Relationship among non-modifiable risk factors for gestational diabetes mellitus, pregnancy weight gain and delivery outcomes at Mama Lucy Kibaki hospital, Nairobi

Abstract

Gestational Diabetes Mellitus (GDM) affects 4–7 percent of pregnancies globally and is associated with adverse delivery outcomes namely; macrosomia, pre-term births, cesarean births and mal-presentation. Non-modifiable risk factors for GDM include previous macrosomia, pre-term births, family history of diabetes and maternal history of GDM. GDM is highly correlated with overweight and obesity conditions which also complicate pregnancies when they are associated with excessive GWG. Hence, the increasing prevalence of obesity estimated at 40% and 20% in urban and rural settings respectively among Kenyan women in 15-49 age bracket means a growing number of them start child-bearing when already vulnerable to GDM. New cases of GDM and adverse delivery outcomes contribute to a growing pool of non-modifiable risk factors for GDM. However, although there is documented association among non-modifiable risk factors for GDM and GDM development one hand, and GWG,GDM and delivery outcomes on the other hand, there is paucity of published information on association among non-modifiable risk factors for GDM, GWG and associated delivery outcomes. This prospective cohort study will investigate this association in expectant women at Mama Lucy Kibaki Hospital, in Umoja sub-locality of Nairobi County. The study will; examine pregnancy weight gain associated with maternal history of GDM and maternal family history of diabetes; establish GWG associated with previous macrosomia births and previous unexplained pre-term births; determine cases of macrosomia and pre-term births associated with GWG and GDM; investigate cases of cesarean section and mal-presentation associated with GWG and GDM. A sample of 334 participants drawn from a population of 4488 women attending antenatal care at the facility will be recruited and followed till delivery time. Document content analysis guides, questionnaires and key informant interview guides will be used. The association between the variables will be determined through application of odds ratio (OR) in regression analysis. The OR will seek to determine odds that excessive GWG will be realized due to non-modifiable risk factors compared to the odds that excessive GWG will be realized in the absence of the risk factors. It will also determine the odds that delivery outcomes will be realized due to influence of excessive GWG and GDM compared with the odds that the delivery outcomes will be realized without excessive GWG and GDM. This study is important because the non-modifiable risk factors for GDM may help to identify women who are vulnerable to excessive GWG, GDM and associated adverse delivery outcomes for timely interventions.