Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery among pregnant women: a national prevalence study of 11 provinces in Iran
Vol. 62 No. 4 (2021), Health Promotion
Vol. 62 No. 4 (2021)

Prevalence of gestational diabetes and its association with stillbirth, preterm birth, macrosomia, abortion and cesarean delivery among pregnant women: a national prevalence study of 11 provinces in Iran

Health Promotion
https://doi.org/10.15167/2421-4248/jpmh2021.62.4.1788
Published 2022-01-04
  • Mitra Darbandi
  • Shahab Rezaeian+−
  • Mostafa Dianatinasab
  • Halime Yaghoobi
  • Maryam Soltani
  • Koorosh Etemad
  • Tannaz Valadbeigi
  • Niloufar Taherpour
  • Mahmoud Hajipour
Mitra Darbandi
Shahab Rezaeian
Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
http://orcid.org/0000-0002-5094-5315
Mostafa Dianatinasab
Halime Yaghoobi
Maryam Soltani
Koorosh Etemad
Tannaz Valadbeigi
Niloufar Taherpour
Mahmoud Hajipour
pdf

Keywords

Gestational diabetes mellitus
macrosomia
abortion
stillbirth

Abstract

Background: Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders during pregnancy that significantly affects perinatal outcomes.

Objective: The aim of this study was to determine the prevalence of GDM and its relation with the incidence of stillbirth, preterm birth, macrosomia, abortion and cesarean section (C-section) delivery in pregnant women.

Methods: This cross-sectional study was conducted on 3675 pregnant women in 11 provinces across Iran. Cluster sampling was used to select samples from mothers covered by health plans in 11 provinces of Iran. Prevalence of adverse pregnancy outcomes, including preterm delivery, type of delivery, macrosomic preterm birth, miscarriage, stillbirth, infant death, and birth weight were measured, using family record and face-to-face interviews. Data were analyzed by logistic regression, using STATA14.2 software.

Results: About four percent of Iranian pregnant women had GDM during pregnancy. Prevalence of C-section was significantly higher in diabetic women than in the non-diabetic ones (53.19 vs 46.81, respectively, P <0.001). Abortion in diabetic mothers was more than twice that of the non-diabetic mothers (P <0.001). In the adjusted logistic regression model, the odds of stillbirth in mothers with GDM were 1.8 (95% CI: 1.11, 2.91, P = 0.018) times higher than that of the non-diabetics. The odds of macrosomia in diabetic women was about 7 times higher than the non-diabetic women (95% CI: 2.81, 17.14, P <0.001). The odds of GDM had an increasing trend according to the BMI (p <0.001). The risk of GDM were significantly lower, according to the daily physical activity (PA) (p <0.001).

Conclusion: The GDM prevalence has a decreasing trend in Iran. It increases the adverse pregnancy outcomes such as stillbirth, neonatal deaths, macrosomia, preterm birth, abortion and C-section delivery. As, some of these consequences like macrosomia are not treatable, thus early prevention is very crucial.

