Association between gestational diabetes mellitus and dyslipidemia in the Buea Health District, Cameroon

Abstract

BACKGROUND

Gestational diabetes mellitus (GDM), characterized by glucose intolerance, is an increasingly prevalent public health issue linked to both maternal and neonatal complications. Dyslipidemia, a cardiovascular risk factor associated with insulin resistance, can exacerbate GDM and lead to more severe maternal and fetal outcomes. While lipid changes are normal in pregnancy, excessive dysregulation may cause endothelial dysfunction, inflammation, and complications such as preeclampsia, macrosomia, and cesarean delivery. Understanding the burden of these conditions in local settings is crucial for early risk identification, targeted prevention, and improved maternal-fetal health.

AIM

To determine the prevalence and identify factors associated with GDM and its association with dyslipidemia among pregnant women attending health facilities in the Buea Health District (BHD), Cameroon.

METHODS

A cross-sectional hospital-based study was conducted from January 2024 to July 2024 in the BHD. A total of 113 pregnant women were selected by convenience. Sociodemographic, obstetric, and lifestyle data were collected using a structured and pretested questionnaire. Lipid profile was evaluated by enzymatic colorimetric methods. GDM was diagnosed by the oral glucose tolerance test using the National Institute for Health and Care Excellence 2015 criteria. Data were analyzed using the Statistical Package for Social Sciences version 26. The Student’s t-test was used to compare mean biochemical parameters between groups. Multivariate logistic regression analysis was conducted to assess the association between GDM and dyslipidemia. P < 0.05 was considered statistically significant.

RESULTS

The age of participants was 28.70 ± 5.19 years. The prevalence of GDM in the BHD was 10.6%. Pregnant women aged ≥ 34 years had an 11.47-fold higher risk of developing GD than their counterparts aged 20-26 years [adjusted odds ratio (aOR) = 11.47, 95% confidence interval (95%CI): 1.19-3.15; P = 0.03]. Also, unemployed women had an 8.80-fold higher risk of developing GDM compared to those who were employed (aOR = 8.80, 95%CI: 1.01-2.06; P = 0.04). Furthermore, women who exercised infrequently had a 10.31-fold higher risk of developing GDM than their counterparts who exercised daily (aOR = 10.31, 95%CI: 1.69-3.06; P = 0.02). Also, women who had a family history of diabetes were 4.35 times more at risk of developing GDM than their counterparts who had no family history (aOR = 4.35, 95%CI: 0.91-2.10; P = 0.04). The prevalence of dyslipidemia was 31.90%, and it was associated with the trimester of pregnancy (P = 0.003). Pregnant women in their third trimester of pregnancy had a 2.86-fold higher risk of developing dyslipidemia compared to those in their second trimester (aOR = 2.86, 95%CI: 1.06-7.70; P = 0.004). Also, GDM was associated with dyslipidemia (P = 0.037).

CONCLUSION

The prevalence of GDM and dyslipidemia among pregnant women in the BHD was 10.6% and 31.90%, respectively. Dyslipidemia was associated with GDM. Advanced maternal age, unemployment, less frequent exercise, and family history of diabetes mellitus were associated with GDM in the BHD.

Key Words: Prevalence; Gestational diabetes mellitus; Dyslipidemia; Association; Buea Health District; Cameroon

Core Tip: This study revealed an association between gestational diabetes mellitus (GDM) and dyslipidemia in the Buea Health District (BHD), Cameroon. The prevalence of GDM and dyslipidemia among pregnant women in the BHD was 10.6% and 31.90%, respectively. Advanced maternal age, unemployment, less frequent exercise, and family history of diabetes mellitus were important predictors of GDM in the BHD. The high prevalence of GDM and associated dyslipidemia in the BHD underscores the urgent need for comprehensive clinical and public health strategies including enhanced screening, lifestyle interventions, and postpartum follow-up to mitigate risks for mothers and newborns.

