Prevalence of and risk factors for gestational diabetes mellitus in South Africa

Abstract

Gestational diabetes mellitus (GDM), defined as glucose intolerance with onset or first recognition during pregnancy, [1] is one of the leading causes of morbidity and mortality for mothers and infants worldwide. Globally, ~16.2% (21.3 million) of live births are associated with hyperglycaemia in pregnancy, of which 86.4% are due to GDM, 6.2% to pre-existing type 1 diabetes (T1D) or type 2 diabetes (T2D), and 7.4% to T1D and T2D first detected during pregnancy. [2] The prevalence of GDM is rapidly increasing worldwide, possibly owing to advanced child-bearing age and obesity. This is particularly concerning, as South African (SA) women are considered among the most overweight globally. [3] GDM is associated with maternal (pre-eclampsia, increase in caesarean deliveries, birth trauma), fetal (macrosomia, hypoglycaemia, shoulder dystocia) and perinatal (respiratory distress syndrome, jaundice, metabolic derangements) complications, while mothers and their offspring are at risk of developing obesity, T2D and other metabolic conditions later in life. GDM thus poses a threat to maternal and child well-being, while its impact on the burden of non-communicable diseases (NCDs) is undeniable. This review provides an update of GDM in SA, focusing on risk factors and prevalence. Furthermore, we highlight recommendations for future research. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

Prevalence of Type 2 Diabetes in South Africa: A Systematic Review and Meta-Analysis

“…A study conducted in a population of urban Black African women in Gauteng reported an IGT prevalence of 20.3% [ 51 ], identifying these women as a high-risk group that requires monitoring and intervention to prevent the development of T2DM. Furthermore, these women are of reproductive age and at risk for developing gestational diabetes, which poses an intergenerational risk of obesity and T2DM to their children [ 52 ].…”

Intimate Partner Violence: A Risk Factor for Gestational Diabetes

“…It has been estimated that insulin sensitivity is decreased by up to 40% in pregnant women with GDM compared to women with normoglycemia [21,28]. Although GDM is reported to affect ≈14% of pregnancies globally, rates between 1% and 28% are reported in different regions, varying according to ethnicity, geographical location (urban vs. rural), environmental factors, and the screening and diagnostic strategies employed [29]. GDM imposes significant economic costs on health systems.…”

Adiponectin as a Potential Biomarker for Pregnancy Disorders

“…The prevalence of GDM has steadily increased over the last 20 years, paralleling the rising obesity epidemic. Globally, it is estimated that 14% of pregnancies are affected by GDM [ 70 ], although rates vary between 1–28% depending on the population studied and the diagnostic criteria used [ 71 ]. The economic costs of GDM are high [ 72 ] and it has been estimated that the health care costs of treating women with GDM are ~25.1% higher than treating women without GDM [ 73 ].…”

“…Early detection and treatment may reduce adverse pregnancy outcomes including stillbirth, neonatal macrosomia, neonatal hypoglycaemia, birth trauma and neonatal respiratory distress syndrome as well as decrease the risk of preeclampsia in the mother. The common risk factors, which include overweight or obesity, excessive gestational weight gain, advanced maternal age, family history of diabetes, previous history of GDM and adverse pregnancy outcomes, however, have poor predictive value and fail to identify a large percentage of women at risk for GDM, thus limiting their use as screening tools [ 71 , 80 , 81 ]. Currently the gold-standard for the diagnosis of GDM is the oral glucose tolerance test (OGTT) performed at 24–28 weeks gestation, although technical challenges, which include the requirement for fasting and multiple blood draws, and the high costs associated with sending blood samples to reference laboratories for testing, limit its widespread use [ 13 ].…”