https://doi.org/10.15167/2421-4248/jpmh2021.62.4.1788
pdf

References

1. Erjavec K, Poljičanin T, Matijević RJJop. Impact of the implementation of new WHO diagnostic criteria for gestational diabetes mellitus on prevalence and perinatal outcomes: a population-based study. Journal of pregnancy. 2016;2016.
2. Eades CE, Cameron DM, Evans JM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. diabetes research clinical practice. 2017;129:173-81.
3. Mwanri AW, Kinabo J, Ramaiya K, Feskens EJ. Gestational diabetes mellitus in sub‐Saharan Africa: systematic review and metaregression on prevalence and risk factors. Tropical Medicine International Health. 2015;20(8):983-1002.
4. Alfadhli EM, Osman EN, Basri TH, Mansuri NS, Youssef MH, Assaaedi SA, et al. Gestational diabetes among Saudi women: prevalence, risk factors and pregnancy outcomes. Annals of Saudi medicine. 2015;35(3):222.
5. Nguyen CL, Pham NM, Binns CW, Duong DV, Lee AH. Prevalence of Gestational Diabetes Mellitus in Eastern and Southeastern Asia: A Systematic Review and Meta-Analysis. Journal of diabetes research. 2018;2018:1-8.
6. Wahi P, Dogra V, Jandial K, Bhagat R, Gupta R, Gupta S, et al. Prevalence of gestational diabetes mellitus (GDM) and its outcomes in Jammu region. J Assoc Physicians India. 2011;59(4):227-30.
7. Alwan N, Tuffnell DJ, West J. Treatments for gestational diabetes. Cochrane database of systematic reviews. 2009;8(3).
8. Metzger BE, Buchanan TA, Coustan DR, De Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the fifth international workshop-conference on gestational diabetes mellitus. Diabetes care. 2007;30(Supplement 2):S251-S60.
9. Ashwal E, Hod M. Gestational diabetes mellitus: where are we now? Clinica chimica acta. 2015;451:14-20.
10. Gorgal R, Gonçalves E, Barros M, Namora G, Magalhães Â, Rodrigues T, et al. Gestational diabetes mellitus: A risk factor for non‐elective cesarean section. Journal of Obstetrics Gynaecology Research. 2012;38(1):154-9.
11. Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstetrics Gynecology. 2006;108(3):644-50.
12. Nielsen GL, Nørgard B, Puho E, Rothman K, Sørensen HT, Czeizel A. Risk of specific congenital abnormalities in offspring of women with diabetes. Diabetic Medicine. 2005;22(6):693-6.
13. Aviram A, Guy L, Ashwal E, Hiersch L, Yogev Y, Hadar E. Pregnancy outcome in pregnancies complicated with gestational diabetes mellitus and late preterm birth. Diabetes research clinical practice. 2016;113:198-203.
14. Sit D, Luther J, Dills JL, Eng H, Wisniewski S, Wisner KL. Abnormal screening for gestational diabetes, maternal mood disorder, and preterm birth. Bipolar disorders. 2014;16(3):308-17.
15. Fatemi MJ, Fararouei M, Moravej H, Dianatinasab M. Stunting and its associated factors among 6–7-year-old children in southern Iran: a nested case–control study. Public health nutrition. 2019;22(1):55-62.
16. World Health Organization. Global database on body mass index: an interactive surveillance tool for monitoring nutrition transition Geneva: WHO; 2009 [Available from: http://www.who.int/bmi/index.jsp.
17. American Diabetes Association. Classification and diagnosis of diabetes mellitus. Diabetes Care. 2006;29(1):S4-S7.
18. Lisowski LA, Verheijen PM, Copel JA, Kleinman CS, Wassink S, Visser GH, et al. Congenital heart disease in pregnancies complicated by maternal diabetes mellitus. Herz. 2010;35(1):19-26.
19. Macumber I, Schwartz S, Leca N. Maternal obesity is associated with congenital anomalies of the kidney and urinary tract in offspring. Pediatric Nephrology. 2017;32(4):635-42.
20. Liu S, Rouleau J, Leon J, Sauve R, Joseph K, Ray J, et al. Impact of pre-pregnancy diabetes mellitus on congenital anomalies, Canada, 2002–2012. Health promotion chronic disease prevention in Canada: research, policy practice. 2015;35(5):79.
21. Nagle C, Skouteris H, Hotchin A, Bruce L, Patterson D, Teale G. Continuity of midwifery care and gestational weight gain in obese women: a randomised controlled trial. BMC public health. 2011;11(1):174.
22. Basraon SK, Mele L, Myatt L, Roberts JM, Hauth JC, Leveno KJ, et al. Relationship of early pregnancy waist to hip ratio versus body mass index with gestational diabetes and insulin resistance. American journal of perinatology. 2016;33(1):114.
23. Makgoba M, Savvidou M, Steer P. An analysis of the interrelationship between maternal age, body mass index and racial origin in the development of gestational diabetes mellitus. BJOG: An International Journal of Obstetrics Gynaecology. 2012;119(3):276-82.
24. Hashemi-Nazari S-S, Najafi F, Rahimi M-A, Izadi N, Heydarpour F, Forooghirad H. Estimation of gestational diabetes mellitus and dose–response association of BMI with the occurrence of diabetes mellitus in pregnant women of the west of Iran. Health care for women international. 2018:1-10.
25. Rana JS, Li TY, Manson JE, Hu FB. Adiposity compared with physical inactivity and risk of type 2 diabetes in women. Diabetes care. 2007;30(1):53-8.
26. Boriboonhirunsarn D, Waiyanikorn R. Emergency cesarean section rate between women with gestational diabetes and normal pregnant women. Taiwanese Journal of Obstetrics Gynecology. 2016;55(1):64-7.
27. Deryabina E, Yakornova G, Pestryaeva L, Sandyreva N. Perinatal outcome in pregnancies complicated with gestational diabetes mellitus and very preterm birth: case–control study. Gynecological Endocrinology. 2016;32(sup2):52-5.
28. Yogev Y, Langer OJAog, obstetrics. Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control. 2007;276(4):361-5.
29. Garshasbi A, Faghihzadeh S, Naghizadeh MM, Ghavam M. Prevalence and risk factors for gestational diabetes mellitus in Tehran. Journal of Family Reproductive Health. 2008;2(2):75-80.
30. Jiang T-t, Zhao L, Lin Y, Zhou D, Wang L, Sun G-q, et al. Effects of gestational diabetes mellitus on time to delivery and pregnancy outcomes in full-term pregnancies with dinoprostone labor induction. Clinical Experimental Hypertension. 2018:1-5.
31. Feleke BE. Determinants of gestational diabetes mellitus: a case-control study. The Journal of Maternal-Fetal Neonatal Medicine. 2018;31(19):2584-9.
32. Leng J, Liu G, Zhang C, Xin S, Chen F, Li B, et al. Physical activity, sedentary behaviors and risk of gestational diabetes mellitus: a population-based cross-sectional study in Tianjin, China. European journal of endocrinology. 2016:EJE-15-1103.
33. Golbidi S, Laher I. Potential mechanisms of exercise in gestational diabetes. Journal of nutrition metabolism. 2013;2013.
34. Daniele G, Mendoza RG, Winnier D, Fiorentino T, Pengou Z, Cornell J, et al. The inflammatory status score including IL-6, TNF-α, osteopontin, fractalkine, MCP-1 and adiponectin underlies whole-body insulin resistance and hyperglycemia in type 2 diabetes mellitus. Acta diabetologica. 2014;51(1):123-31.
35. Hayashino Y, Jackson JL, Hirata T, Fukumori N, Nakamura F, Fukuhara S, et al. Effects of exercise on C-reactive protein, inflammatory cytokine and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism. 2014;63(3):431-40.