Burden, risk factors and maternal and offspring outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa (SSA): a systematic review and meta-analysis
Open accessAbstract
Background: The burden, determinants and outcomes of gestational diabetes mellitus (GDM) in sub-Saharan Africa are not known. We summarized existing evidence on the prevalence, risk factors and complications of GDM in the region. Methods: PubMed was searched from inception to January 31st 2019. Studies were included if carried out in any of the sub-Saharan Africa countries and were available as abstracts or full texts. Interventional studies and those only including qualitative data were excluded. We employed random effects modelling to estimate the pooled GDM prevalence and risk ratios (RRs) for risk factors and outcomes of GDM and their 95%CI. Results: 283 papers were identified in the initial search, 33 of which met the inclusion criteria. Data on GDM burden suggest a pooled prevalence of 9% (95%CI, 7–12%). Family history of type 2 diabetes and previous history of GDM, macrosomia, stillbirth and abortion were important risk factors of GDM. In addition, being overweight or obese, over 25 years of age or hypertensive increased the risk of GDM. In terms of complications, GDM more than doubles the risk macrosomia (RR; 95%CI: 2.2; 1.1–4.4). Conclusions: There is a high burden of gestational diabetes mellitus in sub-Saharan Africa, but more studies are needed to document locally important risk factors as well as maternal and offspring outcomes. Interventions to reduce obesity among older African women might lead to reduced risk of GDM in sub-Saharan Africa.
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Even after changing criteria to WHO/IADPSG 2013, the overall prevalence of gestational diabetes mellitus in Africa is still unknown.
“Even after changing the criteria for a GDM diagnosis in the WHO/IADPSG 2013, the overall prevalence of GDM is still unknown.”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
The Results section estimates overall GDM prevalence in sub-Saharan Africa at 9% (95% CI, 7–12%) and gives a separate estimate of 16% (11–21%) for studies using IADPSG or WHO 2013 criteria. The Background says prevalence in the general population was largely unknown before this review, but the paper does not present it as still unknown after its analysis. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredSeveral studies on gestational diabetes mellitus in Africa were performed, but the majority focused on specific populations.
“Several studies concerning GDM in Africa were performed to try to fill in the gap regarding GDM prevalence, risk factors, outcomes and management, but the majority of them focused on specific populations [30,31,32].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
The Results report 33 eligible studies from 12 sub-Saharan African countries, supporting the statement that several GDM studies had been performed. The Background notes limited data for the general population and cites an earlier review of high-risk individuals, but this paper does not establish that a majority of studies focused on specific populations. Its stated review scope covers prevalence, risk factors and outcomes, not management. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAccording to Natamba et al.'s systematic review, the incidence of gestational diabetes mellitus in sub-Saharan Africa was assessed at 3% before 2010 and approximately 13% between 2010 and 2018.
“According to Natamba et al.’s systematic review, the incidence of GDM was assessed at 3% before 2010 and approximately 13% between 2010 and 2018”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
The Results section (‘Prevalence of GDM in sub-Saharan Africa’) reports the cited 3% and 13% estimates for studies published in 1969–2009 and 2010–2018, respectively. These are pooled prevalence estimates, not incidence estimates; the periods describe when the studies were published, not necessarily when cases occurred. Page numbers are not available in the supplied copy. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThe higher gestational diabetes mellitus prevalence in Africa is connected with urbanization, changing lifestyles, and newer and more common gestational diabetes mellitus screening methods.
“This is connected with urbanization, changing lifestyles, and newer and more common GDM screening methods [30,31].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
The Discussion (page unavailable) says GDM prevalence in sub-Saharan Africa appears to have risen since around 2010 and that adoption of newer diagnostic criteria has increased the proportion diagnosed. It suggests obesity as a possible contributor, but does not link the rise to urbanization or changing lifestyles; it says evidence on lifestyle factors is limited. The paper documents growing adoption of new criteria, not more frequent screening. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn sub-Saharan Africa, age greater than 25 years, overweight or obesity, and multiparity increased the risk of gestational diabetes mellitus, while primiparity decreased this risk.
“Additionally, an age greater than 25 years, overweight, or obesity, and mutliparity also increased the risk of GDM, but primiparity decreased this risk.”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
The Results section, “Risk factors for GDM in sub-Saharan Africa” (page unavailable), reports increased GDM risk for women older than 25, those overweight or obese, and multiparous women. It reports reduced risk for primigravida women (in their first pregnancy), not specifically for primiparous women (who have given birth once). (LLM, conf=0.88)
Experimental — accuracy not yet measured
In sub-Saharan Africa, the most important risk factors for gestational diabetes mellitus were GDM, stillbirth, abortion, macrosomia in previous pregnancies, family history of type 2 diabetes mellitus, and hypertension.
“According to Natamba et al. the most important risk factors for GDM in subSaharan Africa were: GDM, stillbirth, abortion, macrosomia in previous pregnancies, family history of T2DM and hypertension.”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
On the African continent, several diagnostic criteria for gestational diabetes mellitus are used, including WHO 1985, WHO 1999, WHO 2006, CC criteria, ADA 2003/2004, WHO/IADPSG 2013, or individual protocols.
“On the African continent, a few ways diagnosing GDM diagnosis have still exist. The WHO 1985, WHO 1999, WHO 2006, CC criteria, ADA 2003/2004, WHO/IADPSG 2013 or individual protocols are taken into account [30,31].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
In sub-Saharan Africa, HIV infection was not statistically significantly associated with gestational diabetes mellitus.
“Other parameters (e.g., HIV infection) were not statistically significant [30].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
When IADPSG criteria were used, the prevalence of gestational diabetes mellitus in sub-Saharan Africa was approximately 16%.
“but if the IADPSG criteria were used the prevalence was approximately 16% in sub-Saharan Africa [30].”
From Evolution of Gestational Diabetes Mellitus across Continents in 21st Century (2022) · cites this paper as [30]
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- Authors
- Natamba, B. K., Namara, A. A., & Nyirenda, M. J.
- Affiliations
- MRC/UVRI & LSHTM Uganda Research Unit (UG)
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Natamba, Barnabas Kahiira
- Venue
- BMC Pregnancy and Childbirth
- Published
- 2019-11-28
- Volume
- 19
- Issue
- 1
- Pages
- 450-450
- ISSN
- 1471-2393 (ISSN-L)
- PMC
- PMC6883645
- OpenAlex
- W2990004610
- Cited by
- 100
- References
- 71
- Citations by year
- 2026: 17 · 2025: 11 · 2024: 16 · 2023: 12 · 2022: 13 · 2021: 23 · 2020: 6 · 2018: 1 · 2017: 1
- FWCI
- 1.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Pregnancy and Childbirth (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gestational Diabetes Research and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Keywords
- gestational diabetes mellitus, sub-Saharan Africa, prevalence, risk factors, macrosomia, stillbirth, abortion, maternal outcomes, offspring outcomes, family history of type 2 diabetes, maternal obesity, maternal age, hypertension in pregnancy, maternal overweight
- MeSH terms
- Abortion, Spontaneous, Diabetes Mellitus, Type 2, Family Health, Female, Fetal Macrosomia, Humans, Hypertension, Obesity, Pregnancy, Pregnancy Outcome, Risk Factors, Prevalence, Diabetes, Gestational, Africa South of the Sahara, Stillbirth
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