Diabetes In Pregnancy Study Group India Research Articles

Postpartum glycemic and cardiometabolic profile of women testing positive for gestational diabetes mellitus by International Association of Diabetes and Pregnancy Study Groups (IADPSG) but negative by alternate criteria: Insights from CHIP–F study

ObjectiveTo evaluate burden of postpartum diabetes and other cardiometabolic risk factors among women who test positive for gestational diabetes mellitus (GDM) by International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, but negative by alternate criteria. MethodsThis prospective cross-sectional study was conducted from 2019 to 2022 and is a sub-study of the CHIP–F cohort (Cohort Study of Indian Women with Hyperglycemia in Pregnancy and their Families). ResultsStudy participants (n = 826; 183 with normoglycemia and 643 with GDM using IADPSG criteria) were evaluated at a median (IQR) postpartum interval of 31 (21–45) months. Using the United Kingdom National Institute of Health and Care Excellence (UK NICE), Canadian Diabetes Association (CDA), and Diabetes in Pregnancy Study Group India (DIPSI) criteria, 251 (39.0 %), 148 (23.0 %) and 384 (59.7 %) women who tested positive for GDM by IADPSG criteria, would have tested negative. The incidence of postpartum diabetes among such women was 30.4, 34.3, and 48.2 per 1000 women-years, respectively, which was significantly higher than those testing negative by both IADPSG and UK NICE (5.0 per 1000 women-years), IADPSG and CDA (9.2/1000 women-years) and IADPSG and DIPSI criteria (5.0/1000 women-years). The burden of obesity and metabolic syndrome was also significantly higher in such women. ConclusionsWe found a significant burden of postpartum diabetes and cardiometabolic risk factors among women who tested positive for GDM by IADPSG, but negative by alternate criteria. There are potential clinical implications of a “failed” diagnosis for future cardiometabolic diseases that need to be carefully examined.

A comparison study of maternal and perinatal outcomes with gestational diabetes mellitus, impaired glucose tolerance, and normal glucose tolerance

Gestational diabetes mellitus (GDM) and impaired glucose tolerance (IGT), which are growing health concerns globally, are the most common metabolic and endocrine perinatal issues. It is a contentious entity with competing policies and procedures. Most physicians in the United States employ a two-step procedure, starting with a 50-g non-fasting oral glucose challenge test at 24 to 28 weeks and moving on to a 100-g fasting test for women who receive a positive screening result. Instead, doctors use the Diabetes in Pregnancy Study Group India (DIPSI) technique and conduct just a 75-g, two-hour fasting oral glucose tolerance test. The prospective observational study was approved by the hospital's institutional ethics committee and was conducted from April 2020 to September 2021 at the department of obstetrics and gynecology at Stanley Medical College Hospital in Chennai, Tamil Nadu, India. The patients were chosen in accordance with the inclusion criteria, which called for first-trimester pregnant women without diabetes mellitus. Both oral and written consent were also obtained. DIPSI performed the screening. The WHO standards have been updated to be a one-step process with a single glycemic value. According to the results of this study, GDM is linked to harmful consequences that might affect both the mother and the foetus. The short- and long-term consequences in both the mother and the newborn can be greatly reduced with early detection and timely therapy of this illness. In this study, birth weights ranging from 2.5 to 3.5 kg were the same for GDM and IGT moms. IGT mothers should also be followed up on, and we should be more watchful at birth, even though we monitor GDM mothers.

Universal Screening of Gestational Diabetes Mellitus In Upper Egypt: Prospective Cohort Study of The Prevalence, Risk Factors, and Short-Term Outcomes

Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt is still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the foetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and foetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed to all attendant pregnant ladies. Discrete MNT is not an enough management in most of GDM cases. Keywords: GDM; Postpartum OGTT; diabetes; MNT; foetal outcome; maternal outcome.

