Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors

Adam, Sheryl; Rheeder, Paul

doi:10.7196/samj.2017.v107i6.12043

Cited by 91 publications

(143 citation statements)

References 14 publications

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“…Our findings may be suggestive of an increasing prevalence of GDM in Tanzanian urban areas. The prevalence in our study is somewhat similar to 31.9% in Uganda (18), 31% in Cameroon (9) and 25.8% in south Africa (19). These findings show a higher burden than the global prevalence of 16% (3).…”

Section: Discussionsupporting

confidence: 82%

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Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study

Mukuve

Mgonja

Sendagire³

et al. 2020

Preprint

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Background: Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally. The primary objective was to determine the magnitude of screening for GDM among women receiving ANC at the Aga Khan Hospital, Dar es Salaam and Muhimbili National Hospital, Dar es Salaam. Secondary objectives were: to determine the methods used by health practitioners to screen for GDM, to determine the magnitude of undiagnosed gestational diabetes mellitus among women attending ANC and factors associated with screening for GDM among these women. Methods: A cross-sectional analytical study was done. Data collection was done using pre-tested questionnaires and reviewing antenatal care records. The proportion of women attending ANC who were screened for GDM was determined. The 75g Oral Glucose Tolerance Test (OGTT) was offered to women who had not been screened after education and consent. Results: Only 107 out of 358 (29.9%) had been offered some form of GDM screening. Tests used for GDM screening were random blood sugar (56.8%), fasting blood sugar (32.8%), HbA1C (6%) and 75g OGTT (3.4%). The uptake of the OGTT was 27%. Of these women the prevalence of GDM was 27.4%. Factors associated with screening for GDM were history of big baby, history of pregnancy induced hypertension and participant awareness of GDM (all p : <0.05). Conclusions: Screening for GDM among women attending ANC was lower than the World Health Organization target. Efforts should be directed towards promoting GDM screening, increasing awareness about GDM and developing more effective screening methods.

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Section: Discussionsupporting

confidence: 82%

“…Uptake of the OGTT was 27% which was similar to the 22% of the Cameroon study. However the uptake varies from 75.4% found in a Ugandan study (18) and 55.4% in a South African study (19).…”

Section: Discussionmentioning

confidence: 83%

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study

Mukuve

Mgonja

Sendagire³

et al. 2020

Preprint

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“…Lower prevalence has been reported in African countries including Ghana (9.3%) [16], South African (9.1%) [21] and Nigeria (8.6%) [22] compared with developed regions like North America (12%) and Europe (14%) [2]. But Africa appears to be catching-up fast as pockets of high cases have recently been reported in Tanzania (19.5%) [23], South Africa (25.8%) [24] and Morocco (23.7%) [25]. However, diverse algorithms for testing and diagnosing pose challenges in comparing prevalence, risks, treatment effects, pregnancy outcomes, and harmonizing clinical practice [12].…”

Section: Discussionmentioning

confidence: 96%

“…But some women develop GDM without any identifiable risk. Making diagnostic decision based on risk could miss half of all cases [14,24] supporting the call to test all pregnant women [7]. Despite the diverse risk profile, adiposity and excess intake of high GI foods are striking.…”

Section: Discussionmentioning

confidence: 99%

Gestational diabetes using diverse diagnostic criteria, risk factors including dietary intakes, pregnancy outcomes and postpartum glycemic status: a nested case-control study in Ghana

Agbozo

Abubakari

Zotor

et al. 2019

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Organization delivery (aOR:4.01 CI:1.08-14.76) and antenatal care in a primary facility (aOR:4.951 CI:1.87-3.76). A unit rise in blood glucose significantly increased maternal blood loss and birthweight. Adjusting for covariates, adverse birth outcomes were perineal tear (Aor:2.91 CI:1.08-5.57) and birth asphyxia (aOR:3.24 CI:1.01-10.44). Cesarean section (aOR:1.9 CI:0.97-3.68), large for gestational age (aOR:2.7 CI:0.86-5.05) and newborn resuscitation (aOR:2.91 CI 0.94-9.01) were significant at 10%. At 12 weeks postpartum, 30% of the GDM cases were unable to achieve euglycemia. Different estimates could be obtained if other diagnostic criteria were used. ConclusionsFindings show an increasing prevalence of GDM in peri-urban and rural settings highlighting the need to strengthen primary facilities to test and refer cases for management. Diet and adiposity are key risk factors necessitating lifestyle modification interventions focusing on nutrition education and weight control. GDM-exposed newborn need close monitoring as birth asphyxia which is a key outcome is likely to compromise neonatal survival. Postpartum follow-up of cases is crucial to avert transition of GDM into active diabetes.

