IDF21-0112 Gestational diabetes in Upper Egypt: Prevalence, risk factors, and short term outcomes

Abstract

Background: The prevalence of GDM has increased depending on the diagnostic criteria used. GDM is also an area where there are lot of debates regarding its screening, diagnosis, and management. Furthermore, there are wide gaps between guidelines and clinical practice provided to women with GDM particularly in low resources areas as Upper Egypt. Aim: Despite the high prevalence of diabetes in Egypt, our knowledge of gestational diabetes mellitus (GDM) epidemiology in Upper Egypt is still lacking. The study aims to determine the prevalence and risk factors of GDM among pregnant women in Upper Egypt and to evaluate its maternal and fetal outcomes. Method: The current study was a prospective cohort study conducted between July 2014 and July 2018. Universal screening for GDM in all pregnant women attending primary health care clinics was done using Diabetes in Pregnancy Study Group India (DIPSI) criteria (non-fasting 2hr blood glucose after loading with 75gm glucose >140mg/dl). Those with GDM were followed up until delivery and postpartum. Maternal and fetal outcomes were recorded. Results: GDM had been diagnosed in 956 women out of 7141 with a prevalence rate of 13.4% using DIPSI criteria. Previous history of either GDM or macrosomic babies and family history of diabetes were all significantly higher in GDM women (P<0.001 each). However, no definite risk factor was observed in about half of the GDM women. Regarding treatment, 29% of GDM women were only responded to medical nutrition therapy. 81.5% of GDM women were delivered by caesarean section (CS), and 17 % had preterm labour. On the other hand, 74.3% of their neonates had physiological jaundice, 52.1% were admitted to the neonatal intensive care unit (NICU), 20.9% were hypoglycaemic. Postpartum oral glucose tolerance test (OGTT) showed DM in 14.3% of our GDM women, while 25.7% of them had impaired glucose tolerance. Conclusions: The prevalence of GDM is relatively high in Upper Egypt. Half of these cases are without risk factors. Thus, universal screening by OGTT is recommended. MNT alone was not adequate for treatment of all cases. Postpartum OGTT is mandatory for all GDM women to pick up new cases of diabetes and prediabetes.