Universal screening of gestational diabetes mellitus in Upper Egypt: Prospective cohort study of the prevalence, risk factors, and short-term outcomes

Background: Despite the high prevalence of diabetes mellitus in Egypt, the real prevalence and epidemiology of gestational diabetes mellitus (GDM) in Upper Egypt are still lacking. Objective: This study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate the fetal and maternal outcomes of this disease. Methods: This prospective cohort study was conducted between July 2014 and July 2018. Universal screening for GDM among all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Those with GDM were followed up until the end of purpureum. Maternal and fetal outcomes were recorded. Results: GDM was diagnosed in 956 out of 7141 pregnant women (13.4%). Previous history of GDM, macrosomic babies, and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factors were observed in about half of the GDM women. 29% of GDM women responded to medical nutrition therapy (MNT) alone. When the oral glucose tolerance test (OGTT) was repeated Postpartum, diagnosis of DM was established in 14.3% of the cohort, while 25.7% had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of GDM cases lack risk factors. Universal screening using OGTT should be routinely performed on all attendant pregnant ladies. Discrete MNT is not enough management in most GDM cases.

Comparison of Diabetes in Pregnancy Study Group India (DIPSI) and WHO criteria for diagnosis of gestational diabetes by assessment of fetomaternal outcomes.

To evaluate fetomaternal outcomes in women who are normoglycemic by Diabetes in Pregnancy Study Group India (DIPSI) but have gestational diabetes mellitus (GDM) by WHO criteria versus those who are normoglycemic by both DIPSI and WHO criteria. This was a prospective, cohort study. A total of 635 women participated. They underwent a 2-h non-fasting oral glucose tolerance test (OGTT) and results were interpreted by DIPSI. Out of 635 women, 52 were lost to follow up and 33 were diagnosed as GDM by DIPSI and excluded from the study. The remaining 550 women, after 72 h from the first test, underwent a 75-g fasting-OGTT and results were interpreted using WHO 2013 criteria. Results of the second test were blinded till delivery. The 550 women were followed for fetomaternal outcomes. Participants with normal DIPSI and normal WHO 2013 OGTT were labeled group 1. Participants with normal DIPSI but abnormal WHO 2013 OGTT were labeled group 2. Fetomaternal outcomes were compared between these groups. Occurrence of GDM by DIPSI was 5.1%, by WHO 2013 criteria it was 10.5%. Composite fetomaternal outcomes occurred more commonly in women with a normal DIPSI but an abnormal WHO 2013 test. Out of 550 women, 492 had normal DIPSI and normal WHO 2013 test. Out of this 492, 116 (23.6%) women had adverse fetomaternal outcomes. Fifty-eight women out of 550 had a normal DIPSI but an abnormal WHO 2013 test. Thirty-seven (63.8%) women out of 58 had adverse fetomaternal outcomes. We found statistically significant association between adverse fetomaternal outcome and GDM by WHO 2013 test (with normal DIPSI test). WHO 2013 has superior diagnostic value compared with DIPSI criteria for diagnosis of GDM.

Association between serum interleukin-6, leptin and insulin in gestational diabetes mellitus - a cross- sectional study.

Gestational diabetes mellitus (GDM) is a state of leptin resistance which develops a vicious cycle of hyperinsulinemia and hyperleptinemia leading to aggravation of an inflammatory situation. This study was done to find out the association between IL-6, leptin and insulin in gestational diabetes among North Indian women. This cross-sectional study included 100 GDM, 100 non-GDM and 50 non-pregnant women. DIPSI (Diabetes in Pregnancy Study Group India) criteria was used for screening GDM among pregnant women. GDM and non-GDM pregnant women were further categorized into three groups according to the trimester of pregnancy. Serum IL-6, leptin and insulin were measured in all the enrolled women. Serum IL-6 levels were significantly higher among GDM women as compared to non-GDM and non-pregnant women. Although the mean serum leptin and insulin levels were higher in GDM, but the difference was not statistically significant. When GDM and non-GDM women were categorized into three trimester, serum leptin levels were found to be significantly higher in 3rd trimester (p < 0.002) and IL-6 in 1st trimester (p < 0.017) among GDM women. No correlation was found between serum IL-6, leptin and insulin in GDM. Absence of any significant association between leptin and IL-6 signifies that leptin may not be associated with inflammation in gestational diabetes. However, IL-6 may serve as an early marker for screening glucose intolerance during pregnancy. The online version contains supplementary material available at 10.1007/s40200-023-01188-3.

