Abstract:
Globally its is estimated that 7% to 9% pregnancies become complicated as result of Gestational Diabetes Mellitus (GDM), this accounts for approximated 200,000 cases reported annually around the world (Terrie, 2009). Kenya continue to report worrying statistics with approximately 1.8 million young population suffering from diabetes and the latest diagnosis in much younger cases of infants creates the need for an investigation to be conducted to identify predisposing factors that need modification for improvement of health outcomes in mothers and neonates. Gestational diabetes may result to serious health consequences for both the mother and infant making it a challenge to reduce maternal and child mortality as stipualted in the Sustanable Development Goals. Thus, the objective of the study was to establish gestational diabetes exposure factors and the associated health risks in mothers and neonates enrolled for antenatal clinics Nairobi County. The study variables were exposure factors, maternal health outcomes and neonatal birth weight in relation to GDM condition. An ambidirectional cohort study was conducted among 238 women attending antenatal clinic in selected health facilities in Nairobi and were on the third trimester of the pregnancy. Data was collected using semi-structured interviewer administered questionnaires, conducted laboratory tests for GDM case ascertainment and anthropometric measurements were taken for BMI estimation. State version 13 was used to derive descriptive statistics for respondents’ characteristics. Odds ratio, univariate and multivariate logistic regression was calculated to determine the association of GDM and health outcomes in maternal and neonates. The study findings indicated that mothers who had diabetic history in the family had twice the risk of developing GDM [OR= 2.27; 95% C.I:1.23-4.17] compared to those who did not observe diabetic history in the family. The average age for mothers with GDM was high with a mean of 33.06 years compared to a mean of 27.9 years among non-GDM mothers.Mothers with GDM had above normal BMI (overweight and obese) at 54.55% and 24.24% respectively compared to non-GDM with 35.12% and 0.6% in the category of overweight and obese respectively.Further, the results indicated that mothers with GDM are four times likely to experience high frequency of urination [OR = 4.33; 95% C.I: 1.14-16.47], three times high volume of urine [OR = 3.65; 95% C.I: 1.12-11.93] while episiotomy mode of delivery [OR=0.29; 95% C.I:0.10-0.85] and rough skin texture [OR=0.17; 95% C.I:0.077- 0.385] showed negative association but significantly common among GDM mothers [P-value <0.05].Lastly,results indicated that neonatal birth weight was high among mothers with GDM 44[66.67%] compared with 59[34.71%] for mothers with no GDM.In conclusion the study suggested that age, weight and diabetic history are risk factors in GDM condition, pregnancy and delivery complications is significanty common among GDM mothers and large- for –age babies phenomena is significantly high among mothers with GDM. To generally improve maternal and child health, there is need to advocate for inclusion of diabetes screening and Nutrition clinics in MCH and Essential Health Services Package for the country to realise Sustainable Development Goals and Vision 2013.
Key Words: Gestational Diabetes Mellitus, Perinatal Health Outcome, Antenatal Clinic, and Nairobi
