Adverse maternal and neonatal outcomes among women with gestational diabetes mellitus: a retrospective cohort study in Western Kenya
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260669Keywords:
Cesarean section, Gestational diabetes mellitus, Kenya, Macrosomia, Maternal outcomes, Neonatal outcomesAbstract
Background: Gestational diabetes mellitus (GDM) is a growing public health concern associated with adverse maternal and neonatal outcomes, yet evidence from Sub-Saharan Africa, including Kenya, remains limited. This study examined the association between GDM and adverse maternal and neonatal outcomes among women delivering at a tertiary hospital in western Kenya and identified key risk factors for these outcomes.
Methods: A retrospective case-control study was conducted using hospital and maternal fetal medicine (MFM) registry records from January 2020 to December 2022. A total of 210 women were analyzed, 105 with GDM and 105 without, matched by age, parity, and gestational age at delivery. Data on demographic, obstetric, and clinical characteristics were extracted and analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression to determine independent predictors of adverse outcomes.
Results: Women with GDM had significantly higher rates of cesarean delivery (58% versus 40%), postpartum hemorrhage (21% versus 7.6%), and macrosomia (21% versus 1%) compared to those without GDM (p<0.05). Newborn unit admissions (44% versus 27%) and respiratory distress syndrome (15% versus 6.7%) were also more common among infants born to GDM mothers, consistent with previous findings. Obesity (aOR=11.3; 95% CI: 4.3-32.5), prior history of GDM (aOR=4.7; 95% CI: 1.3-22.7), and advanced maternal age emerged as independent predictors of adverse outcomes.
Conclusions: These findings demonstrates that GDM substantially increases the risk of maternal and neonatal complications in this setting. Strengthened screening between 24 and 28 weeks of gestation, targeted management, and structured postpartum follow-up are recommended to improve outcomes and reduce the long-term burden of diabetes among mothers and infants.
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References
International Diabetes Federation. Hyperglycaemia in pregnancy (HIP): prevalence of gestational diabetes mellitus. IDF Diabetes Atlas. 11th edn. Brussels: IDF; 2024.
Druye AA, Owusu G, Yeboa NK, Boso CM, Berchie GO, Nabe B, et al. Self-management interventions for gestational diabetes in Africa: a scoping review. BMC Pregnancy Childbirth. 2024;24(1):549. DOI: https://doi.org/10.1186/s12884-024-06764-w
Chileshe M, Imanga F, Zulu AC, Kazonga E. Prevalence, predictors, and outcomes of gestational diabetes mellitus in Sub-Saharan Africa: a systematic review and meta-analysis. OJEpi. 2025;15:421-38. DOI: https://doi.org/10.4236/ojepi.2025.152027
Abera ET, et al. Adverse pregnancy outcomes among women with gestational diabetes in sub-Saharan Africa: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024;24:122. DOI: https://doi.org/10.1186/s12884-024-06290-9
Njogu PK, Makunyi EG, Musau J. Risk factors for caesarean delivery and fetal macrosomia among women with gestational diabetes in Nyeri County, Kenya: a cross-section study. Pan Afr Med J. 2022;41(1). DOI: https://doi.org/10.11604/pamj.2022.41.322.29734
Saravanan P, Deepa M, Ahmed Z, Ram U, Surapaneni T, Kallur SD, et al. Early pregnancy HbA1c as the first screening test for gestational diabetes: results from three prospective cohorts. Lancet Diabetes Endocrinol. 2024;12(8):535-44. DOI: https://doi.org/10.1016/S2213-8587(24)00151-7
Kleinwechter H, Schäfer-Graf U, Bührer C, Hoesli I, Kainer F, Kautzky-Willer A, et al. Gestational diabetes mellitus (GDM) diagnosis, therapy and follow-up care. Exp Clin Endocrinol Diabetes. 2014;122(07):395-405. DOI: https://doi.org/10.1055/s-0034-1366412
Barnes AC, et al. Birthweight and long-term cardiometabolic risk: evidence from longitudinal cohorts. Lancet Diabetes Endocrinol. 2018;6(5):390–400.
Metzger BE, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002. DOI: https://doi.org/10.1056/NEJMoa0707943
Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361(14):1339-48. DOI: https://doi.org/10.1056/NEJMoa0902430
Mwanri AW, et al. Gestational diabetes mellitus in sub-Saharan Africa: a systematic review. Diabetes Res Clin Pract. 2019;147:1–9.
Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017;60(4):636-44. DOI: https://doi.org/10.1007/s00125-017-4206-6
Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short-term and long-term adverse consequences. Trends Endocrinol Metab. 2017;28(10):744-57. DOI: https://doi.org/10.1136/bmj.j1
Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational diabetes mellitus: mechanisms, treatment, and complications. Trends Endocrinol Metab. 2021;32(11):743-54. DOI: https://doi.org/10.1016/j.tem.2018.09.004
Obongo A, Tallarek M, Spallek J. Determinants of access to and use of gestational diabetes mellitus services in Kenya: a multimethod case study protocol. BMJ Open. 2023;13(12):e074916. DOI: https://doi.org/10.1136/bmjopen-2023-074916
Kenya Ministry of Health. National diabetes management guidelines. Version 15. Nairobi: Ministry of Health; 2024.
World Health Organization. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva: WHO; 2013.
Pastakia SD, Njuguna B, Onyango BA, Washington S, Christoffersen-Deb A, Kosgei WK, et al. Prevalence of gestational diabetes mellitus based on various screening strategies in western Kenya: a prospective comparison of point of care diagnostic methods. BMC Pregnancy Childbirth. 2017;17(1):226. DOI: https://doi.org/10.1186/s12884-017-1415-4
Oti SO, et al. Maternal and neonatal outcomes of diabetes in pregnancy in western Kenya. East Afr Med J. 2022;99(8):311-8.
Catalano PM, McIntyre HD, Cruickshank JK, McCance DR, Dyer AR, Metzger BE, et al. The hyperglycemia and adverse pregnancy outcome study: associations of GDM and obesity with pregnancy outcomes. Diabetes Care. 2012;35(4):780-6. DOI: https://doi.org/10.2337/dc11-1790
Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-86. DOI: https://doi.org/10.1056/NEJMoa042973
Kramer CK, Campbell S, Retnakaran R. Gestational diabetes and cardiovascular risk. Diabetologia. 2019;62:668-79. DOI: https://doi.org/10.1007/s00125-019-4840-2
Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-9. DOI: https://doi.org/10.1016/S0140-6736(09)60731-5
Daly B, et al. Long-term cardiometabolic risk after gestational diabetes. PLoS Med. 2018;15:e1002488. DOI: https://doi.org/10.1371/journal.pmed.1002488
HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes follow-up study. Diabetes Care. 2020;43:288-95.
Kenya National Bureau of Statistics, ICF. Kenya Demographic and Health Survey 2022. Nairobi: KNBS; 2022.
Mann CJ. Observational research methods. BMJ. 2003;327:740-3. DOI: https://doi.org/10.1136/bmj.327.7417.740
Charan J, Biswas T. How to calculate sample size in medical research. Indian J Psychol Med. 2013;35:121-6. DOI: https://doi.org/10.4103/0253-7176.116232
Ayah R, et al. Barriers to follow-up care after gestational diabetes in LMICs. BMC Pregnancy Childbirth. 2020;20:693.
O’Sullivan EP, et al. Fetal metabolic programming in gestational diabetes. Diabetologia. 2022;65:610-24.
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