Prevalence and Risk Factors of Gestational Diabetes Mellitus in Likasi, in The Democratic Republic of The Congo: A Preliminary Study

Hénoch Kabala Tshasuma^*, Chamy Lubamba Cham, Joseph Bulanda Nsambi, Charles Wembonyama Mpoy

Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

*Corresponding author: Hénoch Kabala Tshasuma, Department of Gynecology and Obstetrics, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo

Received: 19 September 2023; Accepted: 29 September 2023; Published: 11 October 2023

1. Introduction

Gestational diabetes mellitus (GDM) is a condition characterized by varying degrees of carbohydrate intolerance, leading to elevated blood sugar levels, that develops or is first detected during pregnancy, regardless of its progression after childbirth [1]. GDM poses a significant public health challenge both nationally and globally. Its prevalence varies significantly across different regions: 9.2% in the United States of America in 2010 [2], 23% in Belgium in 2012 [3], and 17.8% in Canada in 2017 [4]. In Africa, the prevalence of GDM was reported as 8.5% in Morocco in 2014 [5], 13% in Arusha (Tanzania) in 2019 [6], and 33.1% in Dakar (Senegal) in 2017 [7]. In the Democratic Republic of the Congo (DRC), the prevalence ranged from 11.3% in 2014 to 44% in 2015 in Bukavu [8,9], and from 3.9% to 5.2% in Kinshasa in 2009 [10]. Various modifiable risk factors for GDM have been identified, including maternal age, family history of type 2 diabetes, polycystic ovary syndrome, previous history of GDM (with recurrence rates ranging from 30% to 84%), fetal macrosomia, and intrauterine fetal demise (IUFD) [11,12]. Obesity and weight gain during the first trimester of pregnancy have also been identified as modifiable risk factors [13,14]. The objective of this study was to determine the prevalence and to identify risk factors of GDM in Likasi city, in the DRC.

2. Materials and Methods

This was a multicenter cross-sectional study carried out in Likasi, in five health facilities (namely SNCC Hospital, Shekinah Medical Center, ASVIE, La Consolation, and Likasi University Hospital). From April 1, 2021 to March 31, 2022, the sera of 203 pregnant women were collected between the 24th and 28th weeks of amenorrhoea using Naegele’s formula, in cryotubes, at “Time Zero” (fasting), “Time One” (one hour after ingestion of 75g of sugar), and “Time Two” (two hours after the same ingestion). The analysis was performed with the CyanSmart Spectrophotometer and the International Association of Diabetes and Pregnancy Study Group (IADPSG) criteria were applied for the diagnosis of GDM.

In addition to blood samples, epidemiological data concerning maternal age, marital status, occupation, medical history (diabetes mellitus in the first degree), obstetric history (prematurity, macrosomia, congenital malformations, stillbirth, parity, etc.) were collected using a pre-established card. Ethical standards have been respected. We have obtained approval from the ethics committee of the University of Lubumbashi (UNILU/CEM/127/2022).To determine the GDM’s risk factors, a multivariate analysis was conducted. Significant variables (p<0.20) in univariate analysis were introduced into the multivariate model. A p<0.05 value was statistically significant. The odds ratio was presented with a 95% confidence interval (95% CI).

3. Results

We collected a total of 203 pregnant women. The median age was 28 years (interquartile range: 23-33) and the median parity was 3 (interquartile range: 1-5).  The majority of them were housewives (68.97%) and married (98.52%). We found 35 cases of GDM out of a total of 203 pregnant, giving a prevalence of GDM of 17.24% [95% CI: 12.31-23.14%].

In bivariate analysis (Table 1), only the history of prematurity and the history of macrosomia were the determinants of GDM. After multivariate analysis (Table 2), maternal age, parity, history of diabetes mellitus in the first degree, and history of macrosomia were not significantly associated with GDM. In contrast, history of preterm birth (adjusted OR=5.24 [1.40-19.66]) was the only independent factor associated with the occurrence of GDM.

