Gestational Diabetes Mellitus and Associated Factors in Rural Areas of Northern Vietnam: Cross-Sectional Survey

Background: The prevalence of gestational diabetes mellitus (GDM) and its associated factors have not been investigated in Vietnam, especially in rural areas. Objective: This study aimed to determine the prevalence of GDM and its associated factors in rural areas of Vietnam. Methods: This cross-sectional study was conducted among 1003 pregnant women aged ≥18 years in rural areas of northern Vietnam. GDM was identified based on impaired oral glucose tolerance test results according to the guidelines of the International Association of the Diabetes and Pregnancy Study Groups. Associated factors for GDM were analyzed using a modified Poisson regression with robust (sandwich) SE analysis, with maternal age, prepregnancy BMI, and family history of diabetes as explanatory factors, adjusted for parity, method of conception, hormonal therapy for pregnancy maintenance, physical inactivity, and history of chronic medical conditions. Results: The prevalence of GDM was 26.2%. Patients with GDM were more likely to be older than the control group (odds ratio 3.33, 95% CI 2.31-4.78). In the multivariable analysis, maternal age was strongly associated with GDM. Compared with women aged <25 years, those aged 25 to 34 years had a significantly higher prevalence of GDM (adjusted prevalence ratio [PR] 1.50, 95% CI 1.12-1.99; P=.006). The rate was even higher among women aged ≥35 years (adjusted PR 2.40, 95% CI 1.74-3.31; P<.001). These associations remained consistent after further adjustment for confounders (25-34 years: adjusted PR 1.44, 95% CI 1.07-1.95; P=.02 and ≥35 years: adjusted PR 2.15, 95% CI 1.49-3.11; P<.001). Overweight women (BMI 23 to <25 kg/m²) showed a borderline association with GDM, although this did not reach statistical significance (adjusted PR 1.39, 95% CI 0.98-1.98; P=.06), while women with BMI ≥25 kg/m² had a significantly higher prevalence (adjusted PR 1.58, 95% CI 1.10-2.26; P=.01). These findings persisted in the adjusted model, with BMI ≥25 kg/m² remaining significantly associated with GDM (adjusted PR 1.54, 95% CI 1.10-2.17; P=.01). Women with a family history of diabetes had an increased prevalence of GDM in both models, although the association did not reach statistical significance (adjusted PR 1.51, 95% CI 0.85-2.68; P=.16). Most additional covariates included in the multivariable analysis were not significant. However, women who conceived via in vitro fertilization had a significantly higher prevalence of GDM compared with those who conceived naturally (adjusted PR 1.38, 95% CI 1.04-1.85; P=.03). The use of hormonal therapy to maintain pregnancy was also associated with an increased risk (adjusted PR 1.32, 95% CI 1.04-1.68; P=.02). Conclusions: The findings highlight the need for early screening and counseling before pregnancy. Lifestyle programs should focus on weight control and healthy habits. Future research should test whether these programs can reduce the rate of GDM in rural communities.