Comprehensive Assessment of Prevalence and Trends of Gestational Diabetes Mellitus among Bangladeshi Rural Women: A multidisciplinary investigation from basic epidemiology to genetic screening

2013 Fiscal Year Annual Research Report

• Project/Area Number: 25305034
• Research Category: Grant-in-Aid for Scientific Research (B)
• Section: 海外学術
• Research Institution: University of Tsukuba
• Principal Investigator: JESMIN Subrina 筑波大学, 医学医療系, 助教 (60374261)
• Co-Investigator(Kenkyū-buntansha): 水谷 太郎 筑波大学, 医学医療系, 教授 (80181890) ; 岩嶋 義雄 独立行政法人国立循環器病研究センター, その他部局等, その他 (80448068)
• Project Period (FY): 2013-04-01 – 2016-03-31
• Keywords: 妊娠中糖尿病 / バングラデシュ / 疫学 / 遺伝学

Research Abstract

Last year, we estimated the prevalence and the associated risk factors of diabetes in pregnant (gestational diabetes mellitus, GDM) women from a cross sectional study undertaken in Bangladesh. Prevalence of gestational diabetes mellitus (GDM) was 9.7% according to the WHO criteria and 12.9 % according to the new ADA criteria in this study population. The prevalence of GDM increased significantly with increased age. Prevalence of GDM were higher among women with higher educated, higher monthly household income, and those who had higher number of parity. Prevalence were also higher among pregnant women who had hypertension, currently seeking antenatal care, had no previous history of still birth/abortion, and had parental history of hypertension and diabetes. Prevalence of GDM was 2.91 times more likely in hypertensive as compared to non-hypertensive pregnant women (p<0.001). Prevalence of GDM was three times more likely among 3 or more parity women, compared to women with zero parity (p=0.001). Women who attend antenatal care had 1.96 times higher prevalence of GDM than those who did not (p<0.001). GDM status was not differed significantly according to other characteristics of the study population including parental history of hypertension and obstetric risks in the past (still birth/abortion). Thus, our findings show that GDM are highly prevalent among the pregnant women aged 18 years or more in Bangladesh. GDM seems to be a major public health challenge in Bangladesh, so immediate action and universal screening should be taken toward prevention and control strategies.

Current Status of Research Progress

1: Research has progressed more than it was originally planned.

Reason

The current research is on right track both from the contexts of time line and the amount of research activities scheduled to be done (100% done with target milestone achievement). As mentioned in our original research application, last year we already performed a cross sectional study undertaken in pregnant women in Bangladesh to determine the prevalence of gestational diabetes mellitus (GDM) in Bangladesh. A total of 2000 rural pregnant women were screened for GDM. All participants provided written informed consent. The study was approved by the ethical committee of HDRCRP, Bogra Medical College, Bangladesh and Faculty of Medicine, University of Tsukuba, Japan. We have already completed the entry of all data and did statistical analysis and published two papers (Jesmin et al, Diabetes Research and Clinical Practice, 2014; Jesmin et al, Journal of Shaheed Ziaur Rahman Medical College, 2013). All pregnant women were gone through universal screening for GDM with 50gm GCT (glucose challenge test) after 18 weeks and if GCT was negative then the test was repeated after 28 weeks of pregnancy. In addition, screening of patients with risk factors for GDM was done at first prenatal visit. GDM was defined according to WHO criteria and the new ADA criteria. In addition, we did preparation to start a prospective pregnancy cohort including the women free of diabetes either at the early phase of first trimester or suspecting to be pregnant with pregnancy confirmation.

