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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 17
| Issue : 4 | Page : 871-876 |
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Prevalence of diabetes mellitus and depression status among pregnant women in rural population in Kancheepuram District
M Sandhya, M Manikumar, S Jenifer Augustina, M Kamalakannan
Saveetha College of Physiotherapy, SIMATS, Chennai, Tamil Nadu, India
| Date of Submission | 27-Apr-2021 |
| Date of Acceptance | 06-Apr-2022 |
| Date of Web Publication | 10-Feb-2023 |
Correspondence Address:
Dr. M Sandhya
No 20, Prooja Park, Jothi Nagar, Melnallathur, Thiruvallur, Chennai, Tamil Nadu
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_186_21
Background: Gestational diabetes mellitus (GDM) is a condition that lasts for a short period of time during pregnancy. It is usually diagnosed in the second trimester of gestational period and present in almost 12% of pregnant women. Aim: The main aim of the study is to find the prevalence of GDM and depression status among pregnant women in rural population in Kancheepuram district. Methodology: Total of 150 pregnant women belongs to rural area were selected for the study to find out the prevalence of gestational diabetes mellitus. Pregnant women between 24 and 28 weeks of fetal age were included in the study, and pregnant women below 24 weeks and above 28 weeks of the fetal age and women who refused to participate in the study were excluded. Detailed procedure was explained, and written consent was obtained from the subjects. The Diabetes in Pregnancy Study Group India criteria were used for the diagnosis of GDM, and Edinburgh postnatal depression assessment tool was used to measure the depression level among the pregnant women with GDM. Results: About 40% of the women were diagnosed with gestational diabetes mellitus, in which out of 40%, 32% of the women with gestational diabetes were also suffered from depression during pregnancy. Conclusion: This study concluded that there is a high incidence of diabetes during pregnancy among women in rural population in Kancheepuram district. Age, gravida status, parity, and obesity are the main risk factors that are strongly related to gestational diabetes.
Keywords: Depression, diabetes, glucose level, pregnancy, prevalence
How to cite this article:
Sandhya M, Manikumar M, Augustina S J, Kamalakannan M. Prevalence of diabetes mellitus and depression status among pregnant women in rural population in Kancheepuram District. J Datta Meghe Inst Med Sci Univ 2022;17:871-6 |
How to cite this URL:
Sandhya M, Manikumar M, Augustina S J, Kamalakannan M. Prevalence of diabetes mellitus and depression status among pregnant women in rural population in Kancheepuram District. J Datta Meghe Inst Med Sci Univ [serial online] 2022 [cited 2023 Mar 28];17:871-6. Available from: http://www.journaldmims.com/text.asp?2022/17/4/871/369483 |
| Introduction | |  |
Pregnancy is one among the life's most vital event which is involving in social, psychological, and hormonal changes. Gestational diabetes is a condition that lasts for a short period of time during the gestational period. It is a glucose intolerance which is leading to increase in blood sugar level of variable severity with onset or first recognition during pregnancy.[1] It is usually diagnosed in the second trimester of gestational period and present in almost 12% of pregnant women. GDM affects almost four million women in India. The incidence of diabetes during gestational period within the population in India is higher in comparison with the Asian countries. The occurrence of GDM ranges from 6% to 9% in rural and 12% to 21% within urban areas.[2],[3]
Gestational diabetes mellitus is not due to a lack of insulin, but to other hormones released during pregnancy that might make insulin less effective, which is referred to as insulin resistance. Symptoms of gestational diabetes usually go away after delivery, although they can persist in a few rare cases. The placenta supplies a growing fetus with more nutrients and water and also produces a selection of hormones to require care of pregnancy. Some of the hormones such as estrogen, cortisol, and hormone produced by placenta can have a blocking effect on insulin production which is often called as a contra-insulin effect. Because the placenta grows, more of the hormones are produced and therefore the risk of insulin opposition becomes more greater. Normally, the pancreas is in a position to make additional insulin to beat insulin resistance. However, when the assembly of insulin is not enough to beat the effect of placental hormones, gestational diabetes occurs.
