The prevalence and risk factors for gestational diabetes and pregnancy outcome in a tertiary hospital in Ahuja, Nigeria
Objectives: To determine the common diabetes risk factors (or OGTT; the prevalence of GDM; and the maternal and perinatal outcomes of GDM pregnancies in a Nigerian urban antenatal population
Patients and Methods: A retrospective study of pregnant women, who attended antenatal clinic, screened for diabetes mellitus, had OGTT when indicated and delivered in the hospital over a three year period at a tertiary hospital in Abuja, Nigeria. The main outcome measures were diabetes risk factors (or OGTT referral, prevalence of GDM, maternal complications, mode of delivery, birth weight, fetal and neonatal complications. GDM diagnosis was based on the 1999 WHO criteria of glucose lenl at fasting (0-hour) ≥7.0mmol/L(126mg/dl) or2-hour ≥ 7.8mmol/L(140mg/dl).
Results: During the period under study 4,755 women had antenatal care and delivered in the hospital. Five hundred and six patients with various risk factors for diabetes had OGTT. The mean age of the women was 31.6±4.1 years, mean height 1.64 ± 0.1 m; and mean weight 85.1 ± 15.5kg. The three commonest GDM risk factors for referral for OGTT were family history of diabetes mellitus, history of previous delivery of macrosomic baby (≥.4.0 kilogram) and maternal weight greater than 90kg. The risk factors associated with GDM in this study are maternal weight greater than 90kg (OR= 2.39; 95% CI 0.74-6.59) and suspected big baby in index pregnancy (OR= 2.51; 95% CI 0.45-9.22). Twenty four patients met the criteria for GDM giving a prevalence of 0.5% among the antenatal population. The majority, 19(79.2%)of the GDM mothers were delivered by caesarean sections compared with 170(35.3%) women with normal OGTT. Hypertensive complication was present in 7 (29.2%) GDM clients compared with 58 (12.1%) women with normal OGTT. Six (25%) babies born to GDM mothers suffered from jaundice compared with 37 (7.7%) for normal OGTI mothers. The birth of macrosomic babies was however, more common in normal OGTT mothers, 107 (22.2%) compared with 4 (16.3%) in GDM mothers, though this difference did not reach significance level.
Conclusion: OGTT remain a reliable tool forthe diagnosis of GDM. The risk factors for OGTT in our setting need to be reviewed. The detection and management of GDM is essential for prevention of diabetes associated adverse pregnancy outcomes.
Keywords: Gestational diabetes mellitus; Risk factors for OGTT, pregnancy outcome
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