Review of the Screening Guidelines for Gestational Diabetes Mellitus: How to Choose Wisely.

Currently, there is no international unanimity regarding the timings, the optimal cut-off points, and standardized methods of screening or diagnosis of gestational diabetes mellitus (GDM). The screening guidelines and recommendations for GDM evolved over time; concise information has been presented here in the review. We searched electronic databases for various guidelines for screening of GDM in PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Cochrane, Google Scholar, Scopus, Guidelines International Network (GIN library), National Guidelines Clearinghouse (NGC); Web sites of relevant organizations; and trial registries. The mesh headings derived after reviewing the articles and were used to further search the articles are: ("Screening Guidelines GDM" or "Screening Criteria for GDM") and ("Glucose Intolerance in Pregnancy" or "Gestational Diabetes Mellitus"). The articles published from 1960 till December 2022 were included. Key outcomes included the prevalence of GDM is 14.6% according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria and 13.4% according to Diabetes in Pregnancy Study Group India (DIPSI) criteria, making the DIPSI criterion a cost-effective method for low-resource settings. The IADPSG) criterion diagnoses and treats GDM earlier, thus reducing the complications associated with GDM in the mother and newborn. The IADPSG criteria at a cut-off of ≥140 mg/dL have a sensitivity of 81% and specificity of 93%, whereas the World Health Organization (2013) criteria at the same cut-off has a lower sensitivity of 59% and specificity of 81%. The risk factors of having GDM are family history, history during past pregnancy, medical history, multiple current pregnancies, and raised hemoglobin A1c. The screening guidelines have been developed by different organizations and institutions over the years. The guidelines with the threshold values for screening and their standardization for detecting GDM in Indian mothers are yet to be established.

To study the diagnostic accuracy of diabetes in pregnancy study group of india (DIPSI) as compared with international association of diabetes in pregnancy study group (IADPSG) Criteria in pregnancy

To study the diagnostic accuracy of diabetes in pregnancy study group of india (DIPSI) as compared with international association of diabetes in pregnancy study group (IADPSG) Criteria in pregnancy

Prevalence of Hyperglycemia in Pregnancy and Related Screening Practices in Rural Dehradun: The First Population-Based Study from Uttarakhand (PGDRD-1).

Phase I of the Prevalence of Gestational Diabetes Mellitus in Rural Dehradun (PGDRD) project estimates hyperglycemia in pregnancy (HIP) prevalence and identifies gaps in the utilization of community-related services in rural areas of the Dehradun district (western Uttarakhand); a state where notably no prior population-based study has ever been conducted despite being an Empowered Action Group state for more than two decades. Using a multistage random sampling technique, 1,223 pregnant women locally registered in the rural field practice area of a block were identified. Those requiring HIP screening were subjected to a 2-h 75 g oral glucose tolerance test during the house visit irrespective of their period-of-gestation and last meal timings, diagnosed using the Diabetes in Pregnancy Study Group India (DIPSI) criterion (when indicated). Data were collected by personal interviews using a pretested data collection tool. Statistical Package for Social Sciences version 20.0 was used for analysis. The overall HIP prevalence recorded was 9.7% (95% CI: 8.1-11.5%); the majority (95.8%) were GDM followed by overt DIP (4.2%). Less than 1% of the subjects (0.7%) self-reported pre-GDM. Despite this burden, more than three-fourths were never screened for HIP in their pregnancy. Of those tested, the majority availed secondary healthcare facilities. Few even had to bear expenses in private with a very handful being tested free-of-cost by ANM in the community; findings that altogether sharply contrast to those recommended by national protocols. Despite the high HIP burden, beneficiaries are unable to utilize community-related universal screening protocols as desired.

Fetal complications associated with GDM: a matter to worry?