Gestational diabetes is related to an increased mother risk for other pregnancy-related complications such as preeclampsia, postpartum hemorrhage, and increased risk for developing type 2 diabetes after pregnancy. It also puts an infant at risk, since gestational diabetes is associated with an increased risk for macrosomia, jaundice, and birth trauma. Later in life, children of gestational diabetes mothers have an increased risk of obesity, abnormal glucose intolerance, and type 2 diabetes.[4]
Obesity could also be a modifiable risk factor that is strongly related to the event of gestational diabetes.[5] During a survey of 97,000 singleton births, obese women had a 3-fold increased risk of developing GDM than nonobese women. Not only obese but also overweight women have a 1.8–6.5 times greater risk of developing GDM. Gestational diabetes is diagnosed through laboratory screening employing a pregnancy oral glucose tolerance test that is performed between 24 and 28 weeks of gestational period.[6]
In this study, Diabetes in Pregnancy Study Group India (DIPSI criteria) was used to assess the presence of gestational diabetes. DIPSI diagnostic criterion of 2-h plasma glucose ≥140 mg/dl with 75 g of oral glucose load may be a modified version of the WHO, in that the WHO procedure requires women to be within the fasting state, whereas DIPSI procedure is performed in the fasting or nonfasting state regardless of the last meal timing.[7],[8],[9]
There is an evidence that physical inactivity increases the danger of tons of adverse health problems including coronary heart disease, type 2 diabetes, breast cancer, and colon cancer. Reduced daily physical activity levels and scarcity of exercise, not only cause changes in the body during pregnancy.Numerous physical changes happen within the load, within the system and within the hormonal and energy balance. Shifts in maternal metabolism result in an more number of insulin resistance during gestation. The increase in insulin secretion would not be sufficient to compensate the increased level of insulin resistance. Therefore, it leads to gestational diabetes.
GDM is additionally associated with worse psychological outcomes such as anxiety, impaired quality of life, and both prenatal and postnatal depression. Most of the women experience emotional worries and stressful life during pregnancy which is due to new responsibilities associated with their lives and family expectation may cause depression in both prenatal and postnatal periods. Prenatal depression is one among the foremost common mental disturbance in women, with a prevalence rate of about 7%–37%.[10]
Depression during pregnancy or in postpartum period has a negative impact on mother and as well as their newborn baby. Depression during pregnancy is related to poor maternal health, increased obstetrics complication, preterm birth, and neonatal complications. Also, depression issues persist after delivery, resulting in postpartum depression, which is linked to difficulties in maternal-child bonding, insufficient child care, and a lower rate of breastfeeding.[11],[12]
In this study, Edinburgh postnatal depression assessment tool was used to diagnose the extent of depression status among women with GDM. Edinburgh postnatal depression scale (EPDS) is a set of 10 screening questions that indicate whether a mother features symptoms of depression and anxiety during pregnancy and within the year following the birth of a toddler. The entire score is calculated by adding the numbers selected for every of the ten items. If the patient's score is 10 points or above, then it is considered depression.
Exercise is essential for glucose metabolic control and it helps to prevent gestational diabetes and depression.[13] Exercise increases the speed of glucose uptake in striated muscle, a process that is regulated by the GLUT4 transporter. This explains the connection observed between workout and improvement in maternal glucose homeostasis and insulin sensitivity. Similarly, exercise during pregnancy is related to better glucose tolerance. Most gynecological and obstetrics guidelines recommend 25–30 min of mild-to-moderate exercise during pregnancy.
| Methodology | | |
This is an observational study conducted at Saveetha Medical College and Hospital and took nearly 3 months to complete the study. The study population comprised women between 24 and 28 weeks of gestational age who are coming for the antenatal checkup in obstetrics department during the study. A total of 150 pregnant women were selected by convenient sampling method based on eligibility criteria. Pregnant women between 24 and 28 weeks of gestation age were included in the study, and pregnant women below 24 weeks and above 28 weeks of gestational age and women who refused to participate in the study were excluded. Detailed procedure was explained, and written consent was obtained from the subjects. A pro forma containing general information such as age, socioeconomic status, history of diabetes in first-degree relatives, past history diabetes during gestational period, and detailed obstetrics history was filled up for each of the participants. Body mass index (BMI) was also calculated. DIPSI criteria were used to diagnose the presence of GDM, and postnatal depression assessment tool was used to measure the presence of depression and its levels among the pregnant women with GDM.
