loading page

Gestational diabetes (GDM) does not predict large birthweight or perinatal death in a relatively untreated population in Uganda; a prospective observational cohort study.
  • +17
  • Jack Milln,
  • Betty Nakabuye,
  • Barnabas Natamba,
  • Isaac Sekitoleko,
  • Michael Mubiru,
  • Arthur Namara,
  • Samuel Tumwesigire,
  • Tino Salome,
  • Mandy Wilja,
  • Ayoub Kakande,
  • Brian Agaba,
  • Faridah Nansubuga,
  • Daniel Zaake,
  • Ben Ayiko,
  • Herbert Kalema,
  • Sarah Nakubulwa,
  • Musa Sekikubo,
  • Annettee Nakimuli,
  • Emily Webb,
  • Moffat Nyirenda
Jack Milln
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Betty Nakabuye
Lubaga Hospital
Author Profile
Barnabas Natamba
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Isaac Sekitoleko
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Michael Mubiru
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Arthur Namara
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Samuel Tumwesigire
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Tino Salome
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Mandy Wilja
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Ayoub Kakande
MRC/UVRI Uganda Research Unit On AIDS
Author Profile
Brian Agaba
Lubaga Hospital
Author Profile
Faridah Nansubuga
Nsambya Hospital
Author Profile
Daniel Zaake
Nsambya Hospital
Author Profile
Ben Ayiko
Entebbe General Hospital
Author Profile
Herbert Kalema
Masaka Regional Referral Hospital
Author Profile
Sarah Nakubulwa
Makerere University College of Health Sciences
Author Profile
Musa Sekikubo
Makerere University and Mulago National Referral Hospital
Author Profile
Annettee Nakimuli
Makerere University and Mulago National Referral Hospital
Author Profile
Emily Webb
LSHTM
Author Profile
Moffat Nyirenda
MRC/UVRI Uganda Research Unit On AIDS
Author Profile

Abstract

Objective: To determine whether hyperglycaemia in the gestational diabetes (GDM) range independently predicts adverse pregnancy outcomes in Uganda. Design: Prospective observational cohort study. Setting:Five major hospitals in urban/semi-urban central Uganda. Sample:237 women with gestational diabetes, 2,641 normoglycaemic controls. Methods:Women were screened with oral glucose tolerance test (OGTT) at 24-28 weeks of gestation. Cases of GDM were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, prenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Participants with diabetes in pregnancy (DIP) were excluded from the analysis. Outcomes:Primary outcomes: Birthweight large for gestational age (LGA; >90th centile) and perinatal death. Secondary outcomes: Caesarean delivery, preterm birth <37 weeks, umbilical cord c-peptide concentration >90th centile (>1.35 mcg/L), and neonatal admission. Results:Women with GDM had a median of only two glucose measurements recorded in third trimester, and only one fifth received therapeutic management (mostly metformin, one participant received insulin). GDM was not independently associated with LGA (adjusted odds ratio, aOR 1.12; 95% CI 0.81-1.56) or perinatal death (aOR 0.66; 95% CI 0.26-1.66), but increased the risk of Caesarean delivery. Mid-gestational BMI of >30kg/m2 was strongly associated with LGA, and mean arterial pressure >90 mmHg was the strongest predictor of perinatal death. Conclusions:Even without active management, GDM was not associated with large birthweight or perinatal death in this population. Interventions that target blood pressure and obesity are likely to be more beneficial in improving LGA and perinatal mortality, than management of GDM. Funding:Medical Research Council Keywords:Gestational diabetes, Africa