Prevalence Of Gestational Diabetes Among Pregnant Women Attending Antenatal Care

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Prevalence Of Gestational Diabetes Among Pregnant Women Attending Antenatal Care

Abstract

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of variable severity, with onset or first recognition during pregnancy. GDM is associated with increased risk of poor outcomes for the pregnancy and is a risk factor for subsequent diabetes later in life. It is important to determine the prevalence and risk factors for GDM in our centre as this may influence policy formulation regarding screening and diagnosis of the clinical condition. To ascertain the prevalence, pattern of glucose tolerance and risk factors for GDM among pregnant women attending antenatal clinic in Jos University Teaching Hospital, Jos. A descriptive cross sectional study. Two hundred and sixty five (265) pregnant women were recruited by simple random sampling into the study. Patients with known diabetes were excluded. However, two hundred and fifty three (253 ) women participated in the study and were screened between 24 – 28 weeks of pregnancy with a 50g, 1- hour glucose challenge test (GCT). Those with plasma glucose concentration of >7.8mmol/l were given 75g oral glucose tolerance test (OGTT) to confirm the diagnosis. Plasma glucose measurements were performed with glucose oxidase method using a spectrophotometer (optima, model SP-100). GDM was diagnosed according to the WHO criteria. All relevant data including demographic information, obstetric history, and risk factors for GDM, GCT and OGTT results were collected for further statistical analysis.Of the 253 subjects, 28 (11.1% ) had positive GCT ≥ 7.8 mmol/l. Twenty one (21 ) cases of GDM were detected, giving a prevalence rate of 8.3% (95% CI, 5.2-12.4) in the studied population. Among the GDM cases, 17 (6.7%) had IGT while 4 (1.6%) had overt diabetes. The pattern of plasma glucose response (glucose tolerance) in the study population indicated that 232 (91.7%) had normal glucose tolerance, 6.7% had IGT while 1.6% had overt diabetes. Increasing or older age was found to be associated with GDM (31.2±5.8 years versus 28.6±5.6 years respectively) (p < 0.05). Bivariate analysis showed that age >31 years, obesity, previous fetal macrosomia, current polyhydramnios and glycosuria (p values < 0.05) were significantly associated with GDM. After multivariate analysis (multiple logistic regression), only previous history of fetal macrosomia was found to be an independent risk factor for GDM (adjusted OR 11.1; 95% CI 2.93-42.12, P=0.0004). Prevalence of GDM (8.3%) in this antenatal population was relatively high and women with previous history of fetal macrosomia should be routinely screened for GDM. A larger study will be needed to assess the correlation or otherwise of other traditional risk factors with GDM.

Chapter One

Introduction

1.1 Background of the Study

Diabetes mellitus is the commonest metabolic /endocrine disorder in pregnancy and is associated with increased maternal and perinatal morbidity and mortality especially when inadequately controlled 6,7,8. Other metabolic/endocrine disorders include thyroid conditions (Graves’ disease and hypothyroidism), adrenal disorders (Cushing’s syndrome and Conn’s syndrome) and hyperparathyroidism. Diabetes mellitus in pregnancy which is either pre-gestational or gestational, is a heterogeneous group of condition with a common metabolic characteristic of hyperglycaemia 9,10.

Gestational diabetes mellitus is glucose intolerance of variable severity, with onset or first recognition during pregnancy. This includes women with previously undiagnosed diabetes at one end of the spectrum and those with mild disturbances of glucose intolerance resulting from the metabolic changes late in pregnancy at the other end.

9,10,11,12. GDM includes impaired glucose tolerance (IGT) and overt diabetes mellitus. IGT is defined as 2-hour plasma glucose value of between ≥7.8mmol/l – 11.1mmol/l based on the 75g oral glucose tolerance test (OGTT). However, it is overt diabetes if the 2-hour value is >11.1mmol/l 10. According to the WHO, GDM can also be diagnosed using the fasting blood glucose (FBG) when it is ≥7.0mmol/l. This definition requires the fasting or 2-hour value of 75g OGTT to be met 10.

Uncontrolled pre-gestational or gestational diabetes mellitus is associated with adverse pregnancy outcomes including increased rate of miscarriages, congenital malformations, stillbirths, fetal macrosomia and neonatal morbidity and mortality 1,7,13,14,15. Reports suggest that the perinatal morbidity and mortality can be reduced to levels similar to that of non-diabetic women if properly managed 4,10. With the rising tide of obesity, the background prevalence of diabetes mellitus in pregnancy is increasing 10.

There are considerable debates regarding the relevance of detecting GDM especially the impaired glucose tolerance as against diabetes of first onset or recognition in pregnancy, the most effective test for screening, when in pregnancy should screening be undertaken and to whom it should be applied. What has been agreed is that more severe forms of gestational glucose intolerance are linked to adverse fetal, neonatal and maternal outcomes 7,11,12,13,15. Also vigorous management of women with previously undiagnosed diabetes in pregnancy is not in doubt 11.

It is however important to detect gestational diabetes mellitus because: 10,11,12,16,17,18.

