Maternal hyperglycemia during labor and related immediate post-partum maternal and perinatal outcomes at the Yaoundé Central Hospital, Cameroon.

Manuella Djomhou,Nelson J Fomulu,Mickael Essouma,Jean Jacques N Noubiap,Eugene Sobngwi,Philip Nana

doi:10.1186/s41043-016-0065-x

Abstract

BackgroundData on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies.MethodsA prospective cohort study was held at the Maternity of the Yaoundé Central Hospital from March to June 2013. One hundred volunteer women in labor without overt diabetes mellitus and having fasted for 8 to 12 h were recruited. No intervention was given. A clinical examination was done and capillary glucose recorded. Parturient women were categorized into two groups (hyperglycemic and non-hyperglycemic subjects) based on glycemia results interpreted according to the International Association of Diabetes and Pregnancy Study Groups. Mothers’ clinical examination was repeated and neonates examined immediately after delivery. Perinatal outcomes associated with maternal hyperglycemia during labor were assessed using relative risks. A p value <0.05 was considered statistically significant.ResultsOne hundred women with a mean age of 27 (SD 6) years were recruited. Of them, 22 (22 %) had already been screened for gestational diabetes at baseline. Thirty-one (31 %) were diagnosed with hyperglycemia during labor, and this condition was highly associated with macrosomia in neonates (RR = 8.9, 95 % CI 2.70–29.32; p < 0.001). Other complications associated with maternal hyperglycemia during labor were perineal tears, cesarean section, and intrauterine fetal death, though the association was not statistically significant.ConclusionsThe main finding of this study is that maternal hyperglycemia during labor is highly associated with macrosomia in neonates. About a third of mothers were concerned with hyperglycemia during labor, and gestational diabetes was insufficiently screened in this series.

Highlights

Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon
A capillary glycemia was performed, and women were divided into two groups, based on glycemia results interpreted as recommended by the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria
About a third of delivering women were diagnosed with hyperglycemia in the labor room, and this condition was highly associated with neonatal macrosomia

Summary

Introduction

Data on the prevalence and complications of gestational diabetes are very scarce in Cameroon. The aim of this study was to evaluate the uptake of screening for gestational diabetes and assess the immediate post-partum outcome of hyperglycemic parturient mothers and perinatal outcome of their babies. According to the World Health Organization (WHO), gestational diabetes mellitus (GDM) stands for any degree of glucose intolerance, with onset or first recognition during pregnancy, no matter the necessary treatment and post-partum evolution [1, 2]. The most convincing study on adverse outcome associated with maternal glucose intolerance to date is the HAPO (Hyperglycemia and Adverse Pregnancy Outcomes) study [5, 6], from which most of internationally acceptable criteria for diagnosis and classification of GDM are derived. The screening method, and the glucose threshold used can explain this wide gap. In sub-Saharan Africa, the prevalence of GDM varies from 3.7 % in Ethiopia (1999) to 3.8 % in South Africa (2007) and 6.3 % in Cameroon (2013) [8,9,10]

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