Table 4.
Subgroup weighted prevalence of GDM in pregnant women in 16 MENA countries by age, pregnancy trimester, body mass index, study period, ascertainment methodology, tested sample, C-section, and maternal mortality ratio.
| No. of studies | Tested sample | GDM | GDM prevalence | Heterogeneity measures | p–value4(fixed model) | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Range (%) | Median (%) | Weighted prevalence % | 95% CI | Q (p–value)1 | I2(%)2 | 95% prediction interval (%)3 | |||||
| Age | <0.001 (<0.001) | ||||||||||
| 15–29 years | 24 | 19,187 | 2,883 | 0.0–29.9 | 10.8 | 9.7 | 6.7–13.2 | 1,140.7 (p<0.001) | 98.0 | 0.0–31.4 | |
| ≥30 years | 26 | 22,186 | 5,617 | 4.1–50.7 | 25.4 | 21.9 | 18.5–25.5 | 868.6 (p<0.001) | 97.1 | 7.0–42.0 | |
| Unclear age | 148 | 237,518 | 22,281 | 0.0–50.0 | 11.2 | 12.3 | 10.6–14.0 | 20,967.2 (p<0.001) | 99.3 | 0.1–37.6 | |
| Trimester | 0.06 (<0.001) | ||||||||||
| First | 11 | 5,807 | 387 | 2.2–37.2 | 7.6 | 8.9 | 5.3–13.3 | 272.5 (p<0.001) | 96.3 | 0.0–29.7 | |
| Second | 85 | 134,792 | 14,378 | 0.0–50.0 | 12.0 | 12.9 | 10.9–15.0 | 9,687.2 (p<0.001) | 99.1 | 0.6–36.3 | |
| Third | 18 | 14,146 | 1,354 | 2.7–50.7 | 18.5 | 20.0 | 13.1–27.9 | 1,428.2 (p<0.001) | 98.8 | 0.0–60.6 | |
| Not reported | 84 | 124,457 | 14,678 | 0.0–47.0 | 12.5 | 12.5 | 9.8–15.5 | 16,618.8 (p<0.001) | 99.5 | 0.0–46.1 | |
| BMI | <0.001 (<0.001) | ||||||||||
| Underweight | 2 | 94 | 0 | 0 | 0 | 0 | — | — | — | — | |
| Normal weight | 11 | 3,822 | 335 | 1.0–29.2 | 6.0 | 7.8 | 4.1–12.4 | 200.8 (p<0.001) | 95.0 | 0.0–29.5 | |
| Overweight | 7 | 2,502 | 334 | 4.3–35.1 | 9.2 | 12.0 | 5.7–20.1 | 182.2 (p<0.001) | 96.7 | 0.0–47.5 | |
| Obese | 17 | 4,8459 | 941 | 7.6–47.0 | 15.8 | 17.2 | 12.8–22.0 | 241.5 (p<0.001) | 93.8 | 2.6–40.2 | |
| Unclear | 161 | 267,6925 | 29,187 | 0.0–50.7 | 12.8 | 13.4 | 11.7–15.2 | 27,066.0 (p<0.001) | 99.4 | 0.1–41.2 | |
| Study period | 0.14 (<0.001) | ||||||||||
| 2000–2009 | 45 | 55,570 | 6,653 | 0.0–50.7 | 11.1 | 10.6 | 8.1–13.4 | 4,118.0 (p<0.001) | 98.9 | 0.0–34.2 | |
| 2010–2019 | 139 | 193,3649 | 23,527 | 0.0–50.0 | 12.7 | 14.0 | 12.1–16.0 | 19,613.9 (p<0.001) | 99.3 | 0.2–42.2 | |
| Overlapping | 14 | 29,983 | 619 | 1.4–28.6 | 9.1 | 12.0 | 6.5–18.7 | 414.1 (p<0.001) | 96.9 | 0.0–45.3 | |
| GDM ascertainment 5 | <0.001 (<0.001) | ||||||||||
| WHO guidelines | |||||||||||
| WHO 1985 | 4 | 633 | 79 | 0.0–28.3 | 9.9 | 10.4 | 3.2–20.5 | 25.4 (p<0.001) | 88.2 | 0.0–67.5 | |
| WHO 1999 | 6 | 3,335 | 178 | 1.4–20.2 | 14.8 | 11.4 | 3.6–22.8 | 228.9 (p<0.001) | 97.8 | 0.0–62.4 | |
| WHO 2013 | 14 | 30,348 | 7,125 | 13.3–34.6 | 22.6 | 22.8 | 20.2–25.5 | 344.5 (p<0.001) | 96.2 | 13.0–34.5 | |
| WHO year not mentioned | 1 | 2,221 | 801 | — | — | 36.1 | 34.1–38.1 | — | — | — | |
| ADA guidelines | — | — | — | — | — | ||||||
| ADA 1997 | 1 | 5,347 | 1,641 | — | — | 30.7 | 29.5–31.9 | — | — | — | |
| ADA 2002–2010 | 16 | 19,604 | 2,269 | 2.4–37.2 | 12.0 | 11.7 | 9.0–14.7 | 364.6 (p<0.001) | 96.4 | 2.6–25.9 | |
| ADA 2011–2013 | 4 | 3,180 | 605 | 13.4–30.5 | 24.9 | 22.7 | 15.4–30.9 | 67.5 (p<0.001) | 95.6 | 0.2–65.0 | |
| ADA 2015–2016 | 4 | 3,229 | 243 | 6.9–9.3 | 7.0 | 7.5 | 6.4–8.7 | 4.435 (p=0.218) | 32.4 | 4.2–11.7 | |
| ADA year not mentioned | 1 | 877 | 143 | — | — | 16.3 | 14.0–18.9 | — | — | — | |
| ADA/IADPSG | 2 | 700 | 306 | 15.1–50.0 | 32.5 | 43.1 | 39.4–46.8 | — | — | — | |
| Self-reported | 6 | 1,833 | 119 | 2.9–46.2 | 5.5 | 9.6 | 2.7–19.8 | 148.2 (p<0.001) | 96.6 | 0.0–56.2 | |
