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Pramodkumar TA, Hannah W, Anjana RM, Ram U, Tiwaskar M, Gokulakrishnan K, Popova PV, Mohan V. Biomarkers of Gestational Diabetes Mellitus: Mechanisms, Advances, and Clinical Utility. THE JOURNAL OF THE ASSOCIATION OF PHYSICIANS OF INDIA 2025; 73:56-67. [PMID: 39928001 DOI: 10.59556/japi.73.0849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/11/2025]
Abstract
Gestational diabetes mellitus (GDM) continues to pose a significant challenge to maternal and fetal health, driving the need for advanced diagnostic and therapeutic strategies. Biomarker discovery has proven essential for early detection, mechanistic insights, and targeted interventions. This review provides an in-depth examination of biomarkers related to GDM, focusing on glucose metabolism, insulin resistance, inflammatory signaling, adipokines, oxidative stress markers, and genetic/epigenetic determinants. We also evaluate novel biomarkers emerging from omics technologies and their translational potential in clinical practice. Additionally, we explore the role of microRNAs and extracellular vesicles as emerging biomarkers that could offer new perspectives on GDM pathophysiology. Integration of these biomarkers into predictive models holds the potential to improve risk assessment and patient health outcomes.
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Affiliation(s)
| | - Wesley Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India
| | - Ranjit Mohan Anjana
- Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Uma Ram
- Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India
| | | | - Kuppan Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Polina V Popova
- World-Class Research Center for Personalized Medicine, Institute of Endocrinology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Viswanathan Mohan
- Chairman, Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India, Corresponding Author
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Pravinraj S, Tajudeen MM, Zala D, Senthil R, Jafrin MM. Diagnostic accuracy of DIPSI criteria for diagnosing gestational diabetes mellitus in Puducherry. J Family Med Prim Care 2024; 13:5296-5300. [PMID: 39722918 PMCID: PMC11668453 DOI: 10.4103/jfmpc.jfmpc_894_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 08/02/2024] [Accepted: 08/08/2024] [Indexed: 12/28/2024] Open
Abstract
Context Gestational diabetes mellitus (GDM) is a major concern in recent years. During pregnancy, it is difficult to consume 75 g of glucose in the fasting state as pregnant women may experience symptoms such as vomiting. The Diabetes in Pregnancy Study Group India (DIPSI) criterion requires a single prick in the non-fasting state to collect the sample for diagnosing GDM. Aims This study aimed to assess the diagnostic accuracy of DIPSI criteria compared to the WHO criteria for GDM diagnosis. Settings and Design A community-based cross-sectional study was conducted among pregnant mothers attending the primary health centers in Puducherry from August 2022 to November 2022. Methods and Material A total of 384 samples were selected, and 75 g of anhydrous glucose was given after 8 hours of overnight fasting. Both fasting and postprandial venous blood sugar levels were measured to determine the prevalence of GDM as per the WHO 2013 criteria. After 2 days, GDM was diagnosed among all study participants based on the DIPSI criteria. Further analysis was done. Results The prevalence of GDM was 14.1% and 12.8% per the WHO 2013 and DIPSI criteria, respectively. In comparison to the WHO 2013 criteria, DIPSI had 79.63% sensitivity, 98.18% specificity, 87.76% positive predictive value, and 96.72% negative predictive value. The results of kappa statistics showed that there was almost perfect agreement between the WHO 2013 criteria and DIPSI criteria. Conclusions The present study shows that the DIPSI criteria can be used to screen and diagnose GDM as there is no need for overnight fasting. The blood glucose value can be measured easily with a single prick, which is comfortable for both pregnant women and treating doctors.
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Affiliation(s)
- S Pravinraj
- Department of Community Medicine, Sri Lakshmi Narayanan Institute of Medical Science, BIHER, Puducherry, India
| | - Mohamed M. Tajudeen
- Department of Community Medicine, Sri Lakshmi Narayanan Institute of Medical Science, BIHER, Puducherry, India
| | - Darshana Zala
- Department of Community Medicine, Sri Lakshmi Narayanan Institute of Medical Science, BIHER, Puducherry, India
| | - Rajini Senthil
- Department of Community Medicine, Sri Lakshmi Narayanan Institute of Medical Science, BIHER, Puducherry, India
| | - Mercy M. Jafrin
- Department of Community Medicine, Sri Lakshmi Narayanan Institute of Medical Science, BIHER, Puducherry, India
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Ma MY, Zhao YS. Modifiable factors mediating the effects of educational attainment on gestational diabetes mellitus: A two-step Mendelian randomization study. World J Clin Cases 2024; 12:5937-5945. [PMID: 39286378 PMCID: PMC11287499 DOI: 10.12998/wjcc.v12.i26.5937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 07/01/2024] [Accepted: 07/10/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Although there is currently a wealth of evidence to indicate that maternal educational attainment is associated with gestational diabetes mellitus (GDM), the specific modifiable risk factors that mediate the causal relationship between these two variables have yet to be identified. AIM To identify the specific modifiable risk factors that mediate the causal relationship between the level of maternal education and GDM. METHODS Mendelian randomization (MR) was conducted using data from genome-wide association studies of European populations. We initially performed a two-sample MR analysis using data on genetic variants associated with the duration of education as instruments, and subsequently adopted a two-step MR approach using metabolic and lifestyle factors as mediators to examine the mechanisms underlying the relationship between the level of maternal education and risk of developing GDM. In addition, we calculated the proportions of total causal effects mediated by identified metabolic and lifestyle factors. RESULTS A genetically predicted higher educational attainment was found to be associated with a lower risk of developing GDM (OR: 0.71, 95%CI: 0.60-0.84). Among the metabolic factors assessed, four emerged as potential mediators of the education-GDM association, which, ranked by mediated proportions, were as follows: Waist-to-hip-ratio (31.56%, 95%CI: 12.38%-50.70%), body mass index (19.20%, 95%CI: 12.03%-26.42%), high-density lipoprotein cholesterol (12.81%, 95%CI: 8.65%-17.05%), and apolipoprotein A-1 (7.70%, 95%CI: 4.32%-11.05%). These findings proved to be robust to sensitivity analyses. CONCLUSION Our findings indicate a causal relationship between lower levels of maternal education and the risk of developing GDM can be partly explained by adverse metabolic profiles.
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Affiliation(s)
- Ming-Yue Ma
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ya-Song Zhao
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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Mocellin LP, Gomes HDA, Sona L, Giacomini GM, Pizzuti EP, Nunes GB, Zanchet TM, Macedo JLD. Gestational diabetes mellitus prevalence in Brazil: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2024; 40:e00064919. [PMID: 39258680 PMCID: PMC11386532 DOI: 10.1590/0102-311xen064919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/17/2024] [Accepted: 05/27/2024] [Indexed: 09/12/2024] Open
Abstract
This study estimates gestational diabetes mellitus prevalence in Brazil. A systematic review was conducted with articles published between 2010 and 2021 on the PubMed, Scopus, Google Scholar, SciELO, LILACS and Virtual Health Library databases, as well as gray literature. Data were extracted using a standardized instrument together with the risk of bias assessment tool proposed by Hoy et al. A meta-analysis with robust variance and random effects was developed. Heterogeneity was verified using I2 and publication bias was assessed using funnel plot and Egger's test. Prevalence according to risk of bias, diagnostic criteria and country's regions was determined by subgroup analyses. A total of 32 studies were included, representing 21,942 women. gestational diabetes mellitus pooled prevalence was 14% (95%CI: 11.0; 16.0), considerably higher than estimates from previous studies. Regarding risk of bias, studies with low, medium, and high risk showed a pooled prevalence of 12%, 14% and 14%, respectively. Overall GRADE certainty of evidence rating was low. Most studies used the International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria or the adapted IADPSG, showing a pooled prevalence of 15% and 14%, respectively. As for region, the pooled prevalence was higher in the Southeast (14%) and lower in the Central-West (9%). This is the first systematic review to provide evidence on gestational diabetes mellitus prevalence at a national level and to demonstrate considerable heterogeneity among articles and the influence of region, diagnostic criteria and study quality on the referred indicator.