Selected women were subjected to DIPSI test. Women were given 75 ml of oral glucose which is dissolved in 200 ml of water irrespective of their last meal timing. They were asked to drink the glucose within 5–10 min, time was noted. Then, women were asked to take rest for 2 h during which they were asked to avoid any physical activity. Venous blood sample was drawn after 2 h, and the plasma glucose was estimated in the laboratory.
Diagnosis of gestational diabetes mellitus
According to the DIPSI criteria, if the 2-h venous plasma glucose measured after 75 g of oral glucose load was >140 mg/dl, then the women were diagnosed with GDM positive.
Ethical clearance
Ethical approval for this study (Ethical Committee 01/046/2021/ISRB/PGSR/SCPT) was provided by the Ethical Committee Saveetha College of Physiotherapy, Saveetha Institute of Medical and Technical Sciences, Tamil Nadu, India on 12 August 2020.
| Results | | |
A total of 150 pregnant women were enrolled during the study in the last investigation, of which 60 of them were diagnosed with GDM and their overall baseline characteristics are shown in [Table 1] and [Table 2] and [Figure 1]. In this study, the age of the participants ranged between <20 years and >31 years, in which 6.6% of them were <20 years, 40.6% of women were from 21 to 25 years' age group, 36.6% were from 26 to 30 years, and 16% of women were >31 years. Out of these, 58.3% of women were in the age group between 21 and 25 years and 18.3% of them between 26 and 30 years were diagnosed with GDM. The prevalence rate was higher in women aged 21–25 years (58.3%) and 26–30 years (18.3%) compared to women aged <20 and >31 years (8.3% and 16.6%) [Table 3]. | Table 1: Baseline characteristic and prevalence of gestational diabetes mellitus in pregnant women
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 | Table 2: Total distribution of pregnant women with and without gestational diabetes mellitus
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Out of 150 pregnant women, 53% of them were literates, 56% of them were homemakers and 44% of them living in a joint family. Majority of the study population belonged to socioeconomic class 3 (45%); only 10% of them belonged to class 1. 20% of them had normal BMI ranges between 18.5-24.99, 39.3% of them comes under the BMI ranges between 25-29.99 and 31% of them had BMI >30. The prevalence rate was higher in women having BMI of >25 kg/m which is about 53.3% compared to women with BMI of 18.5–24.9 kg/m (28.3%).
Forty-six percent of the females were gravida 1 and only 3.3% of the females have conceived for the fourth time. Majority of the females were nulliparous (46%). Eighteen percent of the females were having family past history of diabetes mellitus. Eight percent of the pregnant women were hypertensive having a blood pressure of about ≥140/90 mmHg.
Among all 150 females, 71 were illiterate, 39 were from class 1 to 10, 23 were from class 11 to 12, 11 were done their undergraduate, and 6 were postgraduates [Table 4]. Out of them, 35 (49.2%) were illiterate, 12 (31%) were from class 1 to 10, 9 (39%) were from class 11 to 12, 3 (27%) were done their undergraduate, and 1 (17%) was postgraduate who had gestational diabetes mellitus (GDM). Only 15 (10%) subjects were having monthly income in the range of 3288 and above, and out of them, 5 (8.3%) was having gestational diabetes [Table 5].
It was observed that out of 150 women, 69 were primigravida, 47 were gravida 2, and 34 of them were gravida ≥3. [Table 6] shows the percentage of gravida and gestational diabetes mellitus in women. Especially in women with GDM, about 38% of them had a history of gravida:1, 40.42% had gravida:2 and 44.11% of them had >gravida:3. Out of 150 females, 38 of them were nulliparous and 42% were parous. Of these, 46.3% were nulliparous and 39.4% of parous women had gestational diabetes [Table 7]. About 19% of the GDM women had a family history of diabetes mellitus [Table 8] and 54 (36%) of them suffered from depression. Out of these 54 women with depression, 31 of them had GDM.
