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Background Identification of gestational diabetes mellitus (GDM) risk factors is pertinent, for it can be an effective intervention for its prevention. As previous information regarding GDM risk factors from India were mostly descriptive and scarce from coastal Karnataka, a current prospective case-control study was designed to identify GDM risk factors among pregnant women seeking antenatal care. Methods A hospital-based prospective matched case–control study was carried among antenatal subjects seeking routine antenatal care at two secondary-level care private hospitals, affiliated to a University Medical College in coastal Karnataka. It comprised of 100 incident GDM cases and 273 frequency-matched controls. Data was collected by personal interviews using a pretested questionnaire. Data was entered and analyzed using Statistical Package for Social Sciences(SPSS), version 15.0. Results Risk factors using Carpenter and Coustan criteria and DIPSI criteria were found similar. Pooled data identified following significant GDM risk factors: marital age (25–29 years)(adjusted OR:18.2; 95% CI:1.9–177.6; p=0.012), delayed menarche (adjusted OR:11.4; 95% CI:1.1–124.6; p=0.045), multiparity (adjusted OR:14.1; 95% CI:1.8–109.8; p=0.011), family history of DM (adjusted OR:66.6; 95% CI:6.9–645.2; p Conclusions Modifiable risk factors identified were low physical activity, high antenatal perceived stress, multiparity, marital age ≥25 years, and low pre-pregnancy intake of GLV, which were also comparable using two criteria in vogue for GDM diagnosis. Pre-conception advice on healthy lifestyle may prove beneficial.

Growing evidence indicates that increasing physical activity may aid in regulating altered glycaemic control, thereby mitigating the risk of diabetes. However, the evidence summarising the efficacy of physical activity on glycaemic control among African adults remains unconsolidated. Our objective was to provide an amalgamated summary of the empirical evidence that explored the effectiveness of physical activity interventions on glycaemic control among African adults.A systematic search of six journal databases for the studies exploring the efficacy of physical activity on glycaemic control among African adults until March 21, 2022, was administered. Two independent reviewers screened the citations based on a priori set eligibility criteria. Data were analysed using inverse variance method and a summary of findings was synthesised using the Grading of Recommendations, Assessment, Development and Evaluations approach.Of the 14,624 citations retrieved, 26 articles with 1474 participants were included for final analysis. Most of the included trials had a high risk of bias (N = 20; 76.92%). Our review found a significant reduction in fasting blood glucose (FBG, -2.18 [ 95% CI -3.18, -1.18] mmol/L), insulin (-0.99 [-2.71, 0.74] μU/L), Glycosylated haemoglobin (HbA1C) (-0.53% [-0.88, -0.19]), Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (-0.74% [-1.10, -0.38]) and insulin sensitivity (-0.90 μU/l/min [-1.75, -0.06]) following physical activity interventions. The review reports low certainty of evidence across all outcome measures.Physical activity interventions were found to improve glycaemic control among African adults. However, the optimal physical activity dose for demonstrating meaningful benefits on glucose tolerance still remains unclear due to the limited number of primary studies available.

Fetal distress indicated as the cause for cesarean delivery based on cardiotocography findings most often does not reflect in the newborn assessment. Cardiotocography findings are just the decision indicators for cesarean delivery, in the background of labor abnormalities owing to deflexed head or occipitoposterior position.This study aimed to investigate the association between cardiotocography findings and the attitude of fetal head and occiput position.We conducted a prospective observational study in a tertiary hospital in South India, including 304 women in labor with vertex presentation. Fetal attitude, the position of the head, labor abnormalities, and cardiotocography findings were noted. The chi-square test was applied using MedCalc software (version 19) to investigate the association of cardiotocography findings with the attitude of fetal head and occiput position.Cardiotocography findings had significant association with occipitoposterior position (relative risk, 1.70; 95% confidence interval, 1.32-2.19) and deflexed attitude of the fetal head (relative risk, 1.44; 95% confidence interval, 1.11-1.87). Among cases with occipitoposterior position, 10 of 42 (24%) had pathologic cardiotocography, and 19 of 42 (45%) had suspicious cardiotocography, whereas among cases with deflexed head position, these proportions were 12 of 61 (20%) and 24 of 61 (40%), respectively.Pathologic and suspicious cardiotocography tracings were more frequent in women with fetal occipitoposterior and deflexed head position. However, the association was not specific to any cardiotocography pattern.

