Background: Gestational diabetes mellitus (GDM) affects nearly 5 million pregnancies in India and is associated with multiple adverse pregnancy outcomes. Exposure to intrauterine hyperglycemia predisposes infants to increased risk obesity and diabetes. Indian phenotype tends to deposit excess central fat, which is linked to insulin resistance. Our study aimed to determine the effect of varying plasma glucose concentrations in predicting adverse maternal and infant outcomes in participants of a birth cohort in India.
Methods: We examined a prospective cohort of pregnant women in the public hospitals of Bengaluru. We conducted a 2-hour 75g Oral glucose Tolerance Test (OGTT) in 1847, pregnant women between 24 to 36 weeks. We followed up women and children at delivery, and recorded skinfold thickness of babies at biceps, triceps, and subscapular region. We fitted 240 robust Poisson models to estimate the risk of the sum of skinfold thickness (SSFT) infants and caesarian section delivery with the FBS and PPBS. With one-unit increase beginning from FBS≥87 up to 92 mg/dL and PPBS ≥134 up to 153 mg/dL were tested with the sum of skinfold Thickness (SSST) and C section delivery.
Results: We found that 10.65% (95% CI 9.19%, 12.30%) of 1847 infants had SSFT above 90th percentile, and 46.91% (95% CI 44.45%, 49.38%) of the women underwent caesarian section. The results indicate that FBS≥87 mg/dL and PPBS of ≥134mg/dl was associated with risk of increased SSST in infants [adjusted RR 1.70 (95% CI 1.06, 2.74)] and caesarian section delivery [Adjusted RR 1.19 (1.07,1.32)] after adjusting for age, parity, socioeconomic status, height and adiposity in mothers.
Discussion: The pregnant women in India are at a higher risk of adverse birth outcomes with lower glucose cut-off values, compared to the international classification systems. These findings offer insights to revise the cut off points based on contextual settings in LMIC countries.
G.R. Babu: None. M.G. Lewis: None. D. R: None. E. Lobo: None. S. Kinra: None. G.V. Murthy: None.
UK Wellcome Trust/DBT India Alliance Fellowship (IA/CPHI/14/1/501499 to G.R.B.)