Gestational diabetes (GDM) does not predict large birthweight or
perinatal death in a relatively untreated population in Uganda; a
prospective observational cohort study.
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