Determinants, Glycemic Control, and Clinical Outcomes of Gestational Diabetes Mellitus Among Rural Pregnant Women Attending Antenatal Clinics at Edo State University Teaching Hospital Auchi, Nigeria
Keywords:
Antenatal care, Edo State University Teaching Hospital Auchi, Gestational Diabetes Mellitus, GlycemicAbstract
Gestational diabetes mellitus (GDM) is an increasingly important contributor to adverse maternal and perinatal outcomes, particularly in low- and middle-income countries where screening and long-term metabolic follow-up remain suboptimal. Evidence from rural Nigerian populations is limited. This study assessed the prevalence, associated factors, treatment patterns, glycemic control, clinical complications, and knowledge of GDM among rural pregnant women attending antenatal clinics in Edo State University Teaching Hospital Auchi, Nigeria: An analytical cross-sectional study was conducted among 160 pregnant women attending rural antenatal clinics. Participants were classified as women with GDM (n=32) and without GDM (n=128). Socio-demographic, obstetric, therapeutic, glycemic-monitoring, complication, knowledge, and self-care variables were compared using chi-square tests. Statistical significance was set at p<0.05. The prevalence of GDM was 20.0%. Previous GDM was strongly associated with current GDM, occurring in 50.0% of affected women compared with 12.5% of women without GDM (χ²=22.86; p<0.001). Income was also significantly associated with GDM (χ²=12.18; p=0.016). Higher gravidity and parity were more frequent among women with GDM but were not statistically significant. Active treatment was documented in 87.5% of GDM women compared with 3.1% of non-GDM women (χ²=92.16; p<0.001). Oral hypoglycaemic therapy was used by 62.5%, while 25.0% received insulin or combination therapy. HbA1c was documented in 62.5% of GDM women; 25.0% had HbA1c ≤6.0%, while 37.5% had levels >6.0%. Clinical complications were significantly associated with GDM (χ²=11.84; p=0.003). Knowledge of GDM complications and risk factors was significantly greater among women with GDM. Conclusively GDM affected one in five rural antenatal attendees. Previous GDM was the strongest identified clinical correlate. Although treatment coverage among diagnosed women was relatively high, incomplete glycemic monitoring and screening/documentation gaps remain important challenges. Strengthening systematic screening, evidence-based treatment, glucose monitoring, patient education, referral systems and postpartum follow-up is warranted.
References
1. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5:47.
2. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. Diabetes Res Clin Pract. 2014 Mar;103(3):341-63. doi: 10.1016/j.diabres.2013.10.012. PMID: 24847517.
3. Plows JF, Stanley JL, Baker PN, Reynolds CM, Vickers MH. The pathophysiology of gestational diabetes mellitus. Int J Mol Sci. 2018;19:3342.
4. Moshe Hod and Anil Kapur and David A. Sacks and Eran Hadar and Mukesh M. Agarwal and Gian Carlo Di Renzo and Luis Cabero Roura and Harold D. Mcintyre and Jessica L. Morris and Hema Divakar}The FIGO initiative on gestational diabetes mellitus. Int J Gynaecol Obstet. 2015;131:S173–S211.volume{131 Suppl 3},pages{ S173-21},{https://api.semanticscholar.org/CorpusID:43079458}
5. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.
6. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: systematic review and meta-analysis. Lancet. 2009;373:1773–1779.
7. Sheiner E. Gestational Diabetes Mellitus: Long-Term Consequences for the Mother and Child Grand Challenge: How to Move on Towards Secondary Prevention? Front Clin Diabetes Healthc. 2020 Nov 4;1:546256. doi: 10.3389/fcdhc.2020.546256. PMID: 36993989; PMCID: PMC10041873.
8. International Association of Diabetes and Pregnancy Study Groups Consensus Panel. Recommendations on diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33:676–682.
9. Sabbagh IT, Seedat F, Hirose A, et al. Prevalence of gestational diabetes mellitus in sub-Saharan Africa: systematic review and meta-analysis. AJOG Global Reports. 2026;6:100607.
10. Azeez TA, Abo-Briggs T, Adeyanju AS. A systematic review and meta-analysis of the prevalence and determinants of gestational diabetes mellitus in Nigeria. Indian J Endocrinol Metab. 2021;25:182–190.
11. Rosemary Ogu . Omosivie Maduka . Vetty Agala . Precious Obuah .Faithwin Horsfall . Esther Azi . Cecilia Nwibubasa . Ufuoma Edewor .Ibimonye Porbeni . Osita John . Ngozi Orazulike . Dango Kalio .Kenneth Okagua . Clement Edet . Agiriye Harry . Henry Ugboma .Claribel Abam
(PDF) The Case for Early and Universal Screening for Gestational Diabetes Mellitus: Findings from 9314 Pregnant Women in a Major City in Nigeria. Available from: https://www.researchgate.net/publication/362934544_The_Case_for_Early_and_Universal_Screening_for_Gestational_Diabetes_Mellitus_Findings_from_9314_Pregnant_Women_in_a_Major_City_in_Nigeria [accessed Sep 24 2026].The case for early and universal screening for gestational diabetes mellitus: findings from 9,314 pregnant women in Nigeria. Diabetes Ther. 2022;13:1769–1778.
