Assessment of gestational diabetes in high-risk women attending Assiut University Women Health Hospital, Egypt
Authors: Ahmed Dina Ali , EL Toony Loobna Farag , El Kader Ahmed A D , Esmail Alaa Mahmoud , Abass Wael Ahmed , El Khated Hanan 
Published: September 2023

Abstract
Background
The prevalence of gestational diabetes mellitus (GDM) has increased dramatically worldwide in the last decades, but unfortunately it was not studied in Egypt.

Objective
The objective of the study is to assess the prevalence and the risk factors of GDM in Assiut City, Egypt and to assess the better management and follow-up of GDM comparing the results of treatment options on maternal and fetal outcomes.

Patients and methods
Our study was a prospective cohort study performed between June 2014 and June 2015. The study included 355 nondiabetic pregnant women at 24–28th weeks of gestation. A total of 242 cases had risk factors for GDM who underwent 75g 2h oral glucose tolerance test (OGTT). Diagnosis of GDM was carried out according to International Association of the Diabetes and Pregnancy Study Groups criteria. GDM cases were followed up and treatment was modified according to the targets for capillary blood glucose levels. Patients received an education program about the preferred food items and on the importance of physical activities, and if targets are not met within 1–2 weeks of initiation of lifestyle management, then those patients will be grouped into two groups: a group treated with metformin and another group treated with insulin. All participants were followed up till the end of pregnancy especially: maternal outcomes, for example preeclampsia and cesarean delivery. Also, fetal outcomes, for example macrosomia, hypoglycemia, hyperbilirubinemia, neonatal respiratory distress syndrome, and neonatal death. Follow-up of GDM cases was done at 6–12 weeks postpartum by OGTT 75g glucose to detect progression to type 2 DM.

Results
Our study has shown that the prevalence rate of GDM was 12.4% among the studied group. Family history of DM was the most prevalent risk factor with a highly significant positive relation that occurred in 73.3% of GDM cases (P<0.001) compared with 32.5% in non-GDM cases. BMI more than 30 was another important risk factor demonstrated in our study as a significant association was found between prevalence of GDM and obesity (BMI >30) was found in 50% of women with GDM (P<0.001) compared with 21.2% in non-GDM cases. Of the studied group, 31.8% had no risk factors for GDM, which shows the importance of usinguniversal screening measures. The prevalence of GDM was higher in those living in urban areas (76.7 vs. 23.3%%), P value 0.045. Our study showed that the most common complications of GDM were cesarean section, which occurred in 33.3% of cases and preeclampsia, which occurred in 23.3% of cases. Regarding fetal complications, the most frequent complications were macrosomia that occurred in 23.35% of cases and hypoglycemia in newborn babies, which occurred in 16.7% of cases. The use of metformin lessened the occurrence of macrosomia in 27.3% of babies compared with 28.6% with the insulin group. Neonatal hypoglycemia occurred less with the use of metformin in 9.1% compared with 28.6% with insulin use. Also, in our study 23.3% (7/30) of GDM cases progressed to type 2 diabetes when 2-h OGTT 75g glucose was done at 6–12 weeks postpartum. All of them had a family history of DM in first-degree relatives, obese with a BMI of above 30 and started insulin from the start of diagnosis.

Conclusion
The prevalence of GDM in high-risk women attending Assiut University Women Health Hospital was 12.4% and family history of DM was the most frequent risk factors for GDM. High prevalence of BMI more than 30, past history of previous GDM, and the increasing age of the pregnant women were other important risk factors. Of the GDM women 31.8% had no definite risk factor and this enhances the need for universal screening of all pregnant women instead of selective screening for the high-risk group to pick up more and more cases with GDM. GDM women were more prevalent in urban than in rural areas. Our study showed that the most common maternal complications of GDM were cesarean section, preeclampsia, and postpartum progression to type 2 diabetes. Regarding fetal complications, the most frequent complications were macrosomia and hypoglycemia. Macrosomia occurred less with the usage of metformin compared with the insulin group. Neonatal hypoglycemia occurred less with the use of metformin compared with insulin use. Of the GDM cases 31.8% (7/30) progressed to type 2 DM when OGTT was done at 6–12 weeks postpartum and all of them had a family history of DM in first-degree relatives, obese with a BMI of above 30 and started insulin from the start of diagnosis.