INTRODUCTION

Gestational diabetes mellitus (GDM) is defined as glucose intolerance first detected during pregnancy in women without pre-existing diabetes, typically manifesting between the 24^th and 28^th weeks of gestation[1]. The underlying etiology of GDM involves multiple hormonal and physiological factors. For instance, maternal pancreatic β-cell dysfunction leads to impaired insulin secretion, while placental hormones increase insulin secretion during the second and third trimesters[2]. When maternal β cells fail to compensate for these pregnancy-induced metabolic changes, hyperglycemia develops[2]. GDM has emerged as a growing public health concern, affecting a substantial proportion of pregnancies worldwide, with prevalent rates varying significantly across different populations and ethnic groups[3]. In 2023, the International Diabetes Federation Diabetes Atlas estimated the global standardized prevalence of GDM to be 14.0%, although this varies depending on the diagnostic criteria used[4]. The proportion of mothers diagnosed with GDM increased in the United States from 6.0% in 2016 to 8.3% by 2021, with similar upward trends observed in other regions[5]. A 2019 systematic review reported a pooled GDM prevalence of 14.28% in sub-Saharan Africa[6], whereas a 2024 review found a lower pooled prevalence of 3.05% across the African continent[7]. Regional disparities exist with Central Africa recording the highest prevalence (20.4%) and Northern Africa the lowest (7.57%)[8]. The high prevalence of GDM has also been observed in East Africa (16.76%) and Southern Africa (14.28%)[8]. In Cameroon, the reported prevalence of GDM ranges from 5% to 20.5%, depending on the diagnostic criteria used[9]. Cameroon reportedly has the highest prevalence of GDM in the Central African Region[8]. Several risk factors for GDM have been identified, including advanced maternal age, high body mass index and obesity, a family history of diabetes, a history of previous GDM, and previous adverse pregnancy outcomes such as macrosomia, stillbirth, or abortion[10]. Additionally, lifestyle, clinical, and sociodemographic factors contribute to GDM[11]. Early detection and management of GDM are important due to its short- and long-term health complications in both the mother and fetus[12]. In the short term, GDM is associated with complications such as hypertension, cesarean section, pre-eclampsia, and difficulty during labor[13]. In the long run, it may reappear in subsequent pregnancies, increasing the mother's risk of developing type 2 diabetes later in life[13]. For the fetus and neonate, GDM can lead to macrosomia, birth trauma, neonatal hypoglycemia, hyperbilirubinemia, and an elevated risk of childhood obesity and type 2 diabetes later in life[14]. Furthermore, GDM can be exacerbated by dyslipidemia, metabolic disorder marked by elevated total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), or triglycerides (TGs), and reduced high-density lipoprotein cholesterol (HDL-C)[15]. Dyslipidemia is a modifiable risk factor for cardiovascular diseases such as stroke, myocardial infarction, and atherosclerosis[16]. During a normal pregnancy, lipid concentrations naturally rise with gestational age to support fetal growth and development; however, excessive elevations in maternal lipid have been associated with adverse pregnancy outcomes such as pregnancy-induced hypertension, macrosomiapreterm birth, preeclampsia, and macrosomia[17]. Furthermore, adverse fetal outcomes such as fetal growth restriction, low Apgar scores, macrosomia, birth asphyxia, fetal distress, and even fetal death have been associated with maternal dyslipidemia and GDM[18]. The interplay among insulin resistance, inflammation, and altered metabolic pathways provides a biological link between GDM and dyslipidemia[19]. To better understand the burden of GDM and generate evidence to strengthen strategies aimed at preventing adverse fetal and neonatal outcomes in settings such as the Buea Health District (BHD), it is essential to investigate the prevalence and determinants of GDM and its association with dyslipidemia.

Therefore, this study determined if women diagnosed with GDM in the BHD of Cameroon are more likely to also experience dyslipidemia. Since both GDM and dyslipidemia can lead to adverse maternal and fetal outcomes, an understanding of their association could inform better screening, prevention, and management strategies in the BHD.

MATERIALS AND METHODS

Study design, period, setting, and sampling

A hospital-based cross-sectional study was conducted among pregnant women in the BHD over a 7-month period, from January 2024 to July 2024. This health district hosts the Buea Regional Hospital, a referral hospital in the South West Region of Cameroon. The district comprises 7 health areas and 25 health facilities. Antenatal care services (ANCs) are offered in all government and some private health facilities. Five integrated public health centers, which together accounted for approximately one-third of the total target population, were purposely selected as study sites. These centers are generally managed by senior nurses or midwives serving as heads of centers.

Participants were enrolled into the study by convenience sampling. A sample size of 113 pregnant women at 16-40 weeks of gestation was calculated using Cochran’s formula, considering a z-value of 1.96, standard normal variate at a 95% confidence level, error margin of 5% (e), and a GDM prevalence of 8.3% reported in Cameroon in 2021[20].

