Analysis of Risk Factors for Gestational Diabetes in El Oued (Algeria) Population

Basma Chihani¹, Chaima Djaballah¹, Samir Derouiche^1,2*

¹Department of Cellular and Molecular Biology, Faculty of the Sciences of Nature and Life, El Oued University, El Oued 39000, El Oued, Algeria.

²Laboratory of Biodiversity and Application of Biotechnology in the Agricultural Field, Faculty of the Sciences of Nature and Life, University of El Oued, El-Oued 39000, Algeria.

*Corresponding Author E-mail: dersamebio@gmail.com

ABSTRACT:

This study was conducted aiming at evaluating some risk factors in patients with Gestational Diabetes (GD) in El Oued (Algeria) region. Our study is based on 140 voluntary individuals divided into pregnancy healthy women reserved as a control with average age of 28.14±0.76 years old and pregnancy gestational diabetes patients with average age of 34.93±0.73 years old; their origin covers the whole El Oued (Algeria) region. Risk of certain socio-clinical factors has been estimated by the determination of the value of Odd Ratio (OR). Our study that disease in the first pregnancy, family history, chronic disease and taking contraceptive after 30 year shown to be significant risk factors for gestational diabetes in the study population with the highest OR value (9.428 - 58.105; P <0.05), while sport and food additifs (OR=0.330; P=0.004, OR=0.404; P=0.010) respectively are important protective factors against this disease. Lifestyle is a contributing factor in GD attainment in the region of El Oued (Algeria), which requires high sensitivity to modify these behavior for limited progression of the disease in this region.

KEYWORDS: GD, Risk Factors, pregnancy, protective factors, El Oued.

1. INTRODUCTION:

Pregnancy is a period of rapid growth and cell differentiation for both the mother and fetus [1] the pregnant woman presents a diagnostic challenge as physiological; anatomical and biochemical changes of pregnancy may mask symptoms and signs, as well as the pregnancy itself being the source of the problem [2]. This event is accompanied by serious health risks, even for women with no previous health problems [3]. Acute complications of pregnancy can appear in all trimesters, their diagnosis and management are great challenges factors affecting pregnancy outcome are socioeconomic status, smoking status and other health related conditions and behaviors [4].

Pregnancy induces changes in maternal glucose metabolism and insulin sensitivity, pregnant women are able to meet the increased insulin demand, but in some cases these needs are not met resulting in poor glycemic control and consequently GDM [5]. In later years, there has been an increased incidence of gestational diabetes mellitus (GDM). GDM is the most common complication of pregnancy, with important effects on maternal and fetal health, even years after delivery [6]. GDM is defined, according to the American Diabetes Association (ADA), as a diabetes that is first diagnosed during pregnancy that is not clearly overt diabetes before gestation [7]. Until now , there is not any directly cause of GDM but several risk factors are introduced as causative factors of developing gestational diabetes mellitus such as advanced age (≥35 yrs.), overweight or obesity, family history of diabetes [8], excessive gestational weight gain, excessive central body fat deposition, short stature (<1.50m), excessive fetal growth, hypertension or preeclampsia in the current pregnancy, and polycystic ovary syndrome [9]. Many studies have suggested that the cause of progression GDM is the oxidative stress [10] that reported increased free radical production and antioxidant depletion in gestational diabetes. Indeed, pregnancy exposes many complications that may be related to an alteration of oxidative stress that is also associated with the appearance of several pathologies during pregnancy which is considered a very important risk factor [11]. Faced with this problem, And in the absence of statistics or scientific study on this disease and its risk factors in these regions of Algeria, this study aims at identifying the factors associated with gestational diabetes disease in relation to levels of socioeconomic development and health-care systems in individuals of the El Oued, (Algeria) population who have undergone hospitalization in a public hospital.