12. Basil B, Mba IN, Gav TA, Myke-Mbata BK, Swende TZ, Adebisi SA. Rising prevalence of gestational diabetes mellitus and its associated risk factors in Makurdi, North-Central Region of Nigeria. Afr Health Sci. 2023 Dec;23(4):348-355. doi: 10.4314/ahs.v23i4.37. PMID: 38974298; PMCID: PMC11225444.
13. Olagbuji BN, Atiba AS, Olofinbiyi BA, Akintayo AA, Awoleke JO, Ade-Ojo IP, Fasubaa OB; Gestational Diabetes Study Group-Nigeria. Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population. Eur J Obstet Gynecol Reprod Biol. 2015 Jun;189:27-32. doi: 10.1016/j.ejogrb.2015.02.030. Epub 2015 Mar 11. PMID: 25855324.
14. International Association of Diabetes and Pregnancy Study Groups Consensus Panel; Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, Dyer AR, Leiva Ad, Hod M, Kitzmiler JL, Lowe LP, McIntyre HD, Oats JJ, Omori Y, Schmidt MI. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010 Mar;33(3):676-82. doi: 10.2337/dc09-1848. PMID: 20190296; PMCID: PMC2827530.
15. Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2010;120:4222–4229.
16. American Diabetes Association Professional Practice Committee. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
17. Rowan JA, Hague WM, Gao W, Battin MR, Moore MP. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:2003–2015.
18. National Institute for Health and Care Excellence. Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. NICE Guideline NG3. London: NICE; updated 2020.
19. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–126. doi:10.4103/0253-7176.116232.
20. Lwanga SK, Lemeshow S, World Health Organization. Sample Size Determination in Health Studies: A Practical Manual. Geneva: World Health Organization; 1991.
21. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS; Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005 Jun 16;352(24):2477-86. doi: 10.1056/NEJMoa042973. Epub 2005 Jun 12. PMID: 15951574.
22. Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, Wapner RJ, Varner MW, Rouse DJ, Thorp JM Jr, Sciscione A, Catalano P, Harper M, Saade G, Lain KY, Sorokin Y, Peaceman AM, Tolosa JE, Anderson GB; Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009 Oct 1;361(14):1339-48. doi: 10.1056/NEJMoa0902430. PMID: 19797280; PMCID: PMC2804874.
23. Kuti MA, Abbiyesuku FM, Akinlade KS, Akinosun OM, Adedapo KS, Adeleye JO, Adesina OA. Oral glucose tolerance testing outcomes among women at high risk for gestational diabetes mellitus. J Clin Pathol. 2011 Aug;64(8):718-21. doi: 10.1136/jcp.2010.087098. Epub 2011 May 23. PMID: 21606228.
24. Fawole AO, Ezeasor C, Bello FA, Roberts A et al. Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: A cross-sectional study. Niger J Clin Pract. 2014;17(4):495-501.
25. Olumodeji AM, Okere RA, Adebara IO, Ajani GO, Adewara OE, Ghazali SM, Olumodeji UO. Implementing the 2013 WHO diagnostic criteria for gestational diabetes mellitus in a Rural Nigerian Population. Pan Afr Med J. 2020 Jul 22;36:208. doi: 10.11604/pamj.2020.36.208.20818. PMID: 32963674; PMCID: PMC7490126.
26. Muche AA, Olayemi OO, Gete YK. Prevalence and determinants of gestational diabetes mellitus in Africa based on the updated international diagnostic criteria: a systematic review and meta-analysis. Arch Public Heal 2019;77:1-20. DOI: https://doi.org/10.1186/s13690-019-0362-0
27. Olarinoye JK, Ohwovoriole AE, Ajayi GO. Diagnosis of gestational diabetes mellitus in Nigerian pregnant women: comparison between 75-g and 100-g oral glucose tolerance tests. West Afr J Med. 2004;23:198–201.
28. Tieu J, Shepherd E, Middleton P, Crowther CA. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017;1:CD006674.
29. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. Geneva: World Health Organization; 2016. PMID: 28079998.
30. International Diabetes Federation. IDF Diabetes Atlas. 11th ed. Brussels: IDF; 2025.
31. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131:e49–e64.
32. HAPO Study Cooperative Research Group; Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, Hadden DR, McCance DR, Hod M, McIntyre HD, Oats JJ, Persson B, Rogers MS, Sacks DA. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008 May 8;358(19):1991-2002. doi: 10.1056/NEJMoa0707943. PMID: 18463375.
