, Volume 65, Issue 3, pp 505–514 | Cite as

Prevalence of gestational diabetes mellitus in Eastern Mediterranean region: a systematic review and meta-analysis

  • Mahin Badakhsh
  • Fereshteh Daneshi
  • Mahnaz Abavisani
  • Hosien Rafiemanesh
  • Salehoddin Bouya
  • Mahmood Sheyback
  • Khadije Rezaie KeikhaieEmail author
  • Abbas Balouchi



Gestational diabetes mellitus (GDM) is one of the costly challenges in the health field. Despite the individual studies in the Eastern Mediterranean, there is no comprehensive study in this regard. The aim of this study was to determine the prevalence of GDM in the Eastern Mediterranean region.


In this meta-analysis and systematic review, three international databases (PubMed, Web of science and Scopus) were searched from inception until 30 December 2018. The Hui tool was used to assess the quality of the included studies.


Thirty-three studies performed on 887166 participants were included in the meta-analysis. Based on the results of random effect method, the overall prevalence of GDM was 11.7%. Between six country with have three or more study, pooled prevalence for Saudi Arabi it was 3.6 times more than Israel (17.6 vs. 4.9%), and for Pakistan, Qatar, Bahrain and Iran were 15.3%, 14.7%, 12.2%, and 8.6%, respectively.


Despite the high diversity of methods, the results of the present study indicate a high prevalence of GDM in the Eastern Mediterranean region, indicating more policymakers’ interest in timely screening and proper management.


Epidemiology Gestational diabetes mellitus Eastern Mediterranean region Meta-analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and informed consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Supplementary material

12020_2019_2026_MOESM1_ESM.pdf (398 kb)


