Gestational Diabetes in Iran: Incidence, Risk Factors and Pregnancy Outcomes

The objective of this study was to determine the incidence of gestational diabetes mellitus (GDM) and compare fetal, maternal and neonatal complications amongst women with GDM and pregnant women with normal glucose tolerance in an urban Iranian population. In a prospective cohort study, universal screening for gestational diabetes mellitus was performed for 1310 pregnant women who were referred from private clinics and community health care centers to Fatemiyeh Hospital in Shahrood City. Screening was performed with a 50 g oral Glucose Challenge Test (GCT) with 130 mg/dl cut-off point, then a diagnostic 100 g Oral Glucose Tolerance Test (OGTT) was done according to Carpenter and Coustan criteria. The incidence of GDM was 4.8%. There were differences in risk factors: age >30 years, family history of diabetes, obesity, previous macrosomia, glycosuria between the two groups (P<0.001). Women with GDM had a higher rate of stillbirth (P<0.001; odds ratio 17.1, 95% CI=4.5-65.5), hydramnios (P<0.001; odds ratio 15.5, 95% CI=4.8-50.5), gestational hypertension (P<0.001; odds ratio 6, 95% CI=2.3-15.3), macrosomia (P<0.05; odds ratio 3.2, 95% CI=1.2-8.6) and caesarean section (P<0.001). We have found that the incidence of GDM in an urban Iranian population is similar to developed countries. Complications were more common in the GDM group than in the normal group and outcomes for women with persistent diabetes post-partum were particularly poor. We recommend screening for GDM in Iran, but further evaluation of selective screening and cost effectiveness will need to be performed. Measures to improve the outcome of GDM pregnancy will also need to be addressed in the future.