Diabetes Mellitus among Pregnant Mothers and Its Effect on Maternal and Birth Outcome in Wolaita Zone, Southern Ethiopia
Creators: name: Wolka, Eskinder(PHD)
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 2019

description: Background: Currently, diabetes mellitus (DM) is considered as one of the top health problems of the World. The World Health Organization (WHO) estimated that, globally, hyperglycemia is the third highest risk factor for premature mortality, next to high blood pressure and tobacco use. World estimate of 8.8% (415 million) adults aged 20-79 affected by DM in 2015 with little gender difference and in the same year the estimate of hyperglycemia in pregnancy in Africa was 10.5% affecting 3.3 million live births. Its burden is increasing and the largest increase will take place in low and middle-income countries. The magnitude of diabetes is nearly equal among both sexes but it uniquely affects women through its impact during pregnancy. Today as many as 60 million women of reproductive age have type 2 diabetes and gestational diabetes mellitus (GDM), affects up to 15% of pregnant women worldwide. Poorly controlled diabetes is important cause of maternal and fetal complications among pregnant mothers. Early identification, close monitoring and management of diabetes mellitus among pregnant women can meaningfully improve pregnancy and birth outcome. In Ethiopia, although diabetes mellitus is recognized as one of the major non-communicable diseases, the burden among pregnant women and its effect on pregnancy and birth outcomes are not well researched. Objective: To assess the magnitude of DM and its effect on maternal and birth outcomes among pregnant mothers in Wolaita Zone, Southern Ethiopia Methods: This study has been undertaken in Wolaita Zone, Southern Ethiopia. Institution-based retrospective document review with a cross-sectional design, cross-sectional study and retrospective cohort study designs were employed respectively to determine magnitude of preexisting diabetes, prevalence of GDM and effect of diabetes on pregnancy and birth outcome among mothers receiving maternity services in selected health facilities in Wolaita Zone. Qualitative study was done to explore detection and management modalities of GDM. The study took place from August 2017 to June 2018. The study populations were pregnant mothers and health care providers. Data were collected by document review or data extraction, interviewing of pregnant women by structured questionnaire, and in-depth interview of health professionals engaged in maternity care. Oral glucose tolerance test was performed and GDM was diagnosed based on WHO criteria. Data were entered in to Epi Info version 7 and analysis was done by STATA version 14. Descriptive statistics was computed and data were presented using figures and tables. Chi-square and corresponding p-value were determined to assess the association between dependent and independent variables for the first objective. Binary logistic regression was applied to show the association of independent variables with dependent variables. Thematic analysis approach was used to analyze qualitative data using NVIVO version 12. The study was approved by Institutional Review Board of College of Health Sciences, Addis Ababa University. Results: Magnitude of pre-existing DM among mothers receiving maternity care within one year period was 2.8% 95% CI (1.5, 4.2). The magnitudes among urban and rural residents were 3.3% and 1.4% respectively. Pre-existing diabetes mellitus was significantly associated with family history of diabetes (Chi square 24.8, P-value, 0.001). Previous history of spontaneous abortion (aOR: 5.3; 95%CI: 1.6-17.4 ) and fetal macrosomia (aOR: 3.9; 95%CI: 1.2-13.1 ), were identified to be significantly associated with pre-existing diabetes. Prevalence of GDM was 4.2% (95% CI, 2.5, 6.2) with mean post glucose load level of 160.1 mg/dl (6.3) and 15(4%) among urban residents and 7(4.9%) among rural residents. The proportion of GDM increases with increase in number of pregnancies. Previous history of spontaneous abortion (aOR: 3.5; 95%CI: 1.7-14.6 ) and family history of type II diabetes (aOR: 4.3; 95%CI: 1.3-8.7 ) were significantly associated with GDM. Mothers with DM were 2.9 times more likely to be delivered by caesarean section than nondiabetic mothers (aRR: 2.9, 95%CI: 1.3-6.2) and the risk of pre-term delivery is 2.5 times higher among mothers with DM, (aRR: 2.5, 95% CI: 1.1-6.2). Screening of women for GDM was done by selective screening within 24-28 weeks of gestational age. The participants also mentioned that they made diagnosis of GDM based on WHO criteria. Health care providers use dietary modification, exercise and drug treatment to treat GDM. Participants confirmed that lack of standard guidelines and protocols, lack of attention of mid-level workers to screen GDM, inadequate trained health care providers, shortage of supplies and equipment and late antenatal care visits were barriers to detection and management of GDM. Conclusions and Recommendations: The magnitude of pre-existing DM is almost the same as that of International Diabetes Federation estimate to Ethiopia. Family history of diabetes is found to be associated with pre-existing DM. Pre-existing diabetes is associated with increased risk of abortion and fetal macrosomia. The prevalence of GDM is higher compared to other studies conducted in the country. Diabetes mellitus among pregnant mothers is associated with increased risk of pre-term birth and caesarean section delivery. Commonly reported challenges to detect GDM among mothers were lack of standard guidelines and protocols, lack of trained health care providers, shortage of supplies and equipment and late antenatal care visits. Strengthening screening, care and prevention strategies for gestational diabetes mellitus are important to improve maternal and child health. Early detection and management of diabetes mellitus should be one of the key activities to improve maternal and child mortality and morbidity. Policy makers and health care leadership need to address challenges for detection and management of GDM, by strengthening the health care system by availing standard guidelines and protocols, providing on job training for mid-level health care providers, fulfilling supplies and consumables and working on early antenatal visits of pregnant mothers. National large scale study is important to estimate the burden of DM among pregnant mothers and its effect on maternal and birth outcomes at national level.