Study population

The study population was pregnant women attending ANC facilities in any of the selected sites in the BHD.

Ethical considerations

Ethical clearance was obtained from the Faculty of Health Sciences Institutional Review Board of the University of Buea (Approval No. 2024/2289-01/UB/SG/IRB/FHS), and administrative authorization was obtained from the Regional Delegation of Public Health, South West Region, Cameroon (Approval No. P42/MPH//SWR/RDPH/CBPT/618/523). Written informed consent was provided by each participant before enrollment into the study.

Participants’ eligibility criteria and study variables

Pregnant women between 16 weeks and 40 weeks of gestation, who attended ANC services at the selected sites, had no prior history of diabetes mellitus, and were willing to participate in the study were included. Those with a previously confirmed history of GDM; who smoke and consume alcohol; and who had a history of hypertension, cardiovascular disease, liver failure, or endocrine disorders were excluded.

GDM was diagnosed using the oral glucose tolerance test based on the 2015 National Institute for Health and Care Excellence (NICE) criteria[21]. In this study, GDM served as the dependent variable, whereas sociodemographic, clinical, lifestyle, and obstetric factors were considered independent variables. The sociodemographic factors included age, occupation, educational level, religion, average monthly income, and marital status. The clinical factors included family history of diabetes mellitus. The lifestyle factors were frequency of exercise and consumption of fruits and vegetables. The obstetric factors evaluated were gestational age (pregnancy trimester), number of life births, and number of miscarriages.

Data collection

Participants’ sociodemographic, lifestyle, and clinical and obstetric data were collected using an interviewer-administered structured questionnaire. The sociodemographic factors (age, religion, marital status, occupation, average monthly income, and level of education), clinical data (family history of diabetes mellitus), obstetric history (number of miscarriages, number of life births, and gestational age (pregnancy trimester), and lifestyle factors (frequency of exercise and fruits/vegetable intake) were considered factors associated with GDM and dyslipidemia. About 5 mL of venous blood was collected from each participant after an 8- to 10-hour overnight fast. About 2 mL of blood was dispensed into a plain tube and centrifuged at 3500 rpm. The serum obtained was used to determine the concentration of lipid parameters (TC, TGs, HDL-C, and LDL-C) by enzymatic colorimetric methods.

About 2 mL of blood was dispensed into a fluoride oxalate tube for the determination of fasting plasma glucose (FPG). Blood samples were centrifuged at 3500 rpm for 5 minutes to obtain plasma, which was used to determine FPG using the glucose oxidase method (Lot 4198; SGM New-Tem, Monza, Italy). D-glucose powder (75 g) was diluted in 250-350 mL of water and administered to pregnant women. A 2-hour 75 g oral glucose tolerance test result of ≥ 140 mg/dL (≥ 7.8 mmol/L) was considered diabetic using NICE criteria[21]. A quality control test was performed for each batch of samples collected.

Operational definition of terms

GDM: The NICE criteria for the diagnosis of GDM were used in this study. GDM according to NICE criteria is defined as an FPG ≥ 5.6 mmol/L (≥ 100 mg/dL) and/or a 2-hour plasma glucose ≥ 7.8 mmol/L (140 mg/dL) following a 75 g oral glucose tolerance test[21].

Dyslipidemia: Dyslipidemia in pregnancy was defined using percentiles criteria[22]. Dyslipidemia was confirmed when there was elevation of TC, LDL-C, and TG concentrations above the 95^th percentile and HDL-C levels below the 5^th percentile for gestational age[22].

Frequency of exercise: This was graded as daily (exercised daily), never (did not exercise), often/frequently (exercised regularly, many days but not every day), and infrequently (rarely exercised or did so only once in a while).

Statistical analyses

Data were entered into a Microsoft Excel worksheet and subsequently exported to the Statistical Package for Social Sciences version 26 (IBM SPSS Software, Armonk, NY, United States) for analyses. Sociodemographic, obstetric, lifestyle, and clinical variables are summarized as n (%). The associations between these characteristics and the presence of GDM and or dyslipidemia were assessed using logistic regression analysis. The Student’s t-test was used to compare the mean biochemical parameters between participants with GDM and the normoglycemic group. P < 0.05 was considered statistically significant.