  1. 1.
    M. Meregaglia, L. Dainelli, H. Banks, C. Benedetto, P. Detzel, G. Fattore, The short-term economic burden of gestational diabetes mellitus in Italy. BMC Pregnancy Childbirth 18, 58 (2018)CrossRefGoogle Scholar
  2. 2.
    C. Bommer, V. Sagalova, E. Heesemann, J. Manne-Goehler, R. Atun, T. Bärnighausen et al. Global economic burden of diabetes in adults: projections from 2015 to 2030. Diabetes Care 41, 963–970 (2018)CrossRefGoogle Scholar
  3. 3.
    E. Chiefari, B. Arcidiacono, D. Foti, A. Brunetti, Gestational diabetes mellitus: an updated overview. J. Endocrinol. Investig. 40, 899–909 (2017)CrossRefGoogle Scholar
  4. 4.
    N. Cho, J. Shaw, S. Karuranga, Y. Huang, J. da Rocha Fernandes, A. Ohlrogge et al. IDF Diabetes Atlas: global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res. Clin. Pract. 138, 271–281 (2018)CrossRefGoogle Scholar
  5. 5.
    A. Jiwani, E. Marseille, N. Lohse, P. Damm, M. Hod, J.G. Kahn, Gestational diabetes mellitus: results from a survey of country prevalence and practices. J. Matern.-Fetal Neonatal Med. 25, 600–610 (2012)CrossRefGoogle Scholar
  6. 6.
    K.W. Lee, S.M. Ching, V. Ramachandran, A. Yee, F.K. Hoo, Y.C. Chia et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC Pregnancy Childbirth 18, 494 (2018)CrossRefGoogle Scholar
  7. 7.
    L. Hartling, D.M. Dryden, A. Guthrie, M. Muise, B. Vandermeer, W.M. Aktary et al. Screening and diagnosing gestational diabetes mellitus. Evid. Rep./Technol. Assess. 210, 1 (2012)Google Scholar
  8. 8.
    E.M. Wendland, M.R. Torloni, M. Falavigna, J. Trujillo, M.A. Dode, M.A. Campos et al. Gestational diabetes and pregnancy outcomes-a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 12, 23 (2012)CrossRefGoogle Scholar
  9. 9.
    D. Moher, A. Liberati, J. Tetzlaff, D.G. Altman, P. Group, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6, e1000097 (2009)CrossRefGoogle Scholar
  10. 10.
    J. McGowan, M. Sampson, D.M. Salzwedel, E. Cogo, V. Foerster, C. Lefebvre, PRESS peer review of electronic search strategies: 2015 guideline statement. J. Clin. Epidemiol. 75, 40–46 (2016)CrossRefGoogle Scholar
  11. 11.
    WHO. Projections of mortality and causes of death 2016 to 2060. 2019.
  12. 12.
    Y. Zhu, C. Zhang, Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr. Diabetes Rep. 16, 7 (2016)CrossRefGoogle Scholar
  13. 13.
    T. Tamayo, M. Tamayo, W. Rathmann, P. Potthoff, Prevalence of gestational diabetes and risk of complications before and after initiation of a general systematic two-step screening strategy in Germany (2012–2014). Diabetes Res. Clin. Pract. 115, 1–8 (2016)CrossRefGoogle Scholar
  14. 14.
    S.S. Casagrande, B. Linder, C.C. Cowie, Prevalence of gestational diabetes and subsequent Type 2 diabetes among US women. Diabetes Res. Clin. Pract. 141, 200–208 (2018)CrossRefGoogle Scholar
  15. 15.
    C. Gao, X. Sun, L. Lu, F. Liu, J. Yuan, Prevalence of gestational diabetes mellitus in mainland China: a systematic review and meta‐analysis. J. Diabetes Investig. 10, 154–162 (2019)CrossRefGoogle Scholar
  16. 16.
    K.T. Li, S. Naik, M. Alexander, J.S. Mathad, Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis. Acta Diabetol. 55, 1–13 (2018).Google Scholar
  17. 17.
    S. Macaulay, D.B. Dunger, S.A. Norris, Gestational diabetes mellitus in Africa: a systematic review. PLoS ONE 9, e97871 (2014)CrossRefGoogle Scholar
  18. 18.
    M. Makgoba, M. Savvidou, P. Steer, An analysis of the interrelationship between maternal age, body mass index and racial origin in the development of gestational diabetes mellitus. BJOG: Int. J. Obstet. Gynaecol. 119, 276–282 (2012)CrossRefGoogle Scholar
  19. 19.
    N. Schwartz, Z. Nachum, M.S. Green, The prevalence of gestational diabetes mellitus recurrence—effect of ethnicity and parity: a metaanalysis. Am. J. Obstet. Gynecol. 213, 310–317 (2015)CrossRefGoogle Scholar
  20. 20.
    E.M. Alfadhli, E.N. Osman, T.H. Basri, N.S. Mansuri, M.H. Youssef, S.A. Assaaedi et al. Gestational diabetes among Saudi women: prevalence, risk factors and pregnancy outcomes. Ann. Saudi Med. 35, 222–230 (2015)CrossRefGoogle Scholar
  21. 21.
