Inadequacy of the risk factor based approach to detect gestational diabetes mellitus

Dahanayaka, N J; Agampodi, Suneth; Ranasinghe, Jagath C.; Jayaweera, P M E D; Wickramasinghe, Nuwan Darshana; Adhikari, Ancwb; Chathurani, Hkju; Dissanayaka, UT

doi:10.4038/cmj.v57i1.4193

Cited by 38 publications

(35 citation statements)

References 13 publications

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“…(24,25) These findings support the argument for universal screening or a more effective way of implementing risk based screening. When the compliance with risk based screening using NICE risk factors was assessed in the Irish cohort versus the UK cohort, the findings showed poorer compliance in the UK.…”

Section: Main Findingssupporting

confidence: 59%

Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women

Murphy

McCarthy

Khashan

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Main Findingssupporting

confidence: 59%

Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women

Murphy

McCarthy

Khashan

et al. 2016

European Journal of Obstetrics & Gynecology and Reproductiv

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“…The included studies were from Pakistan (22–24), India (25–37), Sri Lanka (38, 39), Bangladesh (40), Thailand (41–45), China (46–49), Vietnam (50, 51), Turkey (52–56), Iran (57–59), South Africa (60), Ethiopia (61), Nigeria (62–64), Argentina (65), Brazil (66) and Cuba (67) (Table 1). The largest number of studies (12) came from India.…”

Section: Resultsmentioning

confidence: 99%

The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review

Kanguru

Bezawada

Hussein

et al. 2014

Global Health Action

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BackgroundLittle is known about the burden of diabetes mellitus (DM) in pregnancy in low- and middle-income countries despite high prevalence and mortality rates being observed in these countries.ObjectiveTo investigate the prevalence and geographical patterns of DM in pregnancy up to 1 year post-delivery in low- and middle-income countries.Search strategyMedline, Embase, Cochrane (Central), Cinahl and CAB databases were searched with no date restrictions.Selection criteriaArticles assessing the prevalence of gestational diabetes mellitus (GDM), and types 1 and 2 DM were sought.Data collection and analysisArticles were independently screened by at least two reviewers. Forest plots were used to present prevalence rates and linear trends calculated by linear regression where appropriate.Main resultsA total of 45 articles were included. The prevalence of GDM varied. Diagnosis was made by the American Diabetes Association criteria (1.50–15.5%), the Australian Diabetes in Pregnancy Society criteria (20.8%), the Diabetes in Pregnancy Study Group India criteria (13.4%), the European Association for the Study of Diabetes criteria (1.6%), the International Association of Diabetes and Pregnancy Study Groups criteria (8.9–20.4%), the National Diabetes Data Group criteria (0.56–6.30%) and the World Health Organization criteria (0.4–24.3%). Vietnam, India and Cuba had the highest prevalence rates. Types 1 and 2 DM were less often reported. Reports of maternal mortality due to DM were not found. No geographical patterns of the prevalence of GDM could be confirmed but data from Africa is particularly limited.ConclusionExisting published data are insufficient to build a clear picture of the burden and distribution of DM in pregnancy in low- and middle-income countries. Consensus on a common diagnostic criterion for GDM is needed. Type 1 and 2 DM in pregnancy and postpartum DM are other neglected areas.

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“…Currently recognized risk factors for GDM such as increasing maternal age, obesity, ethnic origin, family history of diabetes, and a previous history of GDM are absent in up to half of affected women [3,11,12]. Psychosocial stress may contribute to the risk of glucose intolerance via the hypothalamic-pituitary-adrenal axis [13,14] by raising the blood concentrations of counter regulatory hormones that inhibit insulin secretion and increase blood glucose level.…”

Section: Introductionmentioning

confidence: 99%

Perceived psychosocial stress and glucose intolerance among pregnant Hispanic women

Silveira

Whitcomb

Pekow

et al. 2014

Diabetes & Metabolism

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Aim Prior literature suggests a positive association between psychosocial stress and the risk of diabetes in non-pregnant populations, but studies during pregnancy are sparse. We evaluated the relationship between stress and glucose intolerance among 1115 Hispanic (predominantly Puerto Rican) prenatal care patients in Proyecto Buena Salud, a prospective cohort study in Western Massachusetts (2006–2011). Methods Cohen’s Perceived Stress Scale (PSS-14) was administered in early (mean = 12.3 weeks gestation; range 4.1–18 weeks) and mid-(mean = 21.3 weeks gestation; range 18.1–26 weeks) pregnancy. Participants were classified as having a pregnancy complicated by gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance, based on the degree of abnormality on glucose tolerance testing between 24 and 28 weeks of gestation. Results The prevalence of gestational diabetes mellitus, impaired glucose tolerance, and abnormal glucose tolerance was 4.1%, 7.2%, and 14.5%, respectively. Absolute levels of early or mid-pregnancy stress were not significantly associated with glucose intolerance. However, participants with an increase in stress from early to mid-pregnancy had a 2.6-fold increased odds of gestational diabetes mellitus (95% confidence intervals: 1.0–6.9) as compared to those with no change or a decrease in stress after adjusting for age and pre-pregnancy body mass index. In addition, every one-point increase in stress scores was associated with a 5.5 mg/dL increase in screening glucose level (β = 5.5; standard deviation = 2.8; P = 0.05), after adjusting for the same variables. Conclusion In this population of predominantly Puerto Rican women, stress patterns during pregnancy may influence the risk of glucose intolerance.

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Inadequacy of the risk factor based approach to detect gestational diabetes mellitus

Abstract: The risk factor based approach misses more than one third of GDM cases. Urgent revision of current GDM screening guidelines is recommended.

Cited by 38 publications

References 13 publications

Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women

Compliance with National Institute of Health and Care Excellence risk-based screening for Gestational Diabetes Mellitus in nulliparous women

The burden of diabetes mellitus during pregnancy in low- and middle-income countries: a systematic review

Perceived psychosocial stress and glucose intolerance among pregnant Hispanic women

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