RESULTS

Sociodemographic characteristics of study participants

One hundred and thirteen pregnant women were enrolled in this study. The mean age was 28.70 ± 5.19 years. Most of the participants (65.5%) were single, and most (74.3%) had attained university education. Only 39.8% of participants were employed (Table 1).

Table 1 Sociodemographic characteristics of pregnant women in the Buea Health District.

Parameter	Category	n (%)
Age groups (years)	20-26	44 (38.9)
	27-33	50 (44.2)
	≥ 34	19(16.8)
	Total	113 (100)
Marital status	Single	74 (65.5)
	Married	38 (33.6)
	Divorced	1 (0.9)
	Total	113 (100)
Occupation	Employed	45 (39.8)
	Unemployed	36 (31.9)
	Student	32 (28.3)
	Total	113 (100)
Level of education	Primary	6 (5.3)
	Secondary	23 (20.4)
	Tertiary	84 (74.3)
	Total	113 (100)

Lifestyle, clinical, and obstetric data of study participants

About half of the participants (52.2%) exercised daily, and more than half of them (56.6%) consumed fruits and vegetables daily. More than one-quarter (27.4%) reported at least three pregnancies, whereas the majority (63.7%) had at least two live births. Also, more than half of the participants (56.6%) had a family history of diabetes mellitus (Table 2).

Table 2 Lifestyle, clinical, and obstetric characteristics of pregnant women in the Buea Health District.

Parameter	Category	n (%)
Family history of diabetes mellitus	Yes	64 (56.6)
	No	49 (43.4)
	Total	113 (100)
Gestational age	2nd trimester	34 (30.1)
	3rd trimester	79 (69.9)
	Total	113 (100)
Number of births	0	10 (8.8)
	≤ 2	72 (63.7)
	> 2	31 (27.4)
	Total	113 (100)
Number of miscarriages	0	96 (85.0)
	1	12 (10.6)
	2	5 (4.4)
	Total	113 (100)
Physical activity	Never	11 (9.7)
	Daily	59 (52.2)
	Often	36 (31.5)
	Infrequently	7 (6.2)
	Total	113 (100)
Daily consumption of fruits and vegetables	Yes	105 (92.9)
	No	8 (7.1)
	Total	113 (100)

Mean measured biochemical parameters of participants

The mean FPG (169.42 ± 38.28 mg/dL vs 89.22 ± 17.92 mg/dL; P < 0.001) and TC (228.67 ± 90.73 mg/dL vs 130.94 ± 45.49 mg/dL; P = 0.003) of women with GDM were significantly higher than those of normoglycemic women (Table 3).

Table 3 Measured biochemical parameters of normoglycemic vs women with gestational diabetes in the Buea Health District, mean ± SD.

Parameter	Gestational diabetes	Normo-glycemic	t value	P value
FPG (mg/dL)	169.42 ± 38.28	89.22 ± 17.92	-7.17	< 0.001
TGs (mg/dL)	129.17 ± 72.54	115.44 ± 52.20	-0.82	0.41
Chol (mg/dL)	228.67 ± 90.73	130.94 ± 45.49	-3.68	0.003
LDL-C (mg/dL)	62.50 ± 40.19	45.51 ± 29.40	-1.82	0.07
HDL-C (mg/dL)	1.17 ± 0.34	63.36 ± 32.51	-0.90	0.386

Chol: Cholesterol; FPG: Fasting plasma glucose; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; TGs: Triglycerides.

Prevalence of GD in pregnant women

Of the 113 pregnant women enrolled in this study, 12 (10.6%) had GDM (Figure 1A).

Figure 1 Prevalence of gestational diabetes and dyslipidemia among pregnant women in the Buea Health District. A: Gestational diabetes mellitus (GDDM); B: Dyslipidemia.

Factors associated with GD among study participants

Bivariate logistic regression analysis revealed that the following sociodemographic factors were significantly associated with GDM. Pregnant women aged ≥ 34 years had an 11.47-fold higher risk of developing GD than their counterparts aged 20-26 years [adjusted odds ratio (aOR) = 11.47, 95% confidence interval (95%CI): 1.19-3.15; P = 0.03]. Also, women who were unemployed had an 8.80-fold higher risk of developing GD than those who were employed (aOR = 8.80, 95%CI: 1.01-2.06; P = 0.04; Table 4).

Table 4 Sociodemographic factors associated with gestational diabetes mellitus in pregnant women in the Buea Health District, n (%).

