Prevalence of and factors associated with gestational diabetes mellitus and diabetes in pregnancy in Bangladesh: a facility-based cross-sectional study (2019-2020).

Abstract

Hyperglycaemia in pregnancy is associated with adverse maternal and offspring outcomes in South and Southeast Asia; however, nationally representative data from Bangladesh using contemporary diagnostic criteria remain limited. We aimed to estimate the nationwide prevalence of gestational diabetes mellitus (GDM) and diabetes in pregnancy (DIP), examine associated maternal factors, and assess the screening performance of the glucose challenge test (GCT). We conducted a nationwide facility-based cross-sectional survey (2019-2020) among pregnant women attending antenatal care across all administrative divisions of Bangladesh. A two-step screening strategy (50-g GCT followed by 75-g OGTT) was applied using WHO 2013 criteria. Multivariable logistic regression examined factors associated with GDM and DIP, and receiver operating characteristic analyses evaluated GCT performance and optimal cut-offs. Among 6631 women, the prevalence of GDM was 19.4% and DIP was 8.1%. Prevalence was higher in urban than rural areas for GDM (24.4% vs 12.6%) and DIP (11.0% vs 4.1%). Older age (≥25 years), urban residence, higher BMI, family history of diabetes, and physical inactivity (<30 min/day) were independently associated with both outcomes. Higher odds were observed with increasing number of maternal factors. The GCT showed good discrimination (AUC 0.83 for GDM; 0.89 for DIP). Hyperglycaemia in pregnancy affects a substantial proportion of women attending antenatal care in Bangladesh. The urban-rural gradient and clustering of modifiable risk factors, together with good GCT performance, support feasible integration of universal screening into routine antenatal care, acknowledging possible underestimation with the two-step approach. None.