Gestational Diabetes Mellitus per Different Diagnostic Criteria, Risk Factors, Obstetric Outcomes and Postpartum Glycemia: A Prospective Study in Ghana.

Faith Agbozo,Albrecht Jahn,Abdulai Abubakari,Francis Zotor

doi:10.3390/clinpract11020039

Abstract

The surge in gestational diabetes mellitus (GDM) globally requires a health system tailored approach towards prevention, detection and management. We estimated the prevalence of GDM using diverse recommended tests and diagnostic thresholds, and also assessed the risk factors and obstetric outcomes, including postpartum glycemia. Using a prospective cohort design, 446 singleton pregnant women without pre-existing diabetes did GDM tests in five hospitals in Ghana from 20–34 weeks using fasting plasma glucose (FPG), one-hour and 2-h oral glucose tolerance test (OGTT). Birth outcomes of 403 were assessed. GDM was diagnosed using six international diagnostic criteria. At 12 weeks postpartum, impaired fasting glucose (6.1–6.9 mmol/L) and diabetes (FPG ≥7.0 mmol/L) were measured for 100 women. Per FPG and 2-h OGTT cut-offs, GDM prevalence ranged between 8.3–23.8% and 4.4–14.3%, respectively. Risk factors included overweight (OR = 2.13, 95% CI: 1.13–4.03), previous miscarriage (OR = 4.01, 95% CI: 1.09–14.76) and high caloric intake (OR = 2.91, 95% CI: 1.05–8.07). Perineal tear (RR = 2.91, 95% CI: 1.08–5.57) and birth asphyxia (RR = 3.24, 95% CI: 1.01–10.45) were the associated perinatal outcomes. At 12 weeks postpartum, 15% had impaired fasting glucose, and 5% had diabetes. Tackling modifiable risk factors is crucial for prevention. Glycemic monitoring needs to be integral in postpartum and well-child reviews.

Highlights

Research on gestational diabetes mellitus (GDM) dates back to 1882 [1]
According to the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study, 18–26% of pregnancies are affected by GDM [2], but globally, prevalence is estimated to be between 1–14% [5]
FPG, fasting plasma glucose; 2-h OGTT, two-hour oral glucose tolerance test; PPH, postpartum hemorrhage; LGA, large-for-gestational age; NICU, neonatal intensive care unit. a World Health Organization [19] recommendation for fasting plasma glucose and 2-h OGTT. b In Ghana, FPG cut-off is ≥6.1 mmol/L but 2-h OGTT is same as for the WHO criteria. c Criteria we propose to use in Ghana showing the c unadjusted and d adjusted regression models. d Model summary: N = 385; Prob > Chi2 = 0.035; Log likelihood = −51.317; Pseudo R2 = 0.1686. e Postpartum hemorrhage was defined as blood loss >500 mL. f Large for gestational age was computed as birth weight >90th percentile for gestational age. g Birth asphyxia diagnosed as Apgar score five minutes after birth after below four

Summary

Introduction

The Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study conducted at 15 centers in nine countries to assess the association between varying degrees of maternal glucose and adverse outcomes [2] sparked interest in GDM research and its clinical practice. It formed the foundation for the diagnostic criteria currently recommended by the International Association of Diabetes and Pregnancy Study Group (IADPSG) [3]. According to the HAPO study, 18–26% of pregnancies are affected by GDM [2], but globally, prevalence is estimated to be between 1–14% [5]. In sub-Saharan Africa, there has been an upward trajectory in prevalence between 2015 [6] and 2019 (8.5%) [7]

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