  1. Pregnancies complicated by GDM are at increased risk of fetal macrosomia, intra- uterine fetal death, neonatal metabolic abnormalities (hypoglycaemia, hypocalcaemia, polycythaemia and hyperbilirubinaemia) and birth trauma.
  2. Maternal complications of GDM include increased incidence of operative and manipulative deliveries (from growth disorders) and hypertensive disorders.
  3. Gestational diabetic women intensively managed can achieve near normal rates of macrosomia and neonatal hypoglycaemia.
  4. GDM predicts the development of diabetes later in life.

Knowing that the management of GDM can lead to the achievement of near normal pregnancy outcome, a study of the prevalence and risk factors in our antenatal population will assist in policy formulation regarding the inclusion or otherwise of routine screening and diagnosis of GDM in such women. This will enable the scale-up of care for these patients and the overall aim is to increase the chances of achieving a better maternal and perinatal outcome in the care of such patients with GDM.

1.2 Statement Of The Problem

In Nigeria, like most other developing countries, women are rarely screened for gestational diabetes mellitus.

Peradventure were they are screened for urinalysis as part of antenatal care, majority who tested positive to glucose in their urine are not referred for either fasting or random glucose confirmatory tests. For those few that were screened and diagnosed for GDM, they have few options for management of the disease. This observed poor management of GDM is not peculiar to GDM alone, but to diabetes mellitus management in general which has been reported to be poor in Nigeria.10-11

Therefore, this retrospective study was designed to access the prevalence of gestational diabetes among pregnant women attending antenatal care using JUTH, Jos as a case study.

1.3 Objectives of the Study

The study generally focus on prevalence of gestational diabetes among pregnant women attending antenatal care.

The study will specifically assess the objectives below;

  1. To determine the prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos
  2. To determine the pattern of glucose tolerance among the antenatal population in JUTH, Jos.
  3. To determine the risk factors for GDM among pregnant women in JUTH, Jos.

1.4 Research Questions

The study will be guided by the following questions;

  1. What is the prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos.
  2. What is the pattern of glucose tolerance among the antenatal population in JUTH, Jos.
  3. What are the risk factors for GDM among pregnant women in JUTH, Jos.

1.5 Research Hypothesis

  • Ho: The prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos is low.
  • Ha: The prevalence of GDM among pregnant women attending antenatal care. in JUTH, Jos is high.

1.6 Significance of the Study

It is important to find out for these reasons the prevalence and risk factors for GDM in our antenatal population and this will highlight the magnitude of the condition in our centre. There has been no previous study of GDM in Jos University Teaching Hospital.

The results from the study will assist in strengthening intervention plans and policy with respect to the development of a local protocol for screening and diagnosis of GDM especially among pregnant women with known risk factors.

1.7 Scope of the Study

This study on the prevalence of gestational diabetes among pregnant women attending antenatal care. The study will be delimited to Jos University Teaching Hospital.

1.8 Limitations of the Study

This was a hospital-based study and may not be a reflection of the true situation in the general community largely due to referral bias. Also few of the women recruited did not participate in the study, giving an attretion rate of 4.5% and plasma insulin response levels were not assayed.

1.9 Definition of Term

Pregnancy:

Pregnancy is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus.

1.10 Organization of the Study

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.

Chapter Five

Summary, Conclusion and Recommendation

5.1 Introduction

This chapter summarizes the findings on the prevalence of gestational diabetes among pregnant women attending antenatal care using JUTH, Jos as a case study. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was to examine prevalence of gestational diabetes among pregnant women attending antenatal care using JUTH, Jos as a case study. The study is was specifically carried out to determine the prevalence of GDM among pregnant women attending antenatal care in JUTH, Jos, determine the pattern of glucose tolerance among the antenatal population in JUTH, Jos and determine the risk factors for GDM among pregnant women in JUTH, Jos.

5.3 Conclusion

The prevalence of GDM in this centre is relatively high (8.3%) and women with previous history of fetal macrosomia should be screened routinely for GDM so that appropriate management can be instituted early to reduce possible maternal and fetal complications.

5.4 Recommendations

Based on the findings of the study, the following recommendations are proffered.

  1. Pregnant women with previous history of fetal macrosomia should be screened routinely for GDM in this centre.
  2. A larger study be undertaken to identify the risk factors for GDM in our population. This will assist in policy plans for the screening and management of this condition.
  3. Women with GDM in this study should be followed up throughout pregnancy and postnatal period to assess the effects of GDM on pregnancy outcomes.
  4. There should be prenatal counseling for all intending pregnant women to ensure that they receive proper counseling from medical experts on how to go through the gestational period successfully with low or minimal complications.
  5. All pregnant women coming for antenatal care should be screened for gestational diabetes as this would help to enhance early detection and avoid long-term complications.
  6. Pregnant women should be encouraged to engage in exercise activities as this would help to prevent diseases and assist during delivery. Exercise goes a long way in preventing and controlling gestational diabetes.
  7. Pregnant women should also be encouraged to eat balanced diet as this would help to prevent and control gestational diabetes.

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