Abstract
BackgroundGestational diabetes mellitus (GDM) in Fiji is a serious public health issue. However, there are no recent studies on GDM among pregnant women in Fiji. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM.MethodsWe used cross-sectional data of 255 pregnant women with GDM who gave birth to singleton infants at Colonial War Memorial Hospital (CWMH) in Suva city. Women underwent testing for GDM during antenatal clinic visits and were diagnosed using modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Multivariable logistic regression analysis was used to investigate factors associated with neonatal outcomes.ResultsWomen with a previous baby weighing > 4 kg were 6.08 times more likely to experience neonatal macrosomia (Adjusted odds ratio (AOR) = 6.08; 95%CI: 2.46, 15.01). Compared to unmarried women, the odds of macrosomia among married women reduced by 71% (AOR = 0.29; 95%CI: 0.11, 0.77). Compared with delivery before 38 weeks of gestation, the infants of women who delivered between 38 and 41 weeks of gestation were 62 and 86% less likely to experience neonatal hypoglycaemia and Apgar score < 7 at 5 mins, respectively. The offspring of women who were overweight and obese had higher odds of neonatal hypoglycaemia. Late booking in gestation (≥28 weeks) was significantly associated with Apgar score < 7 at 5 min (AOR = 7.87; 95%CI: 1.11, 55.75). Maternal pre-eclampsia/pregnancy induced hypertension was another factor associated with low Apgar score in infants.ConclusionsThe study found high rates of adverse neonatal outcomes among off springs of Fijian women with GDM and showed that interventions targeting pregnant women who are overweight, had a previous baby weighing > 4 kg, had pre-eclampsia, delivered before 38 weeks of gestation, and those who booked later than 13 weeks in gestation, are needed to improve pregnancy outcomes.
Highlights
Gestational diabetes mellitus (GDM) is any degree of glucose intolerance that occurs or is diagnosed for the first time during pregnancy [1]
Women with GDM are at high risk of pregnancy complications, including infant macrosomia, neonatal hypoglycaemia, low Apgar score and caesarean delivery [2], have more than a 7-fold increased risk of developing type 2 diabetes 5 to 10 years after delivery [3], and the risk is even higher in obese women with GDM [4]
Stillbirth, premature delivery, large for gestational age (LGA) babies and NICU admissions were other serious adverse neonatal outcomes observed among Fijian women with GDM with prevalence < 10%, each
Summary
Gestational diabetes mellitus (GDM) is any degree of glucose intolerance that occurs or is diagnosed for the first time during pregnancy [1]. Among Pacific people, previous studies conducted in 2008 reported that about 20% of pregnancies are complicated by GDM [8] but lower rates have been documented among European women living in Auckland who delivered between 1994 and 1995 [9], and White-skinned women in Hawaii, who delivered between 2010 and 2011 [10], compared with Pacific Island women. Lower rates of GDM were reported among Pacific Islands women living in Australia (6.3%) [11] and in the US (8.3%) [12], between 2010 and 2011 using the Australasian Diabetes in Pregnancy Society (ADIPS) [1] and the American Diabetes Association (ADA) diagnostic criteria [12]. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM
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