Gestational diabetes mellitus in Cameroon: prevalence, risk factors and screening strategies

Background The burden of gestational diabetes (GDM) and the optimal screening strategies in African populations are yet to be determined. We assessed the prevalence of GDM and the performance of various screening tests in a Cameroonian population.Methods We carried out a cross-sectional study involving the screening of 983 women at 24-28 weeks of pregnancy for GDM using serial tests, including fasting plasma (FPG), random blood glucose (RBG), a 1-hour 50g glucose challenge test (GCT), and standard 2-hour oral glucose tolerance test (OGTT). GDM was defined using the World Health Organization (WHO 1999), International Association of Diabetes and Pregnancy Special Group (IADPSG 2010), and National Institute for Health Care Excellence (NICE 2015) criteria. GDM correlates were assessed using logistic regressions, and c-statistics were used to assess the performance of screening strategies.Findings GDM prevalence was 5 center dot 9%, 17 center dot 7%, and 11 center dot 0% using WHO, IADPSG, and NICE criteria, respectively. Previous stillbirth [odds ratio: 3 center dot 14, 95%CI: 1 center dot 27-7 center dot 76)] was the main correlate of GDM. The optimal cut-points to diagnose WHO-defined GDM were 5 center dot 9 mmol/L for RPG (c-statistic 0 center dot 62) and 7 center dot 1 mmol/L for 1-hour 50g GCT (c-statistic 0 center dot 76). The same cut-off value for RPG was applicable for IADPSG-diagnosed GDM while the threshold was 6 center dot 5 mmol/L (c-statistic 0 center dot 61) for NICE-diagnosed GDM. The optimal cut-off of 1-hour 50g GCT was similar for IADPSG and NICE-diagnosed GDM. WHO-defined GDM was always confirmed by another diagnosis strategy while IADPSG and GCT independently identified at least 66 center dot 9 and 41 center dot 0% of the cases.Interpretation GDM is common among Cameroonian women. Effective detection of GDM in under-resourced settings may require simpler algorithms including the initial use of FPG, which could substantially increase screening yield.