the prevalence of gestational diabetes in women in third world countries
Orientals, first-generation Hispanics, women from the Indian subcontinent and the Middle East, those with a history of infertility, and women with low socioeconomic status are at an increased risk for gestational diabetes (5).
Green et al. (11) from the University of California, San Francisco showed that the incidence of gestational diabetes was significantly greater for Chinese (7.3%) and Hispanic (4.2%) women than for Black (1.7%) and non-Hispanic White (1.6%) women.
In a cross sectional study, Ferrara et al. (12) screened a total of 26,481 women using a 50-g, 1-h oral glucose tolerance test (GTT), and 4,190 of these women underwent a diagnostic 100-g, 3-h oral GTT after an abnormal screening. The age-adjusted GDM prevalence by NDDG and Carpenter and Coustan (C & C) criteria, respectively, was 5.0 and 7.4% in Asians, 3.9 and 5.6% in Hispanics, 3.0 and 4.0% in African-Americans, and 2.4 and 3.8% in whites.
Dabalea et al. (13) showed that the prevalence of GDM is increasing in a universally screened multiethnic population. The increasing GDM prevalence suggests that the vicious cycle prenatal exposure to maternal diabetes predisposing to DM2 initially described among Pima Indians may also be occurring among other US ethnic groups.
Engelgau et al. (14) report that while gestational diabetes complicates about 5% of all pregnancies, the rate of occurrence can range up to 14% depending on the population. Three other studies have also shown that gestational diabetes is more common in those ethnic groups who are at higher risk for diabetes per se - African Americans, Native Americans, Mexican Americans, Asian Americans, and Pacific Islanders (15-17).
Beischer et al. (18) reported in 1991 that in Australia, GDM prevalence was found to be higher in women whose country of birth was China or India than in women whose country of birth was Europe or Northern Africa, and Ishak et al. (19) reported that the prevalence of GDM is significantly higher in the Aboriginal population of Australia than in the country's non-Aboriginal population.
Cheung et al. (20) examined the records of 2,139 Asian women living in Australia. The overall incidence of GDM was 9.2%. Among women born in China, it was 8.6% - the Philippines 6.7%, Sri Lanka 10.5%, and Vietnam 10.6%. These incidences are comparable with those found in studies of Asian women in developed countries but are higher than those found in studies conducted in Asia.
In 1992, Dornhorst et al. (21) assessed 11,205 consecutive women attending a multiracial antenatal clinic in London, where all women were screened for gestational diabetes. Women from ethnic groups other than white had a higher frequency of gestational diabetes than white women (2.9% vs. 0.4%, P < 0.001). Compared with white women the relative risk (RR) of gestational diabetes in the other ethnic groups was as follows: Black 3.1 (95% confidence limits 1.8-5.5), South East Asian 7.6 (4.1-14.1), Indian 11.3 (6.8-18.8), and miscellaneous 5.9 (3.5-9.9).
It is apparent that most of the data relating to ethnic variations in the prevalence/incidence of gestational diabetes are typically based on US, UK, Canadian, or Australian statistics, which are then extrapolated to the country of origin. This extrapolation does not take into account any genetic, cultural, environmental, social, racial, or other differences across the various countries and regions.
At the same time, there a few studies that have been done in the developing countries themselves (Table 4) (22-39). These have been either population- or hospital-based studies.
Reported prevalence rates in population-based studies in Turkey, Iran, Bahrain, Ethiopia, and India ranged from 1.2% in Turkey by National Diabetes Data Group (NDDG) criteria following universal screening to 15.5% in Bahraini women by C & C criteria with a 3-h 75-g OGTT following universal screening. Reported prevalence rates in hospital-based studies in Turkey, Iran, Pakistan, India, and Sri Lanka are between 4.1 and 4.7%, with the exception of the study conducted in India, which used the 1999 World Health Organization (WHO) diagnostic criteria and reports a prevalence of 18.9%, as well as the study conducted in Turkey, which reports a prevalence of 6.6% using the C & C criteria.