Strategy for Future Research Activity

We have already completed the preparation to start a cohort study on pregnant women in Bangladesh. In the second year of this project, we will employ and engage 4 mobile health workers with experience in maternal and child health, to recruit hard-to-reach rural Bangladeshi women for this prospective pregnancy cohort. These women will be free of diabetes either at the early phase of first trimester or suspecting to be pregnant with pregnancy confirmation and will be longitudinally followed up monthly through sociodemographic data (questionnaire and interview), physical assessment with pregnancy profile, biochemical measurement, (study estimated sample size: 1000, study power: 90%) till delivery of babies and subsequent follow up for one year. In addition, in 2014 a case control study will be conducted using the pregnant women with GDM as cases and pregnant women without GDM as control in rural Bangladesh (n=200 for each group). In 2014 we will estimate the followings: estimation of incidence rate of GDM; estimation of clinical outcomes for both mother and child from cohort design; biochemical measurement: blood glucose, insulin, lipid profile; assessment of biomarkers: inflammatory markers TNF-alpha and hsCRP, pro-atherogenic marker PAI-1, adiponectin, splice variants of VEGF (121,165,188), its downstream signaling cascades (Flk-1, Flt-1, eNOS, Akt, NO) by ELISA; assessment of fetal fatality; data interpretation, publication. The generated data in present study will help in developing targeted programs, policy and legislation for GDM treatment and prevention in Bangladesh.

Expenditure Plans for the Next FY Research Funding

Last year we did not measure the expensive biomarkers from this grant money, we had some donations from local Bangladesh to buy some expensive re-agents.
This year we will use the saved money from last year to measure more expensive biomarkers than planned originally.

