Identifying and Treating Gestational Diabetes Among Women Living with HIV in Ethiopia

This blog was originally posted on the Maternal Health Task Force website.

Gestational diabetes may be a neglected contributor to the continuing high rates of maternal and neonatal mortality in sub-Saharan Africa. Without proper care, gestational diabetes—high blood sugar that is detected during pregnancy (and can include previously undetected pre-pregnancy diabetes)—increases the risk of eclampsia, miscarriage, obstructed labor, hemorrhage and fetal death, yet pregnant women in developing countries are rarely screened for the condition. Gestational diabetes is also a leading risk factor for preterm birth and stillbirth and can lead to other newborn health complications, such as abnormal birth weight, congenital malformation, respiratory distress syndrome and hypoglycemia.

A recent study conducted in Ethiopia by Management Sciences for Health at one rural and two urban health centers in the Tigray Region of Ethiopia aimed to understand the prevalence of gestational diabetes in Ethiopia and its risk factors and assess the feasibility of integrating low-cost services for gestational diabetes into antenatal care. The study found that relatively simple and low-cost interventions could help manage gestational diabetes for many women—but there were different outcomes among women living with HIV and those without the condition.

According to the study, more than 11% of the 1,242 pregnant women tested positive for gestational diabetes—higher than expected, since previous prevalence estimates of gestational diabetes in Ethiopia were between 4% and 9%. Nearly a quarter of the women living with HIV were diagnosed with gestational diabetes, compared with 11% of HIV-negative women.

HIV treatment and gestational diabetes

Among the HIV-positive pregnant women, 29% of those who were on antiretroviral treatment (ART) tested positive for gestational diabetes. By comparison, 15% of HIV-positive pregnant women who had not started ART prior to their pregnancies were diagnosed with gestational diabetes. This finding is especially important since Ethiopia has adopted the Option B+ treatment, which places all HIV-positive pregnant women on lifelong treatment.

The study also revealed challenges and discrepancies related to treatment for gestational diabetes. Whereas 79% of pregnant women with gestational diabetes brought their blood glucose levels to normal through low-cost behavioral interventions—including dietary changes and increased physical activity—after two weeks, less than half of the women living with HIV did so. Half of the pregnant women on ART responded positively to behavioral changes, compared to about a third of HIV-positive women not yet on ART.

Future directions

The study results are eye-opening and warrant more attention. First, the prevalence of gestational diabetes among HIV-positive women and the treatment results should be assessed on a larger scale, including the influence of ART. The high prevalence of gestational diabetes among HIV-positive pregnant women highlights the importance of screening all HIV-positive pregnant women for gestational diabetes, especially in light of expanding ART coverage and Ethiopia’s adoption of Option B+ treatment. Furthermore, HIV-positive pregnant women with gestational diabetes may need specialized treatment services. Additional research should develop and test effective new treatment models, especially in low-resource and rural settings, where women frequently have trouble accessing regular care.

Since gestational diabetes is on the rise globally, understanding its prevalence and treatment options among all women—including those living with HIV—is fundamental to ending preventable maternal mortality.

ABOUT THE AUTHORS

Dr. Mebrahtu Abraha is a public health physician with 13 years of clinical and public health work experience. He started his career as a lecturer at Mekelle University in the department of pediatrics and child health, after which he joined the HIV program and the TB program in MSH Ethiopia. He also worked in CU-ICAP Ethiopia as Deputy Regional Director and in WHO Ethiopia as Emergency Technical Officer. Dr. Mebrahtu’s experience includes clinical mentorship, provision of antiretroviral therapy, prevention of mother-to-child transmission, HIV exposed infant care, TB/HIV collaborative activities, TB/MDR TB treatment, PLHIV Care and support, Laboratory support to Regional Reference/HF laboratory quality HIV and TB service/networking, like case finding through improved GeneXpert utilization, and TB prevention and control activities implementation.

Dr. Elke Konings is a Senior Technical Director and the Population Health Practice Lead for MSH. She has more than 20 years of experience designing and leading large-scale public health programs in developing countries, particularly in Africa. Her technical expertise includes  HIV/AIDS, infectious diseases, and maternal and child health to improve health outcomes. Dr. Konings has significant experience in capacity building and skills transfer to local teams, ministries of health, and other partners. She holds a PhD in epidemiology from Imperial College, University of London, as well as an MSc in demography and a BSc in social anthropology from the London School of Economics.

Christie Roberts joined MSH in October 2017 as Senior Proposal Writer after nearly four years as Senior Proposal Writer & Program Design Manager with the Pan American Development Foundation. She has more than ten years of experience writing proposals and developing new business opportunities in the nonprofit sector, including as Director of Programs for the national office of the World Affairs Councils of America and as a consultant to several nonprofit organizations. Christie holds Master’s degrees in International Studies from the University of Denver and in International Conflict Analysis from the University of Kent’s Brussels School of International Studies; she also has a BA in Sociology and a certificate in Women’s Studies from Brandeis University. She speaks French and Spanish, and a useful smattering of Levantine Arabic. 

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