Screening and diagnosis of gestational diabetes in India: a systematic review and meta-analysis
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Although diabetes is rapidly increasing in India, there is no national consensus on best practices for screening, diagnosis, and management of gestational diabetes mellitus (GDM). The goal of this study was to systematically review the literature for studies reporting the prevalence and screening and diagnostic methods for gestational diabetes in India.
We searched MEDLINE, Embase, and POPLINE for studies on screening for GDM in India. We included English-language full reports and conference abstracts of cross-sectional studies, prospective, and retrospective cohorts that reported the screening method and prevalence of GDM. We performed descriptive analysis on all studies and meta-analysis, meta-regression, and subgroup meta-analysis on studies with medium or low risk of bias.
We included 64 studies reporting 90 prevalence estimates. Prevalence estimates ranged from 0 to 41.9%. Subset meta-analyses showed that the IADPSG diagnostic criteria found significantly more GDM cases (prevalence = 19.19% [15.5, 23.6], p < 0.05) than the WHO 1999 criteria (10.13% [8.17, 12.50]) and DIPSI criteria (7.37% [5.2, 10.16]). Studies that compared the IADPSG and WHO 1999 criteria showed poor positive agreement (33–79%). Studies specifying time of GDM diagnosis showed that patients (11–60%) develop GDM as early as the first trimester, but many GDM cases (16–40%) are missed if screened only at first visit.
In India, prevalence estimates of GDM vary substantially by diagnostic criteria. When evaluating screening and diagnostic criteria for GDM, providers should consider their patients’ needs and correlate screening criteria with pregnancy outcomes.
KeywordsGestational diabetes Pregnancy India Screening
We would like to thank Weill Cornell Medicine librarians Kevin J. Pain and Becky B. Nelson for their assistance with searching the literature; Elizabeth Mauer for her assistance in conducting meta-analysis; and Dr. Amita Gupta for her input on writing.
JSM and KL motivated and conceived of the study. KL and SN searched for literature and analyzed results. KL, MA, and JSM interpreted the results. KL wrote the article. MA and JSM critically reviewed the article. All authors reviewed and edited the article.
Compliance with ethical standards
Conflict of interest
All the author declares that they have no conflict of interest.
As this was a review study, no ethics approval was required.
As this was a review study, no informed consent was required.
Consent for publication
All authors provided consent for publication.
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