Prevalence of gestational diabetes mellitus in rural pregnant mothers in northern Ethiopia

Abstract

In a community based survey of gestational diabetes in 18 rural villages of the eastern zone of Tigray administrative region, northern Ethiopia, a total of 890 pregnant women with gestational age of 24 weeks and above were examined for gestational diabetes mellitus based on WHO criteria. A 75 gm oral glucose tolerance test was performed on each subject with measurement of glucose at 0 and 2 h. Blood glucose was determined by glucose oxidase method using capillary blood (Accutrend alpha, Boehringer Mannheim). The mean age of the mothers was 27.4±7.1 years. Forty four percent of the subjects were multiparas. The prevalence rate of gestational diabetes mellitus was found to be 3.7% (95% CI 2.5–4.9). The mean blood glucose 2 h after glucose load in those pregnant diagnosed to have gestational diabetes mellitus was 154.6±14.4 mg/dl (J.W. Rich-Edwards, G.A. Colditz, M.J. Stampfer, W.C. Willett, M.W. Gillman, C. Hennekens, F.E. Speizer, J.E. Manson, Birth weight and the risk for type 2 diabetes mellitus in adult women, Annu. Intern. Med. 130 (1999) 278–284). The prevalence of gestational diabetes mellitus in this region of the country is high as compared to other parts of Africa. The possible role and contribution of exposure of the general population in this area to chronic malnutrition as a result of prolonged famine, drought and war, to the high prevalence of gestational diabetes mellitus warrants further study.

Introduction

Pregnancy has been shown to have a diabetogenic effect on carbohydrate metabolism, increasing the glucose response to a mixed meal as a pure carbohydrate challenge [1]. This transient derangement of the carbohydrate metabolism is known as gestational diabetes mellitus (GDM) [2]. It is defined as glucose intolerance of variable severity with onset as first recognition during pregnancy [3]. GDM occurs in about 3–19% of pregnancies in industrialized nations [4], [5], [6], [7], [8], [9] and 0–1% in African countries [10], [11]. It manifests at the end of the second trimester and more commonly in the third trimester of pregnancy. It resolves after delivery, tends to occur in subsequent pregnancies and is associated with an increased risk for the subsequent development of classical diabetes mellitus.

Numerous studies have demonstrated that women with GDM manifest an increased rates of still births, perinatal mortality, macrosomia, congenital malformations etc. [12]. In order to minimize these risks in developed countries, all pregnant women, regardless of history for GDM are screened. The optimal time to screen for GDM is beyond 24 weeks of gestation [13].

The magnitude of GDM is unknown in Ethiopia and the data on prevalence of GDM in Africa are scanty. Particularly prevalence of GDM in rural pregnant who are exposed to long term malnutrition is virtually unknown. Since the area where the study was conducted is exposed to famine, draught and war for a long period of time, there is distinct intergenerational malnutrition thus we are trying to see if this long standing malnutrition is associated with increased prevalence of GDM.