Poster Presentation Australian Diabetes in Pregnancy Society 2018

Gestational Diabetes Mellitus in Fiji - A single hospital based study of Prevalence and birth outcomes (#108)

Falahola Fuka 1 , Rajat Gyaneshwa 2 , Swaran Naidu 2 , Julia Singh 3 , Nola Mahe 4 , Ilisapeci Kubuabola 5 , Uchechukwu Levi Osuagwu 6 , David Simmons 6 , James Fong 3
  1. OBGYNAE, Ministry of Health, Nukualofa, Tonga
  2. OBGYNAE, Ministry of Health, Lautoka, Fiji
  3. OBGYNAE, Ministry of Health, Suva, Fiji
  4. ICT, WHO, Suva, Fiji
  5. C-POND, Fiji National University, Suva, Fiji
  6. Medicine, Western Sydney University, Campbelltown, NSW, Australia

Aim  Estimates of  gestational diabetes mellitus (GDM) vary widely because of varying diagnostic criteria. Screening of pregnant women using modified (fasting+2 hour glucose only) International Association of Diabetes and Pregnancy Study Group criteria (IADPSG) has been available in Fiji since 2013. This study is the first hospital-based, analysis of the screening coverage and the resulting one-year prevalence.  Prior prevalence (2009-2013) using the 1998 ADIPS criteria was relatively stable at ~1.4%.

Methods  Women attended the antenatal clinic of the Colonial War Memorial Hospital (CWMH) in Suva (2013 -14) for 2 hr 75g oral glucose tolerance test (OGTT) or 50g Glucose Challenge Test≥7.8mmol/L and OGTT if at high/low risk of GDM. GDM diagnosed if fasting glucose ≥5.1 mmol/L and/or 2hr ≥8.5mmol/L unless diabetes in pregnancy (DIP) was present (fasting≥7.0 mmol/L and/or 2hr ≥11.1 mmol/L). Obesity was defined as BMI≥ 30kg/m2. Demography, risk factors (positive family history of diabetes, history of GDM, baby>4000g, still birth and neonatal death) and clinical data were extracted, retrospectively. The prevalence pre and post- IADPSG implementation and the categorical data were calculated.

Results  Of the 8628 singleton births (women aged 38±2yrs), 301(3.4%) had diabetes: GDM/DIP/pre-exisiting DM 2.4%/0.5%/0.1%, respectively and 0.4% unretrieved records. The age-specific prevalence of GDM was 0.5%, 1.8%, 0.6% for 16-25, 26-35 and >35 years, respectively, 63% were obese, 66% had either any risk factor (51%) or 2/more risk factors (15%), mostly strong family history (51%). The mean gestational age at delivery was 38.5±2.1wks (GDM 38.6±2.0 vs DIP 37.7±2.3 p<0.05). Compared with non-diabetes, GDM women had significantly higher risks of caesarean section (OR=2.26; 95%CI:1.72/2.95), hypertensive disorder (OR=4.68; 3.34/6.47), stillbirth (OR=13.08; 7.65/21.7) but similar neonatal death risk. Higher birthweight for neonates with shoulder dystocia (4442g vs 3417g; p<0.001) with 20% of those with macrosomia (>4.0kg birthweight) developing shoulder dystocia.

Conclusion. Adopting the modified IADPSG criteria at the CWM hospital increased the prevalence of GDM (3.4%) and identified women at increased risk of adverse pregnancy outcomes in Fiji.

Key Words: International Association of Diabetes and Pregnancy Study Group’s criteria (IADPSG), Gestational Diabetes (GDM), Prevalence, Diabetes in Pregnancy, Macrosomia, Shoulder Dystocia.