Browsing by Author "Nansubuga Faridah"

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Adverse Pregnancy Outcomes Associated With Moderate Elevations in Blood Pressure or Blood Glucose in Ugandan Women: A Prospective Cohort Study
(Elsevier, 2021-05) Milln Jack; Nakabuye Betty; Natamba Barnabas; Sekitoleko Isaac; Mubiru Michael; Namara Arthur; Tumwesigire Samuel; Tino Salome; Mirembe Mandy; Kakanda Ayoub; Agaba Brian; Nansubuga Faridah; Zaake Daniel; Ayiko Ben; Kalema Herbert; Nakubulwa Sarah; Sekikubo Musa; Nakimuli Annette; Webb L. Emily; Nyirenda J. Maffat
BACKGROUND: The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recentevidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE: This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN: This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization’s criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS: Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36−5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20−2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74−3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17−3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16−2.30). CONCLUSION: Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Antenatal Management and Maternal/fetal Outcomes associated with hyperglycaemia in pregnancy (HIP) in Uganda: A prospective cohort study
(BMC, 2021-05-19) Nakabuye Betty; Sekitoleko Isaac; Mubiru Michael; Tumwesigire Samuel; Tino Salome; Mirembe Sandy; Kakande Ayoub; Agaba Brian; Nansubuga Faridah; Zaake Daniel; Ayiko Ben; Kalema Herbert; Nakubulwa Sarah; Sekikubo Musa; Nakimuli Annettee; Webb Emily L.; Nyirenda Moffat J.; Milln Jack; Natamba Barnabas Kahiira
Background: Hyperglycaemia in pregnancy (HIP) is associated with complications for both mother and baby. The prevalence of the condition is likely to increase across Africa as the continent undergoes a rapid demographic transition. However, little is known about the management and pregnancy outcomes associated with HIP in the region, particularly less severe forms of hyperglycaemia. It is therefore important to generate local data so that resources may be distributed effectively. The aim of this study was to describe the antenatal management and maternal/fetal outcomes associated with HIP in Ugandan women. Methods: A prospective cohort study of 2917 pregnant women in five major hospitals in urban/semi-urban central Uganda. Women were screened with oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Cases of gestational diabetes (GDM) and diabetes in pregnancy (DIP) were identified (WHO 2013 diagnostic criteria) and received standard care. Data was collected on maternal demographics, anthropometrics, antenatal management, umbilical cord c-peptide levels, and pregnancy outcomes. Results: Two hundred and seventy-six women were diagnosed with HIP (237 classified as GDM and 39 DIP). Women had between one and four fasting capillary blood glucose checks during third trimester. All received lifestyle advice, one quarter (69/276) received metformin therapy, and one woman received insulin. HIP was associated with large birthweight (unadjusted relative risk 1.30, 95% CI 1.00–1.68), Caesarean delivery (RR 1.34, 95% CI 1.14–1.57) and neonatal hypoglycaemia (RR 4.37, 95% CI 1.36–14.1), but not perinatal mortality or preterm birth. Pregnancy outcomes were generally worse for women with DIP compared with GDM. Conclusion: HIP is associated with significant adverse pregnancy outcomes in this population, particularly overt diabetes in pregnancy. However pregnancy outcomes in women with milder forms of hyperglycaemia are similar to those with normoglycaemic pregnancies. Intervention strategies are required to improve current monitoring and management practice, and more research needed to understand if this is a cost-effective way of preventing poor perinatal outcomes.
Gestational Diabetes (GDM) Does Not Predict Large Birthweight or Perinatal Death in a Relatively Untreated Population in Uganda: A Prospective Observational Cohort Study.
