Prevalence of hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya

BMC Research Notes Nakabuye et al. BMC Res Notes (2017) 10:174 DOI 10.1186/s13104-017-2493-0 Open Access RESEARCH ARTICLE Prevalence of hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes at St. Francis Hospital Nsambya Betty Nakabuye1,2* , Silver Bahendeka3 and Romano Byaruhanga1,2 Abstract Background: Women with hyperglycaemia detected during pregnancy are at greater risk for adverse pregnancy outcomes. Data on hyperglycaemia in pregnancy in sub-Saharan Africa is scanty and varied depending on the populations studied and the methodologies used to define hyperglycaemia in pregnancy. With the recent 2013 World Health Organisation (WHO) diagnostic criteria and classification, there is yet no sufficient data on the prevalence of hyperglycaemia in sub-Saharan Africa. The objective was to determine the prevalence of Hyperglycaemia first detected during pregnancy and subsequent obstetric outcomes among patients attending antenatal care (ANC) at St. Francis Hospital Nsambya. Methods: A prospective cohort study. All women with no history of diabetes mellitus attending at or after 24 weeks gestation were eligible to participate in the study. Participants underwent a standard 75 g oral glucose tolerance test (OGTT) after an informed written consent. The primary outcome was diagnosis of hyperglycaemia. Enrolled participants were followed up to delivery to assess obstetric outcomes (secondary outcomes were birth weight, neonatal admission, maternal genital trauma, delivery mode, neonatal and maternal status at discharge). Results: 251 women were screened between December 2013 and February 2014. The prevalence of hyperglycaemia first detected in pregnancy was 31.9%. We found 23.8 % of women with hyperglycaemia had no known risk factor. Macrosomia was the only obstetric outcome that was significantly associated with hyperglycaemia. Conclusion: The prevalence of hyperglycaemia first detected in pregnancy was high in the studied population. Clinicians, therefore, should become more vigilant to screen for the condition. Selective screening may miss 23.8% of pregnant women with hyperglycaemia. However the cost/benefit implications of screening strategy and the recent 2013 WHO diagnostic criteria need to be studied in our setting. Keywords: Hyperglycaemia, Screening and pregnancy Background During pregnancy, endocrine and metabolic changes occur that may predispose some women to hyperglycaemia, especially those whose pancreatic function cannot overcome these diabetogenic changes while pregnant [1]. *Correspondence: 1 Department Obstetrics and Gynaecology, St. Francis Hospital Nsambya, P.O.Box 7146, Kampala, Uganda Full list of author information is available at the end of the article Hyperglycaemia during pregnancy puts women at a higher risk of adverse outcomes like foetal macrosomia, obstructed labour, birth injuries, and maternal and perinatal mortality [2, 3]. Coupled with the above, is the longterm health impact of increased risk of developing type 2 diabetes. Cumulative risks of incident diabetes in gestational hyperglycaemic patients ranging from 2.6% to over 70% within 5–10 years of delivery have been reported [4– 6]. Moreover, their off-springs have a higher prevalence © The Author(s) 2017. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nakabuye et al. BMC Res Notes (2017) 10:174 of childhood obesity and overweight and higher risk of developing type 2 diabetes later in life [7, 8]. Over 371 million people have diabetes in the world and more than 14 million people in the African Region; by 2030 this is estimated to rise to 28 million [9]. Approximately half of these are women. Non-communicable diseases (NCDs) are on the rise in sub-Saharan Africa, but without well-established surveillance systems [10]. According to world health statistics, in Uganda, there is no country data available about factors associated with gestational hyperglycaemia. However, the estimate modelled using data from other countries and specific country characteristics showed the prevalence of raised fasting blood glucose among females aged ≥25 years as 6.5%; prevalence of raised blood pressure among women aged ≥25 years as 39.6% and women aged ≥20 years who are obese are about 4.9% [11]. This is predictive of gestational hyperglycaemia and its related events [12]. The prevalence of hyperglycaemia first detected in pregnancy varies worldwide and among ethnic groups depending upon the population studied and the used diagnostic tests. What is similar with the different studies is the fact that the prevalence has been increasing over time in women of different racial/ethnic backgrounds, possibly related to increases in mean maternal age and weight [13–20]. In 2013 the global prevalence of hyperglycaemia in pregnancy was estimated to be 16.9%, with 25.0% as the highest prevalence (South–East Asia) and lowest being 10.4% (North America and Caribbean Region). Low- and middle-income countries contribute 90% of the cases [21]. The diagnostic criteria for hyperglycaemia in pregnancy recommended by the World Health Organization in 1999 used non pregnant ranges with no evidence of their utility in pregnancy. WHO has therefore recently updated the diagnostic criteria and classification of hyperglycaemia first detected in pregnancy [22]. Therefore, hyperglycaemia first diagnosed at any time during pregnancy is currently classified [22] as diabetes mellitus in pregnancy or gestational diabetes. Diabetes in pregnancy is diagnosed if one’s fasting blood glucose ≥7.0 mmol/l and/or 2-h blood glucose ≥11.1 mmol/l following a 75 g oral glucose load while gestational diabetes mellitus is a fasting plasma glucose 5.1–6.9 mmol/l and/or 2-h plasma glucose 8.5– 11.0 mmol/l following a 75 g oral glucose load. The earlier definition included all levels of hyperglycaemia in one umbrella as Gestational diabetes being any degree of impaired glucose tolerance with onset or first recognition during pregnancy [22, 23]. In the 2006 WHO recommendations screening of gestational diabetes was between 24–28 weeks while in the 2013 recommendations screening is at any time during pregnancy [22, 23]. Page 2 of 10 With both criteria, who to screen is still left to the attending health worker. Screening can be universal or selective. In selective screening, criteria utilized to identify those at increased risk of developing gestational hyperglycaemia includes: family history of diabetes, B (...truncated)