Date of Award

7-2025

Degree Type

Dissertation

Degree Name

Master of Medicine (MMed)

First Advisor

Dr. Mwaniki Mukaindo

Second Advisor

Dr. Felix Oindi

Third Advisor

Dr. Joan Okemo

Department

Obstetrics and Gynaecology (East Africa)

Abstract

Background: Gestational diabetes (GDM) is recognized as a major concern in obstetric care. It is associated with adverse obstetric outcomes including the risk of cesarean delivery, pregnancy-induced hypertension, obstetric hemorrhage, induction of labour, large for gestational age fetus, preterm delivery, and admission to neonatal critical care units. However, there is limited evidence on the magnitude of risk conferred by GDM for various adverse pregnancy outcomes

Objectives: The primary objective of our study was to assess the relative risk for adverse obstetric outcomes associated with GDM in women diagnosed using the WHO-recommended 75g 2-hour oral glucose tolerance test (OGTT), compared to women with no GDM. We also sought to determine the factors that had an impact on the risk of adverse outcomes among the sub-population of women with GDM.

Materials and Methods: This was a retrospective cohort study: antenatal, medical, and delivery records for women followed up and delivered at Aga Khan University Hospital-Nairobi (AKUH-N), between the 1st of February 2023 and the 31st of March 2024 were reviewed. Mothers with a singleton pregnancy and a 75g OGTT results diagnostic of GDM were recruited into the exposure arm until the minimum desired sample size was obtained. Systematic sampling was used to recruit mothers with a normal 75g OGTT, and meeting inclusion criteria into the control arm to attain a 1:1 ratio. Outcomes of interest were captured on a standardized questionnaire and analyzed using appropriate statistical tools. Bivariate analysis was done to determine the relative risk conferred by GDM for composite obstetric outcomes; as well as individual maternal and fetal outcomes of interest. Adjustment for confounders was done on the relative risk for composite adverse obstetric outcome.

Results: GDM independently increased the risk for composite adverse obstetric outcomes (ARR 1.5, 95%CI, 1.2-1.9, p < 0.001), risk for composite adverse maternal outcomes (ARR 1.4 95%CI, 1.1-1.7, p- 0.003) and risk for composite adverse neonatal outcomes (ARR 2.5 95%CI 1.5-6.0, p- < 0.001). We found a significant association between GDM risk of individual adverse maternal and fetal outcomes such as induction of labor, large for gestational age fetus, and admission to neonatal critical care units. GDM was not shown to significantly increase the risk of primary cesarean section, pregnancy-induced hypertension, primary postpartum hemorrhage, and a 5 minute APGAR score below 7. Among those with GDM, maternal Age above 30 years and obesity were shown to be associated with a higher risk of adverse pregnancy outcomes.

Conclusion: GDM significantly increases the risk of adverse obstetric outcomes in our population. Factors such as advanced maternal age and maternal obesity further increase the risk of both adverse maternal and neonatal outcomes among women with GDM. Risk stratification can enable the optimization of care among those at increased risk for unfavorable outcomes.

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1

Last Page

50

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