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Affiliation(s)
| | | | - Lincoln Sona
- Universidade Federal do Pampa, Uruguaiana, Brasil
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Deshpande M, Kajale N, Shah N, Pai Raiturker A, Gupte S, Patankar L, Bhawra J, Yadav S, Reddy Katapally T, Khadilkar A. Factors Affecting Sleep Quality and Prenatal Distress Among Rural and Urban Women During Early Pregnancy. Cureus 2024; 16:e69566. [PMID: 39421100 PMCID: PMC11484530 DOI: 10.7759/cureus.69566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/19/2024] Open
Abstract
Background Early pregnancy is characterized by the initiation of physiological and psychological changes, which places pregnant women at risk of psychological distress and poor sleep, which is known to cause adverse maternal and neonatal outcomes. This study aimed to assess the prevalence of prenatal distress and sleep quality during early pregnancy and identify factors associated with prenatal distress among pregnant women from urban and rural settings. Methods The study was conducted with 325 pregnant women (175 rural, 150 urban) as a baseline assessment of the MAI (Mother and Infant) cohort, a longitudinal observational study in Pune, India. Data on sociodemography, anthropometry, clinical history, prenatal distress, and sleep quality were collected between August 2020 and March 2023. Mann Whitney U test and regression were used to assess correlates of sleep quality and prenatal distress. Results Over one-third (37.5%) (n=122) of women experienced prenatal distress. Women from rural areas reported a higher prevalence (40%) (n=70) of distress, and poorer sleep quality than urban women (51.4% (n=90) vs 38.7% (n=58)). High prenatal distress was moderately associated with poor sleep quality (ρ = 0.308, p = 0.001). After controlling for sociodemographic and clinical factors, high prenatal distress (B=2.63, 95% CI: 1.47-4.69) predicted poor sleep quality. Rural residence (OR: 6.37, 2.46-16.51), underweight BMI status (OR: 2.21, 0.97-5.05), presence of episodes of vomiting (OR: 1.70, 0.93-3.13), and poor sleep quality (OR: 0.74, 0.40-1.38) significantly (p<0.05) contributed to prenatal distress. Conclusion Prenatal distress and poor sleep quality are significant concerns for pregnant mothers globally and require early screening and management strategies to avoid adverse maternal and fetal outcomes.
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Affiliation(s)
- Mugdha Deshpande
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, IND
- Department of Health Sciences, Savitribai Phule Pune University, Pune, IND
| | - Neha Kajale
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, IND
- Department of Health Sciences, Savitribai Phule Pune University, Pune, IND
| | - Nikhil Shah
- Department of Pediatric Endocrinology, MRR Children's Hospital, Mumbai, IND
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, IND
| | | | - Sanjay Gupte
- Department of Obstetrics and Gynecology, Gupte Hospital, Pune, IND
| | - Leena Patankar
- Department of Obstetrics and Gynecology, Patankar Hospital, Pune, IND
| | - Jasmin Bhawra
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, CAN
| | - Shilpa Yadav
- Department of Pediatrics, Jehangir Hospital, Pune, IND
| | - Tarun Reddy Katapally
- Digital Epidemiology and Population Health Laboratory (DEPtH Lab) School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, CAN
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, CAN
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, IND
- Department of Health Sciences, Savitribai Phule Pune University, Pune, IND
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Johnson A, Vaithilingan S, Ragunathan L. Quantifying the Occurrence of High-Risk Pregnancy: A Comprehensive Survey. Cureus 2024; 16:e59040. [PMID: 38800298 PMCID: PMC11128061 DOI: 10.7759/cureus.59040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Background High-risk pregnancies are characterized by various factors that pose potential risks to maternal and newborn health outcomes. Early detection of these high-risk pregnancies serves as a crucial initial step in preventing maternal mortality and morbidity, thereby promoting the overall health of both mother and baby. This study sought to assess the occurrence of high-risk pregnancy and investigate the factors associated with it among pregnant women. Methods A descriptive survey was undertaken at the Obstetrics and Gynaecology outpatient department of a District Government Hospital in Tamil Nadu, involving 1889 pregnant women in their second and third trimesters. A structured questionnaire, constructed following the Indian standard criteria outlined by the National Health Portal of India, served as the data collection tool. The survey was conducted in February and March 2022, during which pregnant women were interviewed. Subsequently, the collected data underwent descriptive and inferential statistical analysis. Results Among the 1889 pregnant women surveyed, 29% (n=530) were classified as high-risk pregnancies. Within this group, 34.3% (n=182) were diagnosed with hypothyroidism, while 23.2% (n=123) experienced pregnancy-induced hypertension. Significant associations with high-risk pregnancy were observed for factors such as age, education status, occupation, family income, socioeconomic status, and gravida among the pregnant women. Conclusion Policymakers must urgently implement evidence-based interventions aimed at early detection and treatment of high-risk pregnancies. This proactive approach is essential in preventing maternal mortality and morbidity.
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Affiliation(s)
- Alby Johnson
- Obstetrics and Gynaecology, Vinayaka Mission's Research Foundation, Salem, IND
| | - Sasi Vaithilingan
- Child Health Nursing, Vinayaka Mission's College of Nursing, Puducherry, Vinayaka Mission's Research Foundation, Puducherry, IND
| | - Latha Ragunathan
- Microbiology, Aarupadai Veedu Medical College and Hospital, Vinayaka Mission's Research Foundation, Puducherry, IND
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Ray S, Kapoor N, Deshpande N, Chatterjee S, Kumar J, Tantia O, Goyal G, Mukherjee JJ, Singh AK. An overview of therapeutic options of obesity management in India: the Integrated Diabetes and Endocrinology Academy (IDEA) 2023 Congress update. Expert Rev Clin Pharmacol 2024; 17:349-362. [PMID: 38471973 DOI: 10.1080/17512433.2024.2330468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/11/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION With newer anti-obesity medications (AOMs) being introduced at a rapid pace, it is prudent to make a concise and updated clinical practice document that may help busy clinicians in daily clinical practice. A group of metabolic physicians, diabetologists, endocrinologists, and bariatric surgeons assembled during the Integrated Diabetes and Endocrine Academy 2023 Congress (IDEACON, July 2023, Kolkata, India) to compile an update of pharmacotherapeutic options for managing people with obesity in India. AREAS COVERED After an extensive review of the literature by experts in different domains, this update provides all available information on the management of obesity, with a special emphasis on both currently available and soon-to-be-available AOMs, in people with obesity. EXPERT OPINION Several newer AOMs have been shown to reduce body weight significantly, thus poised to make a paradigm shift in the management of obesity. While the tolerability and key adverse events associated with these AOMs appear to be acceptable in randomized controlled trials, pharmacovigilance is vital in real-world settings, given the absence of sufficiently long-term studies. The easy availability and affordability of these drugs is another area of concern, especially in developing countries like India.
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Affiliation(s)
- Subir Ray
- Department of Medicine, Division of Diabetes & Endocrinology, Apollo Multi-Speciality Hospitals, Kolkata, West Bengal, India
| | - Nitin Kapoor
- Department of Endocrinology, Diabetes and Metabolism Christian Medical College & Hospital, Vellore, Tamil Nadu, India
- Non-Communicable disease Unit, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Neeta Deshpande
- Belgaum Diabetes Centre and CentraCare Institute of Diabetes, Obesity and Metabolic Health (CIDOM), Belgaum, Karnataka, India
| | - Sanjay Chatterjee
- Department of Medicine, Division of Diabetes & Endocrinology, Apollo Multi-Speciality Hospitals, Kolkata, West Bengal, India
| | - Janardanan Kumar
- Department of Medicine, SRM Hospital & Research Centre, SRMIST, Kattankulathur, Tamil Nadu, India
| | - Om Tantia
- Department of Minimal Access and Bariatric Surgery, ILS Hospital, Kolkata, West Bengal, India
| | - Ghanshyam Goyal
- Department of Medicine, ILS Hospital, Salt Lake, Kolkata, West Bengal, India
| | - Jagat Jyoti Mukherjee
- Department of Medicine, Division of Diabetes & Endocrinology, Apollo Multi-Speciality Hospitals, Kolkata, West Bengal, India
| | - Awadhesh Kumar Singh
- Department of Diabetes & Endocrinology, G.D Hospital & Diabetes Institute, Kolkata, West Bengal, India
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Chakraborty A, Yadav S. Prevalence and determinants of gestational diabetes mellitus among pregnant women in India: an analysis of National Family Health Survey Data. BMC Womens Health 2024; 24:147. [PMID: 38424617 PMCID: PMC10902981 DOI: 10.1186/s12905-024-02936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 01/28/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a type of diabetes with its first recognition during pregnancy. GDM is a high-risk maternal and neonatal condition which increases the risk of Type 2 diabetes in mothers and their infants. It is essential to detect and treat GDM since its inception when mothers suffer from Type 1 diabetes while carrying the foetus during the gestational period. METHODS The study analysed individual data from the National Family Health Survey (NFHS) surveyed in 2015-2016 (4th round) and 2019-2021 (5th round) covering a total of approximately 6 lakhs and 7 lakhs women, respectively. Among them, 32,072 women in 2015-2016 and 28,187 in 2019-2021 were pregnant, of whom 180 women in 2014-2015 and 247 women in 2019-2021 had diabetes during their gestational periods, allowing the percentage prevalence calculation of GDM. The analysis of Poisson regression estimates examined the socioeconomic and demographic risk factors for GDM among pregnant women. RESULTS The overall prevalence of GDM in women showed an increase from 0.53% in 2015-16 to 0.80% in 2019-20 at the national level, and a similar increase in many states of India was witnessed, with a few exceptions. The GDM prevalence has shown a gradient over age, with a low prevalence in 15-19- and 25-29-year-olds and the highest prevalence in 40-44-year-olds. Concerning the rural and urban divide, its prevalence in both urban and rural areas has increased from 0.61 to 0.85% and 0.51 to 0.78% between 2015 and 16 and 2019-21. The results of the Poisson regression analysis reveal that older adults with high Body Mass Index (BMI), thyroid disorder, and heart disease have a greater risk of GDM among pregnant women in India. The states of Kerala, Meghalaya, and Goa show a high prevalence of GDM. CONCLUSION The low prevalence of GDM may not be clinically significant but has negative repercussions on the mother and her child cannot be overlooked. Thus, it is essential to curb GDM since its inception and save a generation ahead from the risk of diabetes and other diseases.
