Risk Factors of Gestational Diabetes Mellitus in Gombak District, Selangor – A Case-Control Study A Case-Control Study By Dr Siti Rohana Saad MBBS (MAHE), MPH (UM) Family Health Development Unit, Public Health Division, Selangor State Health Department
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Risk Factors of Gestational
Diabetes Mellitus in
Gombak District, Selangor –
A Case-Control StudyA Case-Control Study
By
Dr Siti Rohana Saad
MBBS (MAHE), MPH (UM)
Family Health Development Unit, Public Health Division, Selangor State Health Department
Outline
• Introduction
• Problem Statement
• Rationale of Study
• Methods
• Results
• Discussion
• Recommendations
• Conclusion
2
Introduction
• Gestational Diabetes Mellitus (GDM)
– Definition 1,2,3
– Represents most common metabolic
complication during pregnancy; earlycomplication during pregnancy; early
manifestation of type 2 diabetes 4,5
– Certain characteristics (risk factors) in the
women may predispose to development of
GDM during pregnancy 3,6
3
Problem statement
• Prevalence of GDM varies from 1-14% betweencountries1,4,6; varies in direct proportion toprevalence of type 2 diabetes in a given population7
• In Malaysia– Diabetes prevalence (among adult ≥ 30yrs of age)– Diabetes prevalence (among adult ≥ 30yrs of age)
had increased from 8.3% to 14.9% (1996 to 2006)8
– Diabetes admission based on type of diabetes (1994-2004): GDM represent ≈ 30% of total admission9
– GDM prevalence:
�1993 (UMMC):12.7%10
� 2001 (HUKM): 24.9%11
� 2003 (Alor Star): 18.3%21
4
• GDM was the cause for 90% of all pregnancies
complicated by diabetes22
• Associated with maternal and foetal morbidity 4,5
• High proportion (>50%) have GDM in the
subsequent pregnancy23
Problem statement (cont)
• Associated with an increased risk of subsequent
type 2 diabetes mellitus.
– approximately 50% of the women with GDM
progressed to DM within five years duration7
– 35-60% of women developed type 2 diabetes within
10 years after being diagnosed with GDM3
5
Rationale of Study
• Literature search done showed scarcity ofpublished article on study done in relation to GDMin this region
• Previous study done mostly at referral andspecialised unit – results may not represent thetrue picture of the diseasetrue picture of the disease
• Identification of GDM risks factors will provideinformation in strengthening public healthmeasures & prevent complications (maternal,foetal, development of overt diabetes &cardiovascular)
6
Study Objectives
• General Objectives– To determine the risk factors of GDM in Gombak
District, Selangor.
• Specific Objectives1. To describe socio-demographic and obstetric
characteristics of pregnant women with GDM.characteristics of pregnant women with GDM.
2. To determine the magnitude of associationbetween the socio-demographic and obstetriccharacteristics with development of GDM
3. To determine the independent risk factors of GDMamong pregnant women in Gombak District,Selangor
7
• Study design
– Case –control study (1:1)
• Study duration
– June 2007- February 2008
• Study population
– Pregnant women who had antenatal visits at MCH
Methods
– Pregnant women who had antenatal visits at MCH
clinics of Gombak District, Selangor.
• Case
– Pregnant women diagnosed with GDM using 75gm
OGTT : 2hpp plasma glucose level ≥ 7.8 mmol/l
• Control
– Pregnant women without GDM sampled from the same
clinic on the same day each case was identified
8
Location of Study Area - Gombak District of Selangor State
• Independent risk factors– This study confirms results from the previous studies that risk
factors for GDM are:
• Maternal age 11,13, 15, 16, 19; Pre pregnant obesity 13, 15, 16, 19;Excessive weight gain 18; Family history of DM 15, 17, 18, 19;Previous history of GDM 11,17; Previous history of big baby 15, 16
• Higher income16 and excessive vaginal discharge
18
Strength of study
• Case and control group were comparable since they
came from the same population – pregnant women
from the same clinic
• High responds rate – as the respondents were not put
into any risk and not subjected to any inconvenienceinto any risk and not subjected to any inconvenience
of OGTT
• Study was done in Government Maternal and Child
Health Clinics which covers almost 80% of antenatal
population of the - Community Based
19
Limitation
• The study design – temporality cannot be ascertained
• Information bias– Respondents are subjected to recall bias
– Interviewer bias in getting information
– Steps taken:
• compared information from the antenatal records
• Single interviewer – reduced inter observer bias
• Selection bias– In selecting controls and cases – based on presence of risk factor/s– In selecting controls and cases – based on presence of risk factor/s
• Measurement bias– Weight measurement not properly done or weighing machine not properly
calibrated
– In defining cases – false positive/ negative result of plasma glucose level
• Confounding bias– Confounders are statistically controlled by subjecting variables to multiple
logistic regression
• Generalizability– Result of study can only be generalised to the antenatal population
attending the government health clinics
20
Recommendation
• Having GDM registry at periphery and the central level
• Considering maternal age ≥ 25 yrs, exc. vaginal discharge
for OGTT
• Concerted effort, multidisciplinary approach in preventing
and managing GDM
– Antenatal services– Antenatal services
– Pre marital health care programme
– Strengthening of family planning programme
• Strengthening the promotive and preventive health care in
tackling the lifestyle factors associated with GDM
• Policy on universal screening of GDM using GCT
21
Conclusion
• Development of GDM is associated with presence of
risk factors
• Strong and significant association between GDM and
the identified independent risk factors in this study
warrants serious attention in its prevention andwarrants serious attention in its prevention and
management prior to and throughout pregnancy
• Screening of GDM using risk criteria should consider
– Maternal age ≥ 25 yrs
– Presence of excessive vaginal discharge in indexpregnancy
22
23
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Suppl 2:B161-7.
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in pregnancy. International Journal of Gynecology and Obstetric 2001;75:27-32.
12. Maternal And Child Health Unit. Towards Improving the Management of Gestational Diabetes in Kulim
District. District Specific Approach; Kulim District Health Office, 2003.
24
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21. Idris N, Che Hatikah CH, Murizah MZ, Rushdan MN. Universal versus selective screening fordetection of gestational diabetes mellitus in a Malaysian population. Malaysian Family Physician.2009;4(2&3):83-87
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