Problem considered Despite enough evidence available supporting temporal relation between gestational diabetes mellitus (GDM) and overt DM, former has earned less attention while managing current diabetes epidemic. This calls for a community-based ‘Life-cycle approach' that could employ mutually-linked interventions specific to GDM prevention at various stages of life cycle by utilizing involving already existing Indian health system. Methods Freely accessible, full-text articles published between 1990 and 2018, available in PubMed and Google Scholar in English language, pertaining to GDM risk factors and its preventive strategies were reviewed using combination of medical subject headings (MeSH) and keywords. Results GDM prevention begins right from pre-pregnancy phase. Adoption of a healthy lifestyle, mass awareness of risk factors, early identification and prompt referral are key to avert pre-GDM development. During pregnancy, government of India (GoI) mandates universal GDM screening for all Indian pregnant women, avoiding any undiagnosed/untreated GDM woman, thus preventing occurrence of complications including overt DM. Those screened GDM positive are more likely to develop overt DM throughout postpartum. During postpartum, American Diabetes Association (ADA) recommends postpartum diabetes screening for all women with GDM, by employing two h 75 g oral glucose tolerance test (OGTT) and HbA1C prior to and beyond three months postpartum, respectively. Conclusions Promotion and practice of life-cycle approach would be key to curb overall diabetes incidence.

BackgroundInjury poses a major threat to health and longevity in adults aged 50 years or older. The increased life expectancy in the Eastern Mediterranean region warrants a further understanding of the ageing population's inevitable changing health demands and challenges. We aimed to examine injury-related morbidity and mortality among adults aged 50 years or older in 22 Eastern Mediterranean countries. MethodsDrawing on data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we categorised the population into adults aged 50–69 years and adults aged 70 years and older. We examined estimates for transport injuries, self-harm injuries, and unintentional injuries for both age groups, with sex differences reported, and analysed the percentage changes from 1990 to 2019. We reported injury-related mortality rates and disability-adjusted life-years (DALYs). The Socio-demographic Index (SDI) and the Healthcare Access and Quality (HAQ) Index were used to better understand the association of socioeconomic factors and health-care system performance, respectively, with injuries and health status in older people. Healthy life expectancy (HALE) was compared with injury-related deaths and DALYs and to the SDI and HAQ Index to understand the effect of injuries on healthy ageing. Finally, risk factors for injury deaths between 1990 and 2019 were assessed. 95% uncertainty intervals (UIs) are given for all estimates. FindingsEstimated injury mortality rates in the Eastern Mediterranean region exceeded the global rates in 2019, with higher injury mortality rates in males than in females for both age groups. Transport injuries were the leading cause of deaths in adults aged 50–69 years (43·0 [95% UI 31·0–51·8] per 100 000 population) and in adults aged 70 years or older (66·2 [52·5–75·5] per 100 000 population), closely followed by conflict and terrorism for both age groups (10·2 [9·3–11·3] deaths per 100 000 population for 50–69 years and 45·7 [41·5–50·3] deaths per 100 000 population for ≥70 years). The highest annual percentage change in mortality rates due to injury was observed in Afghanistan among people aged 70 years or older (400·4% increase; mortality rate 1109·7 [1017·7–1214·7] per 100 000 population). The leading cause of DALYs was transport injuries for people aged 50–69 years (1798·8 [1394·1–2116·0] per 100 000 population) and unintentional injuries for those aged 70 years or older (2013·2 [1682·2–2408·7] per 100 000 population). The estimates for HALE at 50 years and at 70 years in the Eastern Mediterranean region were lower than global estimates. Eastern Mediterranean countries with the lowest SDIs and HAQ Index values had high prevalence of injury DALYs and ranked the lowest for HALE at 50 years of age and HALE at 70 years. The leading injury mortality risk factors were occupational exposure in people aged 50–69 years and low bone mineral density in those aged 70 years or older. InterpretationInjuries still pose a real threat to people aged 50 years or older living in the Eastern Mediterranean region, mainly due to transport and violence-related injuries. Dedicated efforts should be implemented to devise injury prevention strategies that are appropriate for older adults and cost-effective injury programmes tailored to the needs and resources of local health-care systems, and to curtail injury-associated risk and promote healthy ageing. FundingBill & Melinda Gates Foundation. We acknowledge the Bill & Melinda Gates Foundation for funding this study.

Objective To assess incidence of spontaneous preterm births and determine biochemical and obstetric risk factors for spontaneous pre-term births in a cohort of antenatal women visiting a secondary care hospital. Methods A prospective cohort study was designed to include 1420 pregnant women coming for antenatal care at a secondary care hospital. The cohort was followed throughout pregnancy and relevant history, obstetric and ultrasonographic examination and biochemical investigations was carried out in 2nd (20-24 weeks period of gestation) and 3rd trimester (28-32 weeks period of gestation). Outcome of delivery was noted for all the subjects. Results A total of 1133 women were recruited. Among the 1071 respondents, 11 had abortions, 93.1% delivered at term while 5.9% had preterm deliveries. Preterm deliveries were noted among 6.5% women with short stature, 13.3% with cervical length Conclusions The incidence of preterm births (5.9%) was low in the present cohort. Oligohydramnios and Intrauterine Growth Retardation (IUGR) were identified as significant risk factors for preterm births. Conventional risk factors like short cervix, short stature and biochemical inflammatory markers were not identified as predictors of prematurity. Lower levels of salivary estriol identified among women at risk of preterm births demonstrates the utility of the test as a non-invasive investigation for early identification of preterm births.