Factors	GDM		aOR (95%CI)	P value
	No	Yes
Age (year)
20-26	43 (95.5)	1 (4.4)	1
27-33	43 (86.0)	7 (14.0)	7.0 (0.83-2.05)	0.06
≥ 34	15 (78.9)	4 (21.1)	11.47 (1.19-3.15)	0.03
Marital status
Divorced	1 (100.0)	0 (0.0)	1
Married	35 (92.1)	3 (7.9)	-	1.00
Single	65 (87.8)	9 (12.2)	-	1.00
Level of education
Primary	6 (100.0)	0 (0.0)	1
Secondary	21 (91.3)	2 (8.7)	-	1.00
University	74 (88.1)	10 (11.9)	-	1.00
Employment status
Employed	43 (97.7)	1 (2.3)	1
Unemployed	30 (83.3)	6 (16.7)	8.80 (1.01-3.06)	0.04
Student	27 (81.8)	5 (18.2)	8.15 (0.90-1.13)	0.08

aOR: Adjusted odds ratio; CI: Confidence interval; GDM: Gestational diabetes mellitus.

Clinical and lifestyle factors associated with GD in the BHD

Women who exercised infrequently had a 10.31-fold greater risk of developing GD than their counterparts who exercised daily (aOR = 10.31, 95%CI: 1.69-6.93; P = 0.02). Also, women who had a family history of diabetes were 4.35 times more likely to develop GD than their counterparts who had no family history (aOR = 4.35, 95%CI: 0.91-2.10; P = 0.04; Table 5).

Table 5 Clinical and lifestyle factors associated with gestational diabetes mellitus in pregnant women, n (%).

Factors	GDM		aOR (95%CI)	P value
	No	Yes
Physical activity
Daily	55 (93.2)	4 (6.8)	1
Never	10 (90.9)	1 (9.1)	1.38 (0.14-13.61)	1.00
Often	32 (88.9)	4 (11.1)	1.83 (0.43-7.86)	0.46
Infrequently	4 (57.1)	3 (42.9)	10.31 (1.69-6.93)	0.02
Fruits and vegetables
No	8 (100.0)	0 (0.0)	1
Yes	93 (88.6)	12 (11.4)	-	0.59
Family history of diabetes
No	47 (95.9)	2 (4.1)	1
Yes	54 (84.4)	10 (15.6)	4.35 (0.91-2.10)	0.04
Number of births
0	9 (90.0)	1 (10.0)	1
≤ 2	66 (91.7)	6 (8.3)	0.82 (0.09-7.59)	1.00
> 2	26 (83.9)	5 (16.1)	1.73 (0.18-16.87)	1.00
Number of miscarriages
0	87 (90.6)	9 (9.4)	1
1	9 (75.0)	3 (25.0)	3.22 (0.74-14.09)	0.12
2	5 (100.0)	0 (0.0)	-	1.00
Gestational age
2nd trimester	33 (97.1)	1 (2.9)	1
3rd trimester	68 (86.1)	11 (13.9)	5.34 (0.66-43.4)	0.10

aOR: Adjusted odds ratio; CI: Confidence interval; GDM: Gestational diabetes mellitus.

Prevalence of dyslipidemia in pregnant women in the BHD

Of the 113 pregnant women enrolled in this study, 36 (31.9%) had elevated TC, LDL, and TG concentrations above the 95^th percentile, and HDL above the 5^th percentile, indicating dyslipidemia (percentile criteria). Therefore, the overall prevalence of dyslipidemia among pregnant women was 31.90% (Figure 1B).

Using the percentile criteria, the prevalence of dyslipidemia in the second and third trimesters were 5.32% and 26.58%, respectively (Table 6).

Table 6 Distribution of dyslipidemia prevalence among pregnancy trimesters, n (%).

Trimester	Dyslipidemia	Normal	χ²	P value
2nd trimester	6 (5.32)	28 (27.76)	4.52	0.003
3rd trimester	30 (26.58)	49 (43.34)

Sociodemographic factors associated with dyslipidemia in pregnant women

There was no association between dyslipidemia and the sociodemographic parameters of pregnant women (Table 7).

Table 7 Sociodemographic factors associated with dyslipidemia in pregnant women in the Buea Health District, n (%).