Table 1: Bivariate analysis of risk factors for gestational diabetes

Table 2: Multivariate analysis of risk factors for the occurrence of gestational diabetes

4. Discussion

The findings obtained from this study regarding the occurrence and risk factors of GDM in five healthcare facilities in Likasi city (DRC) have the potential to enhance understanding of the epidemiology and management of GDM. The study revealed a GDM prevalence of 17.4% (95% CI: 12.31% - 23.14%). Our results closely align with similar rates reported in Guinea (16.3%) and Canada (17.8%) [4]. In comparison, the prevalence observed in Tanzania (13%) [6] and China (14.8%) [15] was lower, while higher rates were found in Bukavu (DRC) (44.0%) [9] and Dakar in Senegal (33.1%) [7]. These variations may be attributed to factors such as ethnicities, obesity rates, and the prevalence of type 2 diabetes [16]. However, it is worth noting that the use of the IADPSG criteria has led to an increasing trend in GDM prevalence across multiple studies due to its heightened sensitivity and lower diagnostic threshold associated with GDM complications [17].

The association between a history of prematurity and gestational diabetes mellitus (GDM) was found to be significant in our study (adjusted odds ratio [OR]=5.24 [1.40-19.66]), which supports the findings of Lowe and Mustafa [18,19]. Conversely, some authors have not identified a history of prematurity as an independent risk factor for GDM [16,20]. Our results can be explained by the fact that prematurity is a common complication of GDM [21]. The median age of pregnant women in our study was 28 years, and we did not observe an association between maternal age and GDM. This finding aligns with the recommendations of the NICE (National Institute for Health and Clinical Excellence) and the CNGOF (French National Council of Obstetrician Gynecologists), which consider maternal age over 35 years as a risk factor for GDM [16]. Additionally, we found no association between parity and GDM, consistent with Kisindja et al.'s findings in the eastern DRC [22]. However, several authors have reported an association between parity and GDM [7,10,23,24]. The lower rate of large multiparous women in our study (21.68%) may explain this discrepancy. Our study also revealed that a history of macrosomia was not significantly associated with GDM (OR=2.07 [0.68-6.33]) (p=0.203), which is consistent with the findings of Ping Li et al. [25]. Although a history of macrosomia is a known risk factor for GDM [10,22], it is important to note that macrosomia can have multiple causes unrelated to GDM [26]. Lejeune et al. [27] demonstrated that 87% of macrosomic babies were born to women who had a normal result on the GDM screening test proposed by the WHO.

5. Conclusion

Our study shows that GDM is a real public health problem in the city of Likasi (17.24%). The history of prematurity is independently associated with the GDM. Maternal age, parity, history of 1st degree diabetes and macrosomia could directly or indirectly constitute risk factors for GDM; this would need to be confirmed or refuted by further studies. The detection of GDM requires urgent hygiene-dietary measures and insulin therapy if the therapeutic target is not reached.

Conflict of interest:

