Rajesh Jain1*, Veeraswamy Seshiah2 N, Guneeta Mehta Jain3, Pikee Saxena4, 5Shaily Agarwal, 6Sadhana Tiwari 2MD, FRCP, Distinguished Professor, The Tamil Nadu Dr. M.G.R. Medical University, Chennai, India;3MD, Department of Obstetrics & Gynecology, Med Gynae clinic, Saharanpur, UP, India; 4MD, Department of Obstetrics and Gynecology, Lady Hardinge Medical college, New Delhi; 5MD, Department of Obstetrics & Gynecology, GSVM Medical College, Kanpur, India; 6MD Fellow, Department of Obstetrics and Gynecology, GSVM Medical College, Kanpur, India Submitted: 28 June 2024; Accepted: 10 July 2024; Published: 20July 2024 1*Corresponding Author, Rajesh Jain MD, PG Diploma Diabetes (UK), Project Manager, Diabetes Prevention Control Project, NHM, Uttar Pradesh, India, 108 B Gandhi gram, Vinobha nagar, Kanpur-208007, India Email:[email protected] Abstract Gestational diabetes mellitus (GDM) is a state metabolic disorder caused by carbohydrate intolerance during pregnancy for the first time. This disease is very important as it affects the mother and fetus. It is said that GDM disrupts the pregnancy process and causes many diseases, such as recurrent miscarriage, congenital anomalies, preeclampsia, stillbirth, macrosomia, preterm birth, and emergency delivery after pregnancy, pregnancy, and delivery. It also causes long-term complications by inducing type 2 diabetes mellitus in mothers and children. GDM is generally considered a lifestyle disorder, and therefore, its burden varies by race, geographic boundaries, genetics, and reproductive risk. Consequently, it is necessary to investigate the prevalence and risk of GDM to evaluate prevention strategies. Ist Trimester early management of Dysglycemia with Medical Nutrition Treatment (MNT) and Metformin is promising. It might be advocated in the future for curtailing the epidemic of GDM and Type 2 Diabetes. Recently, the TOBOGM study and our ongoing trial with early dysglycemia in 8-10 weeks of gestation resulted in better maternal-fetal outcomes and reduced GDM conversion during pregnancy. This publication is important as the final results of our trial will be published soon. Prevalence India is one of the countries with diabetes in the world and has one of the highest rates of GDM in women, affecting more than 5 million women in the country each year [1]. India currently has the second highest number of people with type 2 diabetes in the world at 77 million; Almost half of these patients are women. IDF 2019 estimates that 6 million newborns in India alone are affected by some form of hyperglycemia (HIP) during pregnancy, 90% of which are due to GDM [1]. Therefore, all women should be tested for gestational diabetes, even if they are asymptomatic. Unfortunately, the diagnostic criteria are not the same. (Table-1) Table – 1: Diagnostic Criteria used by International/National organizations for estimating gestational diabetes. Organization Fasting Plasma Glucose mmol/dl or mg/dl Glucose Challenge 1 h Plasma Glucose mmol/dl or mg/dl 2 h Plasma Glucose 3 h Plasma Glucose WHO1999 1 ≥7.0 or 125 75gm OGTT Not required ≥7.8 or 140 mg/dl Not required WHO2 2013 ≥5.1 or 92 ≥10.0 or 180 ≥8.5 or 153 mg/dl ADA3/American college Obstetricians & Gynaecologist4 2018 ≥ 5.3 or 95 100gm OGTT ≥10.0 or 180 ≥8.6 or 155 mg/dl ≥7.8 or 140 mg/dl ADIPS 5 2014 ≥5.1 or 92 ≥10.0 or 180 ≥8.5 or 153 mg/dl EASD6, 1991 ≥7.0 or 125 ≥10.0 or 180 FIGO7, 2015 ≥5.1 or 92 ≥10.0 or 180 ≥8.5 or 153 mg/dl Diabetes Canada Clinical Practice Guidelines8, 2018 ≥5.3 or 95 75gm OGTT ≥10.6 ≥8.9 or 160 mg/dl Not required IADPSG9 ≥5.1 0r 92 75gm OGTT ≥10.0 0r 180 ≥8.5 or 153 mg/dl Not required DIPSI10 2014 – 75 gm OGTT, non-fasting – ≥7.8 or 140 mg/dl Not required NICE11 ≥5.6 or 100 ≥7.8 or 140 mg/dl Not required Note: 1WHO 1999 Guidelines: World health Organization; 2WHO 2013 Guidelines 3ADA: American Diabetes association; 4ACOG: American College of Obstetrician and Gynecologist; 5ADIPS: Australasian Diabetes in Pregnancy Society; 6EASD: European Association for the Study of Diabetes; 7FIGO: International Federation of Gynaecology and Obstetrics; 8Diabetes Canada clinical Practice Guidelines; 9IADPSG: International Federation of Gynaecology and Obstetrics; 10DIPSI: Diabetes in Pregnancy Study Group in india; 11NICE: National Institute of Clinical Excellence Diabetes in Pregnancy: Global, Regional, and Indian Scenario The global diabetes epidemic is on the rise. According to IDF Head Professor Andrew Boulton, diabetes has become an epidemic. The global prevalence of diabetes is estimated to rise from 537 million in 2021 to 783 million in 2045, an increase of 46%. [1] Diabetes is common worldwide, and this is a concern; by 2021, there will be 74.1 million diabetics in India. This increase may be due to the aging of the Population, physical inactivity, urbanization, and obesity. These conditions increase the risk of diabetes mellitus, but early life is a risk factor. As suggested in David Baker’s “Fetal origins of adult disease” hypothesis, pregnancy planning can significantly impact adult health and disease. Pregnancy can be defined as the process in which stress or stimulus during a sensitive or important period of fetal development permanently changes the structure, body, and metabolism and thus creates a predisposition to a disease in the elderly. Lifestyle changes and medical interventions have been reported to slow or delay the development of Type-2 diabetes mellitus in people affected by impaired glucose tolerance (IGT), the first line of defense. Maintaining normoglycemia in GDM or other vulnerable individuals is the best option to prevent developing type 2 diabetes (T2DM). Diabetes can be reversed or stopped through primary prevention. For primary prevention of diabetes mellitus, women with gestational diabetes (GDM) are considered an ideal group because their children are more likely to have diabetes, and most of them acquired T2DM. Gestational diabetes may be an important factor in diabetes and obesity. By 2021, the Global prevalence of hyperglycemia in pregnancy (HIP) will be 21.1 million people, accounting for 16.7% of births to women aged 20-49. These individuals may experience some form of hyperglycemia during pregnancy; 80.3% of these were due to GDM [2]. Therefore, all women must be tested for GDM, even if they have
