Screening for hyperglycaemia in pregnancy (HIP) is an entry point to a healthy pregnancy and childbirth for both the woman and child, and offers a window of opportunity for the prevention of cardio-metabolic complications over the life-course of the woman and newborn. In Tanzania, two different screening algorithms to identify women with HIP are recommended, with no clear understanding of which performs better. We aimed to determine the prevalence of hyperglycemia in pregnancy (HIP) among antenatal care (ANC) attendees and the accuracy of HIP screening tests.

A cross-sectional study design involving 970 women attending ANC clinic was done in two district hospitals (Mbagala Rangi Tatu and Kisarawe) of Tanzania between June and October 2024. Socio-demographic, obstetric characteristics, and anthropometric parameters were obtained from study participants. A checklist screening test (CST) for gestational diabetes mellitus (GDM), defined by the Tanzanian standard treatment guideline, was used. We tested for glycosuria and two-hour 75-gram oral glucose tolerance test (OGTT) on every study participant. We conducted descriptive statistics and sensitivity analysis to determine the prevalence of HIP and assess the screening performance of CST and glycosuria test against OGTT using World Health Organization 2013 diagnostic criteria for GDM.

The prevalence of HIP was 10% (7.9% GDM and 2.1% diabetes in pregnancy). Glycosuria test missed all women with GDM and could identify only 20% with diabetes in pregnancy. The CST had a sensitivity and specificity of 72.2% and 32.4%, respectively, while the glycosuria test had 4.1% and 97.1%. The area under the receiver operator characteristic curve for both the CST 0.523 (0.48-0.57,95%CI) and glycosuria test 0.506 (0.49-0.53,95%CI) was low, indicating their poor discriminatory performance for HIP.

One in every ten women had HIP. The CST is a better first-step screening test than the glycosuria test based on sensitivity.

The authors have declared no competing interest.

This work was supported by the Directorate-general Development Cooperation and Humanitarian Aid Belgium through the Institute of Tropical Medicine, Antwerp, Belgium (Institute of Tropical Medicine in Antwerp | Institute of Tropical Medicine) as part of the Sandwich PhD scholarship for AK. The Tanzania Diabetes Association (Tanzania Diabetes Association – Support needy people living with diabetes) supported part of the monthly payment of the research assistants and laboratory supplies. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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The study received ethical approval from the Institutional Ethics Committee at the Institute of Tropical Medicine, Antwerp 1687/23, Muhimbili University of Health and Allied Sciences Research and Ethics committee MUHAS-REC-07-2023-1834 and the National Health Research Ethics Review Committee NIMR/HQ/R.8a/Vol.IX/4457.

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