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Affiliation(s)
- Aditi Chakraborty
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India.
| | - Suryakant Yadav
- Department of Bio-Statistics and Epidemiology, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, India
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Kumbhar G, Dhar Chowdhury S, Benjamin S, Kurien RT, Thomas A, Dutta A, Simon EG, Joseph AJ. Pregnancy Outcomes in Patients with Early-Onset Idiopathic Chronic Pancreatitis. Dig Dis Sci 2024; 69:256-261. [PMID: 37985535 DOI: 10.1007/s10620-023-08174-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Early-onset idiopathic chronic pancreatitis (EOICP) is a disease that affects young individuals. Data on pregnancy outcomes in EOICP are limited. AIM To assess the pregnancy outcomes in patients with EOICP and the effect of pregnancy on the course of EOICP. METHODS Patients with EOICP with disease onset before their pregnancy were recruited. Data regarding demographic variables, disease duration, pregnancy outcomes, and course of illness were noted. RESULTS 50 patients were included in the study contributing to a total of 86 pregnancies. The mean age of onset of symptoms and at the time of delivery was 17.95 (5.71) and 23.44 (4.28) years, respectively. Gestational diabetes (GD) and gestational hypertension (GH) noted in one (1.5%) each. 3 (4.5%) pregnancies were preterm. 19 (22.1%) pregnancies did not have successful outcomes (7 (8.1%) were induced abortions). 12 (15.2%) pregnancies had spontaneous pregnancy losses. 8 (10.1%) were spontaneous abortions and 4 (5.1%) were stillbirths. Of 67 successful pregnancies, 33 (49.3%) pregnancies were delivered by LSCS. Compared to average rates of LSCS in India, this was significantly higher (21.5% vs 49.3%-p ≤ 0.001). The average birth weight was 2.87 (0.48) kg. There was one (1.5%) neonatal death. Compared to the published Indian data, there was no significant difference in the incidence of spontaneous pregnancy losses, GD, GH, preterm labor, and birth weight. Pancreatic pain was reported by 21 (42%) women in total 27 (31.4%) pregnancies. There was no difference in maternal or fetal outcomes between pregnancies with or without pancreatic pain. There were no pancreatitis-related complications reported during the pregnancies. CONCLUSION The present study shows that mothers affected with EOICP have pregnancy outcomes similar to healthy women in India.
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Affiliation(s)
- Gauri Kumbhar
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
| | - Sudipta Dhar Chowdhury
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India.
| | - Santosh Benjamin
- Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Reuben Thomas Kurien
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
| | - Ajith Thomas
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
| | - Amit Dutta
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
| | - Ebby George Simon
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
| | - A J Joseph
- Department of Gastroenterology, Christian Medical College, Ranipet Campus, Vellore, Tamil Nadu, 632517, India
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Muralidharan S. Diabetes and current Indian scenario: A narrative review. JOURNAL OF DIABETOLOGY 2024; 15:12-17. [DOI: 10.4103/jod.jod_93_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 05/18/2025] Open
Abstract
Abstract
Health needs assessment plays a critical role in identifying priorities and allocating resources to enhance health outcomes and reduce disparities. This write-up focuses on the health priority of diabetic care in India and highlights the challenges faced in its management. The prevalence of diabetes in India is alarmingly high and is projected to increase in the future, making it a significant concern. Key challenges include lack of awareness among the population, poor diagnosis, limited access to quality care, medication adherence issues, and physicians’ limited time and knowledge. Insufficient awareness hampers prevention efforts and understanding of associated complications. Diagnosis and access to quality care remain major challenges, particularly in rural areas, due to various factors such as treatment costs and underdeveloped healthcare infrastructure. Medication adherence is a significant issue influenced by high costs, complex treatment regimens, and limited transportation options. Healthcare professionals face knowledge gaps and time constraints, affecting the optimal management of diabetes. The scarcity of trained professionals exacerbates the situation. The write-up also discusses current policies and programs in India for diabetes care, including the CARRS diabetes care delivery model, the Diabetes Tele Management System, and doctor training programs. While these initiatives aim to improve care, their effectiveness is not extensively evaluated. The conclusion emphasizes the need for increased awareness, improved diagnosis and access to care, medication affordability, enhanced healthcare professional training, and effective policy implementation to address the challenges in diabetic care in India.
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Mahajan NN, Kesarwani S, Kumbhar P, Kuppusamy P, Pophalkar M, Thamke P, Asawa R, Sharan S, Mahale SD, Gajbhiye RK. Increased risk of early-onset preeclampsia in pregnant women with COVID-19. Hypertens Pregnancy 2023; 42:2187630. [PMID: 36891839 DOI: 10.1080/10641955.2023.2187630] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To estimate incidence, risk of early and late-onset preeclampsia (PE) and understand their relationship with severity of COVID-19. METHODS Pregnant women with COVID-19 (n = 1929) were enrolled from 1 April 2020 to 24 February 2022. Primary outcome measure was incidence and risk of early onset PE in women with COVID-19. RESULTS The incidence of early and late-onset PE was 11.4% and 5.6%. Moderate to severe COVID-19 was associated with eight times higher risk of early onset PE [aOR = 8.13 (1.56-42.46), p = 0.0129] compared to asymptomatic group. CONCLUSIONS Risk of early onset PE was higher in pregnant women with symptomatic COVID-19 as compared to asymptomatic women.
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Affiliation(s)
- Niraj N Mahajan
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Shweta Kesarwani
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Padmaja Kumbhar
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Periyasamy Kuppusamy
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Madhura Pophalkar
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Pratiksha Thamke
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Ruchi Asawa
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Saumya Sharan
- Department of Obstetrics and Gynecology, Topiwala National Medical College & BYL Nair Charitable Hospital, Mumbai, India
| | - Smita D Mahale
- Emeritus Scientist, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Rahul K Gajbhiye
- Clinical Research Laboratory, ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
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Chebrolu P, Chalem A, Ponticiello M, Broderick K, Vaidyanathan A, Lorenc R, Kulkarni V, Onawale A, Mathad JS, Sundararajan R. A community health worker-led program to improve access to gestational diabetes screening in urban slums of Pune, India: Results from a mixed methods study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001622. [PMID: 37889879 PMCID: PMC10610081 DOI: 10.1371/journal.pgph.0001622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 09/14/2023] [Indexed: 10/29/2023]
Abstract
The World Health Organization recommends all pregnant women receive screening for gestational diabetes (GDM) with a fasting oral glucose tolerance test (OGTT). However, very few women receive recommended screening in resource-limited countries like India. We implemented a community health worker (CHW)-delivered program to evaluate if home-based, CHW-delivered OGTT would increase GDM screening in a low-resource setting. We conducted a mixed methods study in two urban slum communities in Pune, India. CHWs were trained to deliver home-based, point-of-care fasting OGTT to women in their third trimester of pregnancy. The primary outcome was uptake of CHW-delivered OGTT. Secondary outcomes included GDM prevalence and linkage to GDM care. Individual interviews were conducted with purposively sampled pregnant women, CHWs, and local clinicians to assess barriers and facilitators of this approach. From October 2021-June 2022, 248 eligible pregnant women were identified. Of these, 223 (90%) accepted CHW-delivered OGTT and 31 (14%) were diagnosed with GDM. Thirty (97%) women diagnosed with GDM subsequently sought GDM care; only 10 (33%) received lifestyle counseling or pharmacologic therapy. Qualitative interviews indicated that CHW-delivered testing was considered highly acceptable as home-based testing saved time and was more convenient than clinic-based testing. Inconsistent clinical management of GDM was attributed to providers' lack of time to deliver counseling, and perceptions that low-income populations are not at risk for GDM. Convenience and trust in a CHW-delivered GDM screening program resulted in high access to gold-standard OGTT screening and identification of a high GDM prevalence among pregnant women in two urban slum communities. Appropriate linkage to care was limited by clinician time constraints and misperceptions of GDM risk. CHW-delivered GDM screening and counseling may improve health education and access to preventive healthcare, offloading busy public clinics in high-need, low-resource settings.