| Medical records | 45 | 70,833 | 2,803 | 0.6–47.0 | 11.4 | 11.5 | 9.1–14.2 | 3,588.1 (p<0.001) | 98.8 | 0.4–33.1 | |
| Unclear | 36 | 31,541 | 1,319 | 0.0–31.4 | 8.4 | 9.3 | 6.2–12.9 | 1,770.5 (p<0.001) | 98.0 | 0.0–36.9 | |
| IADPSG | 23 | 32,911 | 5,577 | 2.7–50.7 | 18.0 | 20.9 | 15.6–26.6 | 3,071.8 (p<0.001) | 99.3 | 1.5–53.5 | |
| Carpenter and Coustan | 13 | 8,468 | 755 | 2.2–24.4 | 8.2 | 8.8 | 5.6–12.7 | 356.1 (p<0.001) | 96.6 | 0.1–27.4 | |
| NDDG | 10 | 51,102 | 5,076 | 6.1–13.3 | 8.7 | 9.4 | 7.8–11.1 | 382.7 (p<0.001) | 97.6 | 4.0–16.7 | |
| Fourth International Workshop–Conference | 2 | 10,495 | 1,394 | 7.5–15.5 | 11.5 | 13.0 | 12.4–13.7 | — | — | — | |
| Fifth International Workshop–Conference | 5 | 1,010 | 215 | 7.3–44.4 | 7.9 | 17.4 | 5.6–33.9 | 149.9 (p<0.001) | 97.3 | 0.0–85.6 | |
| ACOG | 4 | 1,279 | 100 | 0.0–16.7 | 7.6 | 7.7 | 3.7–12.9 | 18.11 (p<0.001) | 83.4 | 0.0–36.8 | |
| NICE | 1 | 256 | 49 | — | — | 19.1 | 14.8–24.4 | — | — | — | |
| Sample size | 0.25 (<0.001) | ||||||||||
| <100 | 32 | 1,779 | 300 | 0.0–50.7 | 12.8 | 14.8 | 10.7–19.5 | 198.8 (p<0.001) | 84.4 | 0.0–44.3 | |
| ≥100 | 166 | 277,423 | 30,497 | 0.6–50.0 | 12.0 | 12.8 | 11.2–14.5 | 27,873.7 (p<0.001) | 99.4 | 0.1–40.1 | |
| C-section rate | <0.001 (<0.001) | ||||||||||
| <15% | 7 | 10,206 | 481 | 2.7–46.2 | 12.0 | 11.5 | 5.6–19.0 | 285.6 (p<0.001) | 97.9 | 0.0–44.2 | |
| 15–29% | 118 | 235,106 | 27,222 | 0.0–50.7 | 13.5 | 14.4 | 12.3–16.6 | 24,307.1 (p<0.001) | 99.5 | 0.2–43.3 | |
| >30% | 69 | 29,101 | 3,010 | 0.0–50.0 | 9.2 | 11.6 | 9.4–14.1 | 2,461.8 (p<0.001) | 97.2 | 0.1–36.1 | |
| Unclear | 4 | 4,789 | 147 | 1.4–15.0 | 3.9 | 4.8 | 1.8–9.0 | 89.2 (p<0.001) | 96.6 | 0.0–34.3 | |
| Maternal mortality ratio | <0.001 (<0.001) | ||||||||||
| ≤100/100,000 | 188 | 273,491 | 30,534 | 0.0–50.7 | 12.5 | 13.2 | 11.6–14.9 | 27,551.7 (p<0.001) | 99.3 | 0.1–40.8 | |
| >100/100,000 | 6 | 922 | 1116 | 3.0–46.2 | 13.6 | 16.5 | 3.4–36.3 | 97.1 (p<0.001) | 96.9 | 0.0–100.0 | |
| Unclear | 4 | 4,789 | 147 | 1.4–15.0 | 3.9 | 4.8 | 1.8–9.0 | 89.2 (p<0.001) | 96.6 | 0.0–34.3 | |
| Overall6 | 198 | 279,202 | 30,797 | 0.0–50.7 | 12.3 | 13.0 | 11.5–14.6 | 28154 (p<0.001) | 99.3 | 0.1–40.6 | — |
CI, confidence interval calculated using the exact binomial method; ACOG, American College of Obstetricians and Gynecologists; ADA, American Diabetes Association; GDM, gestational diabetes mellitus; IADPSG, International Association of Diabetes and Pregnancy Study Groups; NDDG, National Diabetes Data Group; NICE, National Institute for Health and Care Excellence; WHO: World Health Organization.
1Q: Cochran’s Q statistic is a measure assessing the existence of heterogeneity in estimates of GDM prevalence.
2I2 is a measure assessing the percentage of between-study variation due to differences in GDM prevalence estimates across studies rather than chance.
3Prediction intervals estimate the 95% confidence interval in which the true GDM prevalence estimate in a new study is expected to fall.
4Heterogeneity between subgroups using random-effects model (fixed-effect model).
5Regardless of the year of the guidelines for the most updated criteria when GDM was ascertained, based on different criteria in the same population.
6Overall pooled estimates in the 16 countries regardless of the tested population, sample size, and data collection period, using the most updated criteria when GDM was ascertained using different criteria in the same population.