Research Products

• [Journal Article] Screening for gestational diabetes mellitus in Bogra sadar, Bogra Bangladesh. (2014)
  • Author(s): Jesmin S, Rahman A, Sohael F, Akter S, Islam MM, Khatun MT, Sultana SN, Mamun AA, Akashi H, Habib AKMA.
  • Journal Title: Journal of Shaheed Ziaur Rahman Medical College Volume: 20 Pages: 19-24
  • Peer Reviewed / Acknowledgement Compliant
• [Journal Article] Screening for gestational diabetes mellitus and its prevalence in Bangladesh. (2014)
  • Author(s): Jesmin S, Akter S, Akashi H, Mamun AA, Rahman MA, Islam MM, Sohael F, Okazaki O, Moroi M, Kawano S, Mizutani T.
  • Journal Title: Diabetes Research and Clinical Practice Volume: 103 (1) Pages: 57-62
  • DOI: 10.1016/j.diabres.2013.11.024
  • Peer Reviewed
• [Journal Article] Comparison of efficacy of intensive versus mild pitavastin therapy on lipid and inflammation biomarkers in hypertensive patients with dyslipidemia. (2014)
  • Author(s): Yamasaki T, Iwashima Y, Jesmin S, Ohta Y, Kusunoki H, Hayashi S, Horio T, Kawano Y.
  • Journal Title: PLOS ONE Volume: 9(2) Pages: e89057
  • DOI: 0.1371/journal.pone.0089057
  • Peer Reviewed
• [Journal Article] Disruption of components of vascular endothelial growth factor angiogenic signalling system in metabolic syndrome. Findings from a study conducted in rural Bangladeshi women. (2013)
  • Author(s): Jesmin S, Akter S, Rahman MM, Islam MM, Islam AM, Sultana SN, Mowa CN, Yamaguchi N, Okazaki O, Satoru K, Kimura S, Hiroe M, Mizutani T, Moroi M.
  • Journal Title: Thrombosis and Haemostasis Volume: 109(4) Pages: 696-705
  • DOI: 10.1160/TH12-09-0654.
  • Peer Reviewed
• [Journal Article] Vascular Endothelial Growth Factor Induces Growth of uterine Cervix and immune cell recruitment in mice. (2013)
  • Author(s): Donnelly S, Nguyen BT, Rhyne S, Estes J, Jesmin S, MowaCN.
  • Journal Title: Journal of Endocrinology Volume: 217(1) Pages: 83-94
  • DOI: 10.1530/JOE-12-0469.
  • Peer Reviewed
• [Journal Article] Metabolic syndrome among pre and post menopausal rural women in Bangladesh: result from a population based-study. (2013)
  • Author(s): Jesmin S, Islam AMS, Akter S, Islam MM, Sultana SN, Yamaguchi N, Okazaki O, Moroi M, Hiroe M, Kimura S, Watanabe T, Kawano S, Mizutani T.
  • Journal Title: BMC Research Notes Volume: 6 Pages: 157
  • DOI: 10.1186/1756-0500-6-157
  • Peer Reviewed
• [Journal Article] Lower ratio of high-molecular-weight adiponectin level to total may be associated with coronary high-risk plaque. (2013)
  • Author(s): 4. Moroi M, Akter S, Nakazato R, Kunimasa T, Masai H, Furuhashi T, Fukuda H, Koda E, Sugi K, Jesmin S.
  • Journal Title: BMC Research Notes Volume: 6 Pages: 83
  • DOI: 10.1186/1756-0500-6-83.
  • Peer Reviewed
• [Journal Article] Higher gravidity and parity are associated with metabolic syndrome among rural Bangladeshi women. (2013)
  • Author(s): Akter S, Jesmin S, Rahman MM, Islam MM, Khatun MT, Akashi H, Mizunani T.
  • Journal Title: PLOS One Volume: 8(8) Pages: e68319
  • DOI: 10.1371/journal.pone.0068319
  • Peer Reviewed
• [Journal Article] argeted Intervention for the Ultra poor Women in Rural Rangpur, Bangladesh: Does it make Any Difference in Appropriate Cooking Practices, Food Habits and sanitation ? (2013)
  • Author(s): Yeasmin L, Akter S, Islam AMS, Rahman MM, M Moroi, Jesmin S.
  • Journal Title: Journal of Biosocial Science Volume: 20 Pages: 1-12
  • Peer Reviewed
• [Presentation] Gestational diabetes mellitus: A neglected health issue in Bangladesh (2013)
  • Author(s): 10. Mamun AA,Jesmin S,Islam MM,Khatun T,Sohael F, Sultana SN, Rahman M, Mizutani T
  • Organizer: World Diabetes Congress Melbourne 2013
  • Place of Presentation: Melbourne, Australia
  • Year and Date: 20131202-20131206
• [Presentation] Disruption of components of vascular endothelial groth factor angiogenic signaling system in metabolic syndrome: Findings from a study conducted in rural Bangladeshi women (2013)
  • Author(s): Jesmin S, Mamun AA, Akter S, Rahman MM, Islam MM, Khatun T, Rahman A, Sohael F, Sultana SN, Mizutani T
  • Organizer: World Diabetes Congress Melbourne 2013
  • Place of Presentation: Melbourne, Australia
