Maternal and neonatal outcomes following a diabetic pregnancy within the context ofHIV

Abstract

Objective To characterize the demographics, comorbidities, management, and outcomes of pregnant women with pre‐gestational and gestational diabetes (GDM), including overt and true GDM, taking into account HIV infection and the influence of exposure to oral hypoglycemic agents (OHAs). Methods A review of medical records of 1071 diabetic pregnancies (between 2012 and 2018) at a tertiary hospital in South Africa. Results Of the women, 43% had GDM, 19% had type 1 diabetes (T1DM), and 38% had type 2 diabetes (T2DM). Each group had a mean initial body mass index (BMI) >25 kg/m2. Despite poor initial HbA1c for pre‐gestational groups, over 90% of the cohort achieved glycemic control by the time of delivery. The rate of prematurity was 30.9%. Perinatal mortality (PNM) was 5.1% for the pre‐gestational group and 1.8% for GDM. Of the cohort, 23.9% was HIV infected. PNM was higher in the HIV‐infected pregnancies (9.4%) than non‐HIV exposed pregnancies (1.8%, P<0.001). The macrosomia rate was higher in the glibenclamide‐exposed group than the insulin‐alone group (12.2% vs 0%, P=0.025). Conclusion Obesity is a significant predictor for macrosomia and was high in all groups. In a low‐/middle‐income country setting with a high prevalence of HIV and high usage of OHAs as an alternative to insulin therapy, HIV might be associated with higher PNM and glibenclamide with increased rates of macrosomia, which warrants further exploration.

Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting

“…Both groups of women were derived from the same specialist clinic though were identified differently. The HFDP group were selected first and consisted mostly of women who were identified by risk-factor based screening and had attended a specialised gestational endocrine clinic at CHBAH for HFDP with their pregnancy characteristics and outcomes have been previously published [ 19 ]. A subgroup of the HFDP women were referred to the specialist clinic as a result of universal screening being performed by a research study [ 5 ].…”

Obesity and adiposity of 3- to 6-year-old children born to mothers with hyperglycaemia first detected in pregnancy in an urban South African setting

“…While exposure to DIP significantly increased birth weight, exposure to GDM did not. Treatment of hyperglycaemia in pregnancy, including early induction of labour to reduce the risk of macrosomia (Soepnel et al 2019), could have restricted birth weight and thereby minimised differences in FMI/BMI, particularly in the group exposed to GDM (Macaulay, Munthali, et al 2018;Macaulay, Ngobeni, et al 2018). However, this does not rule out the possibility of a programming effect manifesting in later childhood in our population, especially since foetal changes have been measured prior to treatment initiation, at 16-18 weeks' gestation, in a population similar to our GDM group (Macaulay, Munthali, et al 2018;Macaulay, Ngobeni, et al 2018).…”

“…The mothers of the exposed group attended a gestational endocrine clinic at CHBAH for HFDP while pregnant with the participating child. Clinical characteristics and pregnancy outcomes of this group have previously been published (Soepnel et al 2019). Diagnostic testing was based on selective screening of risk factors for GDM, except for some women universally screened in a research context (Macaulay, Munthali, et al 2018;Macaulay, Ngobeni, et al 2018).…”

Perspectives on gestational diabetes mellitus in South Africa

“…The growing body of research in the field of HFDP over the past decade has highlighted numerous shortfalls in healthcare delivery in SA, in addition to the health burden and consequences of HFDP. [5][6][7][8][9][10][11][12][13][14] The significance of HFDP lies in the well-established short-and more recently explored long-term ramifications for both mother and child, ultimately augmenting the intergenerational risk of cardiometabolic diseases. Of profound concern is that HFDP is fuelling the type 2 diabetes mellitus (T2DM) epidemic, with over half the mothers developing diabetes within the first decade following delivery, making HFDP one of the strongest predictors of T2DM.…”

“…Fortunately, there is now a growing body of research in SA highlighting the burden and risk factors for HFDP, as well as maternal, neonatal and early childhood outcomes following HFDP. [5,6,8,10,11,14,[25][26][27][28][29][30][31] The burden of HFDP in SA Urbanisation and recent socioeconomic changes in SA have fuelled a rapid nutritional transition that has been accompanied by a dramatic shift in the burden of disease from communicable diseases, such as HIV, to non-communicable diseases (NCDs) such as diabetes mellitus and HFDP. [32] Prevalence studies of HFDP for SA are limited to seven studies in the past four decades, [8,13,[26][27][28][29]33] in which the prevalence ranged from 1.8% to 25.8% owing to varying screening strategies and diagnostic tests being employed.…”