Risk factors for caesarean delivery and fetal macrosomia among women with gestational diabetes in Nyeri County, Kenya: a cross-section study

Abstract

Introduction gestational diabetes mellitus is an emerging global public health threat due to adverse health outcomes. This study aimed to determine the risk factors for caesarean delivery and macrosomia among women with gestational diabetes in Nyeri County, Kenya. Methods this study used a cross-section design. Randomly, 152 women with gestational diabetes and attending antenatal clinics and maternity were enrolled in this study. Data was collected using a questionnaire upon consent. Data were subjected to binary logistic regression and binomial multiple logistic regression. Results the mean age of the women with gestational diabetes was 30.86 (SD 5.81) years. Among women with gestational diabetes, a proportion of 59.9% (n=91) delivered through caesarean delivery. The positive history of diabetes in a family, previous positive history of gestational diabetes and positive previous adverse obstetric history increased chances of caesarean section delivery by more than 3.824 (95% CI = 1.001-14.608, p=0.05), 10.331 (95% CI = 2.464-43.308, p=0.001) and 7.051 (95% CI = 1.577-31.801, 0.01) folds, respectively. Fetal macrosomia incidence was 42.1% (n=64) among women with gestational diabetes. The primary level of education, previous positive history of gestational diabetes and previous positive adverse obstetric history increased the likelihood of fetal macrosomia by more than 6.289 (95% CI = 1.241-31.870, p=0.03), 5.390 (95% CI = 1.498-19.386, p=0.01) and (95% CI = 5.804 1.349-18.423, p=0.02) folds, respectively. Conclusion antenatal health care programs and delivery facilities should be strengthened in women with gestational diabetes to improve the risk associated with caesarean delivery and fetal macrosomia.

Risk factors for Gestational diabetes mellitus among pregnant women attending antenatal clinic in Kisumu City, western Kenya

“…We found that pregnant women with pregnancies complicated with GDM tend to have advanced age and that advanced maternal age increased the likelihood of having GDM. This nding is in agreement with studies from various countries globally that demonstrated an association between GDM and advanced maternal age [4,12,15,16]. This is probably due to the fact that mothers with advanced maternal age have given birth severally, pregnancy is known to initiate metabolic disorders such as increased insulin resistance and may result in obesity [2].…”

“…One of the most common non-communicable metabolic deregulation that present as glucose or carbohydrate intolerance of differing severity detected at the start or during pregnancy is Gestational Diabetes Mellitus (GDM) [1]. It is a common pregnancy complication accounting for 90% of all pregnancy complicated by diabetes [2,3], associated with poor neonatal and maternal outcomes and poses a signi cant health risk for both the mother and neonates [4,5]. In 2013, the World Health Organization (WHO) adopted the International diagnostic and screening criteria for GDM that include performing oral glucose tolerance test (OGTT) in a fasting state [1,6].…”

“…In Africa, there is also geographic variation in GDM prevalence with North Africa having a prevalence of 24.5%, West Africa (14%) and East Africa prevalence of 6% [5]. Moreover, even within East Africa region there is variation in prevalence with Rwanda having a prevalence of 8.3%, Tanzania having a prevalence of 5.9%, Ethiopia a prevalence of 3.7% and western Kenya presenting with a prevalence of 2.6% [2,4,5].…”

“…The global prevalence of GDM varies from 1-28% depending on the study population genetics, environment and screening methods [5]. Estimates indicate that sub-Saharan Africa (SSA) has a prevalence of 14%, North Africa (24.5%), North America (7%) and Europe (5.4%) [4,5]. In Africa, there is also geographic variation in GDM prevalence with North Africa having a prevalence of 24.5%, West Africa (14%) and East Africa prevalence of 6% [5].…”

“…Developing targeted interventions that will reduce the burden of this problem and result in improvement of both maternal and child health in SSA requires a thorough understanding of the risk factors of non-communicable diseases such as GDM. Although there is a paucity of data on the risk factors for GDM in SSA, previous studies revealed that maternal age, high parity, pregnancy overweight or obesity, family history of diabetes, being hypertensive, previous delivery of macrosomic infants and previous bad obstetric outcomes such as still birth and abortion are important risk factors for GDM [4,8]. Other potential risk factors includes low or high birth weight, smoking, physical inactivity, stature, socioeconomic factors, under-nutrition during early life and exposure to Human Immunode ciency virus and Tuberculosis [9].…”