    E. Alfadhli, Gestational diabetes in Saudi women identified by the International Association of Diabetes and Pregnancy Study Group versus the former American Diabetes Association criteria: a prospective cohort study. Ann. Saudi Med. 35, 428–434 (2015). CrossRefGoogle Scholar
  22. 22.
    M.S. Ardawi, H.A. Nasrat, H.S. Jamal, H.M. Al-Sagaaf, B.E. Mustafa, Screening for gestational diabetes mellitus in pregnant females. Saudi Med. J. 21, 155–160 (2000)Google Scholar
  23. 23.
    M. Bashir, M.E. Abdel-Rahman, M. Aboulfotouh, F. Eltaher, K. Omar, I. Babarinsa et al. Prevalence of newly detected diabetes in pregnancy in Qatar, using universal screening. PLoS ONE 13 (2018).
  24. 24.
    A.O. Abdelmola, M.S. Mahfouz, M.A.M. Gahtani, Y.J. Mouharrq, B.H.O. Hakami, O.I. Daak et al. Gestational diabetes prevalence and risk factors among pregnant women — Jazan Region, Saudi Arabia. Clin. Diabetol. 6, 172–177 (2017). CrossRefGoogle Scholar
  25. 25.
    A.T. Abu-Heija, M. Al-Bash, M. Mathew, Mathew M. Gestational and pregestational diabetes mellitus in omani women: comparison of obstetric and perinatal outcomes. Sultan Qaboos Univ. Med. J. 15, e496–e500 (2015).
  26. 26.
    M.M. Agarwal, G.S. Dhatt, Y. Othman, Gestational diabetes mellitus prevalence: effect of the laboratory analytical variation. Diabetes Res. Clin. Pract. 109, 493–499 (2015). CrossRefGoogle Scholar
  27. 27.
    W. Ahsen, B. Meraj, M. Waseem, S. Ahmed, Incidence of gestation diabetes and viral hepatitis in pregnant women. Med. Forum Mon. 25, 81–84 (2014)Google Scholar
  28. 28.
    S. Al Mahroos, D.S. Nagalla, W. Yousif, H. Sanad, A population-based screening for gestational diabetes mellitus in non-diabetic women in Bahrain. Ann. Saudi Med. 25, 129–133 (2005)CrossRefGoogle Scholar
  29. 29.
    A.D. Ali, A.A. Mehrass, A.H. Al-Adhroey, A.A. Al-Shammakh, A.A. Amran, Prevalence and risk factors of gestational diabetes mellitus in Yemen. Int. J. Women’s Health 8, 35–41 (2016). CrossRefGoogle Scholar
  30. 30.
    A. Ali, A.H. Munir, A. Rafiq, Gestational diabetes in women presenting to teaching hospitals in Khyber Pakhtunkhwa. J. Med. Sci. 26, 14–17 (2018)Google Scholar
  31. 31.
    M.G. Al-Kuwari, B.S. Al-Kubaisi, Prevalence and predictors of gestational diabetes in Qatar. Diabetol. Croat. 40, 65–70 (2011)Google Scholar
  32. 32.
    M.A. Al-Rowaily, M.A. Abolfotouh, Predictors of gestational diabetes mellitus in a high-parity community in Saudi Arabia. East. Mediterr. Health J. 16, 636–641 (2010)CrossRefGoogle Scholar
  33. 33.
    A. Bener, N.M. Saleh, A. Al-Hamaq, Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons. Int. J. Women’s health 3, 367–373 (2011). CrossRefGoogle Scholar
  34. 34.
    S. Bibi, U. Saleem, N. Mahsood, The frequency of gestational diabetes mellitus and associated risk factors at khyber teaching hospital Peshawar. J. Post. Med. Inst. 29, 43–46 (2015)Google Scholar
  35. 35.
    F. Hadaegh, M. Tohidi, H. Harati, M. Kheirandish, S. Rahimi, Prevalence of gestational diabetes mellitus in southern Iran (Bandar Abbas City). Endocr. Pract. 11, 313–318 (2005). CrossRefGoogle Scholar
  36. 36.
    E. Hosseini, M. Janghorbani, A. Aminorroaya, Incidence, risk factors, and pregnancy outcomes of gestational diabetes mellitus using one-step versus two-step diagnostic approaches: a population-based cohort study in Isfahan, Iran. Diabetes Res. Clin. Pract. 140, 288–294 (2018). CrossRefGoogle Scholar
  37. 37.
    A. Hossein-Nezhad, Z. Maghbooli, A.R. Vassigh, B. Larijani, Prevalence of gestational diabetes mellitus and pregnancy outcomes in Iranian women. Taiwan J. Obstet. Gynecol. 46, 236–241 (2007). CrossRefGoogle Scholar
  38. 38.
    M. Keshavarz, N.W. Cheung, G.R. Babaee, H.K. Moghadam, M.E. Ajami, M. Shariati, Gestational diabetes in Iran: incidence, risk factors and pregnancy outcomes. Diabetes Res. Clin. Pract. 69, 279–286 (2005)CrossRefGoogle Scholar
  39. 39.
    M. Manafi, M.H. Khadem-Ansari, Gestational diabetes mellitus in Iranian women: a rising rate. Acta Endocrinol. 9, 71–78 (2013). Google Scholar
  40. 40.
    F. Mohammadzadeh, S. Eshghinia, M.A. Vakili, The prevalence of gestational diabetes mellitus and its related risk factors in Gorgan, north of Iran. Selective or universal screening test is cost-effective? Int. J. Diabetes Dev. Ctries. 35, 225–229 (2015). CrossRefGoogle Scholar
