Diabète gestationnel (DG) en consultation prénatale: dépistage systématique dans un centre de sante urbain de Conakry / Gestational Diabetes in Antenatal Consultation: Systematic Screening In an Urban Health Center of Conakry

Contexte. Pathologie obstétricale fréquente en Guinée, souvent de découverte fortuite, car il n'y a pas de dépistage systématique. L'objectif : était de déterminer la prévalence du diabète gestationnel (DG) en consultation prénatale dans un centre de santé urbain de la ville de Conakry. Méthodes. Il s'agissait d'une étude prospective de type descriptif et analytique Elle a été menée au centre de santéde Koulewondy du 1er novembre 2019 au 29février 2020. Le dépistage était proposé à toutes les femmes enceintes entre 24 et 27 SA. Les comparaisons statistiques étaient à l'aide du test Chi2. Les différences étaient considérées signifi catives pour p<0,05. Résultats.Le passage du dépistage ciblé sur les facteurs de risques à un dépistage systématique a permis d'avoir une prévalence du diabète gestationnel en Consultation Prénatale Recentrée (CPNR) de 16,78% dans notre série. Le profi l épidémiologique était celui d'une gestante ménagère sans niveau instruction, mariée et dont l'âge moyen était de : 28,7± 6,5 ans, la parité moyenne était de : 2,11± 1,9 accouchements , l'âge gestationnel moyen était de 27,1± 5,6 SA , la valeur prédictive positive du test de dépistage en fonction des facteurs de risque était de 32,6% et la sensibilité 0,157. Conclusion. Le dépistage demeure le meilleur moyen de prévention.

Association between maternal lipid profile and gestational diabetes mellitus

Background: Dyslipidemia is the third component of metabolic syndrome and is a wellknown cardiovascular risk factor. However, the association of dyslipidemia with gestational diabetes mellitus is still a subject of ongoing research in Nigerian obstetric populations.Objective: To determine the relationship between second trimester maternal fasting plasma lipid constituents and gestational diabetes mellitus.Methods: This was a prospective nested case control study that enrolled 288 pregnant women out of which 36 women with GDM (cases) where matched with 72 without GDM (controls) following results of oral glucosetolerance testing and plasma fasting lipid profiles done between 24 28 weeks. The patients were followed up until delivery to document maternal and fetal outcomes. Data was analyzed using Statistical Package for Social Sciences (SPSS). Categorical variables were presented in percentages while continuous variables were expressed as means (±Standard Deviation). Student ttest and Chisquare test or Fishers exact test were used for comparing variables between the two groups. A value of <0.05 at 95%confidence interval was considered statistically significant.Results: The overall mean plasma lipid levels for the four lipid constituents in the study population were 187.9mg/dL, 163.5mg/dl, 49.1mg/dL and 108.1mg/dL for TC, TG, HDLc and LDc respectively. The mean plasma triglyceride was significantly higher in cases compared to the controls: 187.0±67.7mg/dL vs. 151.7±66.4mg/dL, (p = 0.01). Abnormaltriglyceride was significantly associated with GDM (AOR:4.8, 95% CI (1.6-14.4), (p= 0.005).Conclusion:Maternal dyslipidemia (abnormal triglyceride) was shown to be significantly associated with GDM in this study and it appeared to be causally related

Women's accounts of the gestational diabetes experience ­ a South African perspective

Background. Considering the perspectives of African women affected by gestational diabetes mellitus (GDM) may facilitate the development of culturally sensitive interventions to address this public health concern. Objective. To identify the personal experiences, challenges, coping strategies and health decisions made by urban indigenous South African women affected by GDM. Methods. The experiences of urban African women (n=10) previously affected by GDM were documented during focus group discussions. The Diabetes Conversation Map educational instrument was used to facilitate discussions. Sessions were audio-recorded, transcribed and thematically analysed. Results. Participants experienced shock and fear on diagnosis of GDM, but family support and sharing their experiences with their peers provided relief from anxiety. They were aware of the inconsistent implementation of GDM diagnostic procedures at tertiary hospitals and community health clinics, which exacerbated their confusion. Despite their initial difficulty in adjusting to a diet perceived as unpalatable, adopting a healthier lifestyle was considered a positive consequence of a GDM diagnosis. Healthy lifestyle changes were partially retained post partum and were reported to have a positive effect on other family members. The participants had little awareness of their long-term risk of developing diabetes mellitus and the need for regular follow-up screening. Unexpectedly, the majority of participants concurred that being HIV-positive would be less stressful than living with diabetes. Conclusion. Participants viewed being HIV-positive as preferable to having GDM, which may reflect the distress caused by inadequate pretest counselling, inconsistent health information, inconsistent screening practices and suboptimal support from healthcare professionals

