Retrospective cohort study on risk factors for development of gestational diabetes among mothers attending antenatal clinics in Nairobi County

Abstract

IntroductionWorld Health Organization estimates that deaths resulting from diabetes will rise above 50% by the year 2020; hence urgent action is needed to reverse the trend notably through nutrition and lifestyle intervention among populations at risks. Studies have established that nutritional environment and physiology of the mother affects neonate's health at infancy and later in life thus this study sought to investigate the risk factors for development of gestational diabetes focusing age, weight, family history and pre-existing medical condition which could be modified to improve population health.MethodsA retrospective cohort study design was used. Subjects were sampled from selected maternity facilities in Nairobi and were subjected to oral glucose test to ascertain Gestational Diabetes mellitus (GDM) status. A questionnaire was administered to a sample of 238 respondents. Quantitative data was then analyzed as descriptive statistic, univariate and multivariate regression.ResultsAverage age for mothers with GDM was high with a mean of 33.06 (95% C.I: 31.59-34.52) compared to a mean of 27.9 (95% C.I: 27.01-28.78) for non-GDM mothers. Weight before pregnancy was high with mean of 74.04 (95% C.I: 70.82-77.30) among mothers with GDM compared to mean of 60.27 (95% C.I:58.59-61.96) among non-GDM mothers. Mothers with diabetic history in the family had twice the risk of developing GDM (OR= 2.27; 95% C.I: 1.23-4.17) compared to those who did not observe diabetic history in the family.ConclusionGestational diabetes cases are relatively high. Age advancement; high weight and diabetic history in family are determining factors for development of diabetes among pregnant women.

Prevalence and determinants of gestational diabetes mellitus in Africa based on the updated international diagnostic criteria: a systematic review and meta-analysis

“…Thirteen African countries were represented in this review. Of these, 9 (39.1%) of the studies were from West African [17, 39–46], 6 (26.08%) from East African countries [11, 13, 47–50], 3 (13.04%) from only one Central Africa (Cameroon) [51–53], 3 (13.04%) from Southern Africa [15, 54, 55], and 2 (8.695%) were from only one Northern African country (Egypt) [56, 57]. Regarding the study design, the majority [13] were cross-sectional [11, 13, 40, 41, 43–45, 48, 53–57], nine were cohort [15, 17, 39, 42, 47, 49–52], and one case control study [46].…”

“…(4.64, 11.36)19Adams and Rheeder, 2017 [15](2012??) NRSouth Africa, Southern AfricaProspective cohort study55455.4%M = 27.2 ± 5.824–28UniversalOne stepLaboratory method + POC test25.8% (22.16, 29.44)20Adoyo et al, 2016 [50](2015)Kenya, East AfricaCohort study design23893.7M = 33.06 (GDM) & 27.9 (Non GDM)≥28NRNRNR27.73% (22.04,33.42)21Mwanri et al, 2013 [11] (2011–2012)Tanzania,East Africacross-sectional study910NRM = 27.5(5.0)Urban &M = 26.6 (5.3) Rural≥20 WeeksUniversalOne stepPOC (HemoCue Glucose B-201)13.1% (10.91, 15.29)22Asare-Anane et al 2014 [46]2010.GhanaWest AfrciaCase control200100NRAll GAUniversalNRNRNA23Mathilda et al, 2017 [55](2010–20140Zimbabwe. Southern AfricaInstitution-based cross-sectional532100%M = 26.9 ± 6.7All GANRNRLaboratory method8.5 (6.13, 10.87) GDM Gestational diabetes mellitus, M mean, R Range, SD Standard deviation, NR Not Reported, GA Gestational Age, POC Point of care, NA Not Applicable…”

“…A total of 13 articles [13, 17, 40, 41, 43–45, 47, 48, 50, 54, 56, 57] were included to determine the association of maternal age and GDM. Seven out of 13 studies [17, 41, 44, 48, 50, 54, 57] had a significant association between maternal age and GDM, while the other six articles [13, 40, 43, 45, 47, 56] showed non-significant associations. In the random-effect model, the pooled odds of GDM among women aged ≥30 years is increased by nearly three folds (OR = 2.83; 95% CI: 1.75, 4.59: The I 2 = 90.5%, p -value < 0.001).…”

“…Similarly, a total of 12 articles [11, 40–42, 44, 45, 47, 48, 50, 54, 56, 57] were included to determine the association of maternal overweight and/or obesity and GDM. Nine of the included studies [11, 17, 44, 45, 47, 48, 54, 56, 57] had significant association while the rest [40, 41, 50] showed a non-significant association between maternal overweight and/or obesity and GDM. Even though, there was heterogeneity (I 2 = 88.4%, p -value < 0.001) among subgroups, there was no influential study that caused variation by sensitivity analysis and no publication bias (Egger’s test, βo = 3.22; p -value = 0.231).…”

<b>Idade como fator de risco para diabetes mellitus gestacional/ Age as a risk factor for gestational diabetes mellitus<b>

“…Um estudo de coorte retrospectivo realizado na África, com 238 gestantes divididas em dois grupos, um com gestantes com DMG e outro sem DMG, identificou mães com DMG com média de idade de 33,06 anos, história de diabetes na família (62,67%), com índice de massa corporal acima do normal, sobrepeso (54,55%) e obesidade (24,24%) (8) . No estudo mencionado, a idade média foi de 33,06 anos.…”