Gestational Diabetes Mellitus per Different Diagnostic Criteria, Risk Factors, Obstetric Outcomes and Postpartum Glycemia: A Prospective Study in Ghana

Abstract

The surge in gestational diabetes mellitus (GDM) globally requires a health system tailored approach towards prevention, detection and management. We estimated the prevalence of GDM using diverse recommended tests and diagnostic thresholds, and also assessed the risk factors and obstetric outcomes, including postpartum glycemia. Using a prospective cohort design, 446 singleton pregnant women without pre-existing diabetes did GDM tests in five hospitals in Ghana from 20-34 weeks using fasting plasma glucose (FPG), one-hour and 2-h oral glucose tolerance test (OGTT). Birth outcomes of 403 were assessed. GDM was diagnosed using six international diagnostic criteria. At 12 weeks postpartum, impaired fasting glucose (6.1-6.9 mmol/L) and diabetes (FPG ≥7.0 mmol/L) were measured for 100 women. Per FPG and 2-h OGTT cut-offs, GDM prevalence ranged between 8.3-23.8% and 4.4-14.3%, respectively. Risk factors included overweight (OR = 2.13, 95% CI: 1.13-4.03), previous miscarriage (OR = 4.01, 95% CI: 1.09-14.76) and high caloric intake (OR = 2.91, 95% CI: 1.05-8.07). Perineal tear (RR = 2.91, 95% CI: 1.08-5.57) and birth asphyxia (RR = 3.24, 95% CI: 1.01-10.45) were the associated perinatal outcomes. At 12 weeks postpartum, 15% had impaired fasting glucose, and 5% had diabetes. Tackling modifiable risk factors is crucial for prevention. Glycemic monitoring needs to be integral in postpartum and well-child reviews.

Keywords: Ghana; blood glucose; gestational diabetes mellitus; hyperglycemia in pregnancy; newborn; postpartum period; pregnancy; pregnancy outcome; prevalence; risk factors.

Figure 1

Conceptual framework showing the current areas of gestational diabetes research. Note: Author designed.

Figure 2

Recommended standard of care for GDM detection in Ghana vis-à-vis the actual clinical practice. Note: Author designed. ANC, antenatal care clinic; 2-h OGTT, two-hour oral glucose tolerance test; GDM, gestational diabetes mellitus; CHPS, Community Health-Based Planning Services.

Figure 3

Number of participants followed-up at each stage of the study. Note: n, number of participants; GDM, gestational diabetes mellitus; CS, cesarean section; LGA, large-for-gestational-age.