Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with increased maternal and perinatal morbidity. In low-resource settings, inadequate screening may lead to late or fortuitous diagnosis, sometimes occurring during labor without prior management. Objective: To assess the maternal impact of gestational diabetes fortuitously diagnosed in the delivery room among women with or without classical risk factors defined by the International Association of Diabetes and Pregnancy Study Groups (IADPSG). Methods: A retrospective descriptive and analytical study was conducted from 2018 to 2023 at the Pikine National Hospital Center, a level III maternity unit in Dakar, Senegal. Included were women not previously known to be diabetic who delivered in the department and had a fasting plasma glucose ≥ 0.92 g/L, with or without classical GDM risk factors, and without prior management. Sociodemographic data, risk factors, maternal complications during pregnancy and delivery, and mode of delivery were analyzed. Statistical analysis was performed using STATA 12, with p < 0.05 considered significant. Results: Eighty percent of women had at least one classical IADPSG risk factor. The presence of at least one risk factor significantly increased the likelihood of maternal complications (OR = 14.39; p = 0.01), without a significant effect on fetal complications. Hypertensive disorders were the most frequent maternal complications (14.45%). Most pregnancies reached term. The cesarean section rate was 41% and was significantly associated with the number of risk factors, maternal glycemic level, and fetal macrosomia. No cases of postpartum hemorrhage or maternal death were recorded. Conclusion: Fortuitously diagnosed gestational diabetes at delivery is associated with significant maternal morbidity, particularly in women with classical risk factors. Early and systematic screening of GDM, including in women without apparent risk factors, is essential to improve maternal outcomes.
References
[1]
American Diabetes Association (2002) Gestational Diabetes Mellitus. Diabetes Care, 25, s94-s96. https://doi.org/10.2337/diacare.25.2007.s94
[2]
American Diabetes Association (2014) Standards of Medical Care in Diabetes 2014. DiabetesCare, 37, S14-S80. https://doi.org/10.2337/dc14-s014
[3]
ElSayed, N.A., Aleppo, G., Aroda, V.R., Bannuru, R.R., Brown, F.M., Bruemmer, D., et al. (2022) 2. Classification and Diagnosis of Diabetes: Standards of Care in Diabetes—2023. Diabetes Care, 46, S19-S40. https://doi.org/10.2337/dc23-s002
[4]
Asemi, Z., Karamali, M. and Esmaillzadeh, A. (2014) Effects of Calcium–Vitamin D Co-Supplementation on Glycaemic Control, Inflammation and Oxidative Stress in Gestational Diabetes: A Randomised Placebo-Controlled Trial. Diabetologia, 57, 1798-1806. https://doi.org/10.1007/s00125-014-3293-x
[5]
Diack Ngoné, D. (2015) Résultats du dépistage du diabète gestationnel selon les recommandations de l’IADPSG au Centre National de Pikine à propos de 128 cas Thèse med, UCAD.
[6]
Dronne, R. (2010) La prise en charge du diabète gestationnel et ses conséquences maternelles et néonatales. Mémoire: Sage-femme. Université d’Angers.
[7]
Ahmed, H. (2011) Issue et pronostic de la grossesse chez la femme diabétique: À propos de 101 cas colligés au centre hospitalier Abass Ndao de Dakar au Sénégal. Thèse, UCAD.
[8]
Dabi, G.J. (2013) Elaboration et mise en œuvre d’un protocole de dépistage du diabète gestationnel suite aux nouvelles recommandations au Centre Hospitalier National de Pikine: Difficultés et résultats préliminaires. Thèses, UCAD.
[9]
Landon, M.B., Spong, C.Y., Thom, E., Carpenter, M.W., Ramin, S.M., Casey, B., et al. (2009) A Multicenter, Randomized Trial of Treatment for Mild Gestational Diabetes. NewEnglandJournalofMedicine, 361, 1339-1348. https://doi.org/10.1056/nejmoa0902430
[10]
Vambergue, A., Nuttens, M.C., Verier‐Mine, O., Dognin, C., Cappoen, J.P. and Fontaine, P. (2000) Is Mild Gestational Hyperglycaemia Associated with Maternal and Neonatal Complications? The Diagest Study. DiabeticMedicine, 17, 203-208. https://doi.org/10.1046/j.1464-5491.2000.00237.x
[11]
Crowther, C.A., Hiller, J.E., Moss, J.R., McPhee, A.J., Jeffries, W.S. and Robinson, J.S. (2005) Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes. New England Journal of Medicine, 352, 2477-2486. https://doi.org/10.1056/nejmoa042973
[12]
Mamabolo, R.L., Alberts, M., Levitt, N.S., et al. (2007) Prevalence of Gestational Diabetes Mellitus and the Effect of Weight on Measures of Insulin Secretion and Insulin Resistance in Third-Trimester Pregnant Rural Women Residing in the Central Region of Limpopo Province, South Africa. Diabetic Medicine, 24, 233-239. https://doi.org/10.1111/j.1464-5491.2006.02073.x
[13]
Seyoum, B., Kiros, K., Haileselase, T. and Leole, A. (1999) Prevalence of Gestational Diabetes Mellitus in Rural Pregnant Mothers in Northern Ethiopia. Diabetes Research and Clinical Practice, 46, 247-251. https://doi.org/10.1016/s0168-8227(99)00101-1
[14]
Kim, C., Berger, D.K. and Chamany, S. (2007) Recurrence of Gestational Diabetes Mellitus: A Systematic Review. DiabetesCare, 30, 1314-1319. https://doi.org/10.2337/dc06-2517
[15]
Pintiaux, A., Chabbert-Buffet, N., Philips, J.C., et al. (2010) Diabète et Grossesse: Impact de l’inertie médicale et de l’observance thérapeutique. Revue médicale de Liège, 65, 399-404.
[16]
Froger, J., Prieur, C., Rimbert, D. and Thibault, N. (2012) Comprendre le diabète gestationnel. Actualités Pharmaceutiques, 51, 10-14. https://doi.org/10.1016/s0515-3700(12)71302-2
[17]
Burguet, A. (2010) Conséquences à long terme d’une exposition fœtale au diabète gestationnel. Journal de Gynécologie Obstétrique et Biologie de la Reproduction, 39, S322-S337. https://doi.org/10.1016/s0368-2315(10)70057-0
[18]
Bensalem, S., Lakehal, A. and Roula, D. (2014) Le diabète gestationnel dans la commune de Constantine, Algérie: Étude prospective. Médecine des Maladies Métaboliques, 8, 216-220. https://doi.org/10.1016/s1957-2557(14)70744-8
[19]
Capula, C., Chiefari, E., Vero, A., Arcidiacono, B., Iiritano, S., Puccio, L., et al. (2013) Gestational Diabetes Mellitus: Screening and Outcomes in Southern Italian Pregnant Women. ISRNEndocrinology, 2013, 1-8. https://doi.org/10.1155/2013/387495
[20]
HAPO Study Cooperative Research Group (2008) Hyperglycemia and Adverse Pregnancy Outcomes. New England Journal of Medicine, 358, 1991-2002.
[21]
Chatzi, L., Plana, E., Pappas, A., Alegkakis, D., Karakosta, P., Daraki, V., et al. (2009) The Metabolic Syndrome in Early Pregnancy and Risk of Gestational Diabetes Mellitus. Diabetes&Metabolism, 35, 490-494. https://doi.org/10.1016/j.diabet.2009.07.003