Background: The consequences of GDM to the fetus are more serious than those to mother. Amongst fetal effects, incidence of fetal macrosomia is increased in women with GDM and DM type 2. Study was conducted to study prevalence of gestational diabetes mellitus using diabetes in pregnancy study group India (DIPSI) criteria in our hospital and to study fetal outcome in pregnancy with Gestational diabetes mellitus.Methods: Case control study was conducted on 500 females between 24-28 weeks of pregnancy. 31 (6.2%) were diagnosed as gestational diabetes mellitus (GDM). 31 other pregnant females between 24-28 not having diabetes were taken in control group. Follow up of all pregnant females was done. Babies were evaluated for any gross anomaly, birthweight of babies were taken, APGAR score was noted.Results: Maximum females (38.7%) with GDM were in age group of 25-29 years. Mean Basal Metabolic Index in GDM was 26.74 while in NGDM it was 22.48. Perinatal loss in GDM was 90.3%. Post-partum haemorrhage was seen in 9.7%. Intrauterine growth retardation (IUGR) in GDM was seen in 12.9%. Macrosomia was seen in 16.1%, preterm delivery in 9.7%, APGAR score &lt;7 at 5 min in 6.5%, birth injury in 3.2%GDM. Mean weight in GDM was seen in 2.944 kgs and NGDM in 2.726 kgs.Conclusions: Postpartum screening should be at regular interval to detect recurrence of future diabetes. With effective screening and management of GDM, from “diabetes capital of the world,” we (INDIA) can lay claim to be “diabetes care capital of world.”

World Health Organization Versus Diabetes in Pregnancy Study Group India Approaches in the Screening of Gestational Diabetes Among Pregnant Women With Risk Factors: A Study Among Rural Population of Telangana, South India.

Background Gestational diabetes mellitus (GDM) represents a pathological condition wherein pregnant women (PW) suffer from glycemic dysregulation, which predisposes them to an increased risk of developing complications related to pregnancy and childbirth.The most commonly used guidelines to screen for GDM include those provided by the World Health Organization (WHO), the American Congress of Obstetricians and Gynecologists, the Canadian Diabetes Association, and the International Association of Diabetes and Pregnancy Study Group. The Diabetes in Pregnancy Study Group India (DIPSI) guidelines are national-level recommendations to screen for GDM in India. Thisstudy aimed to comparethe efficacy of DIPSI criteria versus the WHO guidelinesin screening for GDM among the rural population of Telangana, South India Methods A total of 300 PW aged 19-35 years with a gestational age of 24-28 weeksattending the antenatal clinic attached to Mahavir Institute of Medical Sciences (MIMS), Vikarabad, Telangana, India were included in the study. The study was approved by the Institutional Ethics Committee of MIMS, and informed consent was obtained from all the participants. Of the 300 subjects included, 75 PW were categorized as at-risk for GDM based on risk factors and were included for further analysis. The data relating to body mass index (BMI), oral glucose tolerance test, and the diagnosis ofGDM based on DIPSI and the WHO criteria were collected. Results Out of the 75 PW included in the study, an overall GDM prevalence of 32% was noted among which20 (26.7%) were diagnosedusing the WHO criteria, 12 (16%) by DIPSI criteria, and the remaining 73.3% were non-GDM women. The mean gestational age and BMI among non-GDMand GDM patients were 24.74±4.15 weeks,22.24±3.60 kg/m2, and25.70±4.40, 24.48±3.37kg/m2 (p<0.01), respectively. The activities of glucose at the second hour after a GTT amongnon-GDM andGDM cases were 113.70±20.4mg/dL and 128.04±18.6 mg/dL (p=0.004), respectively. Conclusion DIPSI criteria could identify fewer numbers of GDM women as compared to the WHO criteria. Although the DIPSI criteria are convenientand prescribe less number of interventions,they could possibly miss many cases of GDM. Moreover, PW who remain undiagnosed could, in the future, beat risk of developing diabetes.Based on the study results and because risksshould outweigh the benefits, we propose that DIPSI cannot be implemented as a single criterion to screenfor GDM among PW in Indian settings.

