Title: Prevalence, Risk factors, and Pregnancy Outcomes among Gestational Diabetic Mothers at Aljala Maternity Hospital, 2019
Authors: Hind Basheer Sulayman Karawad, Abdurrahman. J. Asharef, and Azab Elsayed Azab
Volume: 8
Issue: 9
Pages: 96-118
Publication Date: 2024/09/28
Abstract:
Background: The prevalence of gestational diabetes (GDM) has increased recently worldwide. Pregnancy is associated with insulin resistance (IR) and hyperinsulinemia that may predispose some women to develop diabetes, GDM has been defined as any degree of glucose intolerance with an onset, or first recognition during pregnancy. Objectives: The study aims to identify the prevalence, risk factors of GDM, and to examine the relationship of maternal, fetal, and perinatal complications with GDM in Aljala hospital in west of Libya. Method of study: A prospective descriptive study of pregnant Libyan women presenting at the Maternity Aljala Hospital, Tripoli, Libya, between the1st January up to 31th of December, the year of 2019. Case control study, about 205 cases of GDM and 410 control non GDM were included in the study, Data on risk factors and pregnancy outcomes were collected through a face to face interview with the mothers and checking antenatal and delivery records at postnatal word. Data were described by mean, frequency and standard division, and examination of strength of association by odds ratio and confidence interval and test significant by t test, ANOVA test. Results: Out of the 205 pregnant with GDM mothers involved in the study, the mean age for the patients was (33.8±11.3years). The maximum age of the patients was 49 years and the minimum age was 21 years. Most of the age distribution of the patients in this study was between 30-40 years, which account for 48%. The mean weight for the patients was (78.51±15.83kg).The mean height for the patients was (156.92±6.61cm). Almost half of the participated pregnant women with GDM have height between 150-160cm (55.1%). Most of the participated cases have college level of education which accounts 69.7% of the total 205 cases. Most of the participated cases (82.4%) belong to the families with low monthly expenditure less than one thousand per month. Around of 57.6% of the participated ladies are employments. Half of the caese were between G4-G7 in their gravidity. Six percent of the cases have H/O macrosomia, 30.7% miscarriage, 16% preterm history of labor, 15 % IUFD, and 5.3 % have history of still birth. More than half of the cases (56.1%) have history of GDM in previous pregnancies. Oral glucose tolerance test is the method of diagnosis in approximately half of the GDM cases (46.3%), and fasting blood sugar, random blood sugar, and glycosylated hemoglobin level contributed to the remaining cases of GDM, in 42.2%, 5.9%, and 5.6% respectively. About 14 cases of GDM on diet type of control their blood sugar, and 101 (49%) on diet control and oral hypoglycemic agents. 37.1% of the pregnant women with GDM were anemic, around half of the cases have UTI (49.8%), 46.8%) of the cases have candidiasis, 36.4% of the GDM cases have ployhydraminos, 22.3% have PLRM, 17.6% have hypertension, and 16.5% have PPH. Older maternal age, higher body weight, higher blood pressure, past GDM, history of delivering a malformed child, and family history of diabetes were the main risk factors for GDM. Around 66% of the cases were delivered by C/S (45.9% Elective C/S and 20.9 were Emergency one). Twenty percent of the cases were delivered by induced vaginal delivery and around thirteen percent of the cases by spontaneously delivered vaginally. Six cases have instrumental labour which accounts 2.9% of the all cases. 54.2% of the birth weight of the neonates of the participated mothers were above four kilos (more than average). On the other side, nearly one third the participated patients had average birth weight (between 2500g and 4500g), and 31 neonates were small size baby (less than 2500g). The mean birth weight was 3.041kg. 69.7% of the GDM cases have delivered normal alive baby, 10.2% have congenital malformation, 9.3% have IUFD, 6.4% have still birth, and 4.4% have birth injury. 53% of the neonates of the GDM cases were females, and the rest 46.8% of the neonates were males. The most of the delivered neonates for mothers with GDM have Apgar score >7 at five minutes (84.4%). P-Value 0.003. 12.2 % of the neonates who delivered to mothers with GDM have hypoglycemia, 10.2% have hyperbilirubinemia and other 10.2% have infection, 7.8% have respiratory distress syndrome (RDS), and seven neonates have dead (3.6%). GDM increased the risk of neonatal hypoglycemia low Apgar score and induction of labor. The Newborns of GDM mothers had a higher birth weight. Other maternal and neonatal outcomes were not significantly different between the two groups. Conclusion: In Aljala Hospital, the prevalence of gestational diabetes mellitus among women attending antenatal treatment was higher compared to other studies conducted. Older maternal age, higher BMI, higher blood pressure, a history of GDM in previous pregnancies, and a family history of diabetes were the main risk factors. Timely and effective treatment of gestational diabetes reduces perinatal morbidity and improves outcomes. In populations at high risk for GDM, as in Libya, universal screening is recommended to reduce maternal and fetal morbidity and to allow for subsequent attempts to prevent or delay the onset of type 2 diabetes. Larger studies from different regions of Libya are needed to confirm our results. To enhance maternal and child health, improving screening, treatment, and prevention strategies for gestational diabetes mellitus is necessary.