Manga Jaishil, Odell Natalie, Khambule Lungile, Harishun Sayuri, Mohamed Farzahna
Charlotte Maxeke Johannesburg Academic Hospital, Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Charlotte Maxeke Johannesburg Academic Hospital, Department of Obstetrics & Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Clin Med (Lond). 2025 Aug 6;25(5):100495. doi: 10.1016/j.clinme.2025.100495.
The prevalence of diabetes mellitus (DM) during pregnancy is rising globally, yet data on gestational diabetes mellitus (GDM) in South Africa remain limited. This study retrospectively analysed glycaemic characteristics and outcomes in 298 women with pre-gestational DM and hyperglycaemia first detected in pregnancy (HFDP) between August 2019 and January 2021. Hyperglycaemic disorders were attributed to GDM (39.6%, n = 118), followed by type 2 diabetes (T2DM) (29.2%, n = 87), overt DM (22.1%, n = 66) and type 1 diabetes (T1DM) (9.1%, n=27). Significant risk factors for GDM included family history, obesity, poor obstetric history, and a previous history of macrosomia in pregnancy. Glycated haemoglobin (HbA1c) levels at booking were highest in women with pre-gestational DM (8.8% in T1DM and 7.8% in T2DM). A combination of HbA1c ≥ 5.75% and fasting plasma glucose (FPG) of 5.1-6.9 mmol/L was the most accurate method for diagnosing GDM, with an area under the curve (AUC) of 0.93. Postpartum follow-up using an oral glucose tolerance test (OGTT) revealed that 21% of women with GDM developed DM, while 53% had an impaired glucose tolerance (IGT). However, only 48% of those with GDM were followed up postpartum, highlighting the significant challenge of loss to follow-up. These findings emphasise the growing prevalence of HFDP and the elevated risk of postpartum DM, highlighting the need for improved follow-up care to mitigate long-term complications. Additionally, the combination of FPG and HbA1c ≥ 5.75% shows promise for enhancing GDM diagnosis and screening protocols, particularly in developing countries. Further research is needed to validate these findings and assess their broader applicability.
全球范围内，孕期糖尿病（DM）的患病率正在上升，但南非关于妊娠期糖尿病（GDM）的数据仍然有限。本研究回顾性分析了2019年8月至2021年1月期间298例孕前糖尿病和孕期首次检测出血糖升高（HFDP）的女性的血糖特征和结局。高血糖疾病归因于GDM（39.6%，n = 118），其次是2型糖尿病（T2DM）（29.2%，n = 87）、显性糖尿病（22.1%，n = 66）和1型糖尿病（T1DM）（9.1%，n = 27）。GDM的显著危险因素包括家族史、肥胖、不良产科史以及既往妊娠巨大儿史。孕早期糖化血红蛋白（HbA1c）水平在孕前糖尿病女性中最高（T1DM为8.8%，T2DM为7.8%）。HbA1c≥5.75%和空腹血糖（FPG）为5.1 - 6.9 mmol/L的组合是诊断GDM最准确的方法，曲线下面积（AUC）为0.93。产后采用口服葡萄糖耐量试验（OGTT）进行随访发现，21%的GDM女性发展为糖尿病，而53%有糖耐量受损（IGT）。然而，只有48%的GDM患者在产后进行了随访，这凸显了失访的重大挑战。这些发现强调了HFDP患病率的上升以及产后糖尿病风险的增加，凸显了改善随访护理以减轻长期并发症的必要性。此外，FPG和HbA1c≥5.75%的组合有望改进GDM诊断和筛查方案，特别是在发展中国家。需要进一步研究来验证这些发现并评估其更广泛的适用性。