None

References

1. World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1, Diagnosis and classification of diabetes mellitus. World Health Organization (2017).
2. DeSisto CL, Kim SY, Sharma AJ. Peer reviewed: Prevalence estimates of gestational diabetes mellitus in the United States, pregnancy risk assessment monitoring system (prams), 2007–2010. Preventing chronic disease 11 (2014).
3. Selvais L, Buts R, Fernandez C, Gilleman U, Jacobs JL, Loumaye R. Diabète gestationnel: à quoi nous attendre? Medical Leuven 131 (2012): 511-513.
4. Dirar AM, Doupis J. Gestational diabetes from A to Z. World journal of diabetes 8 (2017): 489.
5. Bouhsain S, El Kochri S, Babahabib MA, Hafidi MH, Bouaiti E, Moussaoui MD. Comparaison de deux politiques de dépistage du diabète gestationnel: expérience de l’hôpital militaire d’instruction Mohammed V de Rabat (Maroc). Gynécologie Obstétrique & Fertilité 42 (2014): 317-321.
6. Msollo SS, Martin HD, Mwanri AW, Petrucka P. Prevalence of hyperglycemia in pregnancy and influence of body fat on development of hyperglycemia in pregnancy among pregnant women in urban areas of Arusha region, Tanzania. BMC pregnancy and childbirth 19 (2019): 1-9.
7. Abdoulaye L, DIACK ND, SARR NN, Coumba F, LEYE YM, DIOUF AA, et al. Forte prévalence du diabète gestationnel dépisté selon les critères de l’IADPSG en milieu hospitalier dakarois: résultats préliminaires d’une étude transversale au CHU de Pikine. Revue Africaine de Médecine Interne 4 (2017): 48-55.
8. Bisangamo CK, Mbarambara PM, Ngoli JK, Materanya GB, Kingombe KM. Prévalence du diabète gestationnel et facteurs associés dans la zone de santé de Kadutu à Bukavu (Est de la RDC). Revue Marocaine de Santé Publique 2 (2015).
9. Bisimwa K, Mulume O, Mushengezi S. Fréquence et déterminants du diabète gestationnel à Bukavu, en République Démocratique du Congo. Ann afr med 13.
10. Mbungu MR, Muls E, Paka MA, Tandu-Umba NF. Détermination de la prévalence du diabète gestationnel et des facteurs associés à Kinshasa. Ann afr med 3 (2009): 321-336.
11. Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes care 30 (2007): 1314-9.
12. Rauh-Hain JA, Rana S, Tamez H, Wang A, Cohen B, Cohen A, et al. Risk for developing gestational diabetes in women with twin pregnancies. J Matern Fetal Neonatal Med 22 (2009): 293-9.
13. Villamor E, Cnattingius S. Interpregnancy weight change and risk of adverse pregnancy outcomes: a population-based study. Lancet 368 (2006): 1164-70.
14. Morisset AS, Tchernof A, Dube MC, Veillette J, Weisnagel SJ, Robitaille J. Weight gain measures in women with gestational diabetes mellitus. Journal of Women's Health (2002) 20 (2011): 375-80.
15. Lee KW, Ching SM, Ramachandran V, Yee A, Hoo FK, Chia YC, et al. Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis. BMC pregnancy and childbirth 18 (2018): 1-20.
16. Galtier F. Définitions, épidémiologie, facteurs de risque. Journal de Gynécologie Obstétrique et Biologie de la Reproduction 39 (2010): S144-S170.
17. AI panel. International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy. Diabetes Care 33 (2010): 676-682.
18. Lowe LP, Metzger BE, Dyer AR, Coustan DR, Hadden DR, Hod M, et al. Hyperglycemia and adverse pregnancy outcome (HAPO) study: an overview. Gestational Diabetes During and After Pregnancy 126 (2010): 17-34.
19. Mustafa FN. Pregnancy profile and perinatal outcome in Gestational Diabetes Mellitus: a hospital based study. Journal of Bangladesh College of Physicians and Surgeons 33 (2015): 79-85.
20. Walker JD. NICE guidance on diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period. NICE clinical guideline 63. London, March 2008. Diabetic Medicine 25 (2008): 1025-1027.
21. Mitanchez D. Complications føetales et néonatales du diagnostic gestationnel: mortalité périnatale, malformations congénitales, macrosomie, dystocie des épaules, traumatisme obstétrical, complications néonatales. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction 39 (2010): S189-99.
22. Kisindja RM, Tugirimana PL, Prudence MN, Bosunga K, Sihalikyolo JJJ, Kayamba PKM. Prevalence of gestational diabetes in Eastern Democratic Republic of Congo. BMC Pregnancy and Childbirth 22 (2022): 1-6.
23. Hao M, Lin L. Fasting plasma glucose and body mass index during the first trimester of pregnancy as predictors of gestational diabetes mellitus in a Chinese population. Endocrine journal (2017): EJ16-0359.
24. Mimouni-Zerguini S, Smail M, Boudiba A, Derguini M. Diabète gestationnel : facteurs de risque, évolution et conséquences périnatales : expérience du CHU Mustapha Bacha, Alger (Algérie). Médecine des maladies Métaboliques 3 (2009): 626-633.
25. Li P, Lin S, Li L, Cui J, Zhou S, Fan J. First-trimester fasting plasma glucose as a predictor of gestational diabetes mellitus and the association with adverse pregnancy outcomes. Pakistan Journal of Medical Sciences (2019): 95.
26. Haute Autorité de Santé. Rapport de synthèse sur le dépistage et le diagnostic du diabète gestationnel. Paris: HAS (2005).
27. Lejeune V, Milliez J. Dépistage du diabète gestationnel : chez qui? comment? Journal de gynécologie obstétrique et biologie de la reproduction 26 (1997): 760-769.