Gestational diabetes mellitus in sub‐Saharan Africa: systematic review and metaregression on prevalence and risk factors

Abstract

Abstractobjective We systematically reviewed publications on prevalence and risk factors for gestational diabetes mellitus (GDM) in the 47 countries of sub-Saharan Africa.methods We conducted a systematic search in PUBMED and reviewed articles published until June 2014 and searched the references of retrieved articles. We explored sources of heterogeneity among prevalence proportions with metaregression analysis.results Of 1069 articles retrieved 22 studies were included. Half were from West Africa, specifically Nigeria, five from South Africa and six from East and Central Africa. There were differences in screening methods and diagnosis criteria used, even between studies carried out in the same country and same time period. Metaregression analysis indicated high heterogeneity among the studies (I 2 = 100, P < 0.001), which could not be sufficiently explained by study setting, population, diagnostic criteria or time trend, although we observed a relatively higher prevalence in studies carried out after 2000 (5.1% vs. 3.2%), when women at risk were selected (6.5% vs. 3.8%) and when more current diagnostic criteria were used (5.1% vs. 4.2%). Associations with risk factors were reported in six studies. Significant risk factors reported in more than one study were overweight and/ or obesity, family history for type 2 diabetes, previous stillbirth, previous macrosomic child and age >30 years.conclusions There are few studies on prevalence and risk factors for GDM in Sub-Saharan Africa and heterogeneity is high. Prevalence was up to about 14% when high-risk women were studied. Preventive actions should be taken to reduce the short-and long-term complications related to GDM in Sub-Saharan Africa.

Strategy to improve the burden of gestational diabetes in African women: Rwandan perspective

“…About ~7% of all pregnancies in Africa are complicated by gestational diabetes, and up to 14% of all pregnancies develop gestational diabetesrelated complications (Mwanri et al 2015). Although GDM is a major cause of prenatal and maternal morbidity in Rwanda, it is still on the rise such that by the time it peaks its effects will be confounded.…”

“…The global prevalence of hyperglycemia in pregnant women 20-49 years is increasing to 16.9% affecting over 21.4 million live births, and ~90% of cases are in low-and middleincome countries (LMICs) of Africa (Mwanri et al 2015). As Africa struggles to combat infectious diseases particularly HIV infection, tuberculosis and malaria, the challenge is to cope with increasing burden of non-communicable diseases (NCDs).…”

“…cardiovascular disease (Mwanri et al 2015). Gestational diabetes remains a major cause of maternal and prenatal morbidity in Rwandan health facilities, deserves attention due to its effect on maternal and fetus health.…”

Gestational diabetes: An overview with attention for developing countries

“…Prevalence and risk factors of GDM in sub-Saharan Africa seems to be high up to about 14% and heterogeneous (Mwanri et al 2015). Interestingly, prevalence of GDM is higher in women with previous stillbirth, family history of type 2 DM, and medium upper arm circumference (MUAC) above 28 cm, while women living in rural areas showed signifi cantly lower prevalence (Anzaku and Musa 2013; Mwanri et al 2015).…”

“…Interestingly, prevalence of GDM is higher in women with previous stillbirth, family history of type 2 DM, and medium upper arm circumference (MUAC) above 28 cm, while women living in rural areas showed signifi cantly lower prevalence (Anzaku and Musa 2013; Mwanri et al 2015). In low-income countries, cheaper treatments alternative to insulin are metformin and glibenclamide but authors have suggested as more effective and acceptable strategy a prevention, as an appropriate diet and physical exercise in order to reduce the short-and long-term GDM related complications (Coetzee 2009).…”