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The prevalence of gestational diabetes mellitus amongst black South African women is a public health concern

  • Shelley Macaulay
    Correspondence
    Corresponding author at: Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, P.O. Box 1038, Johannesburg 2000, South Africa.
    Affiliations
    MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg, South Africa

    Division of Human Genetics, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand and the National Health Laboratory Service, P.O. Box 1038, Johannesburg 2000, South Africa
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  • Martha Ngobeni
    Affiliations
    MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg, South Africa
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  • David B. Dunger
    Affiliations
    MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg, South Africa

    Department of Paediatrics, University of Cambridge, Box 116, Level 8, Cambridge Biomedical Campus, Cambridge CB2 0QQ, United Kingdom

    Wellcome Trust-MRC Institute of Metabolic Science, Box 289, Addenbrooke’s Hospital, Cambridge CB2 0QQ, United Kingdom
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  • Shane A. Norris
    Affiliations
    MRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Private Bag 3, Wits, 2050 Johannesburg, South Africa
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      Highlights

      • Largest gestational diabetes mellitus (GDM) prevalence study in South Africa.
      • A prevalence of 9.1% was determined (World Health Organization’s 2013 diagnostic criteria).
      • Fasting plasma glucose reading alone had an 83.3% sensitivity in diagnosing GDM.
      • High rate of anaemia amongst women with GDM compared to women without GDM.

      Abstract

      Aims

      This study aimed to determine the prevalence of gestational diabetes mellitus (GDM) amongst black South African women, describe GDM-associated risk factors and clinical management, and evaluate the efficacy of the fasting plasma glucose reading in diagnosing GDM.

      Methods

      A cross-sectional screening study was performed. Pregnant women were recruited from the Chris Hani Baragwanath Academic Hospital in Johannesburg. A total of 1906 women underwent a two-hour 75 g oral glucose tolerance test at 24–28 weeks gestation. The World Health Organization’s 2013 criteria were used to diagnose GDM.

      Results

      A total of 174/1906 (9.1% (95% confidence interval (CI) 7.9, 10.5)) women were diagnosed with GDM. These women had significantly higher weights and body mass indexes (BMIs), were significantly older, of higher household socioeconomic status, more likely to report a family history of diabetes, and more likely to be diagnosed with anaemia than women without GDM. An age of ≥35 years, BMI ≥ 30 kg/m2, and a family history of diabetes were significant risk factors. The fasting plasma glucose reading had a high sensitivity (83.3% (95% CI 77.0, 88.5)) in diagnosing GDM and 56.9% of the women with GDM were managed by diet therapy alone.

      Conclusion

      This is the largest GDM prevalence study in South Africa to date. A diagnosis of GDM increases the risk of both mother and child developing Type 2 diabetes which causes further health complications, decreases longevity, and burdens a country’s healthcare system. Therefore, a GDM prevalence of 9.1% is concerning and warrants further discussion around current GDM screening policies.

      Keywords

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