Skip to main content

Advertisement

SpringerLink
Log in

Adverse Maternal Outcomes of Fijian Women with Gestational Diabetes Mellitus and the Associated Risk Factors

  • General Gynecology: Original Article
  • Published:
Reproductive Sciences Aims and scope Submit manuscript

Abstract

The purpose of this study is to determine the factors associated with adverse maternal outcomes in pregnancies complicated by gestational diabetes mellitus (GDM) in urban Fiji. This cross-sectional study used data from existing records of singleton pregnant women with GDM attending the Colonial War Memorial Hospital (CWMH) Suva Fiji between June 2013 and May 2014. Data retrieved included demographic data, antenatal and intrapartum care data, route of delivery, treatment modality, and maternal risk factors. The prevalence of GDM is 3.0%, n = 255/8698, and the most frequent maternal complications were induction of labor (66%), C-section (32%), and preeclampsia (19%), and 25% had babies with birthweight > 4 kg. Older women (≥ 36 years) and those treated with insulin were 5.2 times and 10.7 times, respectively, more likely to have labor induction during childbirth compared with younger women and those on dietary management. Family history of diabetes was associated with 2.4× and/or 2.5× higher odds of cesarean delivery and/or develop hypertension in pregnancy, respectively. Parity > 5 children and diagnoses of GDM after the first trimester reduced the odds of cesarean delivery. The odds of developing preeclampsia in GDM was 3.4 times higher (95% confidence interval (CI) of adjusted odds ratio (aOR): 1.03, 18.78) among obese women than normal-weight women, and married women were less likely to have babies with birthweight > 4 kg. The prevalence of and adverse outcomes among women with GDM attending antenatal public health care in Suva Fiji were higher than previously reported from the hospital. Older and multiparous women with GDM, those insulin treated, and with a strong family history and high body mass index (BMI) need special attention and better monitoring by health care personnel to reduce adverse outcomes during pregnancy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of Data

Data for this study is stored on the hospital database and can be made available on request from the first author.

References

  1. Ferrara A. Increasing prevalence of gestational diabetes mellitus: a public health perspective. Diabetes Care. 2007;30(Supplement 2):S141–6.

    Article  PubMed  Google Scholar 

  2. Zhu Y, Zhang C. Prevalence of gestational diabetes and risk of progression to type 2 diabetes: a global perspective. Curr Diab Rep. 2016;16(1):7.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Simmons D. Epidemiology of diabetes in pregnancy. A practical manual of diabetes in pregnancy. 2017:3.

  4. Yuen L, Wong VW, Simmons D. Ethnic disparities in gestational diabetes. Curr Diab Rep. 2018;18(9):68. https://doi.org/10.1007/s11892-018-1040-2.

    Article  CAS  PubMed  Google Scholar 

  5. Cheung NW, Byth K. Population health significance of gestational diabetes. Diabetes Care. 2003;26(7):2005–9.

    Article  PubMed  Google Scholar 

  6. Organization WH. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. 2013

  7. Gray SA, Jones CW, Theall KP, Glackin E, Drury SS. Thinking across generations: unique contributions of maternal early life and prenatal stress to infant physiology. J Am Acad Child Adolesc Psychiatry. 2017;56(11):922–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Simmons D. Diabetes and obesity in pregnancy. Best Pract Res Clin Obstet Gynaecol. 2011;25(1):25–36.

    Article  PubMed  Google Scholar 

  9. Egan AM, Vellinga A, Harreiter J, Simmons D, Desoye G, Corcoy R, et al. Epidemiology of gestational diabetes mellitus according to IADPSG/WHO 2013 criteria among obese pregnant women in Europe. Diabetologia. 2017;60(10):1913–21. https://doi.org/10.1007/s00125-017-4353-9.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Boriboonhirunsarn D, Waiyanikorn R. Emergency cesarean section rate between women with gestational diabetes and normal pregnant women. Taiwan J Obstet Gynecol. 2016;55(1):64–7. https://doi.org/10.1016/j.tjog.2015.08.024.

    Article  PubMed  Google Scholar 

  11. Damm P, Houshmand-Oeregaard A, Kelstrup L, Lauenborg J, Mathiesen ER, Clausen TD. Gestational diabetes mellitus and long-term consequences for mother and offspring: a view from Denmark. Diabetologia. 2016;59(7):1396–9.

    Article  CAS  PubMed  Google Scholar 

  12. Yapa M, Simmons D. Screening for gestational diabetes mellitus in a multiethnic population in New Zealand. Diabetes Res Clin Pract. 2000;48(3):217–23.

    Article  CAS  PubMed  Google Scholar 

  13. Morgan J. Country in focus: turning the tide of diabetes in Fiji. Lancet Diabetes Endocrinol. 2015;3(1):15–6. https://doi.org/10.1016/S2213-8587(14)70240-2.

    Article  PubMed  Google Scholar 

  14. Lin S, Tukana I, Linhart C, Morrell S, Taylor R, Vatucawaqa P, et al. Diabetes and obesity trends in Fiji over 30 years. J Diabetes. 2016;8(4):533–43. https://doi.org/10.1111/1753-0407.12326.

