Gestational Diabetes: a Risk Factor for Maternal Death in Tigray, Ethiopia

In the developed world, pregnant women are routinely screened for gestational diabetes. As a result, in the United States, about nine percent of pregnant women are diagnosed with gestational diabetes, a condition that if left untreated can have devastating effects on both the mother and baby. In the United States, however, as in the rest of the developed world, the vast majority of these women work with their physician or midwife to manage their blood sugar and go on to safely deliver healthy babies.

But in Ethiopia, like most other developing countries, women are rarely screened for gestational diabetes mellitus (GDM). In the rare event that they are screened and diagnosed, they have few options for managing the disease. Diabetes services, if available, are based at urban hospitals, where less than 10 percent of pregnant women seek antenatal care. Providers at these facilities typically follow international guidelines, which require multiple blood tests per day and thus are of limited practical use in resource-poor environments.

Estimated at 676 deaths per 100,000 live births, maternal mortality in Ethiopia is more than three times the worldwide average.The most common causes of maternal death in Ethiopia are hemorrhage, eclampsia, hypertension, and obstructed labor. Interventions to improve maternal health have rightfully focused on preventing and treating these specific complications.

GDM, however, though it is never listed as a cause of maternal death, significantly increases the risk for all four of these maternal killers and yet is rarely addressed in resource-constrained settings.

Diabetes is on the rise in Ethiopia, where it is estimated that 1.4 million people are living with the disease, twice the number of people living with HIV. Identifying women with GDM provides an opportunity not just to improve pregnancy outcomes, but for women to make changes in their lifestyle to help prevent development of diabetes later in life.

It was previously estimated that gestational diabetes occurs in four to nine percent of pregnant women in Ethiopia, but these data are scant and old. An estimated 80 percent of cases remain undiagnosed. Therefore,Management Sciences for Health (MSH) set out to assess the prevalence of gestational diabetes among women served at the public health centers in Tigray, Ethiopia and determine whether or not providers at these facilities could provide adequate care for diabetic pregnant women. MSH funded the study through its Innovation Challenge Fund and implemented it in collaboration with the Ethiopia Network for HIV/AIDS Treatment, Care, & Support (ENHAT-CS) program, a USAID initiative funded by PEPFAR.