Clinical Updates on Screening and Diagnosis Criteria for Gestational Diabetes Mellitus Patients, as well as Therapeutic Management

The most prevalent metabolic and endocrine perinatal issue is gestational diabetes mellitus (GDM), which is an increasing health problem worldwide. It is a controversial entity, with conflicting guidelines and treatment protocols. In the United States, most doctors utilise a two-step strategy, first with a 50-g non fasting oral glucose challenge test at 24 to 28 weeks and then a 100-g fasting test for women who have a positive screening result. Alternatively, Clinicians take a one step Diabetes in Pregnancy Study Group India (DIPSI) method and perform simply a 75-g two hour fasting oral glucose tolerance test. The DIPSI approach of antenatal GDM screening has been demonstrated to be straightforward, cost effective, easy to use, patient friendly, and convenient. When comparing the findings to the gold standard of the International Association of Diabetes and Pregnancy Study Group (IADPSG), DIPSI shows high specificity and acceptable sensitivity. To maintain euglycemia, glucose monitoring, dietary changes, exercise, and, if necessary, medicines are used. Although insulin therapy is the most common treatment, glyburide and metformin may become more popular. Prenatal testing with nonstress tests and amniotic fluid indices, commencing in the third trimester, is commonly used to assess foetal well-being in women undergoing medication. The delivery technique and time are contentious. Women who have gestational diabetes are at a significant risk of developing type 2 diabetes later in life. As a result, along with routine diabetes screening, lifestyle adjustment should be recommended.

Prevalence of Gestational Diabetes Mellitus in Nepal: A Systematic Review and Meta-analysis.

Gestational diabetes mellitus is a condition of glucose intolerance during pregnancy. The burden of Gestational diabetes mellitus is ever increasing including a lower middle-income country like Nepal. This meta-analysis was conducted in accordance to the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases of "Embase", "Google Scholar", "Scopus", "Web of Science" were searched for observational studies in Nepal from 2000 to July 2021. Random effect model was used to estimate the pooled prevalence subgroup analysis. This systematic review and meta-analysis analyzed 9 studies with a total of 20865 participants. Pooled prevalence of gestational diabetes mellitus was 2.61% (95% CI: 1.25- 5.37). From subgroup analysis, the prevalence of Gestational diabetes mellitus according to the diagnostic criteria were: International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6.56% (95% CI: 4.79-8.92), World Health Organization (WHO) criteria 4.81% (95% CI: 3.79-6.08), Diabetes in Pregnancy Study Group of India (DIPSI) criteria 4.71% (95% CI: 3.06-7.18), Carpenter and Coustan criteria (CC) 1.08% (95% CI: 0.43-2.71); prevalence according to the publication time: before 2015 1.20% (95% CI: 3.64-6.41), in and after 2015 4.84% (95% CI: 0.42-3.39); prevalence according to the place: within Kathmandu valley 2.70% (95% CI: 1.17-6.08), outside Kathmandu valley 2.28% (95% CI: 0.26-17.15). Our study revealed the increasing prevalence of GDM in Nepal. Further large observational studies at local levels are essential to measure the actual burden, risk factors and potential preventive measures for Gestational diabetes mellitus.

Gestational Diabetes Mellitus Among Pregnant Women Attending Ante-natal Clinic at a Secondary Care Health Facility in Haryana, India.