Valeur diagnostique de la kératine glyquée élevée dans le diabète gestationnel chez les gestantes de Bukavu, République Démocratique du Congo

Contexte et objectif. Le diabète gestationnel (DG) est très souvent asymptomatique, et donc diagnostiqué systématiquement au cours du dépistage prénatal. L'objectif de la présente étude a été d'évaluer la performance de la kératine glyquée pathologique versus l'HGPO, dans le diagnostic du DG et évaluer son utilité comme un indicateur associé au risque de survenue de macrosomie fœtale. Méthodes. Dans une étude transversale analytique, la glycémie à jeun et le prélèvement d'au moins 7g d'ongle ont été réalisés chez 420 gestantes porteuses d'une grossesse d'au moins 24 à 40 SA venues aux CPN dans trois structures sanitaires de Bukavu en RD Congo de juillet à décembre 2016. Le test d'HGPO avec 75g du glucose anhydre est réalisé chez celles qui avaient une glycémie à jeun ˂ 92 mg/dL. Les critères de l'IADPSG et un seuil de la kératine glyquée > 3,6 ϼmol/g d'ongle ont été utilisés pour diagnostiquer le DG et évaluer le risque de survenue de la macrosomie. Résultats. Une kératine glyquée> 3,6 µmol/g d'ongle (38.5%) est associée à la macrosomie (OR 3,35 [IC 95% : 1,86 - 6,22], p = 0,001). L'HGPO et la kératine glyquée >3,6 ϼmol/g d'ongle pour diagnostiquer le DG étaient comparables (OR 1,57, IC: 0,77 - 3,22, p = 0,205) avec une sensibilité et une spécificité, respectivement de 55,3% et 56%. Conclusion. La kératine glyquée au seuil utilisé est associée au risque de survenue de la macrosomie fœtale. Des études ultérieures sur la révision des standards de la kératine glyquée pour le diagnostic du DG sont à envisager

Vitamin B12 status among pregnant women and Its association with obesity and gestational diabetes

Background: pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and diets that are low in animal products place women at increased risk of vitamin B12 deficiency. Aim of the Work: to investigate the vitamin B12 status of pregnant women in Egypt and its relationship with obesity and gestational diabetes mellitus (GDM). Patients and Methods: this clinical observational prospective study has been conducted at Bab Al-Shaaria University Hospital Obstetrics and Gynecological Department from April 2018 to January 2019. To assess vitamin B12 status among pregnant woman and its association with obesity and gestational diabetes. 80 pregnant women attended to out-patient clinic were included in the study. The evaluation included data collection through: history taking, examination, anthropometric measurement, maternal blood vitamin B12 level estimation at second and third trimester and blood glucose level. Results: vitamin B12 deficiency in pregnancy is common particularly in obese women and those with GDM. Conclusion: vitamin B12 deficiency is silent and common in general population. Causes of vitamin B12 deficiencies are multifactorial and associated with many health problems. Also, obesity is common and its prevalence is increasing in the world. Therefore, both health problems have gained importance in family medicine practice in the last decades

An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Objectives and design: This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth.Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre.Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described.Results: Many patients (32%) booked after 24 weeks' gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0­14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks.Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks' gestation may lower the number of stillbirths

Serum adiponectin levels in pregnant women with gestational diabetes mellitus in Zaria, north west Nigeria: a cross sectional study

Background: Adiponectin is an adipocytokine that is exclusively produced by adipocytes with potent insulin-sensitizing property. It has been proposed to be involved in the pathogenesis of gestational diabetes mellitus, but its role is not clear; Findings from studies done across different ethnic groups are often inconsistent. Objectives: The aim of the study was to compare maternal serum adiponectin levels between Nigerian pregnant women with and without gestational diabetes mellitus. Materials And Methods: A cross sectional analytical study including one hundred and sixty nine pregnant women, 85 with gestational diabetes mellitus and 84 with normal gestation, who were evaluated between 24-28 weeks gestation. Diagnosis of gestational diabetes mellitus was made according to the WHO diagnostic criteria. Maternal serum level of adiponectin was measured and compared between pregnant women with gestational diabetes mellitus and the controls. Results: Mean maternal serum adiponectin level was significantly lower in pregnant women with gestational diabetes mellitus than in the controls (8.1 ± 1.6 vs. 10.1 ± 2.4 µg/ml, p< 0.05). When 2 2 subjects in the study groups were further categorized in to BMI < 25kg/m and BMI 25 kg/m , maternal serum adiponectin level remained significantly lower in the normal weight pregnant women with gestational diabetes compared to their BMI-matched controls (8.4 ± 1.7 vs. 11.4 ± 2.1 2µg/ml, p< 0.05). Among the overweight pregnant women (BMI 25 kg/m) on the other hand, there was no difference in maternal serum adiponectin level between pregnant women with gestational diabetes mellitus and the normal controls (7.8 ± 1.5 vs. 8.0 ± 1.1µg/ml, p> 0.05). Conclusion: It is concluded that normal weight Nigerian pregnant women with gestational diabetes mellitus in this study have lower serum adiponectin level compared to the normal weight pregnant women with normal gestation

