A mobile phone application for the prevention of type 2 diabetes in Malaysian women with gestational diabetes mellitus (MYGODDESS): A feasibility randomised controlled trial.

Background & objectives The prevalence of gestational diabetes mellitus (GDM) is known to be high among South Asians. However, there is no national study on prevalence of GDM in India and few data comparing prevalence of GDM in early pregnancy (Early GDM) and late pregnancy (Late GDM). Methods This is an analysis of pregnant women who participated in the nationally representative Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Of the 1,206 pregnant women 1,032 who underwent oral glucose tolerance test (OGTT) or had fasting blood glucose measurement and did not have overt diabetes, were included in this study. GDM was diagnosed using the NICE criteria. GDM was classified as Early GDM if diagnosed before 20 wk of gestation and Late GDM if diagnosed ≥ 20 wk of gestation, Results The weighted national prevalence of GDM in India was 22.4 per cent (95% CI: 16.7-28%) with no significant urban rural differences (24.2% vs. 21.6%, NS). The prevalence of Early GDM and Late GDM were 19.2 per cent (9.8-28.7%) and 23.4 per cent (16.7-30.2%), respectively. Central India had the highest prevalence of GDM at 32.9 per cent (17.9-48%), and West India, the lowest at 16 per cent (3.1-29.3%). High systolic blood pressure and family history of diabetes were independently associated with risk of GDM. Interpretation & conclusions Nearly one in four pregnant women in India have GDM with regional variability. The prevalence of Early GDM is also high. Thus, there is a need for screening of all pregnant women for GDM starting in early pregnancy.

A total of 1016 pregnant women attending antenatal clinic before 20 weeks of gestation during September 2018 to February 2019 were included in a cohort study with repeated cross-sectional assessments. The study was aimed to determine prevalence and characteristics of gestational diabetes mellitus (GDM) and pregnancy outcomes by early universal screening approach. GDM screening was performed during first visit and repeated during 24–28 weeks of gestation, as necessary, using a 50-g glucose challenge test followed by a 100-g oral glucose tolerance test for GDM diagnosis. Overall prevalence of GDM was 18.6%. A significantly higher prevalence of GDM was observed among high-risk than low-risk women (21.3% vs. 13.1%, p = 0.002). GDM among low-risk women contributed to 23.3% of all GDM cases. The majority of GDM (76.2%) were diagnosed before 20 weeks of gestation, with 74.5% occurring in high-risk women and 81.8% occurring in low-risk women. When initial screening tests were normal, risk of GDM diagnosed during 24–28 weeks was 6.0% (7.5% among high-risk women and 3.1% among low-risk women). Compared to those without GDM, women with GDM significantly had lower gestational weight gain (p < 0.001), higher prevalence of preeclampsia (p = 0.001), large for gestational age (LGA) (p = 0.034) and macrosomia (p = 0.004). These outcomes were more pronounced among high-risk women with GDM. Impact Statement What is already known on this subject? Universal GDM screening is recommended during 24–28 weeks of gestation, either by 1- or 2-step approach. Some also recommend early GDM screening among high-risk women. Prevalence of early-onset GDM varies between studies and benefits of early diagnosis and treatment are still controversial. What do the results of this study add? Early universal GDM screening identified more women with GDM and majority could be diagnosed before 20 weeks of gestation. GDM among low-risk women contributed to 23.3% of all cases. Adverse pregnancy outcomes were more common among high-risk women with GDM. This approach could be useful and can be implemented in other settings, especially those that serve high-risk population or with high GDM prevalence. What are the implications of these findings for clinical practice and/or further research? Early universal GDM screening should be considered in settings with high prevalence of GDM and high-risk women. However, benefits of early detection and treatment of GDM should be determined in more details in the future, especially in terms of cost-effectiveness and improvement in pregnancy outcomes.

