Original article

Influence of Anemia on Prevalence of Gestational

Diabetes among Pregnant Women in Tripoli, Libya

Ahmed Atia*, Hosam Elmahmoudi
Department of Anesthesia and Intensive Care, Faculty of Medical Technology, The
University of Tripoli, Libya
*Correspondence: ah.atia@uot.edu.ly

Abstract
Gestational diabetes mellitus (GDM) is raised globally leading to substantial
maternal and foetal morbidity. This study aimed to determine the prevalence of GDM
among pregnant women delivering in different private polyclinics in Tripoli, Libya. A
cross-sectional study was conducted among pregnant women who were admitted to
gynecology department of in different medical polyclinics, Tripoli, Libya from Jan to
Dec 2022. The prevalence of GDM in pregnant women increased with increase of the
gestational age to reach maximum (86%) at the third trimester of gestation. About
31% (96 patients) anemic pregnant women were observed in 312 GDM. Careful
surveillance is required for these pregnancies in high-risk units for early detection and
treatment of possible complications, in order to try to reduce maternal and neonatal
morbidities.
Keywords: Gestational Diabetes, Anemia, Maternity, Pregnancy.
Introduction
Gestational diabetes (GDM) is defined as diabetes that develops for the first-
time during pregnancy. GDM, like other types of diabetes, changes how your
cells use sugar (glucose). Gestational diabetes is characterized by high blood
sugar levels, which can have an impact on both pregnancy and baby health. It
can occur at any stage of pregnancy, but is most common during the second
or third trimester [1]. All pregnant women should be tested for gestational
diabetes at 24-28 weeks of pregnancy (except those women who already have
diabetes) [2].
GDM is one of the most common health problems for pregnant women. It
affects about 5 percent of all pregnancies, which means there are about
200,000 cases each year. If not treated, gestational diabetes can cause health
problems for mother and fetus [1]. It is crucial to comprehend the healthcare
needs of a given population at a given time, and prevalence estimates are
perfect for this [3]. Regrettably, ethnicity, ethnic variation within and between
populations, and uneven application of screening and diagnostic criteria
account for a large portion of the variation observed in the global estimates of
GDM prevalence (<1%–28%) [4]. Ascertaining the region-specific prevalence
estimate is crucial to accurately projecting the GDM burden of a given area.
The Middle East and North Africa (MENA) region has a low literature on the
prevalence of GDM, despite the fact that two major risk factors—physical
inactivity and an above-normal body mass index (BMI)—are found to be
highly prevalent there [5,6].
In Africa, A meta-analysis estimated that the overall prevalence of gestational
diabetes in sub-Saharan Africa was 9% (95%CI, 7-12%) based on the pooling
of data from 33 studies [7]. Only six nations in this part of the world have had
their prevalence evaluated [8]. Moreover, not much research has been done
on the GDM risk factors in black sub-Saharan African populations. As a
result, in sub-Saharan Africa, traditional risk factors like age, being
overweight, having a history of gestational diabetes, etc., are regarded as risk
factors for GDM [9].
Anemia is the most common disorder in the world and is believed to cause a
number of short- and long-term complications [10]. It also conveyed to lower
the risk of the pregnant woman developing GDM [11]. However, recent
genetic study reported elevated iron stores and increased GDM incidence in
women with heterozygous hemoglobinopathies [12].
There is a dearth of information regarding the state of GDM in Libya.
Additionally, data are not available, according to the IDF atlas [10]. There are
no articles on GDM in the Libyan Medical Journal that discuss the condition's
prevalence, treatment, and aftercare. Therefore, the current study was
conducted to assess the prevalence of GDM among pregnant women in
Tripoli, Libya.
Methods
Study settings
A cross-sectional study design was used to assess the prevalence of GDM and
its risk factors among pregnant women who were admitted to gynecology
department of in different medical polyclinics, Tripoli, Libya from Jun to Dec
2022.
Data collection
Women who visited the gynecology department in different medical
polyclinics, Tripoli, Libya during the study period participated in the study.
After obtaining written informed consent, two milliliters of venous blood
were collected under aseptic conditions and transferred in to glucose tubes by
mixing for 5 minutes. The specimens were labeled with identification number
of each study participant. The blood sugar test was determined using Cobas
Integra 400 Plus which applies fully automated analyzer.

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The reliability of the study findings was guaranteed by implementing quality
control (QC) measures throughout the whole process of the laboratory work.
All materials, equipment and procedures were adequately controlled.
Appropriate volume of blood and anticoagulant was used to maintain the
specimen’s quality. Every day the samples investigated by Cobas Integra 400
machines.

Data analysis
The data were entered, analyzed using the computer software (Microsoft
office excel). Descriptive statistics was applied in the form of number and
percentages.

Ethical approval
Ethical approval was obtained from the research committee at Faculty of
Medical Technology, the University of Tripoli, and a permission letter was
obtained from different medical polyclinics before going ahead with the
study. Confidentiality was kept throughout the collection and processing of
specimens.

Results
Prevalence of GDM
A bout 312 gestational diabetes patients (18%) were observed in 1700
pregnant women admitted to gynecology department in different medical
polyclinics at the time of study.

Gestational diabetes patients Non gestational diabetes patients

18%

82%

Figure 1. The results of total samples.

