Prevalence of Gestational Diabetes in South East Nigeria Using the Updated Diagnostic Guidelines

Abstract

Background: Controversy still surrounds the choice of screening methods for gestational diabetes mellitus (GDM). Updated guidelines on hyperglycemias in pregnancy, recognizes 2 categories; Diabetes in pregnancy or pre-gestational diabetes and GDM. Early screening and diagnosis of GDM prevents maternal and fetal adverse outcomes. Study Objective: The aim of the study was to determine the prevalence of GDM and associated risk factors in a population of pregnant women in Enugu, South East Nigeria. Materials and Methods: The study was cross sectional and descriptive. All pregnant women attending the antenatal clinic were eligible for the study. A risk factor assessment questionnaire was administered. The one step universal screening with 75 g oral glucose tolerance test was used. The results were tabulated and categorized according to the World Health Organization (2013) Diagnostic Criteria. Statistical analysis was by SPSS version 21. Result: A total of 205 women were initially screened. Risk factors for GDM were identified in up to third of the subjects. They were aged 15–41 years (28.6 ± 4.9 years). OGTT was performed in 142 of the subjects (who came fasting). Gestational age was 8–40 weeks (28.5 ± 7.3); gravidity, 1–9 (2.4 ± 1.5); parity, 0–4 (1.3 ± 1.4); miscarriages, 0–5; and live births, 0–5. Blood glucose levels were 60–145 mg/dL (85.5 ± 12.5) fasting; 77–229 mg/dL (131.8 ± 27.2) at 1 h and 72–223 mg/dL (123.1 ± 25.0) at 2 h post glucose load. The WHO (2013) criteria for GDM were met in 51 subjects (35.9%), WHO 1999 in 29 (20.4%); IAPDSG/American Diabetes Association in 54 (38%); NICE in 44 (31%) and DIPSI in 25 (17.6%). Three subjects had diabetes in pregnancy. Previous miscarriages and macrosomic babies, family history of diabetes mellitus, previous GDM, hypertension and recurrent urinary tract infection were found to be significant risk factors for the development of GDM. Conclusion: The study highlights the high prevalence of GDM in our local population. At every level, screening and management of GDM should be incorporated as a routine antenatal service.