Identifying and Treating Gestational Diabetes Among Women Living with HIV in Ethiopia

Gestational diabetes may be a neglected contributor to the continuing high rates of maternal and neonatal mortality in sub-Saharan Africa. Without proper care, gestational diabetes—high blood sugar that is detected during pregnancy (and can include previously undetected pre-pregnancy diabetes)—increases the risk of eclampsia, miscarriage, obstructed labor, hemorrhage and fetal death, yet pregnant women in developing countries are rarely screened for the condition. Gestational diabetes is also a leading risk factor for preterm birth and stillbirth and can lead to other newborn health complications, such as abnormal birth weight, congenital malformation, respiratory distress syndrome and hypoglycemia.

A recent study conducted in Ethiopia by MSH at one rural and two urban health centers in the Tigray Region of Ethiopia aimed to understand the prevalence of gestational diabetes in Ethiopia and its risk factors and assess the feasibility of integrating low-cost services for gestational diabetes into antenatal care. The study found that relatively simple and low-cost interventions could help manage gestational diabetes for many women—but there were different outcomes among women living with HIV and those without the condition.

According to the study, more than 11% of the 1,242 pregnant women tested positive for gestational diabetes—higher than expected, since previous prevalence estimates of gestational diabetes in Ethiopia were between 4% and 9%. Nearly a quarter of the women living with HIV were diagnosed with gestational diabetes, compared with 11% of HIV-negative women.

HIV treatment and gestational diabetes

Among the HIV-positive pregnant women, 29% of those who were on antiretroviral treatment (ART) tested positive for gestational diabetes. By comparison, 15% of HIV-positive pregnant women who had not started ART prior to their pregnancies were diagnosed with gestational diabetes. This finding is especially important since Ethiopia has adopted the Option B+ treatment, which places all HIV-positive pregnant women on lifelong treatment.

The study also revealed challenges and discrepancies related to treatment for gestational diabetes. Whereas 79% of pregnant women with gestational diabetes brought their blood glucose levels to normal through low-cost behavioral interventions—including dietary changes and increased physical activity—after two weeks, less than half of the women living with HIV did so. Half of the pregnant women on ART responded positively to behavioral changes, compared to about a third of HIV-positive women not yet on ART.

Future directions

The study results are eye-opening and warrant more attention. First, the prevalence of gestational diabetes among HIV-positive women and the treatment results should be assessed on a larger scale, including the influence of ART. The high prevalence of gestational diabetes among HIV-positive pregnant women highlights the importance of screening all HIV-positive pregnant women for gestational diabetes, especially in light of expanding ART coverage and Ethiopia’s adoption of Option B+ treatment. Furthermore, HIV-positive pregnant women with gestational diabetes may need specialized treatment services. Additional research should develop and test effective new treatment models, especially in low-resource and rural settings, where women frequently have trouble accessing regular care.

Since gestational diabetes is on the rise globally, understanding its prevalence and treatment options among all women—including those living with HIV—is fundamental to ending preventable maternal mortality.