Foeto-maternal outcome of diabetes in a tertiary health facility in Nigeria

Diabetes complicating pregnancy is associated with adverse maternal, foetal and neonatal outcomes. We have determined the prevalence of both pre-gestational (PGDM) and gestational diabetes mellitus (GDM), and their associated maternal and perinatal morbidities and mortalities at the University of Port-Harcourt Teaching Hospital, Nigeria. A retrospective study was carried out of all cases of diabetes in pregnancy between 2008 and 2012. The case notes of the next two non-diabetic patients, whose gestational ages and parities matched, were examined as case controls. There were 122 cases of diabetes from a total of 14, 521 deliveries (8.4 per 1000 deliveries), 21 cases of PGDM, and 101 cases of GDM (1.45 per 1000 deliveries and 6.96 per 1000 deliveries respectively). There were 60 cases of foetal macrosomia (49%). The mean birth weight was 3.75±0.76 kg. There were 11 perinatal deaths (perinatal mortality rate 90 per 1000 deliveries). The caesarean delivery rate was 89%. Sixty (60) babies (49%) required neonatal intensive care admission. There were no maternal deaths or congenitally malformed babies. We conclude that diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Patients at risk should be encouraged to attend preconception clinics and register early in well-equipped hospitals for antenatal care. Universal screening of all pregnant women at booking and patients with clinical risks characteristics at 24 and 28 weeks of gestation may be effective for the early identification and management of GDM

Determination de la prevalence du diabete gestationnel et des facteurs associes a Kinshasa

Objectif. Determiner la prevalence du diabete gestationnel (DG) et rechercher ses facteurs associes a Kinshasa. Materiel et Methodes. Une etude multicentrique transversale a ete realisee de juin a decembre 2005 dans 10 formations medicales de Kinshasa selectionnees de maniere randomisee. Elle a porte sur 861 gestantes tout venants a partir de 24 semaines de grossesse. Le diagnostic du DG a ete pose grace a des glycemies obtenues a l'aide d_fun glucometre a reflectance lors des epreuves de depistage. Ce dernier a ete effectue en 2 temps :d'abord le test de O'Sullivan apres charge orale de 50g de glucose ; une semaine plus tard; les gestantes ayant eu une glycemie . 140 mg/dL et 200 mg/dL ont subi le test complet apres charge glucosee de 100g. Les tests du Chi-carre et la regression logistique ont ete utilises pour rechercher les determinants du DG. Resultats. La prevalence du DG a ete respectivement de 3;9et 5;2selon les tests de O'Sullivan et de l'epreuve d'hyperglycemie provoquee orale classique. Les facteurs de risque associes au DG dans cette etude on ete lobesite e (OR 5;4; IC95: 1;66 . 16;9); l'age . 35 ans (OR 2;56; IC95: 1;24 . 5;25); la parite (OR 2;84 ; IC95: 1;42 . 5;67) et l'antecedent de macrosomie (OR 2;88 ; IC95: 1;17 . 6;88). Conclusion. Le taux de prevalence de 5;2 montre que le DG constitue un probleme de sante publique dans la ville de Kinshasa. Le test de O'Sullivan est une alternative valable pour sa detection. L'obesite constitue le determinant majeur du DG et plus particulierement apres 35 ans

Diabetes mellitus and pregnancy

Diabetes mellitus is the most common medical complication of pregnancy and it carries a significant risk to the foetus and the mother. Congenital malformations and perinatal morbidity remain common compared with the offspring of non diabetic pregnancies. Diabetic mothers are at risk of progression of microvascular diabetic complications as well as early pregnancy loss, pre-eclampsia, polyhydramnios and premature labour. Glycaemic control before and during pregnancy is critical and the benefit may result in a viable, healthy offspring. Gestational diabetes mellitus (GDM) which manifests for the first time during pregnancy is common and on the increase, its proper management will reduce the risk of neonatal macrosomia and hypoglycaemia. Post-partum evaluation of glucose tolerance and appropriate counselling in women with GDM may help decrease the high risk of subsequent type 2 diabetes in the longterm.This article will briefly review the changes in the carbohydrate metabolism that characterise normal pregnancy and will focus on a practical approach to the care of patients with pre-existing diabetes as well as GDM