DOI: 10.5061/dryad.h147b0m
title: Data from: Detection and initial management of gestational diabetes through primary health care services in Morocco: an effectiveness-implementation trial

description: Background: Gestational Diabetes Mellitus (GDM) testing and management in
 Morocco is associated with delays resulting in late commencement of
 treatment. To reduce delays and to increase access of women to GDM care, a
 country-adapted intervention targeting primary health care providers was
 designed to test the hypothesis that detection and initial management of
 GDM at the primary level of care improves newborn outcomes in terms of
 lower birthweights and less cases of macrosomia and impacts on maternal
 weight gain, glucose balance and pregnancy outcomes. Materials and
 methods: We conducted a cluster randomized controlled trial in two
 districts of Morocco. In each district, 10 health centers were randomly
 selected to serve either as intervention or control sites. Pregnant women
 attending antenatal care in the study facilities were eligible to
 participate. At the intervention sites, women were offered GDM screening
 by capillary glucose testing following International Association of
 Diabetes in Pregnancy Study Groups/WHO criteria. Women diagnosed with GDM
 received counselling on nutrition and exercise and were followed up
 through their health center whereas at control facilities routine practice
 was applied. Primary outcome was birthweight and secondary outcomes
 maternal weight gain, glucose control and pregnancy complications. We
 further assessed GDM prevalence in the intervention arm. Statistical
 analysis was performed on 210 recruited women. Continuous variables were
 reported using means while categorical variables using frequencies with
 tests of independence applying chi-squared tests. Differences of outcome
 variables between the two groups were estimated by mixed-effects
 regression models and effect sizes adjusted for confounders. The trial is
 registered under NCT02979756 at ClinicalTrials.gov. Results: GDM
 prevalence reached 23.7% in Marrakech. Birthweight in the intervention
 group was 147grams lower than in the control group (p = 0.08) as was the
 proportion of macrosomes (3.5% versus 18.4%; p&lt; 0.001). In the
 intervention arm, women did two times more follow-ups than at control
 sites (p = 0.001) and mean follow-up intervals were shorter (11.3 days
 versus 18.7 days; p &lt; 0.001). Overall, 30% more fasting blood sugar
 values were balanced (p = 0.005) and mean weekly maternal weight gain 49
 grams lower (p = 0.032) in the intervention group. More women from control
 facilities had a delivery complication whereas more newborn complications
 were observed in women from intervention facilities. No difference between
 the two groups existed regarding mode of delivery and mean gestational age
 at delivery. One of the main limitations of the study was the
 Hawthorn-effect at control sites that might have led to an underestimation
 of the effect size. Conclusion: A high GDM prevalence in Morocco calls for
 a context-adapted screening and management approach to enable early
 interventions. GDM detection and care through antenatal care at primary
 health facilities may have positively impacted on newborn birthweight but
 findings are inconclusive. Results of this study will contribute to the
 decision on a potential upscaling of the intervention in Morocco. Future
 research could examine long term metabolic changes including diabetes type
 2 in the cohort of women and their children.
description: GDM Morocco data _
 STATAAnonymized dataset GDM
 Morocco STATAdata_for_dryad_4.dtaGDM_Morocco R_scriptR script database GDM Moroccoscript_for_dryad.R