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Chukwuemeka S, Chivese T, Gopinath A, Obikeze K. Adverse pregnancy outcomes in gestational diabetes mellitus: a systematic review and meta-analysis protocol. BMJ Open 2024; 14:e058625. [PMID: 38803262 PMCID: PMC11328635 DOI: 10.1136/bmjopen-2021-058625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Gestational diabetes mellitus (GDM) is associated with adverse pregnancy outcomes, including adverse outcomes for both the mother and the fetus. Different diagnostic criteria are used for GDM, and it is not clear how these affect the reported prevalence of adverse pregnancy outcomes. This protocol is for a systematic review to describe and compare the prevalence of adverse pregnancy outcomes in GDM using the different diagnostic criteria applied in various countries/regions of the world. METHODS AND ANALYSIS A systematic review and meta-analysis will be carried out. A comprehensive search of observational studies that report the outcomes of interest to this review from 2010 to 2021 will be conducted. We will search the major electronic databases such as PubMed, Scopus, CINHAL and Google Scholar, and screen references of included studies for additional studies. Meta-analyses will be performed, if there is low heterogeneity, and pooled estimates per outcome reported. We will use the bias-adjusted inverse variance heterogeneity model and random effects models, depending on the heterogeneity observed, to pool prevalence estimates and perform subgroup analyses by region, by age group, by diagnostic criteria and by GDM screening method if sufficient data are available. We will also compare the prevalence of adverse outcomes by diagnostic method and report prevalence ratios. We will report 95% confidence estimates for all estimates. ETHICS AND DISSEMINATION Ethical approval is not required as the review uses published data. Findings will be published in peer-reviewed journals and presented at conferences. PROSPERO REGISTRATION NUMBER CRD42020155061.
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Affiliation(s)
| | | | | | - Kenechukwu Obikeze
- School of Pharmacy, University of the Western Cape, Bellville, South Africa
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Bowo-Ngandji A, Kenmoe S, Ebogo-Belobo JT, Kenfack-Momo R, Takuissu GR, Kengne-Ndé C, Mbaga DS, Tchatchouang S, Kenfack-Zanguim J, Lontuo Fogang R, Zeuko'o Menkem E, Ndzie Ondigui JL, Kame-Ngasse GI, Magoudjou-Pekam JN, Wandji Nguedjo M, Assam Assam JP, Enyegue Mandob D, Ngondi JL. Prevalence of the metabolic syndrome in African populations: A systematic review and meta-analysis. PLoS One 2023; 18:e0289155. [PMID: 37498832 PMCID: PMC10374159 DOI: 10.1371/journal.pone.0289155] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/12/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND The metabolic syndrome (MS) is a leading cause of death worldwide. Several studies have found MS to be prevalent in various African regions. However, no specific estimates of MS prevalence in African populations exist. The aim of this study was to estimate the overall prevalence of MS in the African populations. METHODS A systematic review was conducted in PubMed, Web of Science, Africa Index Medicus, and African Journal Online Scopus to find studies published up to the 15th of August 2022. Pooled prevalence was calculated based on six diagnostic methods. The pooled prevalence of MS was estimated using a random-effects model. Our risk of bias analysis was based on the Hoy et al. tool. A Heterogeneity (I2) assessment was performed, as well as an Egger test for publication bias. PROSPERO number CRD42021275176 was assigned to this study. RESULTS In total, 297 studies corresponding to 345 prevalence data from 29 African countries and involving 156 464 participants were included. The overall prevalence of MS in Africa was 32.4% (95% CI: 30.2-34.7) with significant heterogeneity (I2 = 98.9%; P<0.001). We obtained prevalence rates of 44.8% (95% CI: 24.8-65.7), 39.7% (95% CI: 31.7-48.1), 33.1% (95% CI: 28.5-37.8), 31.6% (95% CI: 27.8-35.6) and 29.3% (95% CI: 25.7-33) using the WHO, revised NCEP-ATP III, JIS, NCEP/ATP III and IDF definition criteria, respectively. The prevalence of MS was significantly higher in adults >18 years with 33.1% (95%CI: 30.8-35.5) compared to children <18 years with 13.3% (95%CI: 7.3-20.6) (P<0.001). MS prevalence was significantly higher in females with 36.9% (95%CI: 33.2-40.7) compared to males with 26.7% (95%CI: 23.1-30.5) (P<0.001). The prevalence of MS was highest among Type 2 diabetes patients with 66.9% (95%CI: 60.3-73.1), followed by patients with coronary artery disease with 55.2% (95%CI: 50.8-59.6) and cardiovascular diseases with 48.3% (95%CI: 33.5-63.3) (P<0.001). With 33.6% (95% CI: 28.3-39.1), the southern African region was the most affected, followed by upper-middle income economies with 35% (95% CI: 29.5-40.6). CONCLUSION This study, regardless of the definition used, reveals a high prevalence of MS in Africa, confirming the ongoing epidemiological transition in African countries. Early prevention and treatment strategies are urgently needed to reverse this trend.