  41. 41.
    F. Momenzadeh, S.S. Mokhlesi, S. Mohebbi, L.M. Banaem, Gestational diabetes and its risk factors for pregnant women in Tehran Int. J. Trop. Med. 10, 30–33 (2014). Google Scholar
  42. 42.
    K.E. Rajab, A.A. Issa, Z.A. Hasan, E. Rajab, A.A. Jaradat, Incidence of gestational diabetes mellitus in Bahrain from 2002 to 2010. Int. J. Gynaecol. Obstet.: Off. Organ Int. Fed. Gynaecol. Obstet. 117, 74–77 (2012). CrossRefGoogle Scholar
  43. 43.
    K.E. Rajab, J.H. Skerman, A.A. Issa, Screening for gestational diabetes by measuring fasting plasma glucose levels. J. Sci. Res. Med. Sci. 5, 5–8 (2003)Google Scholar
  44. 44.
    M. Riaz, A. Nawaz, S.N. Masood, A. Fawwad, A. Basit,A.S. Shera, Frequency of gestational diabetes mellitus using DIPSI criteria, a study from Pakistan. Clin. Epidemiol. Glob. Health (2018).
  45. 45.
    T. Sella, V. Shalev, U. Elchalal, A. Chovel-Sella, G. Chodick, Screening for gestational diabetes in the 21st century: a population-based cohort study in Israel. J. Matern.-Fetal Neonatal Med. 26, 412–416 (2013). CrossRefGoogle Scholar
  46. 46.
    T. Sella, G. Chodick, M. Barchana, A.D. Heymann, A. Porath, E. Kokia et al. Gestational diabetes and risk of incident primary cancer: a large historical cohort study in Israel. Cancer Causes Control 22, 1513–1520 (2011). CrossRefGoogle Scholar
  47. 47.
    H. Shahbazian, S. Nouhjah, N. Shahbazian, S. Jahanfar, S.M. Latifi, A. Aleali et al. Gestational diabetes mellitus in an Iranian pregnant population using IADPSG criteria: incidence, contributing factors and outcomes. Diabetes Metab. Syndr. 10, 242–246 (2016). CrossRefGoogle Scholar
  48. 48.
    N. Shirazian, R. Emdadi, M. Mahboubi, A. Motevallian, Z. Fazel-Sarjuei, N. Sedighpour et al. Screening for gestational diabetes: usefulness of clinical risk factors. Arch. Gynecol. Obstet. 280, 933–937 (2009). CrossRefGoogle Scholar
  49. 49.
    S. Soheilykhah, M. Mogibian, S. Rahimi-Saghand, M. Rashidi, S. Soheilykhah, M. Piroz, Incidence of gestational diabetes mellitus in pregnant women. Iran. J. Reprod. Med. 8, 24–28 (2010)Google Scholar
  50. 50.
    B. Utz, B. Assarag, T. Smekens., H. Ennassiri, T. Lekhal, N.E. Ansari et al., Detection and initial management of gestational diabetes through primary health care services in Morocco: an effectiveness-implementation trial. PLoS ONE 13 (2018).
  51. 51.
    H. Wahabi, A. Fayed, S. Esmaeil, H. Mamdouh, R. Kotb, Prevalence and complications of pregestational and gestational diabetes in Saudi women: analysis from Riyadh Mother and Baby Cohort Study (RAHMA). BioMed. Res. Int. 2017, 6878263 (2017). CrossRefGoogle Scholar
  52. 52.
    H.A. Wahabi, S.A. Esmaeil, A. Fayed, R.A. Alzeidan, Gestational diabetes mellitus: maternal and perinatal outcomes in King Khalid University Hospital, Saudi Arabia. J. Egypt. Public Health Assoc. 88, 104–108 (2013). CrossRefGoogle Scholar
  53. 53.
    O. Zamstein, E. Sheiner, T. Wainstock, D. Landau, A. Walfisch, Maternal gestational diabetes and long-term respiratory related hospitalizations of the offspring. Diabetes Res. Clin. Pract. 140, 200–207 (2018). CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mahin Badakhsh
    • 1
  • Fereshteh Daneshi
    • 2
  • Mahnaz Abavisani
    • 3
  • Hosien Rafiemanesh
    • 4
  • Salehoddin Bouya
    • 5
  • Mahmood Sheyback
    • 6
  • Khadije Rezaie Keikhaie
    • 7
    Email author
  • Abbas Balouchi
    • 8
  1. 1.Department of Midwifery, School of Nursing and MidwiferyZabol University of Medical ScienceZabolIran
  2. 2.Department of Pediatric Nursing, School of Nursing and MidwiferyJiroft University of Medical SciencesJiroftIran
  3. 3.MSc of Medical Surgical Nursing, Neyshabur University of Medical SciencesNeyshaburIran
  4. 4.Student Research Committee, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
  5. 5.Clinical Immunology Research Center, Ali-ebne Abitaleb HospitalZahedan University of Medical SciencesZahedanIran
  6. 6.Bushehr University of Medical SciencesBushehrIran
  7. 7.Zabol Medicinal Plants Research CenterZabol University of Medical SciencesZabolIran
  8. 8.Student Research Committee, Nursing and Midwifery SchoolIran University of Medical SciencesTehranIran

Personalised recommendations