1.Effectiveness of selective risk based screening for Gestational Diabetes (GDM) in Malaysia: A retrospective cohort study based on the National Obstetric Registry (NOR) of Malaysia
Muniswaran Ganeshan ; Shahrul Aiman Soelar ; Shamala Devi Karalasingam ; Mohammad Adam Bujang ; Jeganathan R, M. ; Harris Suharjono
The Medical Journal of Malaysia 2017;72(1):46-49
Introduction: Gestational diabetes (GDM) has significant
maternal and foetal implications. screening allows active
interventions which significantly improves pregnancy
outcomes. Despite World Health Organization (WHO), FIGO
and National Institute of clinical Excellence (NIcE)
recommendations for universal screening especially among
high risk population; Malaysia currently adopts a selective
risk based screening for GDM.
Objective: the objective is to audit the effectiveness of the
current practice of selective risk based screening in
detection of GDM in Malaysia.
Methodology: this is a retrospective cohort study based on
the National Obstetric Registry (NOR) which comprises of 14
major tertiary hospitals in Malaysia. the study period was
from 1st January 2011 till 31st December 2012 and a total of
22,044 patients with GDM were analysed. Logistic
regression analysis was used to calculate the crude odd
ratio.
Results: the incidence of GDM in Malaysia is 8.4%. Maternal
age of ≥25, booking bMI ≥27kg/m2, booking weight ≥80kg
and previous hypertension are non-significant risk of
developing GDM in Malaysia. Parity 5 and more was only
associated with an odds-ratio of 1.02 (95% confidence
Interval: 0.90-1.17) as compared to parity below 5. the
association of women with previous stillbirth with GDM was
not significant.
conclusion: current risk based screening for GDM based on
maternal age, booking bMI, weight and hypertension is
inappropriate. An ideal screening tool should precede
disease complications, which is the novel objective of
screening. Universal screening for GDM in Malaysia may be
a more accurate measure, especially with regards to
reducing maternal and foetal complications.
Diabetes, Gestational
2.Maternal Obesity and Its Associated Factors and Outcomes in Klang Valley, Malaysia: Finding from National Obstetric Registry
Rohana Abdul Jalil ; Nurul Farehah Shahrir ; J. Ravichandran R Jeganathan ; Shamala Devi Karalasingam ; Noraihan Mohd Nordin ; Mohamad Farouk Abdullah ; Nadiah Sa&rsquo ; at
Malaysian Family Physician 2021;16(3):56-67
Introduction: Maternal obesity presents significant health risks to mothers and their fetuses. This study aimed to determine the proportion, associated factors and outcomes of maternal obesity among pregnant women in Klang Valley, Malaysia.
Methods: A retrospective cross-sectional study was conducted between January 2018 and March 2018 using secondary data from the Malaysian National Obstetric Registry (NOR) for the year 2015. All pregnant women with first-trimester booking at 12 weeks and below that were registered with the NOR and met the inclusion and exclusion criteria were included in the study. Descriptive statistics and multiple logistic regression analysis were used. Data were analysed using SPSS version 22.0. A total of 2113 respondents were included in this study to determine the proportion, associated factors and outcomes of maternal obesity. Regarding the univariate and multivariate analyses, respondents were classified into two groups: normal and obese. The obese group comprised overweight and obese mothers. The underweight group was excluded in the subsequent analysis.
Results: Out of the 2113 respondents, 7.1% were underweight, 41.7% were of normal weight, 28.6% were overweight, 15.9% were in obese class I, 4.6% were in obese class II, and 2.1% were in obese class III according to the WHO (1995) reference. However, when the MOH (2003) cutoff point was used, there was a marked increase in the proportion of respondents in the overweight categories by 2.7% and obesity class I by 12.8%. The Indian (AdjOR 2.06, 95% CI: 1.11, 3.83, p=0.021) and Malay (AdjOR 1.75, 95% CI: 1.02, 3.00, p=0.040) ethnicities, as well as both multiparity (AdjOR 1.46, 95% CI: 1.23, 1.73, p <0.001) and grand multiparity (AdjOR 2.41, 95% CI: 1.78, 3.26, p <0.001), were significantly associated with maternal obesity. There were significant association between maternal obesity with hypertensive disorder in pregnancy (p=0.025), caesarean section delivery (p=0.002) and macrosomic infant (p <0.001).
Conclusion: The identification of risk factors for maternal obesity is important to facilitate intervention programmes focused on improving the pregnancy outcomes for a high-risk group of women.