Gestational diabetes mellitus. prevalence, associated factors and pregnancy outcome in women attending antenatal clinic at Muhimbili national hospital

Abstract

Background: Gestational diabetes mellitus (GDM) is a substantial and growing health concern in many parts of the world. It-also has serious, long-term consequences for both baby and mother, including a predisposition to obesity, metabolic syndrome, and diabetes later in life. Early detection and intervention identifies women with high risk and offers primary prevention for women with this condition and their babies. The prevalence may range from 3- 19% of all pregnancies depending on the population studied and the diagnostic tests employed. There is no recent study which has been done to find the prevalence of GDM and associated factors in our country.

Objective: To determine the prevalence of GDM associated factors and pregnancy outcome in women attending Antenatal Clinic at Muhimbili National Hospital.

Methodology: A structured questionnaire was used to obtain participants' particulars including demographic characteristics including age of patients, marital status, gravidity and gestation age. Information on associated factors was also collected which included previous obstetric history and history of diabetes in the family. Blood samples for Random Blood Glucose (RBG) measurement was taken from all participants and 2hrs oral glucose tolerance test was done to those participants who were found to have impaired RBG. The diagnosis of GDM was obtained using WHO criteria. The pregnancy outcome of among women with GDM was also looked upon.

Results: A total of 549 participants were interviewed and examined 61 (11 %) had impaired RBG. Out of them, 2hrs OGTT was done in 59 participants and 27(45.8%) were found to have GDM. The overall prevalence ofGDM was found to be 4.9% (27/549).

It was noted that among investigated factors participants with history of diabetes in the first degree relatives were three times likely to have GDM than those with no family history of diabetes in the first degree relatives (OR=2.5; 95%CI: 1.14-5.51). All other variable were not significant in bivariate analysis.

"Out of 549- participants 505(92%) delivered" within the "study-period. Clients with GDM 26/27(96.3%) delivered during the study period.

Delivery of big baby was found to have significantly positive association with GDM (p-value <-0.001). Delivery of still birth as well as premature baby did not show association with GDM. Delivery by caesarean section 12/186(6.5%) was high for GDM though this was not statistically significant.

Conclusion and recommendation: There is relatively high prevalence of GDM in women attending antenatal clinic at Muhimbili National Hospital. This is a preventable disease, so efforts should be initiated to stop further increase in its prevalence.