Prevalence and risk factors of gestational diabetes mellitus in a population of pregnant women attending three health facilities in Limbe, Cameroon: a cross-sectional study

Introduction There are few studies regarding gestational diabetes mellitus (GDM) in the South West Region of Cameroon. We aimed at determining the prevalence and risk factors of GDM in three health facilities in the Limbe health district, Cameroon. Methods A cross-sectional study was carried out in one secondary, and two primary healthcare facilities in Limbe, Cameroon during the period 1st November 2016 to 31st January 2017. We administered a pretested questionnaire on 200 consenting pregnant women at 24-28 weeks' gestation. We carried out a 2-hr oral glucose tolerance test after fasting overnight. GDM was diagnosed when ≥1 plasma glucose (PG) test result was abnormal according to the IADPSG criteria (FPG ≥92 mg/dL, PG 1-hr 180mg/L, PG 2-hr 153 mg/dL). Data analysis was with Epi-InfoTM version 3.5.4. Associations were analyzed with the Pearson's chi squared and Fischer's exact test where appropriate. Statistical significance was set at p < 0.05. Results The prevalence of GDM was 20.5% and respondents' mean age was 27.8 (SD 5.7) years. Majority, 13.5% participants had abnormal FPG alone, while 3.5% had any two abnormal values. GDM was associated with: advanced maternal age (OR 3.4: 95% CI 1.7-7.0; P<0.001), BMI≥30 kg/m2 (OR 6.2 : 95% CI 2.9-13.1, P<0.001), past history of unexplained stillbirth (OR 5.7: 95% CI 2.5-12.9, P<0.001) and history of macrosomia (OR 8.5:95% CI 3.8-19, P<0.001). Conclusion With the high prevalence of GDM, identification of its associated factors has the potential to be a target of intervention to prevent poor obstetrical outcomes.


Introduction
The prevalence of diabetes, especially gestational diabetes mellitus (GDM), is increasing globally. Gestational diabetes mellitus is any degree of glucose intolerance leading to a hyperglycemic state of variable severity, first recognition during pregnancy, no matter the treatment required or postpartum evolution [1,2]. The true prevalence of GDM is unknown, but it has been estimated in the United States of America to vary from 1% to 14% of pregnancies, depending on the population studied and the diagnostic tests used [3,4].
GDM complicates approximately 4% of all pregnancies and women with it have an approximate 7-fold risk of developing type-2 diabetes mellitus in the future, as well as their children and subsequent generations [5]. This fact should alert the obstetrician to the necessity to pay special attention to this segment of the population, especially in low-income countries [3,6]. The impact of GDM on maternal and fetal health has been increasingly recognized [7]. GDM increases the risk of fetal macrosomia, which is associated with secondary complications like shoulder dystocia, cesarean delivery and birth trauma. There is also a concomitant increase in neonatal complications like hypoglycemia, respiratory distress syndrome, hypocalcemia and hyperbilirubinemia [8]. Risk assessment for GDM should be done at the first antenatal care visit Oral Glucose Tolerance Test (OGTT) at 24 to 28 weeks' gestation after a 75 g oral glucose loading dose on a fasting subject as has previously been described [1]. Therefore, fasting is defined as no caloric intake for ≥8 hours [9].
It has been reported that the global trend of an increased prevalence of diabetes in African populations and the subsequent increase of diabetes in pregnancy is closely linked to the increase in obesity [11]. In a study of 11 568 pregnant women in six regions of This study will help bridge the gaps regarding the prevalence and risk factors of GDM in a population of pregnant women attending three hospitals in the Limbe Health District; namely, the Limbe Regional Hospital, CMA Limbe and Bota District Hospital. We hypothesize that there is a high prevalence of GDM in the Limbe Health District in Cameroon and that this prevalence will increase significantly given the known risk factors. The aim of this study was to determine the prevalence and risk factors of gestational diabetes mellitus in three health facilities in the Limbe health district. Those whose results were positive were counseled and referred to see a diabetologist or a specialist in internal medicine (in the absence of a diabetologist) for follow-up in collaboration with the obstetrician.

Data management and data analyses
The data was coded, double-checked and entered into Microsoft   (Table 1).

Obstetric and medical history of study participants
The mean gestational age (GA) of participants was 26.  Table 3).

Determinants of gestational diabetes mellitus
Socio-demographic characteristics

Study limitations
The time frame used to undertake this study was short: 3 months.
The sample size was too small to draw epidemiologic conclusions.
Furthermore, we could not study other risk factors like PCOS because of additional cost. We were not able to obtain maternal weight gain in pregnancy because of the cross-sectional nature of the study. This study was done in three health facilities in the LHD.
Conclusions from the study may not represent the actual prevalence of GDM in the whole Health District.

Conclusion
The prevalence of GDM is high (20.5%  There is need to organize early universal screening method for GDM amongst patients in the LHD to avoid adverse maternal and fetal outcomes especially as majority women at the LHD start antenatal care late and are sometimes irregular in their visits.

Competing interests
The authors declare no competing interests.

Acknowledgments
We thank the staff of the health facilities for assisting us during the study. We also thank the medical students of the Faculty of Health Sciences, University of Buea who assisted in data collection. Table 1: Socio-demographic characteristics of study population