK, Davies MJ, Gillies CL. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 2020;369:m1361. https://doi.org/10.1136/bmj.m1361
Inoue H, Ishikawa K, Takeda K, Kobayashi A, Kurita K, Kumagai J, et al. Postpartum risk of diabetes and predictive factors for glucose intolerance in East Asian women with gestational diabetes. Diabetes Res Clin Pract 2018;140:1-8. https://doi.org/10.1016/j.diabres.2018.03.031
Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and the risk of cardiovascular disease in women: a systematic review and meta-analysis. Diabetologia 2019;62(6):905-14. https://doi.org/10.1007/s00125-019-4840-2
Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: a population-based cohort study. PLoS Med 2018;15(1):e1002488. https://doi.org/10.1371/journal.pmed.1002488. Erratum in: PLoS Med 2019;16(7):e1002881.
Yu Y, Arah OA, Liew Z, Cnattingius S, Olsen J, Sørensen HT, et al. Maternal diabetes during pregnancy and early onset of cardiovascular disease in offspring: population based cohort study with 40 years of follow-up. BMJ 2019;367. https://doi.org/10.1136/bmj.l6398.
Kong L, Nilsson IA, Brismar K, Gissler M, Lavebratt C. Associations of different types of maternal diabetes and body mass index with offspring psychiatric disorders. JAMA Netw Open 2020;3(2):e1920787. https://doi.org/10.1001/jamanetworkopen.2019.20787
Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep 2016;16(1):7. https://doi.org/10.1007/s11892-015-0699-x.
Tatem, A.J., Campbell, J., Guerra-Arias, M. et al. Mapping for maternal and newborn health: the distributions of women of childbearing age, pregnancies and births. Int J Health Geogr 2014;13:2. https://doi.org/10.1186/1476-072X-13-2
Riaz M, Nawaz A, Masood SN, Fawwad A, Basit A, Shera AS. Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. Clin Epidemiol Glob Health 2019;7(2):218-21. https://doi.org/10.1016/j.cegh.2018.06.003
Atta J, Das K, Yousfani ZA, Yousfani S, Bala M, Aftab S. Frequency of gestational diabetes mellitus in pregnant women: a cross-sectional study. Ann Romanian Soc Cell Biol 2022;26(01):472-9. http://annalsofrscb.ro/index.php/journal/article/view/10819
Gul B, Mehboob S, Qayuom S, Daud M. The prevalence of gestational diabetes in women of child bearing age belonging to KPK. Khyber J Med Sci 2021;14(4):244.
Latif M, AyazSB, Anwar M, Manzoor M, Aamir M, Bokhari SARS, Ahmad M. Frequency of gestational diabetes mellitus in pregnant women reporting to a public sector tertiary care hospital of Quetta. Pak Armed Forces Med J 2022;72(6):2095-8. https://doi.org/10.51253/pafmj.v72i6.4073
International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82. https://doi.org/10.2337/dc09-1848
Badakhsh M, Daneshi F, Abavisani M, Rafiemanesh H, Bouya S, Sheyback M, Rezaie Keikhaie K, Balouchi A. Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis. Endocrine 2019;65(3):505-14. https://doi.org/10.1007/s12020-019-02026-4.
Bibi S, Saleem U, Mahsood N. The frequency of gestational diabetes mellitus and associated risk factors at Khyber teaching hospital Peshawar. J Postgrad Med Inst 2015;29(1):43-6.
Khan N, Farooq N, Batool A, Altaf A. Frequency of gestational diabetes mellitus and associated risk factors. Rawal Med J 2018;43(3):459-61.
Jiang L, Tang K, Magee LA, von Dadelszen P, Ekeroma A, Li X, et.al. A global view of hypertensive disorders and diabetes mellitus during pregnancy. Nat Rev Endocrinol 2022;18(12):760-75. https://doi.org/10.1038/s41574-022-00734-y.
Lewandowska M. Gestational Diabetes Mellitus (GDM) Risk for Declared Family History of Diabetes, in Combination with BMI Categories. Int J Environ Res Public Health 2021;18(13):6936. https://doi.org/10.3390/ijerph18136936.
Afzal S, Sultana S, Shadab W, Khan MNA. Obstetric ultrasonography as a screening tool for the diagnosis of GDM: Detection of raised AFI and large for gestational age fetus. Isra Med J 2022;14(2):68-71. https://doi.org/10.55282/imj.oa1335