BackgroundOver 50% of women with a history of gestational diabetes mellitus (GDM) will develop type 2 diabetes (T2D) in later life. Asian women experience a disproportionate risk of both GDM and T2D compared to women from other ethnic backgrounds. Lifestyle interventions and behavior change can delay or even prevent the onset of T2D. We have developed a digitalized diabetes prevention intervention for the prevention of T2D in Malaysian women with GDM.ObjectiveThe protocol describes a randomized controlled trial (RCT) to test the feasibility of undertaking a definitive trial of a diabetes prevention intervention, including a smartphone app and group support. Secondary aims are to summarize anthropometric, biomedical, psychological, and lifestyle outcomes overall and by allocation group, and to undertake a process evaluation.MethodsThis is a two-arm parallel feasibility RCT. A total of 60 Malaysian women with GDM will be randomized in the antenatal period to receive the intervention or standard care until 12 months post partum. The intervention is a diabetes prevention intervention delivered via a smartphone app developed based on the Information-Motivation-Behavioral Skills model of behavior change and group support using motivational interviewing. The intervention provides women with tailored information and support to encourage weight loss through adapted dietary intake and physical activity. Women in the control arm will receive standard care. The Malaysian Ministry of Health’s Medical Research and Ethics Committee has approved the trial (NMRR-21-1667-60212).ResultsRecruitment and enrollment began in February 2022. Future outcomes will be published in peer-reviewed health-related research journals and presented at national, regional, or state professional meetings and conferences. This publication is based on protocol version 2, January 19, 2022.ConclusionsTo our knowledge, this will be the first study in Malaysia that aims to determine the feasibility of a digital intervention in T2D prevention among women with GDM. Findings from this feasibility study will inform the design of a full-scale RCT in the future.Trial RegistrationClinicalTrials.gov NCT05204706; https://clinicaltrials.gov/ct2/show/NCT05204706International Registered Report Identifier (IRRID)PRR1-10.2196/37288

Objective To identify the prevalence and related risk factors of gestational diabetes mellitus (GDM) based on studies on the condition conducted in Turkey. Methods The study is a systematic review and meta-analysis and was conducted over the period November–December 2017 by performing a search of the Turkish and English literature. The international databases were accessed using the keywords “gestational diabetes” and “Turkey” and the national databases were scanned using the word groups, “gestational diabetes”, “diabetes in pregnancy”, “pregnancy and diabetes,” and “pregnancy diabetes”. Forty-one complete articles on research carried out in Turkey over the period 2004–2016 and published in 2006–2018 on the prevalence of GDM and/or a reported risk factor were included in the study. Combined percentage calculations were employed to determine GDM prevalence. Results It was found in this systematic review and meta-analysis of the studies examined that out of the total of 50,767 pregnant women included in the studies, 3891 had GDM. Based on these data, combined GDM prevalence was calculated as 7.7% (range: 1.9–27.9%). It was observed that the highest combined GDM prevalence was 17.6% in the black Sea Region and the lowest was 5.1% in the Central Anatolian Region. Fourteen risk factors had been reported as statistically significant in the studies included in the systematic review. The most commonly reported of these was advanced maternal age, being overweight prior to pregnancy, gaining weight in pregnancy, diabetes in the family, a history of GDM or giving birth to a large baby. Conclusions It was observed in this meta-analysis that the prevalence of GDM in Turkey is notably high and risk factors are similar to what has been reported in current international literature. The continuation of routine screening tests to detect GDM may contribute to controlling the condition while ensuring that risk groups take special preventive measures and mother-child health is protected. Implications for practice Results of this study might be used in the organization of prenatal care, especially high-risk pregnant women for GDM. Nursing researchers and health care managers should consider this situation in the implementing of prenatal care serving.

Background: The increasing number of infertile couples has led to the growing popularity of assisted reproductive technologies as a means of achieving desired pregnancy. It is known that assisted reproductive technologies are an independent risk factor for a serious pregnancy complication—gestational diabetes mellitus. The multifactorial and polygenic nature of gestational diabetes mellitus, as well as its high prevalence following in vitro fertilization, make this issue of particular interest for research. Aim: To investigate the prevalence of gestational diabetes mellitus in pregnancies achieved through in vitro fertilization, its pathogenetic features, and possible risk factors. Methods: Scientific publications from eLibrary and PubMed databases were analyzed, focusing on the prevalence, risk factors, and pathogenetic features of gestational diabetes mellitus after assisted reproductive technologies. Outpatient and inpatient medical records of 116 women with singleton pregnancies from 2018 to 2022 were analyzed retrospectively and prospectively. The main group included 77 (66%) patients with in vitro fertilization pregnancies and confirmed gestational diabetes mellitus; the reference group included 39 (34%) in vitro fertilization patients without gestational diabetes mellitus. Results: The prevalence of gestational diabetes mellitus among pregnant women after in vitro fertilization is significantly higher than in the general pregnant population and, according to various sources, reaches up to 12.6%. Gestational diabetes mellitus is a polygenic multifactorial disease, with epigenetic influences acting as triggers in the presence of specific gene polymorphism associations. A high pregestational body mass index was identified as a risk factor for gestational diabetes mellitus after in vitro fertilization, whereas the number of in vitro fertilization attempts and the follicle-stimulating hormone to luteinizing hormone ratio did not significantly affect its development in this cohort. The etiology of infertility may be a risk factor for gestational diabetes mellitus according to some data, but in our study, no statistically significant differences were found between groups based on infertility cause (p 0.05). Conclusion: Understanding the pathogenetic features, identifying, and timely modifying potential risk factors for gestational diabetes mellitus among pregnant women following in vitro fertilization will allow for timely correction of carbohydrate metabolism disorders, as women with gestational diabetes mellitus are at high risk for pregnancy complications and the subsequent development of type 2 diabetes mellitus.