Relation between age and GDM
GDM increased with increase of age where it raised from 23% (74 patients) in
age groups 20-29 years old and then 31 % (96 patients) in age group 30-39-
year-old to reach maximum 46% (142 patients) in age group 40-49 years old.
 50% 46%
45%
40%
35% 31%
30%
25% 23%
20%
15%
10%
5%
0%
20-29 30-39 40-49

Age Groups
Figure 2. The relation between age and incidence of GDM
Stages of pregnancy associated GDM
The prevalence of GDM in pregnant women increased with increase of the
gestational age to reach maximum at the third trimester of gestation. Onset of
GDM pregnant women were 3% (9 patients) during first trimester, 11% (34
patients) in second trimester and 86% (269 patients) in third trimester.

Table1. Prevalence of GDM during the pregnancy stages

Gestational trimester Number of patients %
First trimester 9 (3% )
Second trimester 34 (11% )
Third trimester 269 (86%)

Prevalence of anemia in GDM patients

This result indicates that 31% (96 patients) anemic pregnant women were
observed in 312 gestational diabetes patients.

Anaemic
patients
31%

Non anaemic
patients
69%
Figure 3. The incidence of anemia in gestational diabetes patients.
Degree of anemia in GDM patients
Data shows that 19% (59 Patients) of patients had mild anemia and 10% (31
patients) of patients had moderate anemia and 2% (6 patients) severe anemia
cases were found in this study when compared with 69% (216 patients) non
anemic.
Table 1. The degrees of anemia in GDM patients
Degree of anemia Number of patients (%)
Mild 59 ( 19%)
Moderate 31 (10% )
Severe 6 (2% )

Relation between degree of anemia and stages of pregnancy

The prevalence of anemia was 0.3% (1 patient) during first trimester with
mild anemia, 0.3% (1 patient) with moderate anemia and 0.3% (1 patient) with
severe anemia. While the prevalence of anemia was 5.7% (17 patients) during
second trimester with mild anemia, 4% (12 patients) with moderate anemia
and 1.4% (4 patients) with severe anemia. Moreover, 13% (41 patients) in third
trimester with mild anemia and 5.7% (18 patients) with moderate anemia, 2%
(6 patients) with severe anemia.
Table 2. The relation between degree of anemia and stages of pregnancy
Degree of Anemia
Gestational trimester Mild Moderate Severe
N (%) N (%) N (%)
First trimester 1( 0.3% ) 1 (0.3% ) 1(0.3%)
Second trimester 17(5.7 % ) 12 ( 4% ) 4(1.4%)
Third trimester 41( 13% ) 18( 5.7 % ) 1(0.3%)
Total of patients (%) 59 (19%) 31 (10%) 6 (2%)

Discussion
There are many researches explored the prevalence and cause of GDM during
pregnancy worldwide [13,14]. In the present study, the prevalence of
gestational diabetes disorder among pregnant women were 18% of pregnant
women. This in quite similar to the observation from a previous studies
conducted in Peru that reported prevalence of GDM was 16% [15]. On the
contrary, the observed prevalence of this study higher compared to others
studies done in Ghana 8.5% [16], Nigeria 8.3% [17], 10% in Korea [18], and 6%
in the USA [19]. However, the obtained result in the current study was lower
than the GDM prevalence among Bangladeshi pregnant women was 35% [20].
In present study, gestational diabetes increased with increase of age where it
raised from 23% (74 patients) in age groups 20-29 years old and then 31% (96
patients) in age group 30–39-year-old to reach maximum 46% (142 patients) in
age group 40-49 years old. In similar study, Singh et al., [21] recorded that

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gestational diabetes in pregnant women were 29.0±4.9 years, and concluded
that increased maternal age is an important risk factor for the development of
GDM. Also, Parnas et al., [22] reported that pregnant women with gestational
diabetes were significantly older (30.7 ± 5.9 versus 28.7 ± 5.7; p = 0.001)
compared with pregnant women without gestational diabetes.
GDM is frequently detected during the second and third trimesters of
pregnancy [23]. A previous study had observed a trend between GDM and
pregnancy trimester. The prevalence of GDM in the middle east and north
Africa regions reported to be increased by 45.0%, from 8.9% in the first
trimester to 12.9% in the second trimester, and by 55.0% in the third trimester
(20.0%, 95% CI, 13.1–27.9%, I2, 98.8%) compared with the second trimester
[24]. In our study, we observed similar results, an increase of the gestational
age to reach maximum (86%) at the third trimester of gestation, compared to
11% in the second trimester.
It was hypothesized that GDM may contribute to maternal anemia and that
an anti-inflammatory diet can alleviate this negative effect [25]. In the current
study, 31% of the GDM patients were anemic, majority of them were with
mild and moderate anemia. A recent study conducted in 2023 also reported
higher incidence of moderate anemia among pregnant women with GDM
compared to pregnant without GDM (40.0% vs. 11.4%, P = .029) [25]. Iron-rich
foods and supplements are often consumed as part of dietary interventions
for the prevention and treatment of maternal anemia. However, because of
these treatments, maternal anemia is more likely to develop in GDM women
with higher inflammatory statuses.
Conclusion
The prevalence of GDM in Libya was high in pregnant women aged >39 years
(46%), in their third trimester (86%). Current evidence suggests that GDM
may increase a pregnant woman’s chance of developing anemia. Careful
surveillance is required for these pregnancies for early detection and
treatment of possible complications, in order to try to reduce maternal and
neonatal morbidities. Further prospective studies investigating the link
between GDM and anemia are warrant.
Conflicts of Interest
The authors declare no conflict of interest.
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