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More cases of diabetes during pregnancy likely: Study

The study for prevalence of gestational diabetes mellitus (GDM) that used higher screening cutoff level found 15 percent of the cases had GDM. The number is expected to be higher if a lower screening cutoff level is employed for the study.

GDM is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Treating GDM is important to avoid pre-birth and maternal complications during pregnancy.

Head of Department of Obstetrics and Gynecology at Jigme Dorji Wangchuck National Referral Hospital (JDWNRH), Dr Phurb Dorji, said that treating GDM results in significant decrease in the incidence of preeclampsia (pregnancy complication characterised by high blood pressure and signs of damage to another organ system, most often the liver and kidneys), shoulder dystocia (specific case of obstructed labour whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below, or requires significant manipulation to pass below, the pubic symphysis), fetal macrosomia (newborn who’s significantly larger than average), infant death, bone fracture, and nerve palsy (disorder associated with dysfunction of nerve).”

Although, there are no standardised criteria for GDM screening, there are various guidelines provided by different organisations.

“WHO guidelines can be used in communities or places with lower diabetes rate. Even with a higher screening cutoff, there was 15 percent. If we had taken lower screening cutoff, the cases would have been much higher,” said Dr Phurb Dorji.

He added that to use higher screening cutoff level for GDM, the guidelines of the UK-based National Institute for Health and Care Excellence (NICE) could be used.

NICE guidelines opt 5.6-mmol/L (101-mg/dL) cutoff to diagnose gestational diabetes. World Health Organisation (WHO), on the other hand, use cutoff of 5.1 mmol/L (92 mg/dL).

This means that NICE guidelines will result in fewer women being diagnosed with gestational diabetes.

Dr Phurb Dorji said that the study opted for higher GDM cutoff level because a study conducted in 2007 showed 2.5 percent of people diagnosed with diabetes in Thimphu. “Once identified, GDM should be managed. If we identify more, then we are talking about 6,000 cases and it would be unmanageable.”

The study covered 736 participants from three hospitals – JDWNRH, central regional referral hospital (CRRH), and eastern regional referral (ERRH) hospital.

The study showed 14.6 percent GDM cases in central regional hospital, 15.4 percent in eastern regional hospital, and 15.1 percent in JDWNRH.

Of the total participants, 10 could not be followed up. The study so detected 109 GDM cases, which is 15 percent.

The GDM rate in the India varied from 3.8 to 21 percent, from 2 to 6 percent in Europe, from 9.7 to 12.9 percent in Bangladesh, and from 2.5 to 6.56 percent in Nepal.

Dr Phurb Dorji said that ethnicity and GDM cases in previous pregnancy could be significant risk factors in the prevalence of GDM.

Phurpa Lhamo

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