| dc.description.abstract | Evidence indicates that gestational diabetes mellitus (GDM) has a multifactorial aetiology and results in poor maternal and neonatal outcomes that vary based on geographic locations and ethnicity. However, in Kenya, despite GDM being a public health concern there are very few studies on the risk factors for GDM among pregnant women and its associated pregnancy –related outcomes. Therefore, the aim of this study was to determine the risk factors for GDM and the risk of pregnancy-related outcomes associated with GDM. To this end, a case-control study was carried out among 210 pregnant women attending antenatal clinic at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu County. Screening and diagnosis were performed using the 2013 WHO criteria. Descriptive and inferential statistical analysis were done in SPSS V.23 using Chi-square (χ2) test to test for associations and binary logistic regression analysis to determine predictors of GDM. Of the 105 GDM cases, majority 54(51%) were in 30-34 years age group, 59(56%) were overweight with a BMI of 25-29.9 kg/m2, 56(53%) had history of hypertension, 67(64%) had hypertensive relatives, 67(64%) had history of glycosuria, 72(69%) were multiparous, 64(61%) had history of caesarean delivery, 66(63%) had history of macrosomic delivery and 56(53%) had history of neonatal intensive care unit (NICU) admission. Multivariate analysis showed that having a diabetic relative (adjusted OR (aOR) 7.4, [95%CI: 1.2-76], p=0.049), history of CS delivery (aOR 7, [95%CI: 1.6-35.9], p<0.014), being on IFAS (aOR 16.6, [95%CI: 5-69.2], p<0.014) and having history of NICU admission (aOR 15, [95%CI: 3.5-86.9], p<0.001) were significantly associated with GDM. Further analysis revealed that gestational age at delivery ≥ 40 weeks (Adjusted Odds Ratio (aOR) 1.67, [95% CI 1.29-2.21, p<0.001), caesarean delivery (aOR7.28, [95%CI 3.17-18.0,p<0.001), induced labour (aOR 4.60, [95%CI 2.07-10.8, p<0.001),gestational hypertension (aOR15.2, 95%CI 3.92-103,p<0.001), foetal macrosomia (aOR 22.5, [95%CI 9.42-59.3, p<0.001) and neonatal admission to intensive care unit (aOR 16.2, [95%CI 3.73, 115, p<0.001) were significantly associated with GDM. This data suggests that having a diabetic relative, history of caesarean section, history of NICU admission and being on IFAS are predictors of GDM. GDM screening should be included in the standard routine ANC services for timely detection and treatment of GDM to achieve desirable pregnancy outcomes and limit adverse outcomes linked to GDM. Further, longitudinal multicentre studies should be carried out to explore long term effects of IFAS (in terms of duration and dosage) on GDM in order to provide an evidence-based nutritional interventions during pregnancy complicated by GDM. There is also need for implementation of lifestyle modification programs such as involvement in physical exercise and balanced diet to prevent the development of GDM and pregnancy-related complications being that a majority of cases were overweight. In addition, due to adverse pregnancy outcomes there is need for early screening and management of GDM among the high-risk populations. | en |
