Prenatal and postnatal care of gestational diabetes and gestational hypertension in clinics for high-risk pregnancies in the West Bank, occupied Palestinian territory: a follow-up comparative study

Abstract

Background The prevalence of gestational diabetes and hypertension and the adverse outcomes associated with them are increasing worldwide. Appropriate prenatal care is thought to reduce adverse outcomes for mothers and infants. We describe and evaluate data for high-risk pregnancies in the clinics of the Palestinian Ministry of Health, Hebron, West Bank, occupied Palestinian territory (oPt), especially prenatal care related to gestational hypertension and gestational diabetes. Methods We evaluated data from all files of women (n=600) who were registered at the six main high-risk pregnancy clinics from Jan 1, to Dec 31, 2009, to estimate the prevalence of gestational diabetes and gestational hypertension. From Oct 1, 2010, to Jan 31, 2011, we followed up all women (n=60) who had gestational diabetes or gestational hypertension during their pregnancy and delivery of their baby in 2009. Every tenth file from files of women (n=60) needing antenatal or postnatal care were randomly selected as a comparative group. The women were interviewed with a questionnaire. Data analyses were done with SPSS (version 16.0) and the results were judged to be significant if the p value was less than 0·05. The graduate studies committee at Al-Quds University, East Jerusalem, West Bank, oPt, provided approval for the study. All women provided written informed consent. Findings In 2009, 25 (42%) of 60 women with gestational hypertension and gestational diabetes who were followed up had gestational diabetes, 24 (40%) had gestational hypertension, and 11 (18%) had both. In 2010, 17 (68%) of 25 women with gestational diabetes still had diabetes after the pregnancy, 17 (71%) of 24 with gestational hypertension still had hypertension, and eight (73%) of 11 with both still had both diabetes and hypertension. 25 (42%) of 60 women had not visited a doctor after the birth of their baby; 14 (56%) of 25 women still had hypertension and diabetes: four (29%) of 14 still had diabetes, six (43%) still had hypertension, and four (29%) still had both. None of the 60 women had an oral glucose tolerance test, urine test, or lipid profiling after delivery. We noted significant differences in the frequencies of complications between cases and the comparison group. Major complications included vision problems (25 [42%] of 60 vs zero; p=0), eclampsia (12 [20%] vs two [3%]; p=0), and diabetic coma (eight [13%] vs zero; p=0). Minor complications included vaginal bleeding (15 [25%] of 60 vs eight [14%]; p=0), dizziness (46 [77%] vs nine [16%]; p=0·001), extremities swelling (35 [59%] vs five [9%]; p=0·001), and digestive tract disturbance (11 [19%] vs one [2%]; p=0). Infants born to mothers with gestational hypertension or gestational diabetes had a higher frequency of complications than did those born to mothers in the comparison group—eg, hypoglycaemia (23 [40%] of 58 infants born to the cases vs two [4%] of 56 infants born to women in the comparison group; p=0·001), low haemoglobin concentrations (24 [41%] vs four [7%]; p=0), neonatal jaundice (20 [34%] vs six [11%]; p=0·002), macrosomia (11 [19%] vs one [2%]; p=0·001), and low oxygen at birth (13 [22%] vs three [5%]; p=0·008). Interpretation The results of our study emphasise the need for prenatal and postnatal services specifically for these high-risk disorders and the associated complications. Because Palestinian Ministry of Health clinics do not have a written protocol or guidance to help care providers in managing or screening gestational hypertension and gestational diabetes, strategies and protocols are needed for prenatal and postnatal care of pregnancy disorders and the associated outcomes in mothers and infants. Funding None.