Introduction: Gestational diabetes has serious health effects during pregnancy and childbirth. We estimated the occurrence of gestational diabetes mellitus (GDM) among pregnant women in a secondary care hospital in Haryana.Methods: It was a hospital-based cross-sectional study, done in an ante-natal clinic (ANC) at a sub-district hospital (SDH), Faridabad district of Haryana, India. Eligible pregnant women attending the ANC clinic were recruited. An oral glucose tolerance test (OGTT) with 75 g of glucose was done with a collection of blood for fasting blood sugar (FBS) and two-hour post-OGTT blood glucose. A pre-tested semi-structured interview schedule was administered. Both the modified International Association of the Diabetes and Pregnancy Study Groups criteria (IADPSGC) and the Diabetes in Pregnancy Study Group of India (DIPSI) criteria were used. Data were presented as percentages, means, standard deviation, and 95% confidence interval (CI). Bi-variable and multi-variable logistic regressions were done. The level of significance was set at 0.05.Results: Of the 623 eligible participants, 66.1% were within the 20-25 age group. The GDM was found in 14.1% (95%CI: 11.5-17.1) participants as per modified IADPSG criteria and 6.7% (95%CI: 4.9-9.0) participants as per DIPSI criteria, respectively. Increasing age [adjusted odds ratio (AOR): 1.24 (95% CI: 1.05-1.47), p=0.008] and increasing years of schooling [AOR: 1.19 (1.01-1.41), p=0.032] were significantly associated with GDM by DIPSI criteria. Family history of DM was also found to have an increased odds with GDM using modified IADPSG criteria [AOR 2.87 (95% CI: 1.09-7.54), p=0.032]. Conclusion: Considerable proportion of pregnant women were found to have GDM in a Sub-district hospital at Ballabgarh in north India. The study highlighted the need and generated evidence about the feasibility of GDM screening utilizing routine staff in a secondary care facility.

Comparative Study of DIPSI and WHO (2018) Criteria for Diagnosis of Gestational Diabetes Mellitus

BACKGROUND&#x0D; Gestational diabetes mellitus is defined as carbohydrate intolerance with onset/recognition during pregnancy. There is an increase in incidence worldwide with a range of 0.4 - 10 %. Gestational Diabetes is often asymptomatic and associated with increased foetal and neonatal morbidity and mortality. Over the years there have been many controversies regarding the best screening and diagnostic test for GDM. The testing for GDM by appropriate method at the earliest detects women who need treatment with either diet alone or a combination of diet with insulin therapy. This helps in the prevention of maternal morbidity and mortality. Hence, an appropriate screening test for GDM has been much emphasized. This study was done to compare the non-fasting diabetes in pregnancy study group of India (DIPSI) criteria with the fasting state of the WHO 2018 for the diagnosis of GDM in our hospital setting.&#x0D; METHODS&#x0D; With this background, we conducted a single centric, prospective, observational study in our tertiary care hospital, after obtaining permission from the Institutional Ethics Committee. In this study, we enrolled 200 patients attending obstetric OPD in Basaveshwar teaching and general hospital and Sangameshwar hospital attached to Mahadevappa Rampure Medical College, Kalaburagi with gestational age 24 – 28 weeks as per the inclusion and exclusion criteria. All participants were then subjected to screening and diagnostic tests as per DIPSI and WHO 2018 criteria.&#x0D; RESULTS&#x0D; Prevalence of GDM was 12.5 % in WHO 2018 group when compared to 10.5 % in the DIPSI group. The specificity of the DIPSI method in detecting GDM was 98 %. The highest incidence of GDM was observed in the age group of 26-30 yrs. Incidence of the highest prevalence of GDM was observed with BMI &gt; 25 kg/m2. We studied the co-relation between GDM with DIPSI and WHO 2018. True positive 16, False Negatives 9, True Negatives 179, False Positive 05.&#x0D; CONCLUSIONS&#x0D; Screening with DIPSI has 98 % specificity compared. DIPSI being a one-step procedure offers both a screening and diagnostic test for GDM. It avoids the need for multiple hospital visits, and multiple blood samples.

IDF21-0112 Gestational diabetes in Upper Egypt: Prevalence, risk factors, and short term outcomes

