Agbozo Faith, Abubakari Abdulai, Zotor Francis, Jahn Albrecht
Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Ho, Ghana, Private Mail Bag 31 Ho, Ghana.
Heidelberg Institute of Global Health, University Hospital Heidelberg Germany, Im Neuenheimer Feld 130.3, 60120 Heidelberg, Germany.
Clin Pract. 2021 May 7;11(2):257-271. doi: 10.3390/clinpract11020039.
The surge in gestational diabetes mellitus (GDM) globally requires a health system tailored approach towards prevention, detection and management. We estimated the prevalence of GDM using diverse recommended tests and diagnostic thresholds, and also assessed the risk factors and obstetric outcomes, including postpartum glycemia. Using a prospective cohort design, 446 singleton pregnant women without pre-existing diabetes did GDM tests in five hospitals in Ghana from 20-34 weeks using fasting plasma glucose (FPG), one-hour and 2-h oral glucose tolerance test (OGTT). Birth outcomes of 403 were assessed. GDM was diagnosed using six international diagnostic criteria. At 12 weeks postpartum, impaired fasting glucose (6.1-6.9 mmol/L) and diabetes (FPG ≥7.0 mmol/L) were measured for 100 women. Per FPG and 2-h OGTT cut-offs, GDM prevalence ranged between 8.3-23.8% and 4.4-14.3%, respectively. Risk factors included overweight (OR = 2.13, 95% CI: 1.13-4.03), previous miscarriage (OR = 4.01, 95% CI: 1.09-14.76) and high caloric intake (OR = 2.91, 95% CI: 1.05-8.07). Perineal tear (RR = 2.91, 95% CI: 1.08-5.57) and birth asphyxia (RR = 3.24, 95% CI: 1.01-10.45) were the associated perinatal outcomes. At 12 weeks postpartum, 15% had impaired fasting glucose, and 5% had diabetes. Tackling modifiable risk factors is crucial for prevention. Glycemic monitoring needs to be integral in postpartum and well-child reviews.
全球妊娠期糖尿病（GDM）的激增需要卫生系统采取针对性的预防、检测和管理方法。我们使用多种推荐的检测方法和诊断阈值估算了GDM的患病率，并评估了风险因素和产科结局，包括产后血糖情况。采用前瞻性队列设计，446例无糖尿病史的单胎孕妇于妊娠20 - 34周在加纳的五家医院进行了空腹血糖（FPG）、1小时及2小时口服葡萄糖耐量试验（OGTT）的GDM检测。评估了403例孕妇的分娩结局。采用六种国际诊断标准诊断GDM。产后12周时，对100名女性测量了空腹血糖受损（6.1 - 6.9 mmol/L）和糖尿病（FPG≥7.0 mmol/L）情况。根据FPG和2小时OGTT的临界值，GDM患病率分别在8.3% - 23.8%和4.4% - 14.3%之间。风险因素包括超重（OR = 2.13，95% CI：1.13 - 4.03）、既往流产史（OR = 4.01，95% CI：1.09 - 14.76）和高热量摄入（OR = 2.91，95% CI：1.05 - 8.07）。会阴撕裂（RR = 2.91，95% CI：1.08 - 5.57）和出生窒息（RR = 3.24，95% CI：1.01 - 10.45）是相关的围产期结局。产后12周时，15%的女性空腹血糖受损，5%的女性患有糖尿病。应对可改变的风险因素对预防至关重要。血糖监测需要纳入产后及儿童健康检查。