Out of 150 females studied, 60 (40%) were having diabetes during pregnancy (blood sugar level ≥140 mg/dl). This study shows that about 60 (37.5%) pregnant women were diagnosed with GDM.
| Discussion | | |
Diabetes mellitus is one among the foremost common growing epidemic condition in India. Increased blood sugar level in gestational period has unique diabetes-related risk factors in that there are long-term consequences for the mother and unborn baby. This study provides a chance to research the occurrence of GDM among the pregnant women in rural population in Kancheepuram district. The samples were selected to seek out prevalence with the assistance of fasting blood glucose level and their depression state was evaluated using the depression assessment tool. EPDS appears to be a valid and reliable measure to rate the range of depression within the pregnant women. Out of 150 pregnant womens, about 40% of the women were diagnosed with gestational diabetes mellitus, in that 40%, 32% of the women with gestational diabetes were also suffered from depression during pregnancy. Out of these 54 women with depression, 31 of them had gestational diabetes.
The incidence rate in GDM was reported between 4.6% and 14% in urban areas and 1.7%–13.2% in rural areas. Various studies reported that the prevalence rate was about 3.8% in Kashmir, 6.6% in Rajasthan, 6.94% in Jammu, 7.1% in Haryana, 9.5%, 18.9% in Tamil Nadu, 35% in Punjab, and 41% in Lucknow. The present study reported a prevalence of GDM as 40% out of 150 pregnant women.[14]
Out of 60 GDM women, 31 of them had gestational diabetes mellitus along with depression in which 9 of them had mild depression, 17 of them had moderate and 5 of them had severe depression [Table 9].
They concluded that the ancestor history of diabetes was found to be a positive risk factor of GDM.[15],[16]
The previous study identified the subsequent risk factors of developing GDM by multiparity ≥2, previous history of GDM, congenital anomalies, stillbirth, abortion, preterm delivery, macrosomia, concurrent pregnancy-induced hypertension, Polycystic ovary syndrome, age ≥25, and BMI ≥25.[17] It is reported that prevalence rates range from 3.8% in Kashmir, to 6.2% in Mysore, 9.5% in western India, and 17.9% in Tamil Nadu.[18]
About 7.1% of women were diagnosed with gestational diabetes, during which none of them had a known case of diabetes.[19] A random survey was done in various cities in India from 2002 to 2003; the occurrence of GDM was 16.2% in Chennai, 15% in Thiruvananthapuram, 21% in Alwaye, 12% in Bangalore, 18.8% in Erode, and 17.5% in Ludhiana. In another study which took place in Tamil Nadu between 2005 and 2007, a complete of 4151, 3960, and 3945 pregnant women were screened in urban, semi-urban, and rural areas and GDM was diagnosed in 17.8%, 13.8%, and 9.9% of women, respectively. Obesity is a crucial risk to think about the event of GDM. In our study, GDM was found to be significantly higher in women with higher BMI. Higher incidence of GDM in women with higher BMI has also been observed in earlier studies as well. It had been observed that weight gain was more higher in women with gestational diabetes than in those with normal blood sugar and also hyperglycemia in pregnancy was the main risk factor for excess gestational weight gain. Depressive symptoms were common and more severe among women with gestational diabetes. It was reported that about 31% of the women had mild depressive symptoms and 10% of the women had severe depression symptoms.[20] Age, family history, obesity, and economical status were the main risk factors which are related to diabetes during pregnancy.[21]
| Conclusion | | |
This study concluded that there is a high prevalence of gestational diabetes mellitus among pregnant women living in rural areas .About 40% of the women were diagnosed with gestational diabetes mellitus, in which out of 40%, 32% of the women with gestational diabetes were also suffered from depression during pregnancy. The epidemic of diabetes poses an enormous publish health challenge globally. Age, gravida, and parity are highly related to GDM. Higher level of depression, low economical status, illiterate, and high BMI are the foremost reasons for the occurrence of GDM. The foremost of the participants with gestational diabetes had a low level of education which can be linked with the shortage of data and knowledge also. Only by raising knowledge about gestational diabetes mellitus to pregnant women and helping them to understand the illness will cause reduction in the incidence of diabetes mellitus during pregnancy. A moderate exercise program during pregnancy might reduce the occurrence of diabetes during pregnancy and also improve the extent of maternal glucose tolerance. These findings will help us to form an awareness on gestational diabetes.
Acknowledgment
We sincerely thank our volunteers who participated in this study. We would like to thank our physiotherapy staff and obstetrics and gynecology department for helping in the care given to the patients.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]
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