Rural Living Residence is Associated with Risk Factors of Gestational Diabetes: A Retrospective Comparative Cross-sectional Study in Central Uganda

Background Gestational diabetes (GDM) is a major public health problem. The risk factors of GDM are not the same in gravida residing in different geographical areas due to rural-urban differences in maternal metabolic health and risk factors of diabetes. The study aimed to assess the association between rural living residence and GDM risk factors in Central Uganda. Methods This is a retrospective comparative cross-sectional study in which data from 600 women with GDM from 2016–2018 was extracted, with 300 from Luwero district(rural) and 300 from Mengo hospital(urban). Data on socio-demographics, clinical characteristics and risk factors was collected. Diagnosis of GDM was based on the IADSPG/ADA one step approach using a 75g OGTT (Oral Glucose Tolerance Test). The risk factors for GDM were defined using standard methods. The socio-demographic and clinical characteristics were described appropriately depending on their distribution. The Modified Poisson regression analysis model was used to explore the association between rural living residence and GDM risk factors expressed as adjusted prevalence ratios with their 95% confidence intervals and p-values. Statistical significance was set at < 0.05. Results Overall,600 women with GDM were included (n = 300 urban, n = 300 rural). The median age was 27years (IQR 21–32), with rural women younger than urban ones(P < 0.001). Rural women were shorter (≤ 150cm) P < 0.001, had family history of diabetes (P < 0.001), and parity (≥ 5) P < 0.001 compared to their urban counterparts. Rural living residence was positively and significantly associated with history of hypertension(APR = 1.343,95% CI 1.164–1.55,P < 0.001),history of GDM (APR = 1.391,95% C.I 1.208-1.60,P < 0.001),family history of diabetes(APR = 1.343,95% C.I 1.158–1.557,P < 0.001).Women with parity ≥ 5 were 31.6% more likely to be rural (APR = 1.316,95% CI 1.261–1.584,P < 0.001). The likelihood of having a height < 150cm was more than 38% with rural women than urban ones (APR = 1.381,95% C.I 1.228–1.612, P < 0.001). Women in rural areas were 31% less likely to be older than 35years APR = 0.687 (0.558– 0.847, P < 0.001). Conclusion We found that rural living residence is associated with risk factors of gestational diabetes. With increasing burden of diabetes in rural areas, universal screening for GDM may provide a window of opportunity to detect and manage glucose abnormalities including intermediate hyperglycemia and type 2 diabetes in rural clinical settings.