title: Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3).
abstract: OBJECTIVE
  To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC).
  
  
  METHODS
  Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records.
  
  
  RESULTS
  Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone.
  
  
  CONCLUSIONS
  Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Manni Mohanraj
authors.initials: MM
authors.lastname: Mahalakshmi
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Balaji
authors.initials: B
authors.lastname: Bhavadharini
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Kumar
authors.initials: K
authors.lastname: Maheswari
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Gunasekaran
authors.initials: G
authors.lastname: Kalaiyarasi
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Ranjit Mohan
authors.initials: RM
authors.lastname: Anjana
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Unnikrishnan
authors.initials: U
authors.lastname: Ranjit
authors.affiliation: Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Mohan
authors.affiliation: Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India.
authors.forename: Kurian
authors.initials: K
authors.lastname: Joseph
authors.affiliation: Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India.
authors.forename: Kurian
authors.initials: K
authors.lastname: Rekha
authors.affiliation: Department of Diabetology, Prashanth Infertility Research Centre, Chennai, Tamil Nadu, India.
authors.forename: Sivagnanam
authors.initials: S
authors.lastname: Nallaperumal
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Belma
authors.initials: B
authors.lastname: Malanda
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Arivudainambi
authors.initials: A
authors.lastname: Kayal
authors.affiliation: Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: Belton
authors.affiliation: Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India.
authors.forename: Ram
authors.initials: R
authors.lastname: Uma
keywords: Asian Indians; South Asians; fetal outcomes; gestational diabetes mellitus; maternal outcomes