Hyperglycemia in pregnancy: A sensitivity analysis study of two recommended screening tests in Tanzania.

Abstract

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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

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.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

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.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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Data Availability

Data will be available upon reasonable request through the National Institute of Medical Research, Tanzania - National Health Research Ethics Review Sub-committee - publicationsnimr.or.tz www.nimr.or.tz

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