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“…[1] Although there is a paucity of data on South African (SA) women, GDM prevalences of 9.1% and 25.8% have recently been reported. [2,3] Identifying affected women allows interventions to improve perinatal outcomes. [4] Both screening strategies and diagnostic thresholds for GDM attract controversy.…”

Section: Researchmentioning

confidence: 99%

Fasting plasma glucose and risk factor assessment: Comparing sensitivity and specificity in identifying gestational diabetes in urban black African women

et al. 2019

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Background. Identifying women with gestational diabetes mellitus (GDM) allows interventions to improve perinatal outcomes. A fasting plasma glucose (FPG) level ≥5.1 mmol/L is 100% specific for a diagnosis of GDM. The International Association of Diabetes and Pregnancy Study Groups acknowledges that FPG <4.5 mmol/L is associated with a low probability of GDM. Objectives. The validity of selective screening based on the presence of risk factors was compared with the universal application of FPG ≥4.5 mmol/L to identify women with GDM. FPG ≥4.5 mmol/L or the presence of one or more risk factors was assumed to indicate an intermediate to high risk of GDM and therefore the need for an oral glucose tolerance test (OGTT). Methods. Consecutive black South African (SA) women were recruited to a 2-hour 75 g OGTT at 24 -28 weeks' gestation in an urban community health clinic. Of 969 women recruited, 666 underwent an OGTT, and of these 589 were eligible for analysis. The glucose oxidase laboratory method was used to measure plasma glucose concentrations. The World Health Organization GDM diagnostic criteria were applied. All participants underwent a risk factor assessment. The χ 2 test was used to determine associations between risk factors and a positive diagnosis of GDM. The sensitivity and specificity of a positive diagnosis of GDM were calculated for FPG ≥4.5 mmol/L, FPG ≥5.1 mmol/L, and the presence of one or more risk factors. Results. The prevalence of overt diabetes mellitus and GDM was 0.5% and 7.0%, respectively. Risk factor-based selective screening indicated that 204/589 (34.6%) of participants needed an OGTT, but 18/41 (43.9%) of positive GDM diagnoses were missed. Universal screening using the FPG threshold of ≥4.5 mmol/L indicated that 152/589 (25.8%) of participants needed an OGTT, and 1/41 (2.4%) of positive diagnoses were missed. An FPG of ≥5.1 mmol/L identified 36/41 (87.8%) of GDM-positive participants. The sensitivity and specificity of the presence of one or more risk factors were 56% and 67%, respectively. The sensitivity and specificity of FPG ≥4.5 mmol/L were 98% and 80%, respectively. Conclusions. Universal screening using FPG ≥4.5 mmol/L had greater sensitivity and specificity in identifying GDM-affected women and required fewer women to undergo a resource-intensive diagnostic OGTT than risk factor-based selective screening. A universal screening strategy using FPG ≥4.5 mmol/L may be more efficient and cost-effective than risk factor-based selective screening for GDM in black SA women.

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Screening for gestational diabetes mellitus in a South African population: Prevalence, comparison of diagnostic criteria and the role of risk factors

Cited by 91 publications

References 14 publications

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study

Magnitude of screening for gestational diabetes mellitus in an urban setting in Tanzania; a cross-sectional analytic study

Gestational diabetes using diverse diagnostic criteria, risk factors including dietary intakes, pregnancy outcomes and postpartum glycemic status: a nested case-control study in Ghana

Fasting plasma glucose and risk factor assessment: Comparing sensitivity and specificity in identifying gestational diabetes in urban black African women

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