Background: The prevalence of GDM has increased depending on the diagnostic criteria used. GDM is also an area where there are lot of debates regarding its screening, diagnosis, and management. Furthermore, there are wide gaps between guidelines and clinical practice provided to women with GDM particularly in low resources areas as Upper Egypt. Aim: Despite the high prevalence of diabetes in Egypt, our knowledge of gestational diabetes mellitus (GDM) epidemiology in Upper Egypt is still lacking. The study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate its maternal and fetal outcomes. Method: The current study was a prospective cohort study conducted between July 2014 and July 2018. Universal screening for GDM in all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group India (DIPSI) criteria (non-fasting 2hr blood glucose after loading with 75gm glucose >140mg/dl). Those with GDM were followed up until delivery and postpartum. Maternal and fetal outcomes were recorded. Results: GDM had been diagnosed in 956 women out of 7141 with a prevalence rate of 13.4% using DIPSI criteria. Previous history of either GDM or macrosomic babies and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factor was observed in about half of the GDM women. Regarding treatment, 29% of GDM women were only responded to medical nutrition therapy. 81.5% of GDM women were delivered by caesarean section (CS), and 17 % had preterm labour. On the other hand, 74.3% of their neonates had physiological jaundice, 52.1% were admitted to the neonatal intensive care unit (NICU), 20.9% were hypoglycaemic. Postpartum oral glucose tolerance test (OGTT) showed DM in 14.3% of our GDM women, while 25.7% of them had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of these cases are without risk factors. Thus, universal screening by OGTT is recommended. MNT alone was not adequate for treatment of all cases. Postpartum OGTT is mandatory for all GDM women to pick up new cases of diabetes and prediabetes.

Single-step DIPSI 75g Glucose Tolerance Test-For Diagnosis of Gestational Diabetes Mellitus

Background: Gestational Diabetes Mellitus (GDM) refers to glucose intolerance diagnosed at onset or first recognition during pregnancy. Women with GDM are at risk for maternal and foetal complications, so it is important to screen all pregnant women. The present study was carried out to determine the significance and use of the 75 g Oral Glucose Challenge Test (OGCT) using the Diabetes in Pregnancy Study Group India (DIPSI) criteria for screening of GDM. Objectives: This study was planned to analyze the incidence of GDM in pregnant women attending antenatal care clinic, using DIPSI criteria 75 g OGCT in the first trimester or at the first antenatal visit. Methods: In this prospective observational study, 451 pregnant women attended the antenatal clinic for the first visit at gestation between 6 and 20 weeks. 75 g oral glucose is administered irrespective of whether she is in the fasting or non-fasting state, without regard to the time of the last meal and GDM was diagnosed, and treatment started. Maternal and fetal outcomes were measured. Results: The incidence of GDM using DIPSI criteria (&gt;140 md/dL) was 20.8% in the first trimester or first antenatal visit. Incidence of maternal and foetal complications was lower in our study when compared to other studies. Conclusion: It is concluded that a 75 g glucose challenge test at 6-20 weeks of gestation with a cut-off value of 140 mg/dl is a reliable screening test for GDM. Keywords: Gestational diabetes mellitus; Oral glucose challenge test (OGCT); Glucose intolerance; DIPSI criteria

First Trimester Prediction of Gestational Diabetes using a Predictive Model of Biochemical ParametersA Longitudinal Study

Introduction: Current international guidelines recommend screening for Gestational Diabetes Mellitus (GDM) between 24-28 weeks of gestational age. It has been proven that early diagnosis and prompt treatment can effectively reduce and can even avoid many of the maternal and foetal complications. There are no accepted methods of testing before the recommended 24-28 weeks which can predict the development of GDM. Aim: To develop a risk based predictive model using clinical and biochemical parameters for predicting the development of GDM in the first trimester. Materials and Methods: This longitudinal prospective observational study was conducted in the Department of Obstetrics and Gyanecology at the SRM Institute of Science and Technology, Kancheepuram, Tamil Nadu, India from January 2017 to July 2018 and included 120 pregnant women with gestational age &lt;15 weeks over a period of 18 months. Detailed history, height, weight, Body Mass Index (BMI) and blood pressure were recorded followed by measurement of serum creatinine, uric acid and albumin. At 24-28 weeks of gestation, screening for GDM was performed according to Diabetes in Pregnancy Study group of India (DIPSI) criteria. Predictive modeling using stepwise linear regression to choose the best model that can predict the development of GDM was performed. A Receiver Operating characteristic Curve (ROC) was constructed to identify the best cut-off value that can predict the development of GDM. Results: A total of 130 pregnant women who fulfilled the inclusion criteria were enrolled for the study. Ten women were lost to follow-up in 2nd trimester. Final cohort consisted of 120 women and 19 (15.8%) of them developed GDM based on DIPSI criteria between 24-28 weeks. Rest 101 (84.2%) did not develop GDM. Significant correlation was found between BMI (r=0.49, p&lt;0.005), systolic Blood Pressure (BP) (r=0.35, p&lt;0.005) and diastolic BP (r=0.33, p&lt;0.005) with GDM. There was significant increase in creatinine and uric acid (p&lt;0.005) and decrease in albumin (p&lt;0.005) in GDM as compared to non GDM. First trimester uric acid &gt;3.35 mg/dL showed sensitivity of 100% and specificity of 84.2% for predicting GDM. Predictive modeling showed that model containing uric acid, creatinine and albumin had a higher correlation (r=0.82) with Plasma Glucose (PG) as compared to other models containing uric acid alone or uric acid and creatinine. Conclusion: It is possible to predict the development of GDM early in the first trimester using this predictive model of biochemical parameters with high accuracy

