gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with onset or first recognition during pregnancy . overt diabetes mellitus during pregnancy is associated with significantly increased risks of adverse perinatal outcomes . similar to other members of the asian race , pakistani women are also considered to be at a high risk for developing gestational diabetes . in order to better understand whether this heightened risk attributed to racial basis indeed exists , we conducted a prospective study to assess the glycemic status of primigravida women presenting to our hospital . based on recent recommendations of international association of diabetes and pregnancy study groups , gestational diabetes was defined as at least two out of three elevated serum glucose readings as follows : fasting > 92 mg / dl , 1-hour post 75 glucose ingestion > 180 mg / dl , and 2-hours post ingestion > 153 mg / dl . based on recent recommendations of international association of diabetes and pregnancy study groups , gestational diabetes was defined as at least two out of three elevated serum glucose readings as follows : fasting > 92 mg / dl , 1-hour post 75 glucose ingestion > 180 mg / dl , and 2-hours post ingestion > 153 mg / dl . all primigravida women presenting to the outdoor department of jinnah hospital were offered enrollment in the study . we excluded subjects with known liver , cardiac , and renal disease . after obtaining informed consent , subjects were interviewed regarding their age , monthly income , number of household members , etc , and their height and weight were measured . subjects were then asked to come for laboratory testing the next day in a fasting state . blood specimen was collected using aseptic techniques in appropriate tubes and sent to the pathology laboratory for processing . blood sample was collected for serum glucose levels at baseline as well as at 1 and 2 hours post ingestion of 75 g glucose solution . the mean age was 22 ( 16 - 31 ) with 21 ( 16% ) , 60 ( 44% ) , and 54 ( 40% ) subjects in the first , second , and third trimester , respectively . all belonged to poor socioeconomic class with high member / household ratio . the mean fasting , 1-hour , and 2-hour plasma glucose levels were 69.9 mg / dl ( 3.9 mmol / l ) , 129 mg / dl ( 7.2 mmol / l ) , and 103.6 mg / dl ( 5.7 mmol / l ) , respectively . of the 135 women , 6 had a blood pressure reading 140/90 mmhg ; only one woman met criteria for gestational diabetes mellitus . hyperglycemia and adverse pregnancy outcomes ( hapo ) study by metzger et al . published in 2008 was a turning point in increasing awareness among the healthcare community about hazards of maternal hyperglycemia . this study triggered the task force of international association of diabetes and pregnancy study groups to propose new guidelines for maternal screening for gestational diabetes mellitus . these criteria are stricter and are expected to identify more patients at risk of hyperglycemia . in our study , despite using the newly proposed cut - offs for diagnosis of gestational diabetes , the incidence rate of gestational diabetes mellitus in primigravida was still < 1% . it would make sense that a woman who has conceived for the first time does not seem to have accumulated  enough  risk factors to be predisposed to hyperglycemic states . however , being a high - risk group , we expected a higher incidence rate , especially since a previous study by akhter et al . showed a 3.3% prevalence among pakistani women . the authors believe that our cohort has several positive attributes that could explain the extremely low incidence rate of gestational diabetes mellitus . first , the average body mass index ( bmi ) of the subjects was 24 , suggesting a normal pre - pregnancy body weight . pre - gravid bmi is a known predictor of development of gestational diabetes with far reaching metabolic implications . second , the mean age of our cohort was 22 years , with more than half of the enrolled subjects in their first and second trimesters . advanced maternal age is a well - defined risk factor for development of gestational diabetes mellitus . zargar et al . demonstrated 1.7% prevalence of gestational diabetes in subjects belonging to indian subcontinent and aged less than 25 years . these findings are much in line with low prevalence of gestational diabetes observed in our study . third , multiparity is an established risk factor for glucose intolerance and , ultimately , development of gestational diabetes . all our subjects were primigravid , and hence can not be compared with similar studies in multiparous subjects . if we can make efforts to detect gestational diabetes mellitus early , it is possible to prevent complications in both , and thereby improve the quality of life . there is also a dire need for education among healthcare professionals regarding benefits of early management of diabetes and appropriate use of oral glucose tolerance tests for timely diagnosis . needless to say , larger population based trials are necessary to truly assess the disease burden of gestational diabetes mellitus in pakistani women .
background : gestational diabetes mellitus is a metabolic disorder defined as glucose intolerance with onset or first recognition during pregnancy . 
 similar to other members of the asian race , pakistani women are also considered to be at a high risk for developing gestational diabetes.materials and methods : in order to better understand whether this heightened risk attributed to race really exists , we conducted a prospective study to assess the glycemic status of primigravida women presenting to our hospital.results:the mean age of 135 subjects enrolled was 22 ( 16 - 31 ) , with 21 ( 16% ) , 60 ( 44% ) , and 54 ( 40% ) subjects in the first , second , and third trimesters of pregnancy , respectively . the mean fasting , 1-hour , and 2-hour plasma glucose levels were 69.9 mg / dl ( 3.9 mmol / l ) , 129 mg / dl ( 7.2 mmol / l ) , and 103.6 mg / dl ( 5.76 mmol / l ) , respectively . of 135 women , 6 had a blood pressure reading 140/90 mm hg and only one met the criteria for gestational diabetes mellitus . in our study , 
 despite using the newly proposed international association of diabetes and pregnancy study ( iadps ) cut - offs for diagnosis of gestational diabetes , the incidence rate of gestational diabetes mellitus in primigravida was still < 1%.conclusion : larger trials are needed to truly assess the disease burden of gestational diabetes mellitus in pakistani women .