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Affiliation(s)
- Puja Chebrolu
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Andrea Chalem
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Matthew Ponticiello
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut, United States of America
| | - Kathryn Broderick
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Arthi Vaidyanathan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Rachel Lorenc
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | | | | | - Jyoti S. Mathad
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
| | - Radhika Sundararajan
- Center for Global Health, Weill Cornell Medicine, New York, New York, United States of America
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Phalke RD, Patil RT, Jain P, Patil PS, Ambekar HG, Phalke VD. Study of pre-conception care (PCC) amongst women in the first trimester coming to the obstetrics and gynaecology (OBGY) outpatient department (OPD) of a hospital in a rural area. J Family Med Prim Care 2023; 12:1879-1884. [PMID: 38024891 PMCID: PMC10657082 DOI: 10.4103/jfmpc.jfmpc_1852_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 03/31/2023] [Accepted: 04/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Pre-conception care (PCC) is a set of interventions that aim to identify and modify biomedical, behavioural and social risks to women's health and pregnancy outcomes. Materials and Methods It was an observational descriptive cross-sectional study conducted in the obstetrics and gynaecology (OBGY) outpatient department (OPD) of a tertiary care teaching institute in a rural set-up. Two hundred women in the first trimester of pregnancy were interviewed using a pre-designed and pretested questionnaire following informed verbal consent. The study was conducted between May and September 2019. The study excluded women in the 2nd or 3rd trimester of pregnancy, inpatient department (IPD) patients and those unwilling to participate. Results The study revealed that 25.5% of the women had conceived between 14 and 19 years of age. Fifty-four percent of the pregnancies were unplanned. Merely 14.5% had consulted and 15% had their laboratory investigations performed before pregnancy. Only 11% had received pre-conception folic acid supplementation. Pregnancies with birth spacing <2 years accounted for 15%. The proportion of women with known risk factors was 38% being underweight, 9.5% being overweight, 8% being of short stature (height ≤145 cm), 63% having anaemia (haemoglobin <12 g/dL), 10% with a previous history of abortion, 3.5% with systemic diseases, 4.5% with poor oral hygiene, 1% with domestic violence, 3% with medication, 3% with tobacco addiction and 4.5% with radiation/environmental toxin exposure. One percent had the hepatitis B vaccine and 0.5% had the influenza vaccine. Conclusion From our study, we conclude that the PCC services are meagre, and unhealthy women who conceive without adequate PCC are prone to maternal and foetal health complications.
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Affiliation(s)
- Rucha D. Phalke
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
| | - Riddhi T. Patil
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
| | - Pawni Jain
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
| | - Pratikesh S. Patil
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
| | - Harshada G. Ambekar
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
| | - Vaishali D. Phalke
- Obstetrics and Gynaecology Out Patient Department of Pravara Rural Hospital, Loni, Rahata, Ahmednagar, Maharashtra, India
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14
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Chauhan BG, Chokhandre PK, Kulaste BS, Sivanandan V. Burden of Anaemia, Hypertension and Diabetes among pregnant women in India. J Biosoc Sci 2023; 55:931-946. [PMID: 36621863 DOI: 10.1017/s0021932022000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Non-communicable Diseases such as anaemia, hypertension and diabetes and their treatment may upsurge the risk of childbirth-related complications for both women and their babies. The present study is an attempt to assess the level and determinants of Anaemia, Hypertension and Diabetes among pregnant women using the fourth round of National Family Health Survey-4 (2015-16) data. Bivariate and logistic regression techniques have been used for data analysis. Study findings suggest that the prevalence of anaemia among pregnant women was found to be 25.9%, whereas the corresponding figure for hypertension and diabetes were 4.4% and 2.4%, respectively. Further, substantial socio-economic differentials have been observed in the prevalence of Anaemia, Hypertension and Diabetes among pregnant women. Results of regression analysis suggest that anaemia and hypertension were significantly higher among women in their third trimester [(OR = 2.10; p < 0.001) and (OR = 1.63; p < 0.001)], respectively, compared to women in the first trimester. Similarly, pregnant women in the age group 35-49 were at an elevated risk of hypertension (OR = 2.78; p < 0.001)) and diabetes (OR = 2.50; p < 0.001)) compared to women aged 15-24. Further, the risk of anaemia was found to be significantly lower among pregnant women from the richest quintile (OR = 0.71; p < 0.001) and women with higher educational level (OR = 0.72; p < 0.001) when compared to women from the poorest wealth quintile and women with no formal education respectively. Similarly, pregnant women from the richest quintile (OR = 1.68; p < 0.001) and women from other religion (OR = 1.75; p < 0.001) are significantly more likely to develop diabetes compared to women from the poorest quintile and women from the Hindu religion, respectively. In conclusion, early screening for predicting the risk of gestational anaemia, gestational diabetes, and gestational hypertension is critical in minimizing maternal and reproductive outcomes. The existing guidelines for Screening and Management of Gestational Diabetes, Gestational Hypertension need to be contextualized and modified according to a local need for effective treatment.
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Affiliation(s)
- Bal Govind Chauhan
- Assistant Professor, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
| | - Praveen K Chokhandre
- Assistant Professor, Population Research Centre, JSS Institute of Economic Research, Dharwad, Karnataka580004
| | - Baldev Singh Kulaste
- Office Superintendent, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
| | - Vini Sivanandan
- Assistant Professor, Population Research Centre, Gokhale Institute of Politics and Economics, Pune, Maharashtra, India-411004
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Rohini HN, Punita P, Santhekadur PK, Ravishankar MV. Gestational Diabetes Mellitus - The Modern Indian Perspective. Indian J Endocrinol Metab 2023; 27:387-393. [PMID: 38107727 PMCID: PMC10723610 DOI: 10.4103/ijem.ijem_147_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/08/2023] [Accepted: 04/22/2023] [Indexed: 12/19/2023] Open
Abstract
Gestational diabetes mellitus (GDM) is a serious and most frequent health complication during pregnancy which is associated with a significant increase in the risk of maternal and neonatal outcomes. GDM is usually the result of β-cell dysfunction along with chronic insulin resistance during pregnancy. Seshiah et al. pioneer work led to the adoption of Diabetes in Pregnancy Study Group in India criteria as the norm to diagnose GDM, especially in the community setting. In 2014, the Maternal Health Division of the Ministry of Health and Family Welfare, Government of India, updated guidelines and stressed upon the proper use of guidelines such as using a glucometer for self-monitoring and the use of oral hypoglycaemic agents. The 2018 Government of India guidelines stress the importance of counselling about lifestyle modifications, weight control, exercise, and family planning.
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Affiliation(s)
- H N Rohini
- Department of Physiology, Meeankshi Medical College and Research Institute, Affiliated to Meenakshi Academy of Higher Education and Research, Mysore, India
| | - Pushpanathan Punita
- Department of Physiology, Meeankshi Medical College and Research Institute, Affiliated to Meenakshi Academy of Higher Education and Research, Mysore, India
| | - Prasanna Kumar Santhekadur
- Department of Biochemistry, Center of Excellence in Molecular Biology and Regenerative Medicine, JSS Medical College, Mysore, India
| | - MV Ravishankar
- Department of Anatomy, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, India
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16
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Deshpande S, Kinnunen TI, Khadilkar A, Unni J, Khanijo V, Donga N, Kulathinal S. Pre-pregnancy weight, the rate of gestational weight gain, and the risk of early gestational diabetes mellitus among women registered in a tertiary care hospital in India. BMC Pregnancy Childbirth 2023; 23:586. [PMID: 37582776 PMCID: PMC10428551 DOI: 10.1186/s12884-023-05907-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 08/07/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND The impact of pre-pregnancy weight and the rate of gestational weight gain (GWG) together on the risk of early GDM (< 24 weeks gestation; eGDM) has not been studied in the Indian context. We aimed to study the influence of (1) pre-pregnancy weight on the risk of eGDM diagnosed in two time intervals; and (2) in addition, the rate of GWG by 12 weeks on the risk of eGDM diagnosed in 19-24 weeks. METHOD Our study utilized real-world clinical data on pregnant women routinely collected at an antenatal care clinic at a private tertiary hospital, in Pune, India. Women registering before 12 weeks of gestation (v1), with a singleton pregnancy, and having a follow-up visit between 19-24 weeks (v2) were included (n = 600). The oral glucose tolerance test was conducted universally as per Indian guidelines (DIPSI) at v1 and v2 for diagnosing eGDM. The data on the onset time of eGDM were interval censored; hence, we modeled the risk of eGDM using binomial regression to assess the influence of pre-pregnancy weight on the risk of eGDM in the two intervals. The rate of GWG by 12 weeks was added to assess its impact on the risk of eGDM diagnosed in v2. RESULT Overall, 89 (14.8%) women (age 32 ± 4 years) were diagnosed with eGDM by 24 weeks, of which 59 (9.8%) were diagnosed before 12 weeks and 30 of 541 (5.5%) women were diagnosed between 19-24 weeks. Two-thirds (66%) of eGDM were diagnosed before 12 weeks of gestation. Women's pre-pregnancy weight was positively associated with the risk of GDM in both time intervals though the lower confidence limit was below zero in v1. The rate of GWG by 12 weeks was not observed to be associated with the risk of eGDM diagnosed between 19-24 weeks of gestation. These associations were independent of age, height, and parity. CONCLUSION Health workers may focus on pre-pregnancy weight, a modifiable risk factor for eGDM. A larger community-based study measuring weight and GDM status more frequently may be warranted to deepen the understanding of the role of GWG as a risk factor for GDM.