Silent upsurge of gestational diabetes: Are we aware? A rural tertiary care experience of Central Gujarat.

Background:The prevalence of Gestational Diabetes Mellitus has been on the rise. With the dramatic increase in the prevalence of overweight, obesity, and inactivity amongst the population, it’s becoming a common problem affecting antenatal women and their offspring.Subjects and Methods:A prospective cross-sectional study was carried out involving antenatal women between 24-28 weeks of gestation at a tertiary care centre in a rural part of Gujarat. Patients were screened using the Diabetes in Pregnancy Study Group India (DIPSI) guidelines. Analysis was carried out using Chi-square and ANOVA test.Results:Patients having PG2BS ≥140 mg/dl were diagnosed as having Gestational Diabetes Mellitus (GDM), while those having PG2BS values between 120–139 mg/dl were diagnosed as having Gestational Glucose Intolerance (GGI). Out of the 300 patients screened, we found an overall prevalence of 52 (17.33%) having GDM and 65 (21.67%) having GGI. Most patients belonged to the age bracket of 21-30 years across all groups. The prevalence of GDM in rural antenatal women was 23 (44.2%) and in semi-urban antenatal women was 25 (48.1%) while GGI in the rural antenatal women was 45 (69.2%) followed by semi-urban antenatal women 19 (29.2). We found that Occupation, Residence, Lifestyle, Socio-Economic Class, Family history of Diabetes Mellitus, Body Mass Index (BMI) were all statistically significant whereas Antenatal Complications and Perinatal outcomes weren’t.Conclusion:With such a high prevalence of GGI, almost equivalent to GDM, it is important to identify patients having GGI and monitor them to prevent progression to GDM by starting an appropriate treatment modality.

Role of ferritin and oxidative stress index in gestational diabetes mellitus.

To investigate the role of serum ferritin and oxidative stress in the development of GDM and to assess their relationship with the ensuing hyperglycemia. A case-control study was carried on 90 non-anemic pregnant women of 20-40years with a gestation of 24-28weeks. Study group (n = 65) was identified according to the Diabetes in Pregnancy Study Group India (DIPSI) criteria (2-h plasma glucose ≥ 140mg/dl) and controls (n = 25) having 2-h plasma glucose < 120mg/dl. DIPSI 2-h plasma glucose, HbA1c and serum ferritin were measured and oxidative stress index (OSI) was calculated. Statistical tests were performed using SPSS version 25.0. Pre-pregnancy BMI showed a significant difference between control and study group. DIPSI 2h blood glucose, HbA1c, serum ferritin and OSI were significantly higher in study group compared to control group. Both 2h blood glucose and HbA1c were positively correlated with serum ferritin and OSI, serum ferritin and OSI were also positively correlated with each other. Higher pre-pregnancy BMI elevates serum ferritin, which in turn increases the OSI. Both ferritin and oxidative stress raises 2h blood glucose and HbA1c in GDM patients possibly by causing in-vivo pancreatic β -cell injury and death (ferroptosis). Serum ferritin and OSI could become newer personalized theranostic and monitoring targets in overweight/obese pregnant females especially GDM patients.