Strengths and limitations
To our knowledge this is the largest and most robust prospective investigation of pregnancy outcomes in GDM in Africa. We made efforts to ensure that it is as representative as possible by recruiting from both public and private facilities. We made use of a rigid study protocol to collect detailed data, utilised high quality central laboratory for sample analyses, employed up-to-date diagnostic criteria.
In our study, women diagnosed with GDM were referred to be managed by their clinicians, rather than through a study protocol; the intensity of treatment was therefore likely to be variable and not under study control, which may have influenced outcomes. Similarly, for some of the outcomes (such as pre-eclampsia, poly/oligohydramnios) we relied on healthcare records rather than active investigation by the study team. We did not have data regarding previous operative delivery and so could only report Caesarean delivery, rather than primary Caesarean delivery. The study was performed in urban and peri-urban central Uganda which may reduce generalisability to rural populations.