Dr Lipika Das Mukhopadhyayis Assistant Professor in the Department of Obstetrics and Gynaecology, KPC Medical College, Kolkata. She had presented her papers at AICOG 2019, AOCOG, Malaysia; she is a regular participant of annual scientific conferences of BOGS, AICOG.
Significance of abnormal glucose tolerance in pregnancy is
known to every obstetrician. During pregnancy, an antenatal
mother with normoglycaemia in early months can develop
glucose intolerance of varying severity after midpregnancy
(true gestational diabetes) [1]. International Association of
Diabetes in Pregnancy Study Group (IADPSG) and Diabetes
in Pregnancy Study Group India (DIPSI) are two wellknown
criteria for the detection of gestational diabetes mellitus
(GDM).
Indian women are known to have 11-fold higher risk of
developing GDM compared to Caucasian women [1]. This
single-center cross-sectional study was conducted at S.C Das
Memorial Medical and Research Center, Kolkata, which is a
nonteaching private hospital, after obtaining approval from
the Ethical Committee of the institute.
Aim of this study was to note the prevalence rate of GDM
in a cohort of pregnant women attending the antenatal clinic
at the above-mentioned center. Women with multiple pregnancies
and preexistent diabetes mellitus were excluded
from the study. Verbal consent was taken from every woman
because glucose-tolerance testing was a part of routine antenatal
tests in the clinic.
Assuming a confidence level of 95% with the allowable
error of 5%, requisite sample size calculated was 384. We
studied 416 women presenting to the antenatal clinic in the
first trimester of pregnancy from Aug 2016 to July 2018.
All women underwent complete history taking and clinical
examination. BMI was calculated based on the weight and
height measured in the first trimester (≤ 8 weeks). Fasting
sugar was measured (to exclude preexisting diabetes) along
with the usual antenatal tests, and they were followed up
monthly with usual antenatal advices. After 24 weeks of
gestation, all women were advised to take 75 g glucose load
orally in water within 10 min in the fasting state and blood
by venepuncture was collected in the fasting state then after
1 h and 2 h of glucose intake, as recommended by IADPSG.
Diagnosis of GDM (IADPSG criteria) was made if any one
of the three values exceeds as follows: fasting—92 mg%;
1 h—180 mg% and 2-h—153 mg%. From the same data set,
we calculated separately the prevalence rate of GDM as per
the DIPSI criteria (blood sugar ≥ 140 mg% 2 h the glucose
intake). Though, as per DIPSI, the test can be done at any
time in pregnancy irrespective of food intake. True GDM
develops in the second half of pregnancy. Thus, the blood
report of every woman was utilized separately to calculate
the prevalence of true GDM as per the two proposed definitions.
Glucose was measured by glucose oxidase method.
Table 1 shows the prevalence rates of GDM in the studied
cohort by the two definitions and the average values of age
(years), BMI (kg/m2) and first trimester fasting sugar level
of the two groups (GDM positive and negative).
GopalKrishnan et al. [2] in their study on 332 women
utilizing IADPSG criteria, among North Indians, predominantly
belonging to lower- and middle-income socioeconomic
status reported a prevalence rate of 41.9% (95% CI
36.6–47.2%). Pulkit et al. [3] in their study (IADPSG criteria)
done after 24 weeks found the prevalence rate of GDM as 45.3%. They had also stressed the importance of more
studies from different parts of India in order to determine
the applicability of the two guidelines (IADPSG and DIPSI).
Our study shows that by IADPSG criteria, 49 women
(31.6%) had fasting sugar value above 92 mg%; 82 women
(52.9%) had 1-h value above 180 mg% and 91 women
(58.7%) had 2-h value above 153 mg%. DIPSI criteria has
been recommended by the Ministry of Health Government
of India [4].
Recent Women in India with Gestational Diabetes Mellitus
Strategy (WINGS) [5] done in Chennai, India, had
reported that despite constraints in low- and middle-income
countries at the present time, IADPSG criteria appear to be
the best. It has also been suggested that these criteria will
help to bring out a uniform criteria for screening and diagnosis
of GDM worldwide.
Our analysis shows that there is significant difference in
the average age of women with GDM compared to non-
GDM cases but no difference in BMI values, irrespective of
definitions used. It has been suggested that lower threshold
of the sugar value in IADPSG criteria may be the reason of
getting relatively higher prevalence [6] but our study did not
find any significant difference between the prevalence rates
of GDM among the two criteria.
This study shows that DIPSI being simple in execution
and patient friendly is close to the international consensus.
Keeping in the mind the diversity and variability of Indian
population, authors of the present study also feel that more
studies from different centers of India with a much larger
cohort are urgently needed to develop a national consensus
for the identification of GDM cases under the Indian
scenario.
Conflict of interestThe authors declare that they have no conflict of
interest.
Ethical StatementPermission was taken from the Ethical committee
of S.C.Das Memorial Medical and Research Center where the study
was done.
Human and Animal rights
No experimental study was done. Data generated
from the routine checkups in the outpatient antenatal clinic.
Informed consent
Informed verbal consents were taken from the
patients. This study was for academic interest.
