Diabetes in pregnancy affects women in one of two ways: pregestational (which includes type 1 and type 2 diabetes) or gestational diabetes mellitus (GDM). By the 1950s, the word “gestational diabetes” had been coined to describe what was believed to be a temporary disease that had a negative impact on foetal outcomes and then disappeared after birth (1).

GDM, is carbohydrate resistance that starts or is first recognized throughout pregnancy (2). This diagnosis does not extend to pregnant women who have already been diagnosed with diabetes before becoming pregnant. Gestational diabetes has a pathophysiology which is similar to that of type 2 diabetes. As the pregnancy progresses, tissue resistance to insulin increases, necessitating the use of more insulin (3). The demand is easily met in the vast majority of pregnancies, so the balance between insulin resistance and insulin supply is maintained. Women, on the other hand, become hyperglycaemic if resistance becomes dominant. This typically happens in the second trimester of pregnancy, with insulin resistance steadily increasing before delivery, and usually disappears quickly after delivery (4). In 2017, one in every seven births was diagnosed with GDM, according to the International Diabetes Federation (IDF) (5). Globally, the prevalence of GDM is estimated to be about 15%, according to a systemic review (6). GDM prevalence ranges from 2-6 percent in most racial/ethnic groups studied to, 10-20 percent in high-risk populations, with a growing trend across most racial/ethnic groups (7). Since ethnicity has such a strong impact on GDM, the prevalence rate varies by race. The prevalence of GDM in Sub-Saharan Africa is around 14% (8). As at 2014 in Ghana, GDM was discovered in 10% of pregnant women (9). The prevalence of gestational diabetes in Ghana is increasing at a very fast rate. In 2004 and 2015, studies conducted in Ghana indicated a prevalence of 0.5% and 9.3% respectively (10, 11).

The prevalence of GDM is projected to continue to increase due to the rising obesity epidemic, delayed childbearing, and multiple pregnancies (12). Gestational diabetes is known to have serious short and long-term effect on both the mother and foetus. GDM may cause pregnancy complications such as high blood pressure, heavy birth weight babies, and obstructed labour in the short term (11). GDM tends to be a major risk factor for the development of type 2 diabetes (T2D) and cardiovascular diseases in women (13–15). Obesity and T2D are more likely to occur in children whose mothers had diabetes during pregnancy (16).

The development of gestational diabetes has been associated with several predisposing factors. These predisposing factors can be studied under lifestyle, obstetric, socio-demographic and clinical risk factors. Some of the obstetric risk factors associated with GDM includes previous abortion, parity and stillbirth (17). Socio-demographic risk factors studied so far also include age, ethnicity and family history of diabetes (18, 19). Clinical risk factors assessed are obesity and hypertension. Lifestyle risk factors like diet, physical activity, smoking and alcoholism are also known to have a link with GDM (19).

Despite the fact that urine dipstick has been accepted as the major screening criteria for GDM in Ghana, it is limited to renal threshold, hence most pregnant women who develop GDM later in their pregnancy are still excluded during regular screening programs for women. The risk factors of gestational diabetes can be used as a better diagnostic tool for early screening of women at risk hence it is necessary to identify the socio-demographic, obstetric, clinical and lifestyle risk factors of GDM. However, in Ghana and especially in greater Kumasi metropolis, there is no enough data on the risk factors associated with GDM. Therefore, this study is warranted.

Recently, the incidence of gestational diabetes mellitus (GDM) has increased globally and Africa is not an exception. This study therefore evaluated the prevalence and risk factors of GDM in Kumasi, Ghana. Our study observed a prevalence of 8.5% gestational diabetes mellitus cases among study participants. Previous use of oral contraceptive, and intake of soda drinks as the independent risk factors of gestational diabetes mellitus.

The present study prevalence of 8.5% gestational diabetes is in consistent with that of Anzaku et al. (20), who reported a prevalence of 8.3% among Nigerians (20). On the contrary, the observed prevalence of this study shows a decrease in the prevalence of gestational diabetes compared to that of Oppong et al. (10), who reported 10% prevalence gestational diabetes among Ghanaians. The observed difference in prevalence may be attributed to the present study recruited participants from a clinic setting as opposed to Oppong et al. study conducted at a teaching hospital. Surprisingly, majority of study participants had normal BMI and exercise regularly which explain why we observed a decreased in prevalence of gestational diabetes as compare to previous study reported among Ghanaians.

In this current study, we observed previous use of oral contraceptive as independent risk factor of gestational diabetes. This is in consistent with a study by Kramer et al. (21), who reported the use of oral contraceptives is associated with gestational diabetes (21). The agreement between the current and previous study provides evidence that hormonal contraceptive methods may increase a woman’s risk for GDM since most oral contraceptives are made up of oestrogen and progesterone which in excess induces hypercortisolism and therefore leading to insulin resistance and hyperglycaemia in pregnancy.

Our study observed that, patients with history of preeclampsia were 19-fold more likely to develop GDM. Lee et al. (22), found preeclampsia to be associated with GDM in subsequent pregnancy. This can be explained that the two disease conditions share a common pathophysiology and are characterized by systemic endothelial dysfunction (22).

Another finding of this study was that intake of soda drinks is independently associated with GDM. This finding confirms previous study by Donazar-Ezcurra et al. (23), who reported dietary intake of soda have a strong association with weight gain and metabolic syndrome. This could be explained as leading to spike in insulin which worsen insulin sensitivity overtime thereby enhancing insulin resistance leading to hyperglycaemia.

Previous studies have shown that lifestyle risk factors such as history of smoking, alcoholism and regular exercise are also highly associated with GDM (24). On the contrary, this study did not show similar finding.

Even though the strength of the present study is that it is the first study to be reported in the metropolis, our use of a cross-sectional study design limits this study findings as the casual-effect relationship could not be established. Therefore, it is recommended that a cohort study design should be employed in subsequent studies to help assess more potential risk factors of GDM.

This study evaluated the prevalence and risk factors associated with GDM in Kumasi, Ghana. We observed GDM prevalence of 8.5% among study participants, which was influenced by previous history of oral contraceptives use, history of preeclampsia and consumption of soda drink

It is recommended that pregnant women be educated on lifestyle modification and the need to reduce consumption of soda drinks and the use oral contraceptives.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by The Committee on Human Research, Publication and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology. The patients/participants provided their written informed consent to participate in this study.

EOA, WB, and PK. Methodology: EOA, WB, and PK. Formal analysis, PK, ES, and SO. Investigation, WB, EOA, andPK. Original draft preparation, EOA, PK, SO, and ES. Supervision,EOA and WB. All authors listed reviewed, edited have made a substantial, direct, and intellectual contribution to the work and approved it for publication. All authors contributed to the article and approved the submitted version.

This study was funded by TiDi Foundation, a non-governmental funding body which supports student research with a seed fund of 140 dollars.

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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