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Affiliation(s)
- Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | - Guy Roussel Takuissu
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Epidemiological Surveillance, Evaluation and Research Unit, National AIDS Control Committee, Douala, Cameroon
| | | | | | | | | | | | | | - Ginette Irma Kame-Ngasse
- Institute of Medical Research and Medicinal Plants Studies, Medical Research Centre, Yaounde, Cameroon
| | | | - Maxwell Wandji Nguedjo
- Centre for Food, Food Security and Nutrition Research, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
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Nicolaou V, Soepnel L, Huddle K, Klipstein-Grobusch K, Levitt NS, Norris SA. Cardiometabolic outcomes of women exposed to hyperglycaemia first detected in pregnancy at 3-6 years post-partum in an urban South African setting. PLoS One 2022; 17:e0263529. [PMID: 35139085 PMCID: PMC8827431 DOI: 10.1371/journal.pone.0263529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hyperglycaemia first detected during pregnancy(HFDP) has far-reaching maternal consequences beyond the pregnancy. Our study evaluated the cardiometabolic outcomes in women with prior HFDP versus women without HFDP 3-6 years post-partum in urban South Africa. DESIGN AND METHODS A prospective cohort study was performed of 103 black African women with prior HFDP and 101 without HFDP, 3-6 years post-partum at Chris Hani Baragwanath Academic Hospital, Soweto. Index pregnancy data was obtained from medical records. Post-partum, participants were re-evaluated for anthropometric measurements, body composition utilizing dual energy X-ray absorptiometry(DXA) and biochemical analysis (two-hour 75gm OGTT fasting insulin, lipids, creatinine levels and glucose levels). Cardiovascular risk was assessed by Framingham risk score(FRS). Carotid intima media thickness(cIMT) was used as a surrogate marker for subclinical atherosclerosis. Factors associated with progression to cardiometabolic outcomes were assessed using multivariable logistic and linear regression models. RESULTS Forty-six(45.1%) HFDP women progressed to diabetes compared to 5(4.9%) in non HFDP group(p<0.001); only 20(43.4%) were aware of their diabetic status in the whole group. The odds(OR, 95% confidence interval(CI)) of progressing to type 2 diabetes(T2DM) and metabolic syndrome(MetS) after correcting for confounders in the HFDP group was 10.5(95% CI 3.7-29.5) and 6.3(95%CI 2.2-18.1), respectively. All visceral fat indices were found to be significantly higher in the HFDP group after adjusting for baseline body mass index. Ten-year estimated cardiovascular risk(FRS) and mean cIMT was statistically higher in the HFDP group(8.46 IQR 4.9-14.4; 0.48 mm IQR 0.44-0.53 respectively) compared to the non-HFDP group(3.48 IQR 2.1-5.7; 0.46mm IQR 0.42-0.50) respectively and this remained significant for FRS but was attenuated for cIMT after correcting for confounders. HIV did not play a role in progression to any of these outcomes. CONCLUSION Women with a history of HFDP have a higher risk of cardiometabolic conditions within 6 years post-partum in an urban sub-Saharan African setting.