    Article  PubMed  Google Scholar 

  15. Morrell S, Lin S, Tukana I, Linhart C, Taylor R, Vatucawaqa P, et al. Diabetes incidence and projections from prevalence surveys in Fiji. Popul Health Metrics. 2016;14(1):45.

    Article  Google Scholar 

  16. Lin S, Hufanga S, Linhart C, Morrell S, Taylor R, Magliano DJ, et al. Diabetes and obesity trends in Tonga over 40 years. Asia Pac J Public Health. 2016;28(6):475–85.

    Article  PubMed  Google Scholar 

  17. Joshy G, Simmons D. Epidemiology of diabetes in New Zealand: revisit to a changing landscape. N Z Med J. 2006;119(1235):U1999.

    PubMed  Google Scholar 

  18. Ekeroma AJ, Craig ED, Stewart AW, Manetll CD, Mitchell EA. Ethnicity and birth outcome: New Zealand trends 1980–2001: part 3, Pregnancy outcomes for Pacific women Australia and New Zealand. J Obstet Gynaecol. 2004;44:541–4. https://doi.org/10.1111/j.1479-828X.2004.00311.x.

    Article  Google Scholar 

  19. WHO. Noncommunicable diseases in the Western Pacific Region: a profile. WHO Regional Office for the Western Pacific, Manila, Philippines. 2012

  20. Tin STW, Lee CMY, Colagiuri R. A profile of diabetes in Pacific Island countries and territories. Diabetes Res Clin Pract. 2015;107(2):233–46.

    Article  PubMed  Google Scholar 

  21. Simmons D, Thompson CF, Conroy C. Incidence and risk factors for neonatal hypoglycaemia among women with gestational diabetes mellitus in South Auckland. Diabet Med. 2000;17(12):830–4.

    Article  CAS  PubMed  Google Scholar 

  22. Zimmet P, Taylor R, Ram P, King H, Sloman G, Raper LR, et al. Prevalence of diabetes and impaired glucose tolerance in the biracial (Melanesian and Indian) population of Fiji: a rural-urban comparison. Am J Epidemiol. 1983;118(5):673–88.

    Article  CAS  PubMed  Google Scholar 

  23. Gyaneshwar R, Ram P. The prevalence of gestational diabetes in Fiji. Fiji Med J. 1990;16:40.

    Google Scholar 

  24. Group HSCR. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991–2002.

    Article  Google Scholar 

  25. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676–82.

    Article  PubMed Central  Google Scholar 

  26. Fuka F, Osuagwu UL, Agho K, Gyaneshwar R, Naidu S, Fong J, et al. Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2020;20(1):1–14.

    Article  Google Scholar 

  27. Organization WH. The Fiji Islands health system review. Manila: WHO Regional Office for the Western Pacific; 2011.

    Google Scholar 

  28. Bythell M, Nand D, Tikoduadua L, Vereti I, Kado J, Fong J, et al. Stillbirths, neonatal and infant mortality in Fiji 2012: preliminary findings of a review of medical cause of death certificates. Ministry of Health and Medical Services: Fiji Journal of Public Health; 2016.

    Google Scholar 

  29. Hoffman L, Nolan C, Wilson JD, Oats JJ, Simmons D. Gestational diabetes mellitus--management guidelines. The Australasian Diabetes in Pregnancy Society. Med J Aust. 1998;169(2):93–7.

    Article  CAS  PubMed  Google Scholar 

  30. Yamamoto JM, Kellett JE, Balsells M, Garcia-Patterson A, Hadar E, Sola I, et al. Gestational diabetes mellitus and diet: a systematic review and meta-analysis of randomized controlled trials examining the impact of modified dietary interventions on maternal glucose control and neonatal birth weight. Diabetes Care. 2018;41(7):1346–61. https://doi.org/10.2337/dc18-0102.

    Article  CAS  PubMed  Google Scholar 

  31. King H. Epidemiology of glucose intolerance and gestational diabetes in women of childbearing age. Diabetes Care. 1998;21(Suppl 2):B9–13.

    PubMed  Google Scholar 

  32. Simmons D. Relationship between maternal glycaemia and birth weight in glucose-tolerant women from different ethnic groups in New Zealand. Diabet Med. 2007;24(3):240–4.

    Article  CAS  PubMed  Google Scholar 

  33. Organization WH. The Asia-Pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia; 2000.

    Google Scholar 

  34. FBoS. Fiji statistics at a glance. Suva: Fiji Bureau of Statistics; 2017.

    Google Scholar 

  35. Snowdon W, Tukana I. Fiji-NCD Risk Factors STEPS REPORT 2011. Suva: Ministry of Health and Medical Services; 2011.

    Google Scholar 

  36. Lin S, Naseri T, Linhart C, Morrell S, Taylor R, McGarvey ST, et al. Trends in diabetes and obesity in Samoa over 35 years, 1978–2013. Diabet Med. 2016;34(5):654–61. https://doi.org/10.1111/dme.13197.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Fuka F, Osuagwu UL, Agho K, Gyaneshwar R, Naidu S, Fong J, et al. Factors associated with macrosomia, hypoglycaemia and low Apgar score among Fijian women with gestational diabetes mellitus. BMC Pregnancy Childbirth. 2020;20(1):133. https://doi.org/10.1186/s12884-020-2821-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Sadler L, McCowan L, Stone P. Associations between ethnicity and obstetric intervention in New Zealand. N Z Med J. 2002;115(1148):86.