Factors	Dyslipidemia		aOR (95%CI)	P value
	No	Yes
Age (year)
20-26	34 (72.3)	10 (22.7)	1
27-33	32 (64.0)	18 (36.0)	1.91 (0.77-4.76)	0.18
≥ 34	11 (57.9)	8 (42.1)	2.47 (0.78-7.82)	0.14
Marital status
Divorced	1 (100.0)	0 (0.0)	1
Married	25 (65.8)	13 (34.2)	-	1.00
Single	51 (75.5)	23 (24.5)	-	1.00
Level of education
Primary	4 (66.7)	2 (33.3)	1
Secondary	16 (69.6)	7 (30.4)	0.88 (0.13-5.94)	1.00
University	57 (67.9)	27 (32.1)	0.95 (0.16-5.49)	1.00
Employment status
Employed	32 (71.1)	13 (28.9)	1
Unemployed	25 (69.4)	11 (30.6)	1.08 (0.42-2.82)	1.00
Student	20 (62.5)	12 (37.5)	1.48 (0.56-3.87)	0.47

aOR: Adjusted odds ratio; CI: Confidence interval.

Clinical and lifestyle factors associated with dyslipidemia in pregnant women

Pregnant women in their third trimester of pregnancy had a 2.86-fold increased risk of developing dyslipidemia compared to those in their second trimester (aOR = 2.86, 95%CI: 1.06-7.70; P = 0.004) (Table 8).

Table 8 Clinical and social characteristics associated with dyslipidemia in pregnant women in the Buea Health District, n (%).

Factors	Dyslipidemia		aOR (95%CI)	P value
	No	Yes
Physical activity
Daily	37 (80.4)	9 (19.6)	1
Never	9 (45.0)	11 (55.0)	0.88 (0.30-2.56)	1.00
Often	25 (67.6)	12 (32.4)	1.20 (0.41-3.51)	0.79
Infrequently	14 (77.8)	4 (22.2)	0.57 (0.15-2.25)	0.51
Fruits and vegetables
No	5 (65.20	3 (37.5)	1
Yes	72 (65.3)	33 (34.70	0.76 (0.17-3.39)	0.71
Family history of diabetes
No	33 (67.3)	16 (32.7)	1
Yes	44 (68.8)	20 (31.3)	0.94 (0.42-2.08)	1.00
Number of births
0	5 (50.0)	5 (50.0)	1
≤ 2	54 (75.0)	18 (25.0)	0.33 (0.09-1.28)	0.13
> 2	18 (58.1)	13 (41.9)	0.72 (0.17-3.02)	0.72
Number of miscarriages
0	68 (70.8_	28 (29.2)	1
1	7 (58.3)	5 (41.7)	1.73 (0.51-5.930	0.51
2	2 (40.0)	3 (60.0)	3.64 (0.58-22.99)	0.17
Gestational age
2nd trimester	28 (82.4)	6 (17.6)	1
3rd trimester	49 (62.0)	30 (37.9)	2.86 (1.06-7.70)	0.04

aOR: Adjusted odds ratio; CI: Confidence interval.

Association between GDM and dyslipidemia in pregnant women in the BHD

There was an association between GD and dyslipidemia (P = 0.037; Table 9).

Table 9 Association between gestational diabetes mellitus and dyslipidemia in pregnant women in the Buea Health District, n (%).

Dyslipidemia	GDM		χ²	P value
	No	Yes
No	72 (63.72)	5 (4.42)	4.34	0.037
Yes	29 (25.66)	7 (6.19)

GDM: Gestational diabetes mellitus.