  • Year and Date: 20131202-20131206
• [Presentation] Alteration of cardiac VEGF signaling system in estrogen/estrogen receptor manipulated animal model with or without diabetes (2013)
  • Author(s): 12. Mamun AA,Jesmin S,Islam MM,Khatun T,Sohael F, Sultana SN, Rahman M, Mizutani T
  • Organizer: World Diabetes Congress Melbourne 2013
  • Place of Presentation: Melbourne, Australia
  • Year and Date: 20131202-20131206
• [Presentation] Dual endothelin antagonism from early diabetic stage is effective in preventing various diabetic complications through both improving organ microcirculation and restoration of altered VEGF signaling (2013)
  • Author(s): Jesmin S, Shimojo N, Sultana SN, Islam M, Zaedi S, Kawano S, Mizutani T, Miyauchi T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] Potential association between circulatory level of endothelin-1 and metabolic syndrome in Bangladeshi rural women: a population-based cross-sectional study (2013)
  • Author(s): Islam M, Jesmin S, Rahman A, Habib AKMA, Akter S, Shimojo N, Zaedi S, Yamaguchi N, Moroi M, Kimura S, Okazaki O, Hiroe M, Miyauchi T, Kawano S, Akashi H, Mizutani T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] Higher circulatory level of endothelin-1 in hypertensive subjects screened through a cross sectional study in rural Bangladeshi women (2013)
  • Author(s): Akter S, Jesmin S, Rahman A, Habib AKMA, Shimojo N, Islam M, Zaedi S, Yamaguchi N, Moroi M, Kimura S, Okazaki O, Miyauchi T, Kawano S, Akashi H, Mizutani T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] Assessment of circulatory endothelin-1 level among pre- and post-menopausal rural women in Bangladesh: result from a population-based study (2013)
  • Author(s): Khatutn T, Jesmin S, Rahman A, Habib AKMA, Shimojo N, Islam M, Zaedi S, Yamaguchi N, Moroi M, Kimura S, Okazaki O, Miyauchi T, Kawano S, Akashi H, Mizutani T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] elective endothelin (ET)-A receptor antagonist and dual ET-A/B receptor antagonist are effective in preventing the decrease in VEGF signaling and inadequate coronary collateral development in the diabetic hearts (2013)
  • Author(s): Miyauchi Y, Jesmin S, Shimojo N, Maeda S, Sakai S, Yokota T, Zaedi S, Mizutani T, Homma S, Aonuma K, Miyauchi T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] Endothelin antagonism and diabetic erectile dysfunction: Changes in VEGF and NO in type I diabetic penis and effects of endothelin antagonism (2013)
  • Author(s): Zaedi S, Jesmin S, Shimojo N, Sakai S, Maeda S, Miyauchi Y, Yokota T, Mizutani T, Homma S, Aonuma K, Miyauchi T
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] Inhibitory effect of Eicosapentaenoic acid on cardiomyocyte in endothelin induced hypertrophy via PPAR-α (2013)
  • Author(s): Shimojo N, Jesmin S, Sakai S, Maeda S, Miyauchi T, Kawano S, Mizutani T, Aonuma K
  • Organizer: The Thirteenth International Conference on Endothelin
  • Place of Presentation: 東京
  • Year and Date: 20130908-20130911
• [Presentation] エンドセリンA/Bデュアル受容体遮断薬の心臓血管系と腎臓に対する効果：高血圧肥大心、糖尿病性心筋症、高血圧性血管障害のモデルにおいて.
  • Author(s): 宮内裕美、酒井 俊、Sabrina Jesmin、下條信威、本間 覚、前田清司、渡辺重行、青沼和隆、宮内 卓.
  • Organizer: 第二回 臨床高血圧フォーラム
  • Place of Presentation: 東京
• [Presentation] エンドセリンA/B両受容体遮断薬の心臓血管系と腎臓に対する効果：高血圧肥大心、糖尿病性心筋症、高血圧性血管障害のモデルにおいて.
  • Author(s): 宮内裕美、酒井 俊、 Sabrina Jesmin、下條信威、本間 覚、前田清司、渡辺重行、青沼和隆、宮内 卓.
  • Organizer: 第2回日本肺循環学会学術集会
  • Place of Presentation: 東京
• [Presentation] Potential association between disrupted VEGF angiogenic signaling and metabolic syndrome in Bangladeshi rural women.
  • Author(s): Jesmin S, Akter S, Shimojo N, Islam MM, Zaedi S, Yamaguchi N, Moroi M, Kimura S, Okazaki O, Hiroe M, Kawano S, Akashi H, Mizutani T
  • Organizer: 2013 overseas scientific research Festa
  • Place of Presentation: 東京
• [Presentation] Comprehensive assessment of metabolic syndrome prevalence and its components among rural Bangladeshi women.
  • Author(s): Akter S, Jesmin S, Shimojo N, Islam MM, Zaedi S, Yamaguchi N, Moroi M, Kimura S, Okazaki O, Hiroe M, Kawano S, Akashi H, Mizutani T
  • Organizer: 2013 overseas scientific research Festa
  • Place of Presentation: 東京