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Review Article:
Abstract
As Asian countries undergo economic, social and nutritional transition, type 2 diabetes mellitus and
Gestational diabetes mellitus (GDM) may be increasing. To determine trends of GDM prevalence in
Asian countries, a search of Medline and Embase using defined criteria was performed. Studies
included were conducted in Asia between 1990 - 2011, documented patient selection, defined GDM
criteria, were in English, had a quality grade of Scottish Intercollegiate Guideline Network (SIGN) 2+
and recruited 500 women. Data was extracted using a standardized form. Within country
comparisons of studies using the same diagnostic criteria were made; study heterogeneity limited
results to a narrative synthesis. From 1460 titles and abstracts, 19 papers were included. There was
evidence of GDM increasing in Tianjin, China (2.4% in 2002 to 6.8% in 2008), in Hong Kong (7.4% in 1986
to 10.4% in 1998 to 2001) and in Bangkok, Thailand (2.0% in 1987 - 89 to 3.0% in 2001 - 02). Prevalence in
India varied markedly by location and diagnostic criteria, with high rates in urban Chennai, 17.7% in
2001 and 17.8% in 2005 to 2007. There was no evidence of increase in GDM in Tokyo, Japan (1.8% in
1996 - 2000 to 1.6% in 2008 - 10) or in Seoul, Korea (2.2% in 1991-94 to 2.4% in 1993-97). Other countries
lacked data for comparison. Despite the lack of comparative data there is an increasing trend of GDM
prevalence in some Asian countries. The choice of diagnostic criteria greatly affects prevalence.
Key words: Diabetes mellitus, gestational diabetes, Asian countries
1 Department of Obstetrics & Gynaecology, experiencing a rise in obesity and diet related
Sydney Medical School, University of Sydney, non-communicable diseases. Type 2 diabetes
Australia. mellitus has been documented to be
increasing in Asia (1), although the increase
2Sydney School of Public Health, University of
seems to be greater in South Asia compared to
Sydney, Australia.
East and South East Asia (2). It was estimated
3Sydney School of Public Health, University of that globally in 2011, 366 million people were
Sydney, Department of Neonatal Medicine, living with diabetes. This is predicted to rise to
Royal Prince Alfred Hospital, Sydney, Australia. 552 million people by 2030 with half of these
living in Asia (3).
*Corresponding author: Gestational diabetes mellitus (GDM) is broadly
(Current Details)
defined as any level of glucose intolerance first
Jane E Hirst recognized during pregnancy (4), a definition
that formerly included undiagnosed type 1 and
Department of Obstetrics & Gynaecology,
2 diabetes mellitus. Whilst for most women
Sydney Medical School, University of Sydney,
glucose intolerance resolves after birth, there is
Australia.
up to 50% chance of developing type 2
E-mail: jane.hirst@sydney.edu.au diabetes within 5 years of delivery (5). Diagnosis
and treatment of GDM can reduce adverse
Introduction pregnancy outcomes, including stillbirth,
neonatal macrosomia, neonatal
In most Asian countries, the economic hypoglycaemia, birth trauma and neonatal
prosperity is increasing. This has implications for respiratory distress syndrome as well as
the way people live, what they eat and decrease the risk of preeclampsia in the mother
patterns of disease they experience. China, (6, 7). For the offspring there is evidence of
India and several South East Asian nations are potential lifelong metabolic programming as a
Table 1: Details of studies included in review with comparable populations and screening/diagnostic methods for GDM to estimate trends
Country/First Author/ Year Sample Study type Location and population Screen OGTT Criteria GDM SIGN
Year of Publication size test rate grade
China
Yang, X 2002 (18) 1998-99 9 471 Prospective Tianjin, 6 urban district Antenatal 50g 1 h 75g 2 h WHO 1999 2.3% 2++
cohort Basic Care Units. Singleton
pregnant women without other
known medical conditions
Zhang F 2011 (17) 2008 17563 Prospective As above 50g 1 h 75g 2h WHO 1999 6.8% 2++
cohort
Hong Kong
Lee CP, 1994 (19) 1986 11 300 Retrospective Two University hospital clinics. Random 75g 2h Modified 7.4% 2+
cohort Universal screening of all BSL1 WHO (2h >
pregnant women 8.0mmol/L)
Lao T, 2001 (20) 1994-96 14450 Retrospective Single centre, general hospital. Random 75g 2h WHO 1980 12.1% 2+
cohort Universal screening of all BSL1
pregnant women
Lao T, 2007 (21) 1998- 13685 Retrospective Two University hospital clinics. Random 75g 2h Modified 10.4% 2+
2001 cohort Universal screening of all BSL1 WHO (2h >
pregnant women 8.0mmol/L)
Japan
Miyakoshi, K 2003 (23) 1996-00 2 651 Retrospective Tokyo. Keio University Hospital. 50g 1h 75g 2h JSOG 1.8% 2+
study Consecutive native Japanese
singleton pregnant women.
