World Health Organization Versus Diabetes in Pregnancy Study Group India Approaches in the Screening of Gestational Diabetes Among Pregnant Women With Risk Factors: A Study Among Rural Population of Telangana, South India

BackgroundGestational diabetes mellitus (GDM) represents a pathological condition wherein pregnant women (PW) suffer from glycemic dysregulation, which predisposes them to an increased risk of developing complications related to pregnancy and childbirth. The most commonly used guidelines to screen for GDM include those provided by the World Health Organization (WHO), the American Congress of Obstetricians and Gynecologists, the Canadian Diabetes Association, and the International Association of Diabetes and Pregnancy Study Group. The Diabetes in Pregnancy Study Group India (DIPSI) guidelines are national-level recommendations to screen for GDM in India. This study aimed to compare the efficacy of DIPSI criteria versus the WHO guidelines in screening for GDM among the rural population of Telangana, South IndiaMethodsA total of 300 PW aged 19-35 years with a gestational age of 24-28 weeks attending the antenatal clinic attached to Mahavir Institute of Medical Sciences (MIMS), Vikarabad, Telangana, India were included in the study. The study was approved by the Institutional Ethics Committee of MIMS, and informed consent was obtained from all the participants. Of the 300 subjects included, 75 PW were categorized as at-risk for GDM based on risk factors and were included for further analysis. The data relating to body mass index (BMI), oral glucose tolerance test, and the diagnosis of GDM based on DIPSI and the WHO criteria were collected.ResultsOut of the 75 PW included in the study, an overall GDM prevalence of 32% was noted among which 20 (26.7%) were diagnosed using the WHO criteria, 12 (16%) by DIPSI criteria, and the remaining 73.3% were non-GDM women. The mean gestational age and BMI among non-GDM and GDM patients were 24.74 +/- 4.15 weeks, 22.24 +/- 3.60 kg/m2, and 25.70 +/- 4.40, 24.48 +/- 3.37 kg/m2 (p<0.01), respectively. The activities of glucose at the second hour after a GTT among non-GDM and GDM cases were 113.70 +/- 20.4 mg/dL and 128.04 +/- 18.6 mg/dL (p=0.004), respectively.ConclusionDIPSI criteria could identify fewer numbers of GDM women as compared to the WHO criteria. Although the DIPSI criteria are convenient and prescribe less number of interventions, they could possibly miss many cases of GDM. Moreover, PW who remain undiagnosed could, in the future, be at risk of developing diabetes. Based on the study results and because risks should outweigh the benefits, we propose that DIPSI cannot be implemented as a single criterion to screen for GDM among PW in Indian settings.