DISCUSSION

This study determined the prevalence and factors associated with GDM and dyslipidemia among pregnant women attending antenatal care in the BHD. The prevalence of GD was found to be 10.60% based on the NICE criteria. While this estimate exceeds the 5.9% prevalence reported in Cameroon in 2024 using the 1999 World and Health Organization criteria[23], it is lower than the 17.7% and 11.0% reported by the same study in Cameroon using the 2010 International Association of Diabetes and 2015 NICE criteria, respectively[23]. As observed globally, the prevalence of GDM varies, depending on the diagnostic criteria used[4]. Also, our findings revealed a GDM prevalence exceeding the 4.4% global estimate reported in recent population-based studies. This is also higher than the 5.4% prevalence estimated by a recent meta-analysis in developed European countries[24,25]. However, the prevalence is comparable to a review of data from all European countries, which reported a prevalence of 10.9%, and a meta-analysis in Eastern and Southeastern Asia, which yielded an estimate of 10.1%[26]. It is thought that about 14% of pregnant women worldwide are affected by GDM; however, differences in screening approaches and diagnostic criteria result in variable estimates[4]. The increasing prevalence of GDM worldwide and its associated maternal and neonatal complications highlight the importance of controlling modifiable risk factors to reduce its burden[27]. The risk factors for GD identified in the present study were advanced maternal age, a family history of diabetes, and reduced physical activity. A study conducted by Kim et al[28] reported that advanced maternal age, increased body mass index, parity, family history of diabetes, and previous history of GD were high risk factors for GDM. In our study, women with a family history of diabetes mellitus were approximately four times more likely to develop GDM than those without a family history, likely due to shared genetic factors[29]. There was a significant association between employment status and GDM. Pregnant women who were unemployed were more at risk of developing GD. The association between GDM and socioeconomic status is not well established, as past research has produced conflicting results[30]. Furthermore, different studies have employed different definitions of social status, depending on the monthly income, educational attainment, employment, family influence, type of healthcare, and household characteristics[30]. Morita et al[31] found no association, whereas Clausen et al[32] showed that living in an area of deprivation was positively associated with GDM. The present study also found that pregnant women who exercised infrequently were more likely to develop GDM than those who exercised daily. Physical activity generally helps to regulate blood glucose levels and prevents excessive weight gain during pregnancy[33].

The prevalence of dyslipidemia among pregnant women in this study was 31.90%. This prevalence is higher than the 17.88% reported by a 2022 study conducted in Dschang District Hospital, Cameroon[34], and the 19.6% reported in Brazil using the percentile criteria[35]. The increased synthesis of lipids in the body during pregnancy may be responsible for dyslipidemia, which further increases the risk of cardiovascular disease[36]. The frequent consumption of saturated lipids may be responsible for the high prevalence of dyslipidemia recorded among pregnant women in both trimesters in the present study. Our study further recorded a significant association between dyslipidemia and gestational age, with women in their third trimester of pregnancy more likely to develop dyslipidemia than those in the second trimester. This is because there is increased maternal fat during the third trimester of pregnancy and increased insulin resistance caused by placenta hormones such as estrogen, progesterone, and placental lactogen[37]. Pregnancy leads to substantial maternal metabolic and lifestyle alterations, including decreased insulin sensitivity, accumulation of body fat, decreased physical activity, and increased calorie intake, all of which contribute to dyslipidemia in pregnancy[38]. High levels of maternal insulin during pregnancy also lead to increased synthesis of lipids with reduced lipolysis[39]. The prevalence of dyslipidemia varies extensively based on the physiological state of the body, ethnic group, dietary pattern, sociodemographic factors, cultural practices, and economic status[40]. Although 31.90% of study participants reportedly have dyslipidemia, most exhibited isolated lipid elevations rather than meeting the specific percentile criteria for the condition. The high prevalence of GDM and dyslipidemia, along with their association within the BHD, underscores the urgent need for comprehensive clinical and public health strategies, including enhanced screening, lifestyle changes, and postpartum follow-up in order to mitigate the long-term health risks for both mothers and newborns.

This study established a 10.6% prevalence of GDM in the BHD, offering valuable data on the local burden of the disease and for comparison with other populations. The study also identified several statistically significant risk factors for GDM and dyslipidemia, providing baseline understanding of the disease burden in the BHD. Specifically, the study highlights age, employment status, exercise habits, and family history of diabetes as significant risk factors for GDM The use of aOR suggests an attempt to control for confounding variables, which enhances the credibility of the associations found. Due to the cross-sectional nature of the study, the cause-effect relationship of the independent variables to the outcome variable could not be made. Our findings might also be limited by recall bias as pregnant women were required to fill lifestyle information in the questionnaire. The use of convenient sampling introduces bias.

CONCLUSION

This study reveals a relatively low prevalence of GDM among pregnant women in the BHD. Factors associated with GDM were advanced maternal age, reduced physical activity and a family history of diabetes. The prevalence of dyslipidemia was high, and it was associated with both gestational age and GDM. These observations underscore the need for early screening and lifestyle interventions during pregnancy to identify and manage women at risk, thereby reducing adverse maternal and neonatal outcomes.

ACKNOWLEDGEMENTS

The authors wish to thank all pregnant women in the Buea Health District who consented to participate in this study. The authors sincerely acknowledge the management of selected hospitals in the Buea Health District for administrative approval of this study