gestational diabetes mellitus ( gdm ) , as a common pregnancy complication , is defined as glucose intolerance with onset or first recognition during pregnancy ( 1 ) .
gdm is associated with adverse perinatal outcome , and increased long - term risks of type 2 diabetes mellitus , metabolic syndrome and cardiovascular disorders for both mother and offspring ( 2 - 6 ) .
hence , the impact of gdm on maternal and infant health is of great clinical and public health importance .
the prevalence of the disorder is increasing all over the world , but most noticeable in developing countries ( 7 ) . like many developing countries ,
bosnia and herzegovina is experiencing increased prevalence of obesity and other risks of gdm development ( 8 - 10 ) .
the aim of this study was to determine gdm prevalence , maternal characteristics and pregnancy outcomes for the first time among women in bosnia and herzegovina by using the who diagnostic criteria .
a cross - sectional observational study was conducted in the herzegovina - neretva county , southern part of bosnia and hezegovina from october 2010 through march 2011 .
actually , the research was conducted at two public , ante - natal clinics in the western part of mostar city and apljina city and in the university hospital mostar as a reference institution for deliveries in southern - western region of bosnia and herzegovina .
the participants were pregnant women with singleton pregnancies aged 18 years or older who participated in this research during their usual ante - natal clinic visits . in the study period , as recommended for high - risk population , all pregnant women from the western part of mostar and apljina city who consecutively attended local public antenatal clinic at 22 - 32 weeks of gestation underwent an oral glucose tolerance test ( ogtt ) with 75 g glucose due to one or more gdm risk factors or characteristic pregnancy complications : pre - pregnancy overweight and obesity ( maternal body mass index  25kg / m ) , family history of diabetes type 2 , previous pregnancy complicated with gdm , birth weight  4000 g , stillbirth with no clear obstetric cause or major cardiovascular / cns malformation , history of polycystic ovary syndrome , current hypertensive disorder after 20 weeks of gestation , recurrence of glucosuria , and polyhydramnios .
those with no gdm risk factors were advised to participate in the study at 22 - 32 weeks of gestation , and they were informed about ogtt procedure and the possible effects in the same manner as we informed the high - risk pregnant women .
gestational age was determined by last menstrual period ( lmp ) and according to early ultrasound examination .
exclusion criteria were diabetes type 1 or 2 prior to pregnancy , multifetal pregnancy and age younger than 18 .
all of them completed ogtt and gave birth at the university hospital mostar where the data were finally collected for the prevalence , maternal characteristics and pregnancy outcomes ( premature delivery , cesarean delivery , large for gestational age / lga , birth trauma , neonatal hypoglycemia , neonatal hyperbilirubinemia , early neonatal death ) .
neonatal hypoglycemia was defined as glucose level < 2.2 mmol / l or < 40mg / dl .
neonatal hyperbilirubinemia was defined as jaundice requiring phototherapy , except the one caused by abo or rh isoimmunisation .
each participant underwent a standard 2-h ogtt , with the use of a 75 g dose of glucose , and with plasma glucose levels ( pgl ) measured fasting and 2-hour after ingestion .
pgl was measured by means of enzymatic methods according to international federation of clinical chemistry ( ifcc ) .
statistical analysis was performed using descriptive statistics , c test , fisher s exact test , and student s t - test for independent samples or mann - whitney u test depending on the sample distribution .
mean and standard deviations , as well as , median and interquartile range are reported for continuous variables .
software system spss for windows ( 11.0 , spss inc , chicago , illinois , usa ) was used for statistical analysis of the obtained data .
a total of 285 participants had a diagnostic ogtt and complete data regarding maternal characteristics and perinatal outcomes during the study period were obtained .
the mean age of the participants was 29.8  5.6 years ( mean  sd ) , and more than half of them were primiparas ( 51.2% ) .
the gdm was diagnosed in 31 ( 10.9% ) participants according to the who diagnostic criteria ( table 2 ) .
cigarette smoking and previous gdm as gdm risk factors were significantly more frequent in the gdm group ( p = 0.015 , p < 0.001 ) compared to the group of pregnancies with normal glucose tolerance .
further , table 2 shows differences in pregnancy complications and adverse perinatal outcomes of the participants according to gdm status .
there were significant differences in cesarean deliveries and neonatal hypoglycemia ( p = 0.015 , p = 0.002 ) .
maternal and newborns characteristics , and pregnancy outcomes in the group of participants ( n=285 ) comparison of the maternal characteristics , pregnancy complications and adverse outcomes between the groups of pregnancies with normal glucose tolerance ( ngt ) ( n = 254 ) and gdm ( n = 31 )
gestational diabetes mellitus has long been recognised as a complex problem in pregnancy due to significant levels of fetal and maternal morbidity ( 2 , 4 , 11 ) .
the prevalence of the disorder is increasing all over the world , but most noticeable in developing countries ( 7 ) . the main objective of this study was to asses prevalence of gdm and associated risk factors as well as pregnancy outcomes in the southern part of bosnia and herzegovina .
