Meta-analysis finds high prevalence of adverse outcomes in African women with hyperglycaemia in pregnancy

This systematic review and meta-analysis examined the prevalence of adverse maternal and neonatal outcomes among women with hyperglycaemia in pregnancy in Africa. The study included 9,742 women across the continent, encompassing those with gestational diabetes mellitus (GDM), type 1 diabetes (T1DM), and type 2 diabetes (T2DM). The analysis synthesized data from multiple studies to provide population-level estimates, though specific study designs, settings, and inclusion criteria for individual studies were not reported in the available data. The population specifically focused on African women experiencing hyperglycaemia during pregnancy, representing an important regional perspective on this global health concern.

The intervention or exposure was hyperglycaemia in pregnancy, which included GDM, T1DM, and T2DM. No specific comparator group was reported in the available data, indicating this was a prevalence study rather than a comparative effectiveness analysis. The analysis examined outcomes across different types of hyperglycaemia without direct comparison to normoglycemic pregnancies, limiting causal interpretation. Dosing protocols, treatment approaches, and management strategies for the hyperglycaemia were not detailed in the reported findings.

Primary outcome results were not specifically reported in the available data. However, key secondary outcomes revealed substantial prevalence rates across different types of hyperglycaemia. For women with GDM, caesarean section prevalence was 46.0% (95% CI 35.7-56.4), preterm delivery prevalence was 25.2% (95% CI 12.7-40.2), and neonatal intensive care unit admission prevalence was 25.9% (95% CI 13.7-40.2). For women with T1DM, caesarean section prevalence was 57.5% (95% CI 44.9-69.7), preterm delivery prevalence was 50.7% (95% CI 16.3-84.8), and neonatal hypoglycaemia prevalence was 20.2% (95% CI 0.0-61.4). For women with T2DM, caesarean section prevalence was 60.6% (95% CI 45.5-74.8) and preterm delivery prevalence was 35.2% (95% CI 29.5-41.1). Postpartum type 2 diabetes was listed as a secondary outcome but specific prevalence data were not provided.

Additional secondary outcomes beyond those with specific prevalence data included postpartum type 2 diabetes, though numerical results for this outcome were not reported. The wide confidence intervals for many outcomes, particularly for T1DM outcomes (preterm delivery 95% CI 16.3-84.8, neonatal hypoglycaemia 95% CI 0.0-61.4), indicate substantial uncertainty in these estimates. The neonatal intensive care unit admission data for GDM (95% CI 13.7-40.2) and caesarean section data for T2DM (95% CI 45.5-74.8) also show considerable variability in the underlying studies.

Safety and tolerability findings were reported through the adverse outcomes themselves, with caesarean section, preterm delivery, neonatal hypoglycaemia, neonatal intensive care unit admission, and postpartum type 2 diabetes all identified as adverse events associated with hyperglycaemia in pregnancy. Specific rates of serious adverse events, treatment discontinuations, and tolerability assessments were not reported. The prevalence data themselves represent the frequency of these adverse outcomes in the studied population, with caesarean section rates ranging from 46.0% to 60.6% depending on diabetes type, preterm delivery from 25.2% to 50.7%, and neonatal intensive care unit admission at 25.9% for GDM.

These results should be interpreted in the context of prior research on hyperglycaemia in pregnancy, which has consistently shown increased risks of adverse outcomes globally. The prevalence rates reported in this African population appear generally higher than those reported in some studies from other regions, particularly for caesarean section and preterm delivery. However, direct comparison is limited by differences in study design, population characteristics, and healthcare systems. The findings contribute to a growing body of literature highlighting the substantial burden of hyperglycaemia-related complications in pregnancy, with this study providing important regional data from Africa.

Key methodological limitations include the fact that outcome data predominantly come from a few studies, significant heterogeneity across most outcomes, and variation in prevalence across populations. The wide confidence intervals for many outcomes reflect this heterogeneity and uncertainty. The analysis did not include a comparator group of normoglycemic pregnancies, limiting causal interpretation of the associations. Funding sources and potential conflicts of interest were not reported, and the study phase was not specified. These limitations necessitate cautious interpretation of the findings.

Clinical implications of these findings include recognition of the high burden of adverse outcomes associated with hyperglycaemia in pregnancy among African women. Healthcare providers should be aware of the elevated risks of caesarean section, preterm delivery, neonatal intensive care unit admission, and neonatal hypoglycaemia in this population. The findings support the importance of vigilant monitoring and management of hyperglycaemia during pregnancy in African settings. However, the observational nature of the data means these are associations rather than proven causal relationships, and clinical decisions should be based on individual patient assessments and available local guidelines.

Unanswered questions include how these prevalence rates compare to those in normoglycemic African pregnancies, what specific management strategies might mitigate these risks in African settings, and how healthcare system factors influence outcomes. The role of glycemic control levels, timing of diagnosis, and specific treatment approaches in modifying these risks remains unclear from this analysis. Long-term maternal and child outcomes beyond the immediate perinatal period were not addressed. More high-quality, prospective studies with appropriate comparator groups are needed to better understand the causal pathways and identify effective interventions for improving outcomes in this population.