Table 4
Community and Hospital-Based Gestational Diabetes Prevalence Studies Carried out in Third World Countries (22-39)
Country
Screening criteria
GDM criteria
Ethnic group
GDM prevalence
Iran
Community based (22)
Community based (23)
Hospital based (24)
Brazil Community based (25)
Ethiopia Community based (26)
India
Community based (27)
Hospital based (28)
Hospital based (29)
Turkey Community based (30)
Hospital based (31)
Universal screening at 24-28 weeks; 1-h 50-g GCT > 130 Universal screening at 24-28 weeks; 1-h 50-g GCT > 130 Universal screening high risk - initial visit and at 24-28 weeks; 1-h 50-g GCT > 130
Universal testing at 24-28 weeks; 2-h 75-g OGTT
Universal testing after 24 weeks
Universal screening second or third trimester; 1-h 50-g GCT > 140 Universal screening second or third trimester; 1-h 50-g GCT > 130 100-g, 3-h oral glucose tolerance test (GTT) at 30 ± 2 weeks gestation
Universal screening at 24-28 weeks; 1-h 50-g GCT > 140 Universal screening at 24-32 weeks; 1-h 50-g GCT > 140
NDDG
ADA post 1997 and WHO 1999 including 0 h >126
WHO 1999
WHO, 1999 including 0 h >126
NDDG
Urban Iranian, ethnicity non-specified Urban Iranian, ethnicity non-specified Urban Iranian, ethnicity non-specified
Mixed
Community based;
ethnicity non-specified
Kashmiri Indian 6 districts
S. Indian urban, ethnicity non-specified
S. Indian urban, ethnicity non-specified
Urban Turkish, ethnicity non-specified Urban Turkish
(continued)
|
Table 4 | ||||
|
(continued) | ||||
|
Country |
Screening criteria |
GDM criteria |
Ethnic group |
GDM prevalence |
|
China | ||||
|
Community based (32) |
Universal screening at |
WHO, 1999 |
Six urban |
2.3% |
|
26-30 weeks; 1-h |
including |
districts | ||
|
50-g GCT > 140 |
0 h >126 | |||
|
Bahrain | ||||
|
Community based (33) |
Universal screening at |
C & C with a 3 h |
Mixed; Bahraini |
13.3% Total; |
|
24-28 weeks; 1-h |
75 g OGTT |
and expats |
15.5% | |
|
50-g GCT > 140 |
expatriate | |||
|
Mexico | ||||
|
Hospital based (34) |
Universal screening; |
NDDG; C & C; |
Ethnicity non- |
3.2%, NDDG; |
|
1-h 50-g GCT > 140 |
WHO 1999 |
specified |
4.1%, C & | |
|
(initial visit); WHO |
C; 8.7%, | |||
|
diagnostic (second |
WHO | |||
|
visit) | ||||
|
Pakistan | ||||
|
Hospital based (35) |
Universal screening at 24-36 weeks; 1-h 50-g GCT > 130 |
NDDG |
Urban Pakistani, ethnicity non-specified |
4.3% |
|
Hospital based (36) |
2-h 75-g glucose chal- |
Modified |
Urban Pakistani, |
3.2% |
|
lenge on initial visit; |
O'Sullivan |
ethnicity non- | ||
|
the test was repeated |
criteria |
specified | ||
|
at 28-32 weeks of | ||||
|
gestation | ||||
|
Hospital based (37) |
50-g glucose load. 1-h |
Modified |
Urban Pakistani, |
3.45% |
|
50-g GCT > 130+ |
O'Sullivan |
ethnicity non- | ||
|
and followed by a |
criteria |
specified | ||
|
3-h oral GTT with | ||||
|
a 100-g glucose | ||||
|
load. Women with a | ||||
|
negative result were | ||||
|
retested at 24-weeks | ||||
|
gestation | ||||
|
Sri Lanka | ||||
|
Hospital based (38) |
Universal testing at 24-28 weeks |
WHO, 1985 |
Urban Sri Lankan, ethnicity nonspecified |
4.1% |
|
Hospital based (39) |
Universal screening at |
75-g oral GTT |
Urban Sri |
5.5% |
|
24-36 weeks; 1-h |
and WHO |
Lankan, | ||
|
50-g GCT > 130 |
criteria |
ethnicity nonspecified | ||
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