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Affiliation(s)
- Swapna Deshpande
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Tarja I Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Anuradha Khadilkar
- Paediatric Growth and Endocrine Department, Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Jyothi Unni
- Department of Obstetrics and Gynaecology, Jehangir Hospital, Pune, India
| | - Vandana Khanijo
- Department of Obstetrics and Gynaecology, Jehangir Hospital, Pune, India
| | - Namrata Donga
- Department of Obstetrics and Gynaecology, Jehangir Hospital, Pune, India
| | - Sangita Kulathinal
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
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Velmurugan H, Neelambaran K, Thangaraju P. Gestational diabetes: Unfolded area still a concern. J Family Med Prim Care 2023; 12:1747-1748. [PMID: 37767447 PMCID: PMC10521814 DOI: 10.4103/jfmpc.jfmpc_331_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 09/29/2023] Open
Affiliation(s)
- Hemasri Velmurugan
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Krishnapriya Neelambaran
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Pugazhenthan Thangaraju
- Department of Pharmacology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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18
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Nagraj S, Kennedy S, Jha V, Norton R, Hinton L, Billot L, Rajan E, Mohammed Abdul A, Phalswal A, Arora V, Praveen D, Hirst J. A Mobile Clinical Decision Support System for High-Risk Pregnant Women in Rural India (SMARThealth Pregnancy): Pilot Cluster Randomized Controlled Trial. JMIR Form Res 2023; 7:e44362. [PMID: 37471135 PMCID: PMC10401191 DOI: 10.2196/44362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of death in women in India. Early identification is crucial to reducing deaths. Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) carry independent risks for future CVD, and antenatal care is a window to screen and counsel high-risk women. In rural India, community health workers (CHWs) deliver antenatal and postnatal care. We developed a complex intervention (SMARThealth Pregnancy) involving mobile clinical decision support for CHWs and evaluated it in a pilot cluster randomized controlled trial (cRCT). OBJECTIVE The aim of the study is to co-design a theory-informed intervention for CHWs to screen, refer, and counsel pregnant women at high risk of future CVD in rural India and evaluate its feasibility and acceptability. METHODS In phase 1, we used qualitative methods to explore community priorities for high-risk pregnant women in rural areas of 2 diverse states in India. In phase 2, informed by behavior change theory and human-centered design, we used these qualitative data to develop the intervention components and implementation strategies for SMARThealth Pregnancy in an iterative process with end users. In phase 3, using mixed methods, we evaluated the intervention in a cRCT with an embedded qualitative substudy across 4 primary health centres: 2 in Jhajjar district, Haryana, and 2 in Guntur district, Andhra Pradesh. RESULTS SMARThealth Pregnancy embedded a total of 15 behavior change techniques and included (1) community awareness programs; (2) targeted training, including point-of-care blood pressure and hemoglobin measurement; and (3) mobile clinical decision support for CHWs to screen women in their homes. The intervention focused on 3 priority conditions: anemia, HDP, and GDM. The evaluation involved a total of 200 pregnant women, equally randomized to intervention or enhanced standard care (control). Recruitment was completed within 5 months, with minimal loss to follow-up (4/200, 2%) at 6 weeks postpartum. A total of 4 primary care doctors and 54 CHWs in the intervention clusters took part in the study. Fidelity to intervention practices was 100% prepandemic. Over half the study population was affected by moderate to severe anemia at baseline. The prevalence of HDP (2.5%) and GDM (2%) was low in our study population. Results suggest a possible improvement in mean hemoglobin (anemia) in the intervention group, although an adequately powered trial is needed. The model of home-based care was feasible and acceptable for pregnant or postpartum women and CHWs, who perceived improvements in quality of care, self-efficacy, and professional recognition. CONCLUSIONS SMARThealth Pregnancy is an innovative model of home-based care for high-risk pregnant women during the transitions between antenatal and postnatal care and adult health services. The use of theory and co-design during intervention development facilitated acceptability of the intervention and implementation strategies. Our experience has informed the decision to initiate a larger-scale cRCT. TRIAL REGISTRATION ClinicalTrials.gov NCT03968952; https://clinicaltrials.gov/ct2/show/NCT03968952. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.3389/fgwh.2021.620759.
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Affiliation(s)
- Shobhana Nagraj
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- Health Systems Collaborative, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Global Surgery Group, University of Oxford, Oxford, United Kingdom
| | - Stephen Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Vivekananda Jha
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Robyn Norton
- The George Institute for Global Health, Imperial College London, London, United Kingdom
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia
| | - Lisa Hinton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Laurent Billot
- The George Institute for Global Health, UNSW Sydney, Kensington, Australia
| | - Eldho Rajan
- The George Institute for Global Health, New Delhi, India
| | | | - Anita Phalswal
- The George Institute for Global Health, New Delhi, India
| | - Varun Arora
- Post Graduate Institute of Medical Science, Rohtak, India
| | - Devarsetty Praveen
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jane Hirst
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
- The George Institute for Global Health, Imperial College London, London, United Kingdom
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Rawat D, Chowdhury SR, Yadav AK, Gupta Y, Singh N, Sharma KA, Bharti J, Vatsa R, Zangmo R. Meta-analysis comparing diabetes in pregnancy study group India (DIPSI) vs the international association of the diabetes and pregnancy study groups (IADPSG) criteria for diagnosis of gestational diabetes among Indian population. Taiwan J Obstet Gynecol 2023; 62:498-505. [PMID: 37407183 DOI: 10.1016/j.tjog.2023.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 07/07/2023] Open
Abstract
Despite consensus on universal screening of women at 24-28 weeks for a diagnosis of gestational diabetes, controversy remains on an appropriate criterion. The study is aimed to find out the sensitivity and specificity of Diabetes in Pregnancy Study Group India (DIPSI) criteria compared to the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of Gestational Diabetes Mellitus (GDM). A meta-analysis of studies comparing DIPSI as an index test to IADPSG as the reference test for diagnosing GDM was carried out. A total of 8 comparative studies were included. Pooled analysis showed a sensitivity of 0.44 [0.29 to 0.60] and specificity of 0.97 [0.94 to 0.98], which means the index test DIPSI will correctly identify only 44% of the subjects who have the disease (GDM positive) but it will also fail to identify 56% of the GDM positive subjects. Derek's funnel graph revealed fewerchances of publication bias. Though convenient, DIPSI criteria was not found to be sensitive enough for a diagnosis of GDM and missed an opportunity to improve pregnancy and subsequent long-term outcomes for a substantial number of women. Further studies should focus on comparing pregnancy outcomes for the two criteria, so that decision to adopt any criteria is more evidence-based.
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Affiliation(s)
- Dimple Rawat
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Sumit Roy Chowdhury
- Department of Neuroanesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Arun Kumar Yadav
- Department of Community Medicine, Armed Forces Medical College (AFMC), Pune, India.
| | - Yashdeep Gupta
- Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India.
| | - Neeta Singh
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - K Aparna Sharma
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Juhi Bharti
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Richa Vatsa
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
| | - Rinchen Zangmo
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India.
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20
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Srivastava N, Singh K, Singh N, Mahdi AA. Association between serum interleukin-6, leptin and insulin in gestational diabetes mellitus - a cross- sectional study. J Diabetes Metab Disord 2023; 22:639-648. [PMID: 37255771 PMCID: PMC10225451 DOI: 10.1007/s40200-023-01188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/26/2022] [Accepted: 01/14/2023] [Indexed: 06/01/2023]
Abstract
Purpose 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. Method 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. Results 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. Conclusion 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. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01188-3.
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Affiliation(s)
- Neha Srivastava
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Kalpana Singh
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Nisha Singh
- Department of Obstetrics & Gynaecology, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
| | - Abbas Ali Mahdi
- Department of Biochemistry, King George’s Medical University, 226003 Lucknow, Uttar Pradesh India
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Sharma K, Mehta N, Kalita R. The Effect of Gestational Diabetes Mellitus on Hearing of Neonates in a Tertiary Healthcare Centre. Indian J Otolaryngol Head Neck Surg 2023; 75:620-627. [PMID: 37206780 PMCID: PMC10188788 DOI: 10.1007/s12070-023-03659-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023] Open
Abstract
Congenital hearing loss is hearing loss present in a child at birth or soon after birth. It is a debilitating condition with the potential for lifelong disability. It is thought to be multifactorial in aetiology with both genetic (autosomal and X-linked) and acquired causes (such as maternal infections, drug intake, trauma). Gestational Diabetes Mellitus (GDM) is a relatively common condition found in pregnant females but is a rather understudied risk factor in terms of congenital hearing loss. GDM is easily treatable which makes the hearing loss due to it easily preventable. (1) Determine correlation between Gestational Diabetes Mellitus and congenital hearing loss in neonates. (2) Calculate the prevalence of Gestational Diabetes Mellitus related congenital hearing loss. A two-step screening process was used for hearing evaluation of neonates with normal mothers (non-exposed) and neonates with mothers suffering from GDM (exposed) through Otoacoustic emission (OAE) and Brainstem Evoked Response Audiometry (BERA). (1) The difference of neonates diagnosed with hearing impairment in exposed and non-exposed group was statistically significant with a p-value of 0.024. OR 2.1538 95% CI 0.6120-7.5796, p < 0.05. (2) Prevalence of hearing loss in neonates of GDM mothers: 13.3%. Through rigorous exclusion of the already known risk factors for congenital hearing loss, Gestational Diabetes Mellitus has been isolated as an independent risk factor for neonatal hearing impairment. We hope to identify additional cases of congenital hearing loss early leading to a decrease in disease burden.
