Integrated care of diabetes during pregnancy: a Qatari nationwide cohort

Mohammed Bashir; Ibrahim Ibrahim; Stephen Beer; Hessa Shahbic; Faten Eltaher; Kholoud Al-Mutawaa; Mahmoud Zirie; Abdul-Badi Abou-Samra

doi:10.1016/j.eclinm.2024.102605

Integrated care of diabetes during pregnancy: a Qatari nationwide cohort

EClinicalMedicine. 2024 Apr 22:72:102605. doi: 10.1016/j.eclinm.2024.102605. eCollection 2024 Jun.

Authors

Mohammed Bashir^{1

2}, Ibrahim Ibrahim³, Stephen Beer^{1

2}, Hessa Shahbic⁴, Faten Eltaher⁵, Kholoud Al-Mutawaa^{6

7}, Mahmoud Zirie^{1

7}, Abdul-Badi Abou-Samra^{2

7}

Affiliations

¹ Endocrine Section, Internal Medicine Department, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar.
² Qatar Metabolic Institute, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
³ Sidra Medicine, Qatar Foundation, P.O Box 26999, Doha, Qatar.
⁴ Women's Health Program, Primary Health Care Corporation, Box: 26555, Doha, Qatar.
⁵ Department of Obstetrics and Gynaecology, Women's Wellness and Research Centre, Hamad Medical Corporation, P.O Box 3050, Doha, Qatar.
⁶ Non-communicable Diseases, Public Health Department, Ministry of Public Health, P.O Box. 7744, Doha, Qatar.
⁷ Qatar National Diabetes Committee, Ministry of Public Health, P.O Box. 7744, Doha, Qatar.

Abstract

Background: Diabetes in pregnancy (DIP) is associated with adverse fetal and maternal outcomes. DIP is classified as either pre-existing or new-onset diabetes mellitus (DM), which is classified into gestational DM (GDM) and newly detected type 2 (N-T2D). All pregnant women in Qatar who are not known to have pre-existing DM are offered screening for DIP during the first antenatal care visit and after 24 weeks gestation. The study aims to report the DIP screening rates, the prevalence of DIP, and the impact of the universal screening program on adverse pregnancy outcomes.

Methods: This retrospective study included all women who gave birth in Hamad Medical Corporation (HMC) hospitals between 2019 and 2022. New-onset DIP was defined using the WHO-2013 criteria. The primary outcomes were the screening rates and the prevalence of DIP in Qatar. The secondary outcomes were the difference in preterm delivery, C-section, macrosomia, large for gestational age (LGA), small for gestational age (SGA), and intra-uterine fetal death (IUFD) between women with or without GDM.

Findings: We included 94,422 women who gave birth to 96,017 neonates (85.7%) out of 112,080 neonates born nationwide. The number of women with pre-existing diabetes was 2496 women. Of 91,926 eligible women, 77,372 (84.2%) were screened for DIP. The prevalence of GDM is 31.6% (95% CI: 31.3-32.0%); N-T2D is 2.2% (95% CI: 2.1-2.3%), and pre-existing Type 2 DM and Type 1 DM was 2.6% (95% CI: 0.8-3.0%) and 0.2% (0.19-0.25), respectively. Compared to the non-GDM group, women with GDM were older (30.8 ± 5.3 versus 29.7 ± 5.2 years, p < 0.001). After adjusting for age, women with GDM had lower risk of IUFD and SGA (0.63 [95% CI 0.50-0.80, p < 0.001], 0.88 [95% CI 0.84-0.92, p < 0.001] respectively) but higher risk of C-section and LFD (1.07 [95% CI 1.04-1.10, p < 0.001], 1.09 [95% CI 1.01-1.15, p = 0.01], respectively, compared to women with no-GDM.

Interpretation: Of the women eligible for screening, 84.2% were screened by the DIP program in Qatar. The prevalence of DIP in Qatar is 36.9%. Integrated care is critical for the screening and management of diabetes during pregnancy.

Fundings: The authors did not receive any funding for this project.

Keywords: Diabetes; Pregnancy; Prevalence; Universal screening.