Screening and diagnosis of gestational diabetes mellitus in a primary health-care center in Assiut

Abstract

Background Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition in pregnancy, is a common complication of pregnancy. The American Diabetes Association 2017 redefined GDM as follows: ‘diabetes diagnosed in the second and third trimesters of pregnancy.’ It is estimated by the International Diabetes Federation that 21.3 million or 16.2% of live births to women in 2017 had some form of hyperglycemia in pregnancy. An estimated 86.4% of those cases were due to GDM. Aim The aim was to evaluate the prevalence of gestational diabetes using Diabetes in Pregnancy Study Group India criteria and to determine the magnitude of gestational diabetes among pregnant women at 24–28 weeks gestation attending Al-Fath Primary Health-care Center in Assiut Governorate to identify the possible risk factors of GDM among this group of pregnant women and to increase awareness about GDM and importance of early detection in primary health-care providers and among population as a whole. Patients and methods A cross-sectional clinical study which included 500 pregnant women not known to have diabetes mellitus before gestation, who attended the Al-Fath Primary Health-care Center in Assiut Governorate between the period of July 2015 and July 2016.. Non-fasting oral glucose tolerance test at 24–28 weeks gestation using 75\u2009g glucose anhydrous in 250–300\u2009ml water and woman was considered to have GDM if 2h-postprandial blood glucose exceeded 140\u2009mg/dl (Diabetes in Pregnancy Study Group India criteria) and HBA1C was indicated only if 2\u2009h Blood sugar greater than or equal to 200\u2009g/dl to exclude pre-pregnancy diabetes from GDM. This study was part of a Gestational Diabetes Care in Upper Egypt project in collaboration with World Diabetes Foundation 13–797. Results The present study included 500 pregnant women, 8% of them had GDM, 24 (60%) GDM women had significantly different risk factors for GDM, 10 of them (25%) had a family history of GDM, eight of them (20%) had multiple risk factors, and four (10%) women had a previous history of twins. A high percentage of GDM women (about 40%) had no definite risk factor and this encourages universal screening of GDM to pick up more and more cases of GDM. Increased age of pregnant women (>30 years, 40%) is a significant risk factor for GDM. BMI was significantly higher in those with GDM (85%), As regards dietary habits, significant difference between women with GDM and those without GDM presented only with excess consumption of sweets/desserts. Conclusion The prevalence of GDM in the Al-Fath district of Assiut was 8%, in which a family history of diabetes mellitus was the most frequent risk factor for GDM. Presence of multiple risk factors, previous history of twins, advanced maternal age, and increased BMI were other risk factors for GDM. Sweet/deserts were the most frequent type of food among GDM women.