2. MATERIAL AND METHODS:

2.1. Subject of Study:

Ethical approval was requested and approved by the ethics committee (63 EC/DCMB/FNSL/EU2019) of the department of cellular and molecular biology, faculty of natural sciences and life, University of El Oued. Our study was based on 140 voluntary individuals divided into pregnancy healthy women reserved as a control (n=70) with average age of 28.14±0.76 years old and pregnancy gestational diabetes patients (n=70) with average age of 34.93±0.73 years old. In this study, we divided the subjects into two groups according to the simple randomization method. All of the volunteers (control and patients) in this study live in the El Oued area located in the south east of Algeria. Therefore, their social and demographic information including age, weight, social case, job, educational level, and blood group were collected by completing the questionnaires from their medical records or through a direct discussion with patients. In the questionnaires, we relied on many variables, which can be the cause of the dis ease, including Clinicopathological variables such as Contraceptive pill, Regular menstrual, Caesaran births and Polycysticovarian disease. There are also other variables related to social behaviors of people such as Passive Smoke, Social problems, using spices and Obesity.

2.2. Inclusion and Exclusion Criteria:

We included in this study women who had clinical diagnosis and laboratory findings of pregnancy gestational diabetes, lived in the El Oued (Algeria) region. Regarding the control group, the participants are pregnancy health people not suffering from diabetes or other chronic or acute diseases. Exclusion criteria were to eliminate all other types of diabetes.

2.3. Statistical Analysis:

Values were expressed as percent per population or as the mean±Standard Deviation (SD). Data were presented using frequency tables. Chi-square test was used to test for association between risk factors and gestational diabetes (GD). Relative risks and Odds ratios were calculated by Cochran's and Mantel Haenszel statistics using SPSS 16. Odds ratios >1 and P<0.05 indicate a significant risk factor. OR<1 and P<0.05 indicate a significant protective factor.

3. RESULTS:

3.1. Description of study population:

Characteristics of the study population are shown in table 1. Women volunteers for this study from wilaya of El Oued. After a women agreement to participate in this study, the selected population reaches 70 control and 70 women with gestational diabetes a sample size large enough to maintain statistical power. The results obtained are homogeneous in both control and women with gestational diabetes, there is shown that no significant difference concerning mean age, number of children, body weight, job (worker and house wife), masse index and educational level. On the other hand, the blood types are different between the two groups studied.

Table 1. Description of study population.

Patients	Control
0.736±34.938	0.767±28.145	Age (year)
3.615±0.217	0.269±2.297	Number of children
4.50 ±89.30	72.66±2.56	Weight (kg)
2.18 ± 28.69	26.985±0.863	Mass index (kg/m²)
20.96	12.85	Worker (%)	Job
79.03	87.14	Housewife (%)	Job
3.51	12.85	Primary (%)	Educational Level
33.33	38.57	Medium (%)
35.09	21.42	Secondry (%)
28.07	25.71	High School (%)
32.25	27.27	A (%)	Blood type
6.45	16.66	B (%)
6.45	3.03	AB (%)
54.8	53.03	O (%)

3.2. Study of socioeconomic and clinic factors:

Odds ratio (OR) values for socioeconomic factors (table 2) and clinic pathological factors (table 3) show that passive smoke, social problems, obesity, big baby, eating sugar and overweight are shown to be significant risk factors for gestational diabetes OR (1.99-5.41) with P<0.05. In addition disease in the first pregnancy, family history, chronic disease and taking contraceptive after 30 year also shown to be significant risk factors for gestational diabetes in the study population with the highest OR value (9.428-58.105) with P<0.05. In contrast sport is protective factors against gestational diabetes in the study population (OR=0.330; P=0.004, OR=0.404; P=0.010) respectively. As that fast food, soda, canned food, spices, tap water, movement, nervousness, contraceptive pill, pills regularly, abortion, caesarean births, regular menstrual and polycystic ovarian disease are not considered as predictors of gestational diabetes in our population since the OR values obtained are not significant.

