Mwanri Akwilina W, Kinabo Joyce, Ramaiya Kaushik, Feskens Edith J M
Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
Department of Food Science and Nutrition, Sokoine University of Agriculture, Morogoro, Tanzania.
Trop Med Int Health. 2015 Aug;20(8):983-1002. doi: 10.1111/tmi.12521. Epub 2015 May 10.
We systematically reviewed publications on prevalence and risk factors for gestational diabetes mellitus (GDM) in the 47 countries of sub-Saharan Africa.
We conducted a systematic search in PUBMED and reviewed articles published until June 2014 and searched the references of retrieved articles. We explored sources of heterogeneity among prevalence proportions with metaregression analysis.
Of 1069 articles retrieved 22 studies were included. Half were from West Africa, specifically Nigeria, five from South Africa and six from East and Central Africa. There were differences in screening methods and diagnosis criteria used, even between studies carried out in the same country and same time period. Metaregression analysis indicated high heterogeneity among the studies (I(2) = 100, P < 0.001), which could not be sufficiently explained by study setting, population, diagnostic criteria or time trend, although we observed a relatively higher prevalence in studies carried out after 2000 (5.1% vs. 3.2%), when women at risk were selected (6.5% vs. 3.8%) and when more current diagnostic criteria were used (5.1% vs. 4.2%). Associations with risk factors were reported in six studies. Significant risk factors reported in more than one study were overweight and/or obesity, family history for type 2 diabetes, previous stillbirth, previous macrosomic child and age >30 years.
There are few studies on prevalence and risk factors for GDM in Sub-Saharan Africa and heterogeneity is high. Prevalence was up to about 14% when high-risk women were studied. Preventive actions should be taken to reduce the short- and long-term complications related to GDM in Sub-Saharan Africa.
我们系统回顾了撒哈拉以南非洲47个国家中关于妊娠期糖尿病（GDM）患病率及危险因素的文献。
我们在PUBMED中进行了系统检索，并回顾了截至2014年6月发表的文章，同时检索了所获文章的参考文献。我们通过元回归分析探讨了患病率比例之间的异质性来源。
在检索到的1069篇文章中，纳入了22项研究。其中一半来自西非，特别是尼日利亚，5项来自南非，6项来自东非和中非。即使在同一国家同一时期开展的研究之间，所使用的筛查方法和诊断标准也存在差异。元回归分析表明这些研究之间存在高度异质性（I(2)=100，P<0.001），尽管我们观察到2000年后开展的研究患病率相对较高（5.1%对3.2%）、选择了高危女性的研究患病率相对较高（6.5%对3.8%）以及使用了更新诊断标准的研究患病率相对较高（5.1%对4.2%），但研究背景、人群、诊断标准或时间趋势均无法充分解释这种异质性。6项研究报告了与危险因素的关联。在不止一项研究中报告的显著危险因素有超重和/或肥胖、2型糖尿病家族史、既往死产史、既往巨大儿分娩史以及年龄>30岁。
撒哈拉以南非洲关于GDM患病率及危险因素的研究较少，且异质性较高。对高危女性进行研究时，患病率高达约14%。应采取预防措施以减少撒哈拉以南非洲与GDM相关的短期和长期并发症。
