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.