Table 2. Comparison of the Socioeconomic features of gestational diabetes patients and control (N=140)

P-value	CI _95%	OR*	Patient (%)	Control (%)
0.001	6.117-1.536	3.065	64.6 37.3	35.4 62.7	Passive Smoke Positive Negative
0.419	2.661- 0.528	1.185	53.3 49.1	46.7 50.9	Fast food Positive Negative
0.571	2.010-0.498	1.000	50 50	50 50	Soda Positive Negative
0.048	4.17 -0.952	1.994	61.9 44.9	38.1 55.1	Sugars Positive Negative
0.004	0.723-0.150	0.330	30.8 57.4	69.2 42.6	Sport Positive Negative
0.297	2.596-0.640	1.289	54.2 47.8	45.8 52.2	Canned food Positive Negative
0.002	6.240-1.452	3.010	67.3 40.7	32.7 59.3	Social problems Positive Negative
0.429	2.283-0.565	1.135	51.1 47.9	48.9 52.1	Spices Positive Negative
0.401	3.494-0.477	1.292	55.6 49.2	44.4 50.8	Tap water Positive Negative
0.010	0.830-0.196	0.404	35.4 57.6	64.6 42.4	Food additives Positive Negative
0.002	8.326-1.502	3.536	72.7 43	27.3 57	Obesity Positive Negative
0.002	5.693-1.444	2.867	63.2 37.5	36.8 62.5	Overweight Positive Negative
0.225	1.639-0.217	0.596	48.4 61.1	51.6 38.9	Movement/Activity Positive Negative
0.500	2.151-0.529	1.066	50.5 48.9	49.5 51.1	Nervousness Positive Negative

*OR > 1 and P < 0.05indicate a risk factor.

*OR < 1 and P < 0.05 indicate a protective factor.

Table 3. Comparison of the clinic pathological of gestational diabetes patients and controls (N=140)

P-value	CI _95%	OR*	Patient (%)	Control (%)
0.429	2.283-0.565	1.135	52.1 48.9	47.9 51.1	Contraceptive pill Positive Negative
0.018	0.911-0.012	9.428	48.8 90.0	51.2 10.0	Contraceptive pill after 30 y Positive Negative
0.201	1.638-0.162	0.516	42.9 59.3	57.1 40.7	Pills regularly Positive Negative
0.122	1.403-0.120	0.411	48.0 69.2	52.0 30.8	First birth before 30 y Positive Negative
0.500	2.219-0.517	1.071	51.2 49.5	48.8 50.5	Caesaran births Positive Negative
0.476	1.888-0.441	0.913	52.7 55	47.3 45	Regular menstrual Positive Negative
0.181	4.220-0.680	1.694	60.9 47.9	39.1 52.1	Polycysticovarian disease Positive Negative
0.500	1.837-0.485	0.944	49.2 50.6	50.8 49.4	The fall of pregnant Positive Negative
0.000	184.716-3.088	23.885	94.7 43.0	5.3 57.0	Disease in the first pregnancy Positive Negative
0.000	442.132-7.636	58.105	97 35.5	3 64.5	Family history Positive Negative
0.000	252.653-4.369	33.222	96.3 43.9	3.7 56.1	Chronic disease Positive Negative
0.000	11.808-2.487	5.419	75.5 36.3	24.5 63.7	Big baby Positive Negative
0.226	1.472-0.333	0.700	43.6 52.5	56.4 47.5	Others diseases Positive Negative

*OR > 1 and P < 0.05 indicate a risk factor.

*OR < 1 and P < 0.05 indicate a protective factor.

