Pregnancy Outcomes and Risk Factors for Caesarean Delivery and Fetal Macrosomia among Gestational Diabetic Women in Nyeri County, Kenya

Abstract

Gestational diabetes mellitus (GDM) is a global public health risk that adversely affects health of women and infants. Interventions to improve adverse health outcomes associated with GDM reduces maternal and neonatal complications and eventually lowers mortality and morbidity rates. This study goal was to learn more about pregnancy outcomes and risk factors for caesarean delivery and fetal macrosomia amongst GDM mothers in Kenya (Nyeri County). A cross-sectional descriptive design was adopted for this study, which enrolled 152 gestational diabetic women attending Nyeri County Referral Hospital level 5, Othaya level 4, Mukurweini level 4 and Karatina level 4 hospitals. The age categories 30-34 and greater than 34, gestations of 37-40 weeks and live newborn delivery were all significant predictors of caesarean section delivery (p0.05). For women aged 30-34 and over 34, it was 4.674 and 12.709 times more likely to deliver via caesarean birth, respectively. Also, the females with gestation age of 37-40 weeks and those who delivered live newborns were 7.343 and 17.739 times likely to deliver through caesarean section, respectively. The age groups 30-34 and beyond 34 years, as well as the gestational age of delivery of 37-40 weeks, remained significant predictors of delivering newborns weighing 4 kg or more (p0.05). Age groups of 30-34 , above 34 years and women who delivered between 37-40 weeks of the gestational period were 6.758, 4.976 and 33.421 times more likely to deliver newborns weighing 4kg and above, respectively. Having diabetes history in the family, a prior positive history of GDM, and a prior positive unfavorable obstetric history were all independent risk factors for caesarian section birth (p0.05). For the existence of familial history of diabetes , previous positive history of GDM and positive past bad obstetric history, the odd ratios of delivering through caesarean section were 3.824, 10.331 and 7.051 times higher, respectively. The primary level of education, previous positive history of GDM and positive previous adverse obstetric history were independent risk factors for fetal macrosomia (p<0.05). The primary level of education, previous positive history of GDM and positive previous adverse obstetric history increased fetal macrosomia by more than 6.289, 5.390 and 5.804 folds, respectively. Finally, caesarean birth was independently linked with age groups 30-34 and above 34 years old, delivery during 37-40 weeks, and living newborns. The age group of 30-34 and above 34 years and the gestation period of 37-40 weeks were independent predictors of neonates delivered weighing 4kg and above. Furthermore, having diabetes in the family, having a prior positive history of GDM, and having a prior positive adverse obstetric history were all independent risk factors for caesarean birth. Besides, in Nyeri County, the primary level of education, previous positive history of GDM, and previous positive unfavorable obstetric history were all independent factors that increased the likelihood of fetal macrosomia. To enhance pregnancy outcomes, this study suggests that maternal care interventions measures for women with GDM be strengthened. In addition, the risk factors for caesarean birth and fetal macrosomia among women with GDM in Nyeri County, Kenya, should be considered in order to develop the mother and child health program among women with GDM.