    Google Scholar 

  39. Kelly Y, Panico L, Bartley M, Marmot M, Nazroo J, Sacker A. Why does birthweight vary among ethnic groups in the UK? Findings from the Millennium Cohort Study. J Public Health. 2008;31(1):131–7. https://doi.org/10.1093/pubmed/fdn057.

    Article  Google Scholar 

  40. 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. https://doi.org/10.1016/s0140-6736(09)60731-5.

    Article  CAS  PubMed  Google Scholar 

  41. Berger H, Melamed N. Timing of delivery in women with diabetes in pregnancy. Obstet Med. 2014;7(1):8–16.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

  43. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Caughey AB. ACOG Practice Bulletin No. 190: gestational diabetes mellitus. Obstet Gynecol. 2018;131(2):e49–64. https://doi.org/10.1097/AOG.0000000000002501.

    Article  Google Scholar 

  45. Caughey AB, Valent AM. When to deliver women with diabetes in pregnancy? Am J Perinatol. 2016;33(13):1250–4.

    Article  PubMed  Google Scholar 

  46. Hildingsson I, KarlstrÖm A, Nystedt A. Women’s experiences of induction of labour–findings from a Swedish regional study. Aust N Z J Obstet Gynaecol. 2011;51(2):151–7.

    Article  PubMed  Google Scholar 

  47. Benhalima K, Robyns K, Van Crombrugge P, Deprez N, Seynhave B, Devlieger R, et al. Differences in pregnancy outcomes and characteristics between insulin- and diet-treated women with gestational diabetes. BMC Pregnancy Childbirth. 2015;15:271. https://doi.org/10.1186/s12884-015-0706-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Yuen L, Wong VW. Gestational diabetes mellitus: challenges for different ethnic groups. World J Diabetes. 2015;6(8):1024–32.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Gamson K, Chia S, Jovanovic L. The safety and efficacy of insulin analogs in pregnancy. J Matern Fetal Neonatal Med. 2004;15(1):26–34. https://doi.org/10.1080/14767050310001650680.

    Article  CAS  PubMed  Google Scholar 

  50. Kane JB. Marriage advantages in perinatal health: evidence of marriage selection or marriage protection? J Marriage Fam. 2016;78(1):212–29.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to the following persons for their help during data collection: James Fong, Nola Mahe, Ilisapeci Kubuabola, Drs Julia Singh, Amanda Noovao, Pushpa Nusair, Litia Narube, Swaran Naidu, Dr. Viliame Nasila, Dr. Vasiti Cati, and Professor Rajat Gyaneshwar.

Author information

Authors and Affiliations

  1. Diabetes, Obesity and Metabolism Translational Research Unit, Western Sydney University, Campbelltown, NSW, 2560, Australia

    Uchechukwu L. Osuagwu & David Simmons

  2. Ministry of Health, Vaoila Hospital, Tongatapu, Tonga

    Falahola Fuka

  3. School of Science and Health, Western Sydney University, Campbelltown, NSW, 2560, Australia

    Kingsley Agho

  4. African Vision Research Institute, University of KwaZulu-Natal Durban, Durban, South Africa

    Kingsley Agho

  5. Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar

    Adnan Khan

  6. Department of Medicine, Weill Cornell Medicine, New York, NY, USA

    Adnan Khan

Authors
  1. Uchechukwu L. Osuagwu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Falahola Fuka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kingsley Agho
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adnan Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. David Simmons
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

UL Osuagwu: Protocol/project development, data management, data analysis, manuscript writing

F Falahola: Protocol/project development, data collection or management

A Khan: Protocol/project development, manuscript writing

K Agho: Data analysis, manuscript writing/editing

D Simmons: Protocol/project development, manuscript editing

Corresponding author

Correspondence to Uchechukwu L. Osuagwu.

Ethics declarations

I certify on behalf of myself and all co-authors that all authors have read and approved the manuscript, and there are no financial disclosures or conflict of interest of any sort. The protocol for the research conforms to the provisions of the Declaration of Helsinki in 1995 (as revised in Edinburgh 2000) and was approved by Research Ethics Committee of the College of Medical Nursing and Health Sciences of the Fiji National University and by the Fiji National Health Research Ethics Review Committees (ref #: 2015.48.CEN).

Conflict of Interest

The authors declare no conflict of interest.

Ethical Consent

The submitted work is an original retrospective study and not under consideration for publication in any other journal.

Code Availability

Not applicable

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Osuagwu, U.L., Fuka, F., Agho, K. et al. Adverse Maternal Outcomes of Fijian Women with Gestational Diabetes Mellitus and the Associated Risk Factors. Reprod. Sci. 27, 2029–2037 (2020). https://doi.org/10.1007/s43032-020-00222-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43032-020-00222-6

Keywords

Search

Navigation