Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus

Abstract

Background: Gestational diabetes mellitus (GDM) in Fiji is a serious public health issue. However, there are no recent studies on GDM among pregnant women in Fiji. The aim of this study was to examine prevalence of, and sociodemographic factors associated with adverse neonatal outcomes among Fijian women with GDM.

Methods: We used cross-sectional data of 255 pregnant women with GDM who gave birth to singleton infants at Colonial War Memorial Hospital (CWMH) in Suva city. Women underwent testing for GDM during antenatal clinic visits and were diagnosed using modified International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Multivariable logistic regression analysis was used to investigate factors associated with neonatal outcomes.

Results: Women with a previous baby weighing > 4 kg were 6.08 times more likely to experience neonatal macrosomia (Adjusted odds ratio (AOR) = 6.08; 95%CI: 2.46, 15.01). Compared to unmarried women, the odds of macrosomia among married women reduced by 71% (AOR = 0.29; 95%CI: 0.11, 0.77). Compared with delivery before 38 weeks of gestation, the infants of women who delivered between 38 and 41 weeks of gestation were 62 and 86% less likely to experience neonatal hypoglycaemia and Apgar score < 7 at 5 mins, respectively. The offspring of women who were overweight and obese had higher odds of neonatal hypoglycaemia. Late booking in gestation (≥28 weeks) was significantly associated with Apgar score < 7 at 5 min (AOR = 7.87; 95%CI: 1.11, 55.75). Maternal pre-eclampsia/pregnancy induced hypertension was another factor associated with low Apgar score in infants.

Conclusions: The study found high rates of adverse neonatal outcomes among off springs of Fijian women with GDM and showed that interventions targeting pregnant women who are overweight, had a previous baby weighing > 4 kg, had pre-eclampsia, delivered before 38 weeks of gestation, and those who booked later than 13 weeks in gestation, are needed to improve pregnancy outcomes.

Keywords: Apgar score; Diabetes; Fiji; Gestational diabetes mellitus (GDM); Hypoglycaemia; Macrosomia; Pacific people; Pregnancy.

Fig. 1

Flow chart for gestational diabetes mellitus (GDM) testing among pregnant women in an urban Fiji hospital. All pregnant women are routinely tested for GDM using a two-step process consisting of the 1-h glucose challenge test (GCT) at 24–28 weeks including a non-fasting 50 g glucose load and if GCT was ≥ 7.8 mmol/l, a 2-h 75 g oral glucose tolerance test (OGTT) was then performed. One abnormal value is sufficient for diagnosis. The women with any known risk factor for GDM including age ≥ 30 years, strong family history of diabetes, past history of GDM, previous macrosomic baby and high maternal pre-pregnancy BMI ≥ 30 kg/m², proceed to OGTT at initial testing. Those who are at high risk for GDM (i.e. women with two or more of the risk factors present at booking) proceed directly to a 2-h 75 g OGTT at the time of their booking with the antenatal clinic. If the early testing with OGTT was normal (fasting < 5.1 mmol/L, 2 h < 8.5 mmol/L), the high-risk women underwent another 75-g OGTT at 24–28 weeks’ gestation

Fig. 2

Prevalence of neonatal outcomes among Fijian women with gestational diabetes mellitus (GDM). LGA, large for gestational age