this is the first study to estimate the prevalence of gdm in this region of developing countries .
gdm prevalence in european countries is most often reported as 2 - 6% of all pregnancies ( 12 ) .
reported gdm prevalence is higher in the southern mediterranean seaboard but also in some other parts of europe such as ireland ( 10% ) and finland ( 10 - 11% ) ( 12,13 ) .
accordingly , our unselected population of pregnant women should be classified to the high gdm prevalence group ( 10.9% ) .
this result is comparable with the studies published from asian developing countries , including bangladesh ( 9.6% ) , malaysia ( 11.4% ) and india ( 13.9% ) ( 7 , 14 , 15 ) .
south asian ethnic origin was observed as an independent risk of gdm and type 2 diabetes development ( 16 , 17 ) .
it is well known that the prevalence of gdm varies widely worlwide according to the various diagnostic criteria that are of significantly different sensitivities and specificities ( 18 )
. the variation may be also due to age and ethnic structure of the study population , dietary habits diversity , and socioeconomic factors .
the estimated high prevalence of gdm in developing countries , including bosnia and herzegovina could be explanined by socioeconomic factors .
like many developing countries , bosnia and herzegovina is experiencing increased prevalence of obesity and other risks of gdm development due to socioeconomic status and lifestyle factors ( 8 - 10 ) .
it is likely that stressful events , dietary habits and sedentary life styles are responsible for the increase in obesity and gdm ( 19 ) . in a previous study , cullinan at al .
found increased prevalence of gdm for women in the lowest socioeconomic group when compared to the highest , suggesting a strong association between socioeconomic status and gdm prevalence ( 20 ) . comparing maternal characteristics according to the gdm status we observed statistically significant association between gdm and prenatal cigarette smoking .
previous studies of associations between cigarette smoking and gdm are uncommon and conflicting ( 10 ) .
however , prevalence of cigarette smoking as a behavioural risk factor in our pregnant women population is worrying in comparison with some other reports ( 21 ) .
this data is consistent with the observations published in some other studies ( 22 , 23 ) .
previous studies reported older age as an independent risk factor for gdm , as well as increasing pre - pregnancy bmi and excessive gestational weight gain ( 10 , 22 - 24 ) . in the present study , the mean age of gdm participants as well as the mean pre - pregnancy bmi and the mean gestational weight gain was higher , but not statistically significant .
in addition , family history of diabetes type 2 , history of polycystic ovary syndrome , birth weight of the previous child  4 kg and previous stillbirth as gdm risk factors were more frequent in the gdm group compared to the group of pregnancies with normal glucose tolerance , but not significantly .
most of the previous studies that reported significant associations between gdm and listed maternal charasteristics ( family history od diabetes type 2 , increasing pre - pregnancy bmi , excessive gestational weigt gain , history of polycystic ovary syndrome , birth weight of the previous child  4 kg and previous stillbirth ) had significantly higher number of participants and thus increased statistical power ( 10 , 22 - 25 ) .
analyzing specific gdm pregnancy complications and outcomes , we found significant difference between gdm group and normal tolerance glucose group in cesarean delivery rate and neonatal hypoglycemia .
these data are consistent with previous published observations ( 26 , 27 ) . our study had some limitations .
a cross - sectional design of our research could have resulted in selection bias because only women with singleton pregnancies who had an antenatal check - up during an observed time interval and in selected clinics participated in the study .
further , our study did not have sufficient statistical power for maternal characteristics as gdm risk factors and pregnancy outcomes examination due to relatively small sample .
there is a general observation that the prevalence of gdm is increasing in developing countries .
accordingly , it is important to increase awareness of gdm among medical professionals and pregnant women in bosnia and herzegovina .
ultimately , there is a need for large well - designed study on gdm prevalence and its other features in this region of the developing countries .
 background : the prevalence of gestational diabetes mellitus ( gdm ) , as a complex problem in pregnancy , is increasing all over the world , but most noticeable in developing countries.aims:to estimate gdm prevalence and associated pregnancy features in the southern part of bosnia and herzegovina.methods:a cross - sectional observational study was conducted from october 2010 through march 2011 . 
 a total of 285 pregnant women with singleton pregnancies participated and were asigned to the study in the order they came for their usual ante - natal clinic examination . 
 they underwent an oral glucose tolerance test ( ogtt ) with 75 g of glucose . 
 information on ogtt results , maternal characteristics and pregnancy outcomes were collected from database and medical records.results:prevalence of gdm was 10.9% according to 1999 world health organisation ( who ) diagnostic criteria . 
 prenatal cigarette smoking , previous gdm , cesarean delivery rate and neonatal hypoglycemia were significantly more frequent in the gdm group compared to the group of pregnancies with normal glucose tolerance ( p = 0.015 , p < 0.001 , p = 0.015 , p = 0.002).conclusion : this study presents a relatively high prevalence of gdm in bosnia and herzegovina . there is a need for large well - designed study on gdm prevalence and its other features . 
1. INTRODUCTION
2. MATERIALS AND METHODS
3. RESULTS
4. DISCUSSION
5. CONCLUSION