# Comparative differences in metabolic, mental health and perinatal outcomes of women with gestational diabetes in Ghana and Switzerland: the G-MUM study

## TL;DR

This study compares the health outcomes of pregnant women with gestational diabetes in Ghana and Switzerland, finding differences in metabolism, mental health, and birth outcomes.

## Contribution

The study provides the first comparative analysis of GDM outcomes in Ghana and Switzerland, highlighting the need for specialized care in Ghana.

## Key findings

- Ghana women had worse metabolic outcomes but better mental health scores compared to Swiss women.
- Higher rates of large-for-gestational-age babies and neonatal ICU admissions were observed in Ghana, independent of metabolic factors.
- Ghana women were more likely to have undiagnosed pre-existing diabetes and to be treated with metformin.

## Abstract

Gestational diabetes mellitus (GDM) prevalence (9–15%) is similar in Ghana and Switzerland, despite differences in sociodemographic characteristics, lifestyle, and healthcare systems. Contrary to Switzerland, data on the metabolic and mental health outcomes of women with GDM in Ghana is lacking. We compared the metabolic, mental health, and perinatal outcomes of GDM during pregnancy in Ghana and Switzerland.

This prospective observational study included 170 women with GDM from two cohorts (n = 88 in Switzerland, n = 82 in Ghana) who were followed-up until delivery. Primary outcomes were metabolic [HbA1c, gestational weight gain (GWG)], well-being (WHO-5), and depression symptoms (EPDS) during pregnancy. Secondary outcomes were obstetric and neonatal outcomes. Differences in metabolic, mental health and perinatal outcomes were tested using ANOVA, Chi-square test or ANCOVA when appropriate. For the perinatal outcomes, we adjusted for metabolic confounders.

Compared to the Swiss cohort (SC), the Ghana cohort (GC) had a higher pre-pregnancy weight (79.8 ± 18.0 vs. 71.8 ± 15.3 kg, p = 0.003) and BMI (30.8 ± 6.6 vs. 26.5 ± 4.9 kg/m2, p < 0.001), lower total GWG (6.2 ± 5.4 vs. 11.3 ± 5.8 kg, p < 0.001), but similar BMI-based excessive weight gain, higher fasting glucose (7.1 ± 2.4 vs. 5.1 ± 0.7 mmol/l) and HbA1c at GDM diagnosis (5.6 ± 1.0 vs. 5.3 ± 0.3%; both p ≤ 0.019), higher prevalence of previously undiagnosed pre-existing diabetes before 15-weeks gestational age (35.4% vs. 9.4%) and of metformin-treated women (84% vs. 1.1%, both p ≤ 0.001). The GC had higher well-being scores (74.4 ± 17.6 vs. 59.8 ± 18.3, p < 0.001), but similar symptoms of depression scores. In the GC, LGA (30% vs. 17%), and NICU hospitalizations (42% vs. 15%) were higher (all p ≤ 0.044) independent of HbA1c and pre-pregnancy BMI.

Women in the GC had worse metabolic outcomes but improved mental health during pregnancy. In this context, LGA and neonatal hospitalisations were higher, independent of HbA1c and pre-pregnancy BMI. Our results suggest the need for specialized GDM clinics in Ghana to improve metabolic and perinatal outcomes in women with GDM.