(Elsevier, 2021-05) Milln Jack; Nakabuye Betty; Natamba Barnabas; Sekitoleko Isaac; Mubiru Michael; Namara Arthur; Tumwesigire Samuel; Tino Salome; Wilja Mandy; Kakande Ayoub; Agaba Brian; Nansubuga Faridah; Zaake Daniel; Ayiko Ben; Nakubulwa Sarah; Sekikubo Musa; Nakimuli Annettee; Webb Emily; Nyirenda Moffat
BACKGROUND The association between overt hypertension and diabetes and adverse pregnancy outcomes is well documented. Recent evidence suggests that even moderate elevations in blood pressure or blood glucose may confer a significant risk in a dose-dependent manner. However, these studies have primarily been undertaken in white populations in high-income settings. Hypertension and diabetes are emerging as major public health issues in sub-Saharan Africa as the region undergoes rapid urbanization. It is therefore important to understand how such noncommunicable conditions contribute to pregnancy outcomes in these populations. OBJECTIVE This study aimed to determine the association between stage 1 hypertension or fasting blood glucose in the gestational diabetes mellitus-range and adverse pregnancy outcomes in Uganda, and to describe the effects of other contributing factors such as maternal obesity. STUDY DESIGN This was a prospective cohort study of 2857 women at 5 major hospitals in urban and semiurban central Uganda. Women were enrolled at 24 to 28 weeks’ gestation. Data about the maternal demographics, anthropometrics, fasting venous blood glucose, blood pressure, and pregnancy outcomes were collected. Moderate elevations in blood pressure and blood glucose were defined using the latest American College of Cardiology and American Heart Association definition of stage 1 hypertension and the World Health Organization's criteria for fasting blood glucose in the gestational diabetes mellitus-range. The primary outcomes of interest were perinatal death and large birthweight for gestational age, and the secondary outcomes were preterm birth, cesarean delivery, and neonatal admission. A multivariable logistic regression analysis was used. RESULTS Stage 1 hypertension increased the odds of perinatal death by more than 2-fold (adjusted odds ratio, 2.68; 95% confidence interval, 1.36–5.29), with a positive but insignificant association with preterm birth. Hyperglycemia in the gestational diabetes mellitus-range was associated with cesarean delivery only (adjusted odds ratio, 1.65; 95% confidence interval, 1.20–2.27). Maternal obesity increased the risk of having large birthweight babies (adjusted odds ratio, 2.30; 95% confidence interval, 1.74–3.02), a cesarean delivery (adjusted odds ratio, 2.75; 95% confidence interval, 2.17–3.48), and neonatal admission (adjusted odds ratio, 1.63; 95% confidence interval, 1.16–2.30). CONCLUSION Moderate elevations in blood pressure and maternal obesity are stronger predictors of adverse maternal and neonatal outcomes than moderate elevations in blood glucose levels and should be the focus of intervention in these resource-poor settings. Further research is needed to determine the cost-effectiveness of identifying and managing moderate elevations in blood pressure and maternal obesity
Prevalence of vitamin D deficiency and its association with adverse obstetric outcomes among pregnant women in Uganda: a cross- sectional study
(PubMed Central, 2025-01-09) Reverzani Cristina; Zaake Daniel; Nansubuga Faridah; Ssempewo Herman; Manirakiza Leonard; Kayiira Anthony; Tumwine Gilbert
The study was conducted on 351 pregnant women aged ≥18 years who consented to participate in the study, who had a single intrauterine pregnancy and a gestational age greater than 26 weeks, and who delivered at St. Francis Hospital, Nsambya. We excluded pregnant women admitted to the hospital longer than 1 week before delivery; pregnant women with self-reported pre-existing kidney diseases, liver diseases, or gut or malabsorption disorders and pregnant women with severe pregnancy-unrelated comorbidities requiring intensive care unit admission before delivery. Maternal venous blood was collected at admission, and serum 25-hydroxy-vitamin D (25(OH)D) was measured by an electrochemiluminescence binding assay. Maternal sociodemographic characteristics and obstetric-medical factors, and adverse maternal and foetal outcomes were captured by using a data collection form. The data were analysed by logistic regression analysis at the univariate, bivariate and multivariate levels. The prevalence of vitamin D deficiency, defined as a serum 25(OH)D concentration less than 20 ng/mL, was 40.2%. This was seen more among the Muslims (OR 2.4, 95% CI 1.33 to 4.43, p value 0.004), members of the Banyankore tribe (OR 2.1, 95% CI 1.02 to 4.36, p value 0.043) and primigravidae (OR 0.6 for women with parity of 1–4 compared with primigravidity, 95% CI 0.36 to 0.94, p value 0.028). Among adverse maternal outcomes, vitamin D deficiency was associated with hypertensive disorders in pregnancy (OR 2.4, 95% CI 1.16 to 4.10, p value <0.001), in particular gestational hypertension (OR 2.2, 95% CI 1.21 to 4.94, p value 0.014), and pre-eclampsia/eclampsia/haemolysis, elevated liver enzymes and low platelets syndrome (OR 2.9, 95% CI 1.45 to 6.08, p value 0.003), with increased preterm birth (OR of 4.0, 95% CI 1.78 to 10.84, p value<0.001) and with delivery of babies with low birth weight (OR 4.2, 95% CI 2.63 to 13.62, p value 0.001). The study found a high prevalence (40.2%) of vitamin D deficiency among pregnant women delivering at St. Francis Hospital, Nsambya. Additionally, vitamin D deficiency was linked with adverse maternal and foetal outcomes such as hypertensive disorders in pregnancy, preterm birth and low birth weight.