Abstract
BackgroundWomen with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to define hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classification, there is yet no sufficient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya.MethodsA prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge).Results251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia first detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was significantly associated with hyperglycaemia.ConclusionThe prevalence of hyperglycaemia first detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/benefit implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting.
Highlights
Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes
The new antenatal care (ANC) attendance during the study period was 1201, and 633 were potentially eligible mothers in that time period but 401 were assessed for eligibility, 333 were confirmed eligible and 251 consented for the test. Those who were never willing to do the test were mothers who did not have enough time sit through the two hours of the oral glucose tolerance test (OGTT)
The prevalence of hyperglycaemia first detected in pregnancy was 31.9 with 95% of the hyperglycaemic women classified as having gestational diabetes (GDM) and only 5% with diabetes first diagnosed in pregnancy
Summary
Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Cumulative risks of incident diabetes in gestational hyperglycaemic patients ranging from 2.6% to over 70% within 5–10 years of delivery have been reported [4,5,6] The estimate modelled using data from other countries and specific country characteristics showed the prevalence of raised fasting blood glucose among females aged ≥25 years as 6.5%; prevalence of raised blood pressure among women aged ≥25 years as 39.6% and women aged ≥20 years who are obese are about 4.9% [11] This is predictive of gestational hyperglycaemia and its related events [12]
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