Abstract
BackgroundThe burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region.MethodsPubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI.Results283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7–12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1–4.4).ConclusionsThere is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.
Highlights
The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known
We included in this review any studies that: 1) were conducted in subSaharan Africa (SSA) countries according to the United Nations Statistics Division [26]; 2) reported prevalence or risk factors or outcomes of Gestational diabetes mellitus (GDM) as primary results; 3) were peer reviewed articles published in journals from inception to January 31st 2019; and, 4) had a sample size ≥100 participants
28 papers contributed towards estimation of GDM prevalence [21, 23, 24, 33,34,35,36,37,38, 40,41,42, 46,47,48,49,50,51,52,53,54,55, 57,58,59,60,61], 20 towards assessment of risk factors of GDM [21,22,23,24, 39, 41, 44, 45, 47,48,49,50, 52,53,54,55, 57, 58, 60, 61] and 6 towards the
Summary
The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region. The risk factors for GDM among Africans have not been adequately documented. Classical factors such as maternal age, overweight or obesity and family history for type 2 diabetes have been reported to be important risk factors of GDM in SSA [14], as they are in other populations [4]. Chronic infections (such as in HIV or TB that are highly prevalent in the region), perhaps via inflammation and immune activation, are thought to increase risk of diabetes [17]
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