Gestational diabetes mellitus in Tajikistan

Pirmatova, Dilnoza (2022): Gestational diabetes mellitus in Tajikistan: prevalence and management. Dissertation, LMU München: Medizinische Fakultät

Abstract

Background: Gestational diabetes mellitus (GDM) is currently the most common medical complication of pregnancy worldwide. The prevalence of undiagnosed hyperglycemia and even overt diabetes in women of reproductive age is increasing. No data are available on the prevalence of GDM in Tajikistan. This study evaluated the prevalence of GDM and the obstetric and neonatal outcomes of pregnancies in an urban and a rural setting of Tajikistan. Methods: Cross-sectional study conducted among pregnant women presented to the the Reproductive Health Centers in Dushanbe and Qurghonteppa between December 2015 and May 2018. Pregnant women were included in the study during the 1st trimester of pregnancy. The collection of data was carried out according to a specially structured questionnaire, where data on visits were recorded. Between weeks 24 and weeks 28 of gestation an oral glucose tolerance test (OGTT) with 75 g of glucose was performed. GDM was diagnosed if any one of the venous plasma glucose values was met or exceeded (fasting ≥ 5.1 mmol/L; at 60 min ≥ 10.0 mmol/L and at 120 min ≥ 8.5-11.0 mmol/L). Obstetric and neonatal otcomes were recorded after delivery. H-Kruskal-Wallis, Mann-Whitney U and Chi-square tests were used. Results: Of 2643 women (age 25.3±5.3 years, BMI 23.8±4.3 kg/m2), 92.2% underwent an OGTT and of these 29.7% had elevated fasting plasma glucose values (mostly minimally elevat-ed), while 2.8% had elevated 60 min and/or 120 min values. The overall prevalence of GDM was 32.4%. Age (p=0.001), weight (p=0.001), BMI (p=0.002) and parity (p=0.012) were associated with GDM. The obstetric and neonatal outcome of women with only elevated fasting glucose levels was not different from women with normal glucose levels. Women with abnormal blood glucose concentration after 60 min and/or 120 min had a significantly higher rate of complica-tions, threatening miscarriage, infection of urinary tract and emergency Cesarean section while affected newborns had lower birth weight, lower APGAR and lower 30 min glucose levels. Discussion: The study determined for the first time the prevalence of GDM in Tajikistan both in urban and rural areas. Most cases of GDM were diagnosed on the basis of slightly elevated fast-ing glucose level, which was not associated with adverse obstetric or neonatal outcomes, while women and neonates from women with elevated 60 min or 120 min values had significantly more complications. These findings are in agreement with recent studies from Denmark and the USA, showing that very mild forms of GDM (identified by slightly elevated fasting glucose levels) are not associated with an adverse outcome. Conclusion: Although the formal prevalence of GDM is high in Tajikistan, the applicability of the one step OGTT for the screening and diagnosis of GDM must be questioned, as most of the identified women have a normal pregnancy outcome. At the same time this strategy puts the burden of receiving a diagnosis of GDM on individual women and the burden of treating many more women on the health care system. A two-step screening or a one step screening in women with risk factors for GDM maybe a better strategy in a setting were the prevalence of « severe » GDM is low.

• Dokumententyp: Dissertationen (Dissertation, LMU München)
• Keywords: Gestational diabetes, prevalence, fasting plasma glucose level, OGTT, risk, outcomes
• Themengebiete: 600 Technik, Medizin, angewandte Wissenschaften ; 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin und Gesundheit
• Fakultäten: Medizinische Fakultät
• Sprache der Hochschulschrift: Englisch
• Datum der mündlichen Prüfung: 25. Juli 2022
• 1. Bericht­erstatter:in: Parhofer, Klaus