The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Ethnic differences in risk factors and perinatal outcomes are clinically important. Chinese women constitute approximately 10% of the world's population, and are an increasing migrant population, yet prevalence, risk factors, and outcomes of GDM in this population are insufficiently explored. A retrospective study of a large pregnancy dataset comparing GDM prevalence, risk factors, and perinatal outcomes between immigrant ethnic Chinese women and Australian-born Caucasian women was conducted using logistic regression. Overall, 73 517 births were extracted from the pregnancy databases of two of Australia's largest maternity services. Chinese women (n = 3419) had a 4-fold higher risk of GDM than Caucasians (n = 28 594) after adjusting for risk factors of GDM. A past history of GDM (adjusted odds ratio [aOR] 5.24; 95% confidence interval [95% CI] 2.91-9.42] was the main GDM risk factor in both groups. Other GDM risk factors varied between groups. Perinatal outcomes in Chinese women with and without GDM were similar, except for neonatal hypoglycemia (aOR 2.01; 95% CI 1.14-3.56]. Caucasian women with GDM had more adverse perinatal outcomes than women without GDM. After adjusting for confounders, Chinese women with GDM had a lower risk of labor induction, large-for-gestational-age babies, neonatal hypoglycemia, respiratory distress, and low Apgar scores than Caucasian women with GDM. Differences in prevalence, risk profile, and adverse outcomes in GDM were evident between ethnic Chinese and Caucasian women. A precision medicine approach to GDM may be warranted considering ethnicity and individual risk profiles rather than a one-size-fits-all approach.

This retrospective cohort study was designed to examine the prevalence and risk factors of gestational diabetes mellitus (GDM) in Manitoba. A total of 324,605 deliveries by 165,969 women were reported to Manitoba Health in the years 1985-2004. Data on maternal ages, delivery dates, GDM, self-declared First Nation (FN) status, rural or urban residence and previous GDM were collected for the study. Data were analyzed using multivariate logistic regression models. The prevalence of GDM during the 20-year period was 2.9%, which was 2.3% in 1985-1989 and 3.7% in 1999-2004 (P < 0.01). The trend of increase in the prevalence of GDM continued after major modifications on the screening and diagnostic criteria for GDM in 1998. The prevalence of GDM in FN women was 3-times greater than that in non-FN women. Higher prevalence of GDM was detected in FN pregnant women living in rural areas compared to those in urban areas (P < 0.01), which was opposite for non-FN pregnant women living in rural and urban areas. The prevalence of GDM in pregnant women > or =35 yr was 2.3-fold higher than that in those < 35 yr (P < 0.01). The recurrent rate of GDM was 44.4%. Adjusted odds ratios of GDM for FN status, advanced age, a history of GDM and rural living were 2.2, 2.4, 25.1 and 0.8, respectively. The prevalence of GDM is increased in Manitoba. FN status, advanced age and a history of GDM, but not rural living, are independent predictors for GDM.