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Affiliation(s)
- Veronique Nicolaou
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Faculty of Health Sciences, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Larske Soepnel
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kenneth Huddle
- Faculty of Health Sciences, Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital, University of Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Faculty of Health Sciences, Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Naomi S. Levitt
- Faculty of Health Sciences, Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shane A. Norris
- Faculty of Health Sciences, SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, United Kingdom
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Doi SAR, Bashir M, Sheehan MT, Onitilo AA, Chivese T, Ibrahim IM, Beer SF, Furuya-Kanamori L, Abou-Samra AB, McIntyre HD. Unifying the diagnosis of gestational diabetes mellitus: Introducing the NPRP criteria. Prim Care Diabetes 2022; 16:96-101. [PMID: 34419366 DOI: 10.1016/j.pcd.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 11/23/2022]
Abstract
AIMS Disagreement about the appropriate criteria for the diagnosis of gestational diabetes mellitus (GDM) persists. This study examines an alternative approach which combines information from all time-points on the glucose tolerance test (GTT) into a single index and expands the GDM spectrum into four categories using data from three geographically and ethnically distinct populations. METHODS A retrospective observational study design was used. Data from Wisconsin, USA (723 women) was used in derivation of the criterion and data from Doha, Qatar (1284 women) and Cape Town, South Africa (220 women) for confirmation. Pregnant women without pre-existing diabetes with a GTT done between 23 and 30 weeks gestation were included. A novel index was derived from the GTT termed the weighted average glucose (wAG). This was categorized into four pre-defined groups (henceforth National Priorities Research Program (NPRP) criterion); i) normal gestational glycemia (NGG), ii) impaired gestational glycemia (IGG), iii) GDM and iv) high risk GDM (hGDM). RESULTS In the Doha cohort, compared to the NGG group, the odds of large for gestational age babies increased 1.33 fold (P = 0.432), 2.86 fold (P < 0.001) and 3.35 fold (P < 0.001) in the IGG, GDM and hGDM groups respectively. The odds of pregnancy induced hypertension increased 2.10 fold (P = 0.024) in GDM & hGDM groups compared to the IGG and NGG groups. In the Cape Town cohort, a third of women in the GDM group and two-thirds in the hGDM group progressed to T2DM at 5 years. CONCLUSIONS The NPRP categorization identifies four distinct risk clusters of glycemia in pregnancy which may aid better decision making in routine management, avoid potential over-diagnosis of women at lower risk of complications and assist with diabetes prevention in women at high-risk after an index pregnancy with GDM.
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Affiliation(s)
- Suhail A R Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar.
| | - Mohammed Bashir
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Michael T Sheehan
- Department of Endocrinology, Marshfield Clinic Health System -Weston Center, Weston, WI, USA
| | | | - Tawanda Chivese
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - Ibrahim M Ibrahim
- Endocrinology and Diabetes Services Division, Sidra Medicine, Qatar Foundation, Doha, Qatar
| | - Stephen F Beer
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Abdul-Badi Abou-Samra
- Division of Endocrinology and Qatar Metabolic Institute, Hamad Medical Corporation, Doha, Qatar
| | - H David McIntyre
- Mater Research and The University of Queensland, Brisbane, Queensland, Australia
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The influence of maternal blood glucose during pregnancy on weight outcomes at birth and preschool age in offspring exposed to hyperglycemia first detected during pregnancy, in a South African cohort. PLoS One 2021; 16:e0258894. [PMID: 34673829 PMCID: PMC8530360 DOI: 10.1371/journal.pone.0258894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/07/2021] [Indexed: 01/10/2023] Open
Abstract
