Abstract
BackgroundThe absence of universal gold standards for screening of gestational diabetes (GDM) has led to heterogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. We aimed to evaluate the effect of different diagnostic criteria for GDM on its prevalence among general populations of pregnant women worldwide, and also to investigate the prevalence of GDM based on various geographic regions.MethodsA comprehensive literature search was performed in PubMed, Scopus and Google-scholar databases for retrieving articles in English investigating the prevalence of GDM. All populations were classified to seven groups based-on their diagnostic criteria for GDM. Heterogeneous and non-heterogeneous results were analyzed using the fixed effect and random-effects inverse variance model for calculating the pooled effect. Publication bias was assessed by Begg’s test. The Meta-prop method was used for the pooled estimation of the prevalence of GDM. Meta-regression was conducted to explore the association between prevalence of GDM and its diagnostic criteria. Modified Newcastle–Ottawa Quality Assessment Scale for nonrandomized studies was used for quality assessment of the studies included; the ROBINS and the Cochrane Collaboration’s risk of bias assessment tools were used to evaluate the risk of bias.ResultsWe used data from 51 population-based studies, i.e. a study population of 5,349,476 pregnant women. Worldwide, the pooled overall-prevalence of GDM, regardless of type of screening threshold categories was 4.4%, (95% CI 4.3–4.4%). The pooled overall prevalence of GDM in the diagnostic threshold used in IADPSG criteria was 10.6% (95% CI 10.5–10.6%), which was the highest pooled prevalence of GDM among studies included. Meta-regression showed that the prevalence of GDM among studies that used the IADPSG criteria was significantly higher (6–11 fold) than other subgroups. The highest and lowest prevalence of GDM, regardless of screening criteria were reported in East-Asia and Australia (Pooled-P = 11.4%, 95% CI 11.1–11.7%) and (Pooled-P = 3.6%, 95% CI 3.6–3.7%), respectively.ConclusionOver the past quarter century, the diagnosis of gestational diabetes has been changed several times; along with worldwide increasing trend of obesity and diabetes, reducing the threshold of GDM is associated with a significant increase in the incidence of GDM. The harm and benefit of reducing the threshold of diagnostic criteria on pregnancy outcomes, women’s psychological aspects, and health costs should be evaluated precisely.
Highlights
The absence of universal gold standards for screening of gestational diabetes (GDM) has led to het‐ erogeneity in the identification of Gestational diabetes mellitus (GDM), thereby impacting the accurate estimation of the prevalence of GDM
Gestational diabetes mellitus (GDM), is one of the most common endocrinopathies during pregnancy which is defined as hyperglycemia at any time in pregnancy based on defined thresholds that are less than those considered for overt diabetes [1]
It is estimated that GDM affects around 7–10% of all pregnancies worldwide [8–11]; the prevalence is difficult to estimate as rates differ between studies due to prevalence of different risk factors in the population, such as maternal age and BMI, prevalence of diabetes and ethnicity among women [12]
Summary
The absence of universal gold standards for screening of gestational diabetes (GDM) has led to het‐ erogeneity in the identification of GDM, thereby impacting the accurate estimation of the prevalence of GDM. Screening strategies, testing methods and even diagnostic optimum glycemic thresholds for GDM remain the subject of considerable debate [13] In this respect, the first definition of GDM was based on maternal risk for developing postpartum diabetes; subsequently, it was defined based on adverse maternal and neonatal outcomes [14]. The study of the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study [15] demonstrated a linear continuous correlation between increasing levels of maternal blood glucose levels on a 75-g oral glucose tolerance test (GTT) and adverse perinatal outcomes without specific threshold In this respect, potential GDM diagnostic criteria were defined based on the odds ratio (OR) of 1.75, relative to the mean, for specific selected outcomes [15, 16]
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