Introduction In low- and middle-income countries, gestational diabetes mellitus is increasing globally; it is also a double burden of illness for both mothers and children. While gestational diabetes mellitus is recognized in Ethiopia, according to recent diagnostic criteria, information regarding it remains scarce. Objective To assess the prevalence of gestational diabetes mellitus and associated factors among women attending antenatal care in Hadiya Zone public Hospitals, Southern Ethiopia. Methods An institution-based cross-sectional research on a total of 470 pregnant mothers was conducted in the Hadiya Region from August 2019 to December 2020. Finally, via the systematic random sampling process, the study subjects were chosen. A two-hour oral glucose tolerance test of 75 g was used to conduct the universal one-step screening and diagnostic technique. Bivariate and multivariate analyses were used to identify factors associated with gestational diabetes mellitus. Results Gestational diabetes mellitus prevalence was 26.2% (95% CI, 21.8, 30.5). Urban residents (AOR: 2.181; 95% CI: 1.274, 3.733), primary education (AOR:2.286; 95% CI: 1.396, 3.745), without previous history of abortion (AOR: 0.097; 95% CI: 0.048, 0.196), with history of late gestational age in weeks (29-32) (AOR: 0.393; 95% CI: 0.213, 0.723), with no history of coffee drinking (AOR: 2.704; 95% CI: 1.044, 7.006), and adequate dietary diversity (AOR: 2.740; 95% CI: 1.585, 4.739) were significantly associated with gestational diabetes mellitus. Conclusion In Hadiya Zone public Hospitals, the prevalence of gestational diabetes mellitus among women attending antenatal treatment was higher compared to other studies conducted. The urban residents, primary schooling, no prior history of abortion, late gestational age, no history of coffee drinking, and sufficient dietary diversity were significantly linked with gestational diabetes mellitus. To enhance maternal and child health, reinforcing screening, treatment, and prevention strategies for gestational diabetes mellitus is essential.

Introduction: Gestational diabetes mellitus (GDM) is a global problem that occurs in the world. This case occurred in pregnant women at 24-28 weeks of gestation. The global prevalence of GDM varies widely from 1% to 28%. Objective: The purpose of this study is to describe the prevalence of GDM in Asia and the risk factors for GDM.Materials and Methods: This research method used a systematic review for observational studies. The research inclusion criteria were original English papers, with full text published in peerreviewed journals. Method of 23 international articles in 2012-2022, which have articles that meet the requirements to be researched subjects regarding the description of the average prevalence of GDM cases in Asia and the risk factors for GDM.Results: The results of the study found that the lowest prevalence of GDM was in India at 1.9%, and the highest prevalence was found in Australia at 30%. The average risk factors for GDM are a family history of DM, BMI 25 kg/m2, multiparity and history of GDM in previous pregnancies, and history of abortion. The results of a journal review also show that mothers who give birth to GDM have a 48% risk of developing DM in the future.Conclusion: Based on the conclusion in this study, with the wide variation in GDM prevalence rates, it is better to set a GDM risk factor score so that other health services can use these indicators as the gold standard for screening GDM.

Background: This analysis was conducted to understand prevalence and determinants of gestational diabetes mellitus (GDM) and (overt) diabetes in pregnancy (DIP) in India, and also ascertain their health-seeking behaviour. Materials and Methods: The authors analysed data from the fifth National Family Health Survey of India. Binary logistic regression was used to assess the factors independently associated with GDM and (overt) DIP. Results: The weighted prevalence of GDM was 4.2% (95% confidence interval [CI]: 3.9–4.5), and the age-adjusted prevalence was 5.4% (95% CI: 4.5–6.4). The prevalence of GDM increased with age. The weighted prevalence of (overt) DIP was 0.38% (95% CI: 0.30–0.48), and the age-adjusted prevalence was 1.04% (95% CI: 0.64–1.68). On adjusted analysis, it was found that increasing age and obesity had significantly higher odds of having GDM. Higher odds of access to private facilities were found amongst women with higher education and those who were overweight. Significant regional variation in the prevalence of GDM was observed, with a very low burden observed in northeastern states and a comparatively higher burden in Central, Western and Southern Indian states. Conclusions: There is an increasing prevalence of GDM in India. Strengthening primary health systems to enhance GDM-related service availability, quality and delivery could be logical policy intervention.

BACKGROUND: Gestational diabetes mellitus (GDM) is a global public health concern with potential implications for the health of a mother and her offspring. However, data on the prevalence and risk factors of GDM in Latin America are scarce. The study was designed to estimate the prevalence of GDM and identify maternal risk factors among Peruvian women. METHODS: A cross-sectional study was conducted among 1300 pregnant women attending a prenatal clinic in Lima, Peru. GDM was diagnosed using an Oral Glucose Tolerance Test (OGTT) performed between 24 and 28 gestational weeks using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Depression status was assessed using the Patient Health Questionnaire-9. Multivariate logistic regression models were used to identify risk factors of GDM. RESULTS: Approximately 16% of pregnant women were diagnosed with GDM. The prevalence of obesity and depression were 24.4 and 10.6%, respectively. After adjusting for confounders, mid-pregnancy obesity was associated with a 1.64-fold increased odds of GDM (OR: 1.64; 95% CI: 1.03-2.61). Participants with a family history of diabetes had a 1.5-fold increased odds of developing GDM (OR: 1.51, 95% CI: 1.10-2.07) as compared to women without this family history. Depression was associated with a 1.54-fold increased odds of GDM (OR: 1.54; 95% CI:1.09-2.17). CONCLUSIONS: GDM is highly prevalent and was associated with maternal obesity, family history of diabetes and antepartum depression among Peruvian women. Intervention programs aimed at early diagnoses and management of GDM need to take maternal obesity, family history of diabetes and antepartum depression into account.

Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women evaluated by National Diabetes Data Group and Carpenter and Coustan criteria

Prepregnancy body mass index and gestational diabetes mellitus across Asian and Pacific Islander subgroups in California

ObjectivesTo assess whether recurrent gestational diabetes mellitus (GDM) and newly diagnosed GDM share similar risk factors.MethodsThe study recruited a cohort of 10,151 multipara women with singleton pregnancy who delivered between 2016 and 2019 in Beijing, China. The prevalence of recurrent GDM and associated risk factors were analyzed between women with and without prior GDM history.ResultsEight hundred and seventy-five (8.6%) multipara women had a diagnosis of GDM during previous pregnancies. The prevalence of GDM and pre-gestational diabetes mellitus were 48.34% (423/875) and 7.89% (69/875) if the women were diagnosed with GDM during previous pregnancies, as compared to 16.00% (1484/9276) and 0.50% (46/9276) if the women were never diagnosed with GDM before. In women without a history of GDM, a variety of factors including older maternal age, higher pre-pregnancy body mass index (PPBMI), prolonged interval between the two pregnancies, higher early pregnancy weight gain, family history of type 2 diabetes mellitus (T2DM), maternal low birth weight, and higher early pregnancy glycemic and lipid indexes were generally associated with an increased risk of GDM at subsequent pregnancy. In women with a history of GDM, higher PPBMI, higher fasting glucose level and maternal birthweight ≥4000 g were independent risk factors for recurrent GDM.ConclusionsGDM reoccurred in nearly half of women with a history of GDM. Risk factors for recurrent GDM and newly diagnosed GDM were different. Identifying additional factors for GDM recurrence can help guide clinical management for future pregnancies to prevent GDM recurrence.

BackgroundThe prevalence of gestational diabetes mellitus (GDM) is rising rapidly in many low- and middle-income countries (LMICs). Most women with GDM in LMICs are undiagnosed and/or inadequately managed due to a lack of knowledge and skills about GDM on the part of both providers and patients. Following contextual analysis, we developed an educational/behavioural intervention for GDM delivered through a package of culturally tailored films. This trial aims to evaluate whether the intervention can improve the timely detection and management of GDM in two LMIC settings.MethodsTwo independent cluster randomised controlled trials, one each to be conducted in Uganda and India. Thirty maternity facilities in each country have been recruited to the study and randomised in a 1:1 ratio to the intervention and control arms. The intervention comprises of three interconnected sets of films with the following aims: to improve knowledge of GDM guidelines and skills of health providers, to raise awareness of GDM screening among pregnant women and their families, and to improve confidence and skills in self-management among those diagnosed with GDM. In facilities randomised to the intervention arm, a GDM awareness-raising film will be shown in antenatal care waiting rooms, and four films for pregnant women with GDM will be shown in group settings and made available for viewing on mobile devices. Short films for doctors and nurses will be presented at professional development meetings. Data will be collected on approximately 10,000 pregnant women receiving care at participating facilities, with follow-up at 32 weeks gestational age and 6 weeks postnatally. Women who self-report a GDM diagnosis will be invited for a clinic visit at 34 weeks. Primary outcomes are (a) the proportion of women who report a GDM diagnosis by 32 weeks of pregnancy and (b) glycaemic control (fasting glucose and HbA1C) in women with GDM at ~34 weeks of pregnancy. The secondary outcome is a composite measure of GDM-related adverse perinatal-neonatal outcome.DiscussionScreening and management of GDM are suboptimal in most LMICs. We hypothesise that a scalable film-based intervention has the potential to improve the timely detection and management of GDM in varied LMIC settings.Trial registrationClinicalTrials.gov NCT03937050, registered on 3 May 2019. Clinical Trials Registry India CTRI/2020/02/023605, registered on 26 February 2020.