Introduction Little is known about the influence of hyperglycemia first detected in pregnancy (HFDP) on weight outcomes in exposed offspring in Africa. We investigated the influence of maternal blood glucose concentrations during pregnancy on offspring weight outcomes at birth and preschool age, in offspring exposed to HFDP, in South Africa. Research design and methods Women diagnosed with HFDP had data routinely collected during the pregnancy and at delivery, at a referral hospital, and the offspring followed up at preschool age. Maternal fasting, oral glucose tolerance test 1 and 2-hour blood glucose were measured at diagnosis of HFDP and 2-hour postprandial blood glucose during the third trimester. Offspring were classified as either those exposed to diabetes first recognized in pregnancy (DIP) or gestational diabetes (GDM). At birth, neonates were classified into macrosomia, low birth weight (LBW), large for gestational age (LGA), appropriate (AGA) and small for gestational age (SGA)groups. At preschool age, offspring had height and weight measured and Z-scores for weight, height and BMI calculated. Results Four hundred and forty-three neonates were included in the study at birth, with 165 exposed to DIP and 278 exposed to GDM. At birth, the prevalence of LGA, macrosomia and LBW were 29.6%, 12.2% and 7.5%, respectively, with a higher prevalence of LGA and macrosomia in neonates exposed to DIP. At pre-school age, the combined prevalence of overweight and obesity was 26.5%. Maternal third trimester 2-hour postprandial blood glucose was significantly associated with z-scores for weight at birth and preschool age, and both SGA and LGA at birth. Conclusion In offspring exposed to HFDP, there is a high prevalence of LGA and macrosomia at birth, and overweight and obesity at preschool age, with higher prevalence in those exposed to DIP, compared to GDM. Maternal blood glucose control during the pregnancy influences offspring weight at birth and preschool age.
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Hijikata M, Higa M, Ichijo T, Hirose T. A comparison of meal tolerance test and oral glucose tolerance test for predicting insulin therapy in patients with gestational diabetes. Food Nutr Res 2021; 65:5490. [PMID: 33776619 PMCID: PMC7955519 DOI: 10.29219/fnr.v65.5490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 12/30/2022] Open
Abstract
AIMS To identify factors predicting a need for insulin therapy in gestational diabetes mellitus (GDM) by comparing plasma glucose (PG) levels in a 75-g oral glucose tolerance test (75-g OGTT) with those in a 500-kcal meal tolerance test (MTT) containing 75 g of carbohydrate. SUBJECTS AND METHODS The MTT was performed in 61 patients who diagnosed with GDM by a 75-g OGTT (age, 33.2 ± 4.5 years; prepregnancy body mass index, 22.6 ± 4.7 kg/m2; number of gestational weeks, 25.1 ± 6.4 weeks). PG and serum insulin levels were measured before the meal and up to 180 min after the meal. The insulin secretion capacity and resistance index were calculated. RESULTS PG levels increased from 86.8 ± 8.8 mg/dL at fasting to 132.7 ± 20.1 mg/dL at 30 min, and 137.8 ± 27.7 mg/dL at 60 min after MTT in the 35 patients with needed insulin therapy; these levels were significantly higher than those in the 26 patients, who only needed diet therapy. The patients with needed insulin therapy had significantly higher fasting PG levels in the 75-g OGTT, PG levels at fasting and 30 min after the MTT, and homeostasis model assessment of insulin resistance (HOMA-IR), and a significantly lower disposition index (DI) and insulin index than patients treated by diet alone. Receiver operating characteristic curve analysis was performed for factors involved in insulin therapy, with the following cutoff values: fasting PG in the 75-g OGTT, 92 mg/dL; PG 30 min after MTT, 129 mg/dL; HOMA-IR, 1.51; DI, 3.9; HbA1c, 5.4%. Multivariate analysis revealed that the 30-min PG level after MTT and HOMA-IR predicted insulin therapy. CONCLUSION PG levels at 30 min after MTT may be useful for identifying patients with GDM, who need insulin therapy.
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Affiliation(s)
- Mai Hijikata
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
- Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Mariko Higa
- Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Takamasa Ichijo
- Division of Diabetes and Endocrinology, Department of Medicine, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan
| | - Takahisa Hirose
- Division of Diabetes, Metabolism, and Endocrinology, Department of Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
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