The incidence and risk factors of postpartum diabetes in women from Bangladesh, India and Sri Lanka (South Asia) with prior gestational diabetes mellitus: Results from the LIVING study.

Joseph Alvin Santos, Anushka Patel, Dorairaj Prabhakaran, Arunasalam Pathmeswaran, Ankush Desai, Saumiyah Ajanthan, Noshin Farzana, H Asita de Silva, Aliya Naheed, Laurent Billot, Nikhil Tandon, Devarsetty Praveen, Josyula K Lakshmi, Yashdeep Gupta, Renu John, Ishita Gupta, Deksha Kapoor, Neerja Bhatla, Helena Teede, Sophia Zoungas

Journal: Diabetes research and clinical practice 2023;204():110893

PMID: 37657646

Full Text on Elsevier Science View on PubMed

Abstract

AIM

To study, the incidence and risk factors for postpartum diabetes (DM), in women with gestational diabetes mellitus (GDM) from South Asia (Bangladesh, India and Sri Lanka), followed for nearly two years after delivery.

METHODS

Women with prior GDM diagnosed using IADPSG criteria were invited at 19 centres across Bangladesh, India and Sri Lanka for an oral glucose tolerance test (OGTT) following childbirth, and were enrolled in a randomized controlled trial. The glycaemic category (outcome) was defined from an OGTT based on American Diabetes Association criteria.

RESULTS

Participants (n = 1808) recruited had a mean ± SD age of 31.0 ± 5.0 years. Incident DM was identified, between childbirth and the last follow-up, in 310 (17.1 %) women [incidence 10.75/100 person years], with a median follow-up duration of 1.82 years after childbirth. Higher age, lower education status, higher prior pregnancy count, prior history of GDM, family history of DM, and postpartum overweight/obese status were significantly associated with incident DM. Women in Bangladesh had a higher cumulative incidence of DM [16.49/100 person years] than in Sri Lanka [12.74/100 person years] and India [7.21/100 person years].

CONCLUSIONS

A high incidence of DM was found in women with prior GDM in South Asia, with significant variation between countries. Women from Bangladesh had a significantly higher pregnancy count, family history of DM and overweight/obese status, despite having significantly lower age, which could be responsible for their higher rates of DM. Registration of this study: The study was registered with the Clinical Trials Registry of India (CTRI/2017/06/008744), Sri Lanka Clinical Trials Registry (SLCTR/2017/001), and ClinicalTrials.gov (NCT03305939).

Address: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India. Electronic address: [email protected].; Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.; George Institute for Global Health, Hyderabad, India; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.; George Institute for Global Health, Sydney, Australia.; Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; George Institute for Global Health, Sydney, Australia.; Initiative for Non Communicable Diseases, Nutrition Research Division, International Centre for Diarrhoeal Disease Research (ICDDR, B), Dhaka, Bangladesh.; Clinical Trials Unit, Department of Pharmacology, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka.; Centre for Chronic Disease Control, New Delhi, India.; George Institute for Global Health, Hyderabad, India.; RemediumOne, Colombo, Sri Lanka.; Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India.; Department of Endocrinology, Goa Medical College, Goa, India.; Department of Public Health, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.; Centre for Chronic Disease Control, New Delhi, India; Public Health Foundation of India, New Delhi, India; London School of Hygiene and Tropical Medicine, London, United Kingdom.; Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.

DOI: 10.1016/j.diabres.2023.110893

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MeSH Terms: Pregnancy, Female, Humans, Adult, Diabetes, Gestational, Incidence, Sri Lanka, Bangladesh, Asia, Southern, Overweight, Risk Factors, Postpartum Period, India, Obesity