Geographical Determinants of the Prevalence of Gestational Diabetes in North and South Kivu in the Democratic Republic of Congo

Abstract

Objectives: To explore the geographic determinants of gestational diabetes in eastern DRC and to seek confounding factors. Methods: Cross-sectional descriptive study with a multicenter analytical aim conducted in the hot and cold season from April 2019 to February 2021. Included were 392 pregnant women at 24-28 weeks of amenorrhea. Blood glucose, cortisol, SO2, anthropometric measurements, 30 previous day’s temperature, altitude and atmospheric pressure (atm) were examined. The glycaemia ≥92mg/dL was pathological, in which case cortisolaemia was measured after matching with normal glycaemia. Data were analyzed using SPSS version 23 by calculating median, proportion, ANOVA, Pearson's Chi2 or Fisher's exact test, Wilcoxon -Mann–Whitney test. Results: The proportion of 23.8%, 37.4%, 13.8% and 25.0% of 392 pregnant women lived respectively at the altitude of 1400 m, 1500m, 1700m and 2419m. Pathological glycaemia was twice higher at < 1700 m = atm > 82% [32.9% (n = 295)] Vs ≥ 1700 m [15.0% (n = 295)] [OR 2.2 95% CI (1.5- 3.2)] (p<0.001)] and at SO2 > 95% [30.8% (n= 331)] Vs SO2 ≤ 95% [15.3% (n= 144)] [OR 2.0 95% CI (1.3 - 3.1)] (p < 0.001). Cases with pathological glycaemia had elevated cortisol [281.1 nmol/L (87.6)] (n=118) Vs normal glycaemia [261.1 nmol/L (71.1)] (n= 156)] (p= 0.024). Conclusion: The prevalence of pathological glycaemia was higher at <1700 m altitude corresponding to the atm > 82% and when the SO2 was >95%. After adjustment, blood glucose was no longer correlated with temperature.