Screening for Gestational Diabetes Mellitus: Is There a Need for Early Screening for All Women in Developing Countries?

BACKGROUND: Gestational diabetes mellitus (GDM) is associated with significant adverse pregnancy outcomes. Early diagnosis and treatment have been proven to reduce adverse pregnancy outcomes among women diagnosed with GDM. Current guidelines recommend routine screening for GDM at 24-28 weeks of pregnancy, with early screening offered to those considered high risk. However, risk stratification may not always be helpful for those who would benefit from early screening, especially in non-Western settings. AIM: To determine the need for early screening for GDM among pregnant women attending antenatal clinics in two tertiary hospitals in Nigeria. METHODS: We conducted a cross-sectional study from December 2016 to May 2017. We identified women who presented at the antenatal clinics of the Federal Teaching Hospital Ido-Ekiti and Ekiti State University Teaching Hospital, Ado Ekiti. A total of 270 women who fulfilled the study inclusion criteria were enrolled. The 75 g oral glucose tolerance test was used to screen participants for GDM before 24 weeks and between 24 and 28 weeks for those who screened negative before 24 weeks. Pearson's chi-square test, Fisher's exact test, independent t-test, and Mann-Whitney U test were utilized in the final analysis. RESULTS: The median age of the women in the study was 30 (interquartile range: 27-32) years. Of our study participants, 40 (14.8%) were obese, 27 (10%) had a history of diabetes mellitus in a first-degree relative, and three (1.1%) women had a previous history of GDM. Twenty-one women (7.8%) were diagnosed with GDM, and six (28.6%) were diagnosed before 24 weeks. Women diagnosed with GDM before 24 weeks were older (37 years; interquartile range: 34-37) and more likely to be obese (80.0%). A significant number of these women also had identifiable risk factors for GDM: previous GDM (20.0%), family history of diabetes mellitus in a first-degree relative (80.0%), prior delivery of fetal macrosomia (60.0%), and previous history of congenital fetal anomaly (20.0%). CONCLUSION:  The findings from the present study did not justify universal screening for GDM in all pregnant women. Patients diagnosed before the 24-28 weeks of universal screening are more likely to have significant risk factors for GDM and, therefore, would have been selected for screening based on the risk factor screening.

Comparison of self-esteem and depression among fertile and infertile women in a low resource setting.

This study aimed to explore the effect of infertility on self-esteem and depression, and to identify the sociodemographic and infertility characteristics associated with self-esteem and depression among infertile women in Ekiti State, Nigeria. Self-esteem and depression were assessed in 100 infertile women and 100 women seeking family planning (controls) using the Rosenberg Self-Esteem Scale (RSES) and Patient Health Questionnaire (PHQ-9), respectively. Infertile women had significantly lower RSES score (19.4 ± 4.5 vs. 20.7 ± 4.4, p=.038) and higher PHQ-9 score (5.1 ± 4.1 vs. 3.8 ± 3.5, p=.023) compared to controls. Among infertile women, marital status, being remarried, duration of infertility, and RSES score were associated with PHQ-9 score on simple linear regression. On multiple linear regression analysis, the RSES score had a negative association with the PHQ-9 score (ß= -0.32, p<.001). In conclusion, infertile women have lower self-esteem and higher depression scores. Mental health screening and management should be an integral part of care administered to infertile women.Impact StatementWhat is already known on this subject? Infertility is a global health problem with negative effects on the mental health and quality of life of couples, especially women.What the results of this study add? Infertile women have lower self-esteem and higher depression scores. The prevalence of major depressive disorder (MDD) is higher among infertile women. Longer duration of infertility, older age, ≤6 years of formal education, and low self-esteem are significant associations of MDD among infertile women.What the implications are of these findings for clinical practice and/or further research? Mental health screening and management should be included in the care given to women undergoing evaluation and treatment for infertility. Larger community-based studies evaluating other aspects of mental health among infertile couples are encouraged.

Combined Foley's catheter with vaginal misoprostol for pre-induction cervical ripening: A randomised controlled trial.

BACKGROUND: Pre-induction cervical ripening greatly influences the outcome of induction of labour (IOL). AIMS: To compare the efficacy of combined Foley's catheter and vaginal misoprostol with Foley's catheter or low-dose vaginal misoprostol alone for cervical ripening. MATERIALS AND METHODS: Women with a singleton pregnancy admitted at term for cervical ripening and IOL based on clinical indication were randomised into three groups. Oxytocin augmentation was done in the groups as indicated. Significant tests were done using chi square, Fisher's exact and analysis of variance tests. RESULTS: A total of 210 women were randomised into the study. Women in the combined group (Foley's catheter and vaginal misoprostol) had significantly higher postcervical ripening Bishop's score than the women in the other two groups; P = 0.001. Cervical ripening time, induction-delivery time and cervical ripening-delivery interval were significantly shorter in the combined group compared to the other two groups; P = 0.001. Also, women in the combined group required significantly lesser oxytocin augmentation than the other two groups; P = 0.001. There was no difference in Apgar scores at 1 or 5 minutes or in special baby care unit admission among the groups. There were no reported cases of uterine contractile abnormalities or rupture in this study. CONCLUSION: Combined Foley's catheter and vaginal misoprostol provide a shorter duration to the achievement of cervical ripening.

Intraligamentary Extrauterine Pregnancy Delivered at Term: A Case Report and Review of Literature.

Intraligamentary pregnancy is extremely rare. Preoperative diagnosis is often difficult. We report a case of a 33 year old female who had an ectopic pregnancy in the right broad ligament. The pregnancy remained viable till term, but unfortunately resulted in a perinatal death prior delivery. Diagnosis was not made until laparotomy and a well formed still born was delivered. A high index of suspicion and prompt therapeutic intervention are necessary to prevent adverse fetal and or maternal outcome.

Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population.

OBJECTIVES: To investigate the impact of the new consensus diagnostic criteria on the prevalence of gestational diabetes, evaluate risk factors, and missed opportunities for diagnosis if selective screening strategy was employed. STUDY DESIGN: A prospective observational data of 1059 women with singleton pregnancy screened for gestational diabetes between 24 and 32 weeks gestation in a universal one-step screening and diagnostic strategy using 75-g oral glucose tolerance testing in an obstetric unit in Nigeria. Logistic regression was used to identify risk factors for GDM. RESULTS: The prevalence of gestational diabetes in accordance with 1999 WHO, new 2013 WHO modified IADPSG and IADPSG criteria was 3.8%, 8.1%, 7.5%, and 8.6%, respectively. Overt diabetes was diagnosed in 1.03% of the study population. Using the new consensus criteria, approximately 20% of GDM cases would have been missed if selective screening strategy was employed. Using multivariable analysis, glycosuria [aOR 8.60 (3.29-22.46)] and previous poor obstetric outcome [aOR 3.01 (1.23-7.37)] were significantly associated with GDM on 1999 WHO criteria. Glycosuria [aOR 2.54 (1.10-6.42)] was the only risk significantly associated with increased risk of developing GDM diagnosed based on new 2013 and IADPSG criteria. CONCLUSION: Using the new consensus screening and diagnostic guidelines, gestational diabetes is prevalent in our obstetric population. Missed opportunities exist with selective screening approach.