| 研究概要 |
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.
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| 現在までの達成度 (区分) |
現在までの達成度 (区分)
1: 当初の計画以上に進展している
理由
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.
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| 今後の研究の推進方策 |
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.
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