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Affiliation(s)
- Kalpana Sharma
- Department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati, Assam 781032 India
| | - Navroz Mehta
- Department of Otorhinolaryngology, Gauhati Medical College and Hospital, Guwahati, Assam 781032 India
| | - Ruplekha Kalita
- Department of Obstetrics and Gynecology, Gauhati Medical College and Hospital, Guwahati, Assam India
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Gautam PK, Agarwal M, Agarwal A, Singh VK, Jauhari S. Gestational glucose intolerance (GGI) and gestational diabetes mellitus (GDM) among antenatal women attending urban community health centers of Lucknow: A cross-sectional study. J Family Med Prim Care 2023; 12:611-618. [PMID: 37312767 PMCID: PMC10259573 DOI: 10.4103/jfmpc.jfmpc_1134_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/07/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023] Open
Abstract
Background Gestational diabetes mellitus (GDM) is an emerging public health concern in India, which has detrimental effects on both the mother and the baby. The data on prevalence of GDM was unavailable at secondary urban health facilities, from where a majority of pregnant women seek antenatal services, and the following study identifies this burden. Methods A cross-sectional study was conducted from May 2019 to June 2020 among pregnant women attending the antenatal outpatient department (OPD) at secondary level health facilities in urban Lucknow. A semi-structured interview schedule was administered to the study subjects for collecting the relevant information and 75 g of oral glucose tolerance test was performed irrespective of the meal. The cut-off points taken for the diagnosis of GDM and gestational glucose intolerance (GGI) was as per the guidelines of the Ministry of Health and Family Welfare for diagnosis of GGI/GDM. Results The overall prevalence of GDM and GGI in the study was 11.6% and 16.8%, respectively. Three-fourth of the women (22/29) were diagnosed with GDM in the second trimester of pregnancy. The prevalence of GDM (16.7%) was significantly higher in pregnant women aged more than 25 years and in those who were overweight. Mean birth weight (3.2 ± 8.1 kg) of the babies was significantly higher in the women with GDM. Among the fetal complications was respiratory distress observed among 28 pregnant women and 31% of them had GDM and this was statistically significant. Conclusion The prevalence of GGI and GDM was found 16.8% and 11.6%, respectively. Gestational age, pre-pregnancy weight, pre-pregnancy BMI, weight gain during the pregnancy, family history of diabetes. PCOS, macrosomia and GDM in prior pregnancies was found to significant with GDM in the study.
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Affiliation(s)
- Pradeep K. Gautam
- Department of Community Medicine, Autonomous State Medical College, Hardoi, Uttar Pradesh, India
| | - Monika Agarwal
- Department of Community Medicine and Public Health, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Anjoo Agarwal
- Department of Obstetrics and Gynaecology, King George Medical University, Lucknow, Uttar Pradesh, India
| | - V. K. Singh
- Department of Community Medicine and Public Health, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Sugandha Jauhari
- Department of Community Medicine and Public Health, King George Medical University, Lucknow, Uttar Pradesh, India
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Scheuer CM, Andersen MH, Mathiesen ER, Ringholm L, Müller CL, Truong JM, Lie-Olesen MM, Overgaard M, McIntyre HD, Jensen DM, Damm P, Clausen TD. Regional divergence and time trends in the prevalence of gestational diabetes mellitus: a national Danish cohort study. Acta Diabetol 2023; 60:379-386. [PMID: 36539623 PMCID: PMC9931790 DOI: 10.1007/s00592-022-02013-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
AIMS To evaluate the prevalence and time trends of gestational diabetes mellitus (GDM) across the five regions of Denmark with uniform national guidelines for screening and diagnosing GDM. METHODS This register-based national cohort study included 287,684 births from 2013 to 2017. Trends in GDM prevalence over time and differences between the five regions were evaluated. Crude and adjusted odd ratios (ORs) for GDM were calculated including potential confounding clinical risk factors as age, BMI, educational level, marital status, parity, country of origin and assisted reproduction. RESULTS From 2013 to 2017, GDM prevalence in Denmark increased by 7% per year (OR 1.07, 95% CI 1.06-1.09, P < 0.001). GDM prevalence varied considerably between regions and ranged from 3.0 to 5.9% in 2017, corresponding to a maximal regional difference of 97%. In crude analyses, the risk of GDM in 2017 was significantly different in four of five regions compared to the remaining regions (OR ranging from 0.60 to 1.55), and these differences persisted after adjusting for confounding clinical risk factors (adjusted OR: 0.59-1.45). CONCLUSION The prevalence of GDM increased over time in all Danish regions with substantial regional divergence. Up to a 97%, difference in GDM prevalence was observed between Danish regions, which was not explained by available clinical risk factors. This occurred despite national guidelines and raises the question of whether regional variations in screening efficacy, diagnostic procedures or inequality in clinical health care access may explain the observed differences.
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Affiliation(s)
- Cathrine M Scheuer
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark.
| | - Maria H Andersen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Elisabeth R Mathiesen
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Ringholm
- Department of Endocrinology and Metabolism, Center for Pregnant Women with Diabetes, Copenhagen, Denmark
| | - Clara L Müller
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | - Jun-Mei Truong
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
| | | | - Martin Overgaard
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - H David McIntyre
- Mater Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Dorte M Jensen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Damm
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, Copenhagen, Denmark
| | - Tine D Clausen
- Department of Gynaecology and Obstetrics, Nordsjællands Hospital, Hillerød, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Das AK, Saboo B, Maheshwari A, Nair V M, Banerjee S, C J, V BP, Prasobh P S, Mohan AR, Potty VS, Kesavadev J. Health care delivery model in India with relevance to diabetes care. Heliyon 2022; 8:e10904. [PMID: 36237970 PMCID: PMC9552106 DOI: 10.1016/j.heliyon.2022.e10904] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 05/04/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
The Indian healthcare scenario presents a spectrum of contrasting landscapes. Socioeconomic factors, problems with medical infrastructure, insufficiency in the supply of medical requisites, economic disparities due to major differences in diabetes care delivery in the government and private sectors and difficulty in accessing quality health care facilities challenges effective diabetes care in India. The article gives insights into the practical solutions and the proposed White paper model to resolve major challenges faced by the Indian diabetes care sector for effective diabetes care delivered at Jothydev's Diabetes Educational Forum Global Diabetes Convention 2019.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology, Pondicherry Institute of Medical Sciences, Pondicherry, Tamil Nadu, India
| | - Banshi Saboo
- Diacare, Diabetes Care & Hormone Clinic, Ahmedabad, India
| | | | | | - Samar Banerjee
- Dept. of Medicine, Vivekananda Institute of Medical Sciences, Kolkata, West Bengal, India
| | - Jayakumar C
- Department of General Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Benny P. V
- Department of Community Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, Kerala, India
| | - Sunil Prasobh P
- Department of Internal Medicine, Government Medical College, Kollam, Kerala, India
| | - Anjana Ranjit Mohan
- Department of Diabetology, Dr. Mohan's Diabetes Specialities Centre, Chennai, India
| | | | - Jothydev Kesavadev
- Department of Diabetology, Jothydev's Diabetes Research Centers, Trivandrum, Kerala, India
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Khan M, Khurshid M, Vatsa M, Singh R, Duggal M, Singh K. On AI Approaches for Promoting Maternal and Neonatal Health in Low Resource Settings: A Review. Front Public Health 2022; 10:880034. [PMID: 36249249 PMCID: PMC9562034 DOI: 10.3389/fpubh.2022.880034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/30/2022] [Indexed: 01/21/2023] Open
Abstract
A significant challenge for hospitals and medical practitioners in low- and middle-income nations is the lack of sufficient health care facilities for timely medical diagnosis of chronic and deadly diseases. Particularly, maternal and neonatal morbidity due to various non-communicable and nutrition related diseases is a serious public health issue that leads to several deaths every year. These diseases affecting either mother or child can be hospital-acquired, contracted during pregnancy or delivery, postpartum and even during child growth and development. Many of these conditions are challenging to detect at their early stages, which puts the patient at risk of developing severe conditions over time. Therefore, there is a need for early screening, detection and diagnosis, which could reduce maternal and neonatal mortality. With the advent of Artificial Intelligence (AI), digital technologies have emerged as practical assistive tools in different healthcare sectors but are still in their nascent stages when applied to maternal and neonatal health. This review article presents an in-depth examination of digital solutions proposed for maternal and neonatal healthcare in low resource settings and discusses the open problems as well as future research directions.