Yachi, Y. 2011 (24) 2008-10 509 Prospective Tokyo. Tanaka Womens clinic. 50g 1h 75g 2h JSOG 1.6% 2+
cohort Women with prior diabetes
excluded.
Korea
Jang, H. 1998 (25) 1991-94 9 005 Prospective Seoul. Samsung Cheil hospital. 50g 1h 100g NDDG 1.9% 2++
cohort Consecutive pregnant women. 3h
Previous GDM, known diabetes
and high-risk transfers excluded.
Jang, H. 2003 (26) 1993-97 16 654 Prospective Seoul. Samsung Cheil hospital. 50g 1h 100g NDDG 2.4% 2+
cohort No exclusions stated. 3h
Thailand
Serirat, S 1992 (28) 1987-89 25 992 Prospective Bangkok. Rajavithi Hospital. Prior 50g 1h 100g NDDG 2.02% 2++
cohort diabetes excluded. 3h
Sunsaneevithayakul, P 2001-02 9 861 Prospective Bangkok. Siriraj Hospital. All 50g 1h 100g NDDG 3.0% 2+
2004 (29) cohort women presenting for antenatal 3h
care.
India
Ramachandran, A. 1992 944 Cross- Chennai. 2 general prenatal 50g 1h 100g OSullivan 0.56% 2+
1994(32) sectional clinics. Consecutive women, 3h
study gestation > 24 weeks. Diabetes
on insulin excluded.
Hill, J 2005 (34) 1997-98 830 Prospective Mysore. Holdsworth Memorial - 100g CC 6.2% 2+
cohort Hospital. Singleton pregnancy, 3h
known diabetes excluded, plan
to deliver at hospital
Zargar, AH. 2004 (35) 1999-02 2000 Cross- Kashmir. Cluster sampling of 50g 1h 100g CC 3.1% 2++
sectional antenatal clinics in 6 districts in 3h
study Kashmir (urban and rural). WHO 1999 4.4%
Previous diabetes excluded. 75g 2h
Seshiah, V 2004 (30) 2001 1251 Cross- Chennai. General antenatal 50g 1h 75g 2h WHO 1998 17.7%2 2+
sectional hospital population (fasting 7.0
study or 2 h 7.8
mmol/L)
Seshiah, V 2008 (31) 2005-07 11786 Cross- Tamilnadu state. Community - 75g 2h WHO 1994 (2 13.9% 2++
sectional based. 4151 Chennai (urban), 3 h overall
study 690 Saidapet (semi urban), 3 945 7.8mmol/L) 17.8%
Thiruvallur (rural). Consecutive urban
pregnant women attending 13.8%
public health centres. semi
urban
9.9%
rural
Tripathi R 2012 (33) 2007 687 Prospective Lok Nayak Hospital, New Delhi 50g 1 h 100g CC 1.5% 2+
cohort 3h
Pakistan
Rizvi, JH 1992 (36) 1988-89 2 330 Prospective Karachi. Aga Khan University 75g 2h 75g 2h WHO 1980 1.3% 2+
cohort Hospital. Universal screening.
Known diabetes excluded.
Akhter J. 1996 (37) 1989-93 6830 Retrospective Karachi. Aga Khan hospital. 50g 1h 75g 2h WHO 1980 3.3% 2+
cohort Universal screening