Average Third Trimester Fasting Blood Sugar Level and Poor Pregnancy Outcomes Among Women With Pregnancy Diabetes at Kenyatta National Hospital – Retrospective Descriptive Cohort

Abstract

Background The prevalence of Gestational Diabetes Mellitus, a form of hyperglycaemia recognised for the first time in pregnancy, is increasing globally. The prevalence at Kenyatta National Hospital was 11.6% in 2012. Uncontrolled hyperglycaemia, a consequence of poor glycaemic control, can result in foetal macrosomia and stillbirths. Macrosomia can lead to a variety of pregnancy outcomes: shoulder dystocia, perineal trauma, postpartum haemorrhage, neonatal hypoglycaemia, neonatal hyperbilirubinemia, and later obesity along with type 2 diabetes in the neonate. The level of glycaemic control and incidence of macrosomia and poor pregnancy outcomes among women with diabetes in pregnancy on treatment at Kenyatta National Hospital is unknown. Objective To determine the prevalence of poor glycaemic control and compare the incidence of poor pregnancy outcomes among women with diabetes in pregnancy who have poor glycaemic control (average third trimester fasting blood sugar ≥ 5.3mmol/L) with the incidence of poor pregnancy outcomes among women with diabetes in pregnancy who have good glycaemic control (average third trimester fasting blood sugar < 5.3mmol/L. Methodology Study Design: This was a retrospective descriptive cohort study. Study Population: Women with diabetes in pregnancy (gestational diabetes and preexisting diabetes) on treatment Study Setting: Kenyatta National Hospital antenatal clinic, antenatal ward and labour ward. Sample Size: A sample of 258 files of diabetic pregnant patients, with the exposed group of 230 with average third trimester fasting blood sugar level ≥ 5.3mmol/L, and

the unexposed group of 28 with average third trimester fasting blood sugar level < 5.3mmol/L Data Collection: A structured questionnaire was used to retrieve data from patients’ files. Data Analysis: Data was entered and analysed with the use of SPSS 23. Demographic data was analysed and presented as means and standard deviations. The prevalence of poor glycaemic control (average third trimester fasting blood sugar ≥ 5.3mmol/L) was presented as proportion of women with levels at or above 5.3mmol/L. The incidences of the macrosomia and poor pregnancy outcomes were calculated. Results The prevalence of poor glycaemic control (average third trimester fasting blood sugar level ≥ 5.3mmol/L) was 89.1%. There was a higher incidence of macrosomia (25.7% vs 21.4%; p-value 0.627), stillbirths (17.9% vs 3.6%; p-value 0.058) and preterm birth (43.9% vs 21.4%; p-value 0.025) among diabetic pregnant women with poor glycaemic control compared to diabetic pregnant women with good glycaemic control. Furthermore, among those with poor glycaemic control, the pre-existing diabetics experienced significantly worse outcomes of stillbirths (20.9% vs 0%; p-value 0.004) and preterm births (47.2% vs 24.2%; p-value 0.014) than the gestational diabetics. Conclusion Poorly controlled diabetes in pregnancy heightens the risk of adverse pregnancy outcomes such as macrosomia, stillbirths and preterm births, with poorly controlled pre-existing diabetic women experiencing significantly worse outcomes of stillbirths and preterm births than poorly controlled gestational diabetics.