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Affiliation(s)
- Misaal Khan
- Department of Smart Healthcare, Indian Institute of Technology Jodhpur, Karwar, India,All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Mahapara Khurshid
- Department of Computer Science and Engineering, Indian Institute of Technology Jodhpur, Karwar, India
| | - Mayank Vatsa
- Department of Computer Science and Engineering, Indian Institute of Technology Jodhpur, Karwar, India,*Correspondence: Mayank Vatsa
| | - Richa Singh
- Department of Computer Science and Engineering, Indian Institute of Technology Jodhpur, Karwar, India
| | - Mona Duggal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
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Thirumoorthy C, Deepa M, Srikumar BN, Hannah W, Venkatesan U, Nikhil PJ, Hemavathy S, Binukumar B, Anjana RM, Ram U, Balasubramanyam M, Saravanan P, Mohan V, Gokulakrishnan K. Altered levels of neurobiological biomarkers at the interface of depression and gestational diabetes mellitus in Asian Indian women. Neuropeptides 2022; 93:102245. [PMID: 35461022 DOI: 10.1016/j.npep.2022.102245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/17/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
Abstract
AIM Gestational diabetes mellitus (GDM) might predispose the mothers to depression. Studies have reported the role of biomarkers either in GDM or depression, but very few have examined them in GDM with depression. The present study profiled the circulating levels of brain-derived neurotrophic factor (BDNF), Beta Endorphin (BE) and nesfatin-1 in women with GDM (with and without depression). METHODS 160 pregnant women at 24-28 weeks of pregnancy (NGT/GDM with & without depression, n = 40 each) were randomly selected from the ongoing STRiDE (STratification of Risk of Diabetes in Early pregnancy) study. Depression score was derived using PHQ-9 questionnaire and ELISA was used to quantify the biomarkers. RESULTS Circulatory levels of BDNF, BE and nesfatin-1 were lower in GDM women with or without depression compared to NGT without depression, however, nesfatin-1 levels were higher in NGT with depression. Notably, GDM with depression had the lowest levels of BDNF and BE. Both BDNF and BE levels were negatively correlated with depression, 1 h and 2 h plasma glucose. Regression analysis confirmed that each standard deviation decreases in BDNF and BE were independently associated with higher odds of GDM with or without depression even after adjusting for potential confounders. CONCLUSION Our study has identified altered levels of a panel of neurobiological biomarkers (BDNF/BE/nesfatin-1) in those with combined GDM and depression. BDNF/BE could be potential biomarkers to assess the higher risk of coexisting depression and GDM.
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Affiliation(s)
- C Thirumoorthy
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - M Deepa
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B N Srikumar
- Department of Neurophysiology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - W Hannah
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - U Venkatesan
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P J Nikhil
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India
| | - S Hemavathy
- Department of Epidemiology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - B Binukumar
- Department of Biostatistics, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India
| | - R M Anjana
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - Uma Ram
- Seethapathy Clinic & Hospital, Chennai, India
| | - M Balasubramanyam
- Department of Cell & Molecular Biology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - P Saravanan
- Populations, Evidence and Technologies, Division of Health Sciences, Warwick Medical School, University of Warwick, UK; Department of Diabetes, Endocrinology and Metabolism, George Eliot Hospital, Nuneaton, UK
| | - V Mohan
- Department of Diabetology, Madras Diabetes Research Foundation (MDRF), Chennai, India
| | - K Gokulakrishnan
- Department of Neurochemistry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru, India.
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Mazumder T, Akter E, Rahman SM, Islam MT, Talukder MR. Prevalence and Risk Factors of Gestational Diabetes Mellitus in Bangladesh: Findings from Demographic Health Survey 2017-2018. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052583. [PMID: 35270274 PMCID: PMC8909680 DOI: 10.3390/ijerph19052583] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/17/2022] [Accepted: 02/21/2022] [Indexed: 12/18/2022]
Abstract
Gestational diabetes mellitus (GDM) has serious consequences for both maternal and neonatal health. The growing number of noncommunicable diseases and related risk factors as well as the introduction of new World Health Organization (WHO) diagnostic criteria for GDM are likely to impact the GDM prevalence in Bangladesh. Our study aimed to assess the national prevalence and identify the risk factors using the most recent WHO criteria. We used the secondary data of 272 pregnant women (weighted for sampling strategy) from the Bangladesh Demographic and Health Survey 2017–2018. Multivariate logistic regression was performed to determine the risk factors of GDM. The overall prevalence of GDM in Bangladesh was 35% (95/272). Increased odds of GDM were observed among women living in the urban areas (adjusted odds ratio (aOR) 2.74, 95% confidence interval (CI) 1.43–5.27) compared to rural areas and those aged ≥25 years (aOR 2.03, 95% CI 1.13–3.65). GDM rates were less prevalent in the later weeks of pregnancy compared to early weeks. Our study demonstrates that the national prevalence of GDM in Bangladesh is very high, which warrants immediate attention of policy makers, health practitioners, public health researchers, and the community. Context-specific and properly tailored interventions are needed for the prevention and early diagnosis of GDM.
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Affiliation(s)
- Tapas Mazumder
- Health Research Institute, Faculty of Health, University of Canberra, Canberra 2617, Australia;
| | - Ema Akter
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (E.A.); (S.M.R.)
| | - Syed Moshfiqur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka 1212, Bangladesh; (E.A.); (S.M.R.)
- Department of Women’s and Children’s Health, Uppsala University, MTC-huset, Dag Hammarskjölds väg 14B, SE-75237 Uppsala, Sweden
| | - Md. Tauhidul Islam
- Health Administration, Policy and Leadership Program, Murdoch Business School, Murdoch University, Perth 6150, Australia;
| | - Mohammad Radwanur Talukder
- Wellbeing Preventable and Chronic Disease Division, Menzies School of Health Research, Darwin 0810, Australia
- Baker Heart and Diabetes Institute, Melbourne 3004, Australia
- Charles Darwin University, Darwin 0810, Australia
- Correspondence: ; Tel.: +61-889-466-857
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Pace NP, Vella B, Craus J, Caruana R, Savona-Ventura C, Vassallo J. Screening for monogenic subtypes of gestational diabetes in a high prevalence island population - A whole exome sequencing study. Diabetes Metab Res Rev 2022; 38:e3486. [PMID: 34278679 DOI: 10.1002/dmrr.3486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 12/12/2022]
Abstract
AIMS The reported frequency of monogenic defects of beta cell function in gestational diabetes (GDM) varies extensively. This study aimed to evaluate the frequency and molecular spectrum of variants in genes associated with monogenic/atypical diabetes in non-obese females of Maltese ethnicity with GDM. METHODS 50 non-obese females who met the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for diagnosis of GDM and with a first-degree relative with non-autoimmune diabetes were included in this study. Whole exome capture and high throughput sequencing was carried out. Rare sequence variants were filtered, annotated, and prioritised according to the American College for Medical Genetics guidelines. For selected missense variants we explored effects on protein stability and structure through in-silico tools. RESULTS We identified three pathogenic variants in GCK, ABCC8 and HNF1A and several variants of uncertain significance in the cohort. Genotype-phenotype correlations and post-pregnancy follow-up data are described. CONCLUSIONS This study provides the first insight into an underlying monogenic aetiology in non-obese females with GDM from an island population having a high prevalence of diabetes. It suggests that monogenic variants constitute an underestimated cause of diabetes detected in pregnancy, and that careful evaluation of GDM probands to identify monogenic disease subtypes is indicated.
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Affiliation(s)
- Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Barbara Vella
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Johann Craus
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Ruth Caruana
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Charles Savona-Ventura
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Josanne Vassallo
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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Seetharaman R, Pawar S, Advani M. One hundred years since insulin discovery: An update on current and future perspectives for pharmacotherapy of diabetes mellitus. Br J Clin Pharmacol 2022; 88:1598-1612. [PMID: 34608666 DOI: 10.1111/bcp.15100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 12/30/2022] Open
Abstract
Diabetes mellitus was considered a fatal malady until the discovery, extraction and commercial availability of insulins. Numerous other classes of drugs ranging from sulfonylureas to sodium-glucose co-transporter-2 inhibitors were then marketed. However, with the prevalence of diabetes mellitus increasing every year, many more drugs and therapies are under investigation. This review article aimed to summarize the significant developments in the pharmacotherapy of diabetes mellitus and outline the progress made by the recent advances, 100 years since insulins were first extracted successfully. Insulin analogues and insulin delivery pumps have further improved glycaemic control in diabetes mellitus. Cardiovascular and renal outcome trials have changed the landscape of diabetology, with some of these drugs also efficacious in nondiabetics. Newer drug delivery systems are being evaluated to improve the efficacy and reduce the dosing frequency and adverse effects of antidiabetics. Some newer drugs with novel mechanisms of action targeting type 1 and type 2 diabetes have also shown promise in recent clinical trials. These drugs include dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1-agonists, glucokinase activators, anti-CD3 monoclonal antibodies and glimins. Their efficacy needs to be evaluated in larger studies.
