SCREENING STRATEGIES TO DETECT GESTATIONAL DIABETES MELLITUS IN AIC KIJABE HOSPITAL, KENYA

Abstract

Background Gestational DM has been associated with increased risk of perinatal mortality and morbidity however, screening recommendations are not clearly described in Kenyan guidelines. Kenyan studies have shown wide-ranging prevalence rates for GDM between 1.1%-16.7% which reflects inconsistences in GDM screening strategies. The purpose of this study was to assess the utility of the selective and universal screening strategies in detecting GDM in AIC Kijabe Hospital. Methods This was a cross-sectional retrospective and prospective study. Study participants between 24- and 32-weeks’ gestation had a risk factor screening questionnaire administered, followed by a 75g oral glucose tolerance test (OGTT) if appropriate. Results A total of 343 were selectively screened for GDM from the retrospective data, while 38 women were universally screened for GDM in the prospective arm of the study. The detection of GDM was 13.2% and 2.6% in the universal and selective screening strategies, respectively (p=0.016). A first degree relative with DM, stillbirth and macrosomia were the most frequently observed risk factors at 21.8%, 17.2% and 9.2%, respectively. Forty-three percent (42.9%) of GDM cases were diagnosed in the absence of risk factors for GDM. Conclusion Universal screening detected a significantly higher rate of GDM than the selective screening strategy. Recommendations Kenyan health facilities should adopt the universal screening strategy for GDM, for early diagnosis and prevention of maternal and neonatal complications amongst pregnant women in Kenya. The true prevalence of GDM in Kenya will be clearly defined once universal screening is widely adopted.