4. DISCUSSION:

Our study showed that passive smoke was significantly associated with gestational diabetes risk. This result is in agreement with study of Leng et al., (2010) who showed that passive smoking during pregnancy increased gestational diabetes mellitus (GDM) risk with pre-pregnancy obesity [12]. Passive smoking or involuntary smoking or second-hand smoke (SHS) which is also called environmental tobacco smoke, is formed from the burning of cigarettes and other tobacco products and from smoke exhaled by the smoker [13], passive smoke inhalation during pregnancy makes gestational diabetes more likely, bringing with it negative health consequences for the mother and her baby [14]. Obesity is a well-established risk factor for GDM [15]. Several studies have shown that passive smoking amplified the effect of maternal pre-pregnancy obesity on GDM risk to further increase the prevalence of GDM [16]. Our result showed that overweight and obesity was significantly associated with gestational diabetes risk. Other study confirmed that obesity is a strong risk factor for pregnancy complications and also overweight women increased risk for gestational diabetes [17]. Obesity in pregnant women increases the risk of gestational diabetes mellitus (GDM). Maternal body mass index is positively correlated with systemic inflammation, as shown by the high levels of TNF-α, macrophages accumulate in the stroma of placental villi [18]. This accumulation is associated with an increase in pro-inflammatory cytokines as leptin, Tumor Necrosis Factor (TNF), and Interleukin-1 (IL-1) [19]. These cytokines participate in the pathophysiology of this disease as well as oxidative stress causing an increase in gestational diabetes associated with insulin resistance [20]. Obesity and insulin resistance are central attributes of both GDM and the metabolic syndrome. These characteristics and dyslipidemia are associated with endothelial dysfunction, oxidative stress and over expression of inflammatory responses [21,22]. Our study showed that eating sugars a lot during pregnancy and the big weight of baby were significantly associated with gestational diabetes risk. During pregnancy, some of the hormones produced by the placenta reduce the action of insulin. The pancreas then needs to produce extra insulin to keep blood glucose levels in the normal range [23]. If the pancreas is unable to produce enough insulin, blood glucose levels rise and gestational diabetes develop [24]. If blood glucose levels are high during pregnancy, glucose passes through the placenta to the baby, who then makes extra insulin. This can make the baby grow too big, which can cause problems during labor, and increase the risk of early delivery or the need for a caesarean section [25]. The results of our study showed that women at first pregnancy and the use of contraceptive pill after the age 30 years are prone to gestational diabetes risk .Our results is in agreement with the study of Buchanan et al., (2012) which showed that women in the first baby have a GDM risk [26] and with the results of Rebecca et al (2013) show that the use contraceptive pill, after the age 40 years is a risk factor for gestational diabetes [27]. The use of oral contraceptives has a direct effect on the regulation of blood glucose by promoting a disruption of the glucose control system in the body [28]. It is in agreement with the study of Catherine et al (2002), which show that the use of contraceptive increased glucose and insulin levels and risk of diabetes. Social problem is a significant risk for GDM according to our results [29]. It may represent in depression. Depression during pregnancy is associated with poorer maternal health, increased likelihood of obstetric complications, preterm birth, and neonatal complications [30], depression is linked to obesity and insulin resistance [31], women with depression who become pregnant should be carefully monitored for impaired glucose tolerance. In addition, certain antidepressant and centrally acting antipsychotic medications may increase the risk of type 2 diabetes. This relationship is attributable to several mechanisms, both associated with and independent of weight gain [32], and a similar relationship may exist for GDM. Our results show that family history is a risk factor for GDM. There are studies that have examined the familial clustering of GDM and type 1and type 2 diabetes [33]. Studies of Dorner et al (1987) who showed an increase in familial aggregation of diabetes on the maternal side of offspring with type 1 diabetes whose mothers had GDM [34].

5. CONCLUSION:

Hence, in this study it was found that passive smoking, social problems and clinical factors such as obesity, contraceptive pills and gestational diabetes, but family history and chronic disease are the most dangerous risk factors for GDM. which indicates the importance of social behavior and the clinical factor of Gestational Diabetes involvement. In contrast, sports and daily activity are important protective factors for GD disease in the study population.

6. COMPETING INTERESTS:

The authors declare no competing interests.

7. ACKNOWLEDGEMENT:

This work was supported by the research project D01N01UN390120190001 funded by the ministry of higher education, Algeria.

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Received on 10.04.2020 Modified on 28.04.2020

Asian J. Pharm. Res. 2020; 10(3):177-182.

DOI: 10.5958/2231-5691.2020.00031.3