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Affiliation(s)
- Rajmohan Seetharaman
- Department of Pharmacology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
| | - Sudhir Pawar
- Department of Pharmacology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
| | - Manjari Advani
- Department of Pharmacology, Lokmanya Tilak Municipal Medical College & General Hospital, Sion, Mumbai, India
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Dash P, Tiwari R, Nayak S, Jena SK, Mangaraj M. Prevalence of Subclinical Hypothyroidism in Pregnancy and Its Association With Anti-thyroperoxidase Antibody and the Occurrence of Gestational Diabetes Mellitus. Cureus 2022; 14:e21087. [PMID: 35165548 PMCID: PMC8828193 DOI: 10.7759/cureus.21087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Subclinical hypothyroidism (SCH) and gestational diabetes mellitus (GDM) are common endocrinological abnormalities associated with pregnancy. The presence of a raised anti-thyroperoxidase (anti-TPO) antibody titer increases the risk of progression of subclinical hypothyroidism to overt hypothyroidism. Subclinical hypothyroidism and GDM are known to affect maternal and fetal outcomes adversely. A few studies have shown an increased risk of GDM with autoimmune hypothyroidism. However, data regarding this association between GDM, SCH, and anti-TPO Ab are scarce. This study aimed to find the prevalence of autoimmune subclinical hypothyroidism and its association with GDM in pregnancy. Materials and methods In a cross-sectional study, 382 pregnant women at their first antenatal checkup (ANC) were enrolled in the study. Serum thyroid-stimulating hormone (TSH), free T4 (FT4), anti-TPO Ab, and the 75 g oral glucose tolerance test (OGTT) were evaluated. The results obtained were analyzed in Systat Version 13.2 (SPSS Inc., Chicago, IL). Observations Results showed an SCH prevalence of 37.69% with a raised anti-TPO Ab titer in 49.31% of the diagnosed SCH cases, pointing towards an autoimmune etiology. Our study revealed a GDM prevalence of 12.04%. Out of the 46 GDM cases, 16 were found to have SCH and 3 cases had raised anti-TPO Ab titers. In our study, 27.73% of euthyroid pregnant women had a raised anti-TPO Ab titer. Our study revealed no significant association between GDM, SCH, and raised anti-TPO Ab titer. Conclusion Anti-TPO antibody subsequently leads to hypothyroxinemia, for which it is necessary that cases with high titer of anti-TPO antibody though euthyroid should be meticulously followed up and screened for to detect development of hypothyroidism or SCH, particularly in future pregnancies. However, GDM prevalence was at par with the national figure, but with no significant association of SCH and a high anti-TPO ab titer was found with GDM in our study. Further studies with a larger cohort may establish a causal association between the two most common endocrinological disorders observed in pregnancy.
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Affiliation(s)
- Prakruti Dash
- Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Rajlaxmi Tiwari
- Biochemistry, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, IND
| | - Saurav Nayak
- Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Saubhagya K Jena
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Manaswini Mangaraj
- Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
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Shah C, Vaishnav S, Mankad S, Sharma T, Sapre S, Raithatha N, Patel M, Mannari J. Silent upsurge of gestational diabetes: Are we aware? A rural tertiary care experience of Central Gujarat. J Family Med Prim Care 2022; 11:1019-1025. [PMID: 35495827 PMCID: PMC9051691 DOI: 10.4103/jfmpc.jfmpc_1059_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/12/2021] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background: Subjects and Methods: Results: Conclusion:
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Role of ferritin and oxidative stress index in gestational diabetes mellitus. J Diabetes Metab Disord 2021; 20:1615-1619. [PMID: 34900812 DOI: 10.1007/s40200-021-00911-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/25/2021] [Indexed: 02/08/2023]
Abstract
Objectives To investigate the role of serum ferritin and oxidative stress in the development of GDM and to assess their relationship with the ensuing hyperglycemia. Methods A case-control study was carried on 90 non-anemic pregnant women of 20-40 years with a gestation of 24-28 weeks. Study group (n = 65) was identified according to the Diabetes in Pregnancy Study Group India (DIPSI) criteria (2-h plasma glucose ≥ 140 mg/dl) and controls (n = 25) having 2-h plasma glucose < 120 mg/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. Results Pre-pregnancy BMI showed a significant difference between control and study group. DIPSI 2 h blood glucose, HbA1c, serum ferritin and OSI were significantly higher in study group compared to control group. Both 2 h blood glucose and HbA1c were positively correlated with serum ferritin and OSI, serum ferritin and OSI were also positively correlated with each other. Conclusion Higher pre-pregnancy BMI elevates serum ferritin, which in turn increases the OSI. Both ferritin and oxidative stress raises 2 h 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.
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Chandrasekaran PR, Madanagopalan VG, Narayanan R. Diabetic retinopathy in pregnancy - A review. Indian J Ophthalmol 2021; 69:3015-3025. [PMID: 34708737 PMCID: PMC8725079 DOI: 10.4103/ijo.ijo_1377_21] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetes and gestational diabetes (GD) are areas of concern worldwide. GD can eventually lead to serious development of diabetic retinopathy (DR) during pregnancy or worsening of an already existing DR. GD confers future risk of diabetes, both in the mother and fetus, further complicating their lives. DR in pregnant women has been intriguing in terms of understanding the prevalence, assessing risk factors causing pathogenesis, and problems associated with treating them. Pregnancy itself is a risk factor for progression of DR. Physiological changes such as metabolic, vascular, immunologic, and hormonal changes that occur during pregnancy can cause development as well as worsening of DR. This can eventually lead to permanent visual loss if not addressed on time. Timing of laser, choice of treatment for diabetic macular edema with laser, intravitreal anti-vascular endothelial growth factor agents (VEGF), and intravitreal steroids pose a serious challenge in managing these patients without causing damage to the mother and fetus. This review article showcases the prevalence, risk factors, and pathogenesis, outlines the management of DR in pregnancy, and recommends guidelines based on the available evidence. PubMed and MEDLINE searches were performed pertaining to the prevalence of GD in India, DR in pregnancy, risk factors for progression of DR, role of vasoactive mediators in DR, role of angiopoietic factors in DR, hormonal influence of DR, role of growth factors in DR, use of fluorescein and indocyanine green angiography, retinal lasers, anti-VEGF agents, intravitreal steroids, anesthesia, and retinal surgery, all pertaining to pregnancy and guidelines and recommendations for managing DR in pregnancy.
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Affiliation(s)
| | - V G Madanagopalan
- Cataract and Vitreoretinal Services, JB Eye Hospital, Salem, Tamil Nadu, India
| | - Raja Narayanan
- Director-The Retina Institute and Suven Clinical Research Centre, Consultant Ophthalmologist, Vitreo Retinal Diseases, Kallam Anji Reddy Campus, L V Prasad Eye Institute, Hyderabad, Telangana, India
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A study to investigate the elevated maternal haemoglobin value as a risk biomarker for gestational diabetes: A nested case control study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Thanawala U, Divakar H, Jain R, Agarwal MM. Negotiating Gestational Diabetes Mellitus in India: A National Approach. ACTA ACUST UNITED AC 2021; 57:medicina57090942. [PMID: 34577865 PMCID: PMC8467131 DOI: 10.3390/medicina57090942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 11/21/2022]
Abstract
The worldwide epidemic of diabetes mellitus and hyperglycemia in pregnancy (HIP) presents many challenges, some of which are country-specific. To address these specific problems, parochial resolutions are essential. In India, the government, by working in tandem with (a) national groups such as the Diabetes in Pregnancy Study Group of India, and (b) global organizations such as the International Diabetes Federation, has empowered the medical and paramedical staff throughout the country to manage HIP. Additionally, despite their academic university backgrounds, Indian health planners have provided practical guidelines for caregivers at the ground level, who look up to these experts for guidance. This multipronged process has helped to negotiate some of the multiple problems that are indigenous and exclusive to India. This review traces the Indian journey to manage and prevent HIP with simple, constructive, and pragmatic solutions.
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Affiliation(s)
| | - Hema Divakar
- Divakar Specialty Hospital, Bengaluru 560078, India;
| | | | - Mukesh M. Agarwal
- Department of Pathology, California University of Science and Medicine, Colton, CA 92324, USA
- Correspondence:
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Pace NP, Vassallo J. Association Between Neutrophil-Lymphocyte Ratio and Gestational Diabetes-A Systematic Review and Meta-Analysis. J Endocr Soc 2021; 5:bvab051. [PMID: 34095691 PMCID: PMC8169042 DOI: 10.1210/jendso/bvab051] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Indexed: 12/21/2022] Open
Abstract
A growing body of evidence shows that the neutrophil-lymphocyte ratio (NLR) is a surrogate index of systemic inflammation in several chronic diseases. Conflicting associations between NLR and gestational diabetes mellitus (GDM) have been reported in individual studies. This meta-analysis sought to investigate the association between NLR and GDM. The PubMed, EMBASE, and Google Scholar databases were searched to identify relevant articles. The pooled standardized mean difference with 95% CI was calculated using a random-effects model. Subgroup and meta-regression analysis were carried out to control for the effects of GDM diagnostic criteria, ethnicity, body mass index (BMI), and age. Eleven eligible articles were included, containing 1271 participants with GDM and 1504 controls. Pooled outcomes indicated a higher NLR in GDM pregnancies than in normoglycemic controls (SMD = 0.584; 95% CI, 0.339-0.830; P < .001), although extensive heterogeneity between studies was noted. Subgroup analysis revealed that the higher pooled estimate in GDM was not affected by diagnostic criteria, ethnicity, or BMI, although matching for BMI reduced heterogeneity between studies. This meta-analysis supports the higher NLR in GDM described by some individual studies.
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Affiliation(s)
- Nikolai Paul Pace
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
| | - Josanne Vassallo
- Centre for Molecular Medicine and Biobanking, Faculty of Medicine and Surgery, University of Malta, MSD2080 Msida, Malta
- Department of Medicine, Faculty of Medicine and Surgery, University of Malta, MSD2080, Msida, Malta
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