Association between adherence to anti-diabetic therapy and adverse maternal outcomes in Diabetes in pregnancy

Objectives: To analyse the association between adherence to anti-diabetic therapy (diet, physical activity and medications) and perinatal outcomes. Methods: A cohort design was used. Participants were 157 pregnant women with diabetes, and the setting was Mbuya Nehanda and Chitungwiza Maternity Hospitals, Harare, Zimbabwe. Results: Main outcome measures were maternal and perinatal outcomes. Mean adherence to anti-diabetic therapy was 66.7%. Perinatal outcomes observed were hypertensive disorders (34.5%), Caesarean delivery (45.9%), maternal diabetic ketoacidosis (5.1%), maternal hypoglycaemia (15.9%), and candidiasis (19.7%). Neonatal outcomes were perinatal mortality (15.9%), low Apgar score at 1 minute (26.8%), low Apgar score at 5 minutes (24.8%), macrosomia (33.8%), neonatal hypoglycaemia (15.3%), and neonatal hyperbilirubinemia (7.6%). There were significant associations between adherence and Caesarean delivery (RR 1.9, 95% CI 1.28 to 2.81, p = 0.0014), candidiasis (RR 3.95, 95% CI 1.65 to 9.47, p = 0.002), low Apgar score at 1 minute (RR 2.15, 95% CI 1.16 to 3.98, p = 0.015) and at 5 minutes (RR 1.95, 95% CI 1.03 to 3.69, p = 0.039), and perinatal mortality (RR 3.08, 95% CI 1.11 to 8.52, p = 0.018). Conclusions: Adherence to anti-diabetic therapy was sub-optimal and was associated with some adverse perinatal outcomes. Promotion of adherence, through routine individualised counselling, monitoring and assessment, is vital to minimise adverse outcomes. (Full text available online at www.medpharm.tandfonline.com/oemd ) Journal of Endocrinology, Metabolism and Diabetes of South Africa 2018; DOI: 16089677.2018.1465247