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Open Journal of Obstetrics and Gynecology, 2011, 1, 208-212
doi:10.4236/ojog.2011.14040 Published Online December 2011 (http://www.SciRP.org/journal/ojog/
OJOG
).
Published Online December 2011 in SciRes. http://www.scirp.org/journal/OJOG
Effect of maternal alcohol consumption on gestational
diabetes detection and mother-infant’s outcomes in
Kinshasa, DR Congo
Tandu-Umba Barthélémy*, Mbangama Muela Andy, Mbungu Mwimba Roger
Department of OB-GYN, University Clinics, Kinshasa, Congo.
Email: *btanduumba@yahoo.fr
Received 11 August 2011; revised 28 September 2011; accepted 16 October 2011.
ABSTRACT
Objectives: Since it has been suggested that moderate
alcohol drinking would increase insulin sensitivity,
which could benefit Gestational Diabetes Mellitus
(GDM), the study aimed at evaluating alcohol con-
sumption during pregnancy, and seeing whether this
consumption influences GDM detection and mater-
nal/perinatal outcomes. Study design: Women with
already known diabetes and those with multiple pre-
gnancy were excluded. All other pregnant women
attending antenatal care unit of the university clinics,
Kinshasa, DR Congo during the period from 1 March
throughout 31 October 2010, were invited at 24-week
gestation to enroll in O’Sullivan blood glucose testing
and if eligible in 100-gram oral glucose tolerance test.
Alcohol consumption, risk factors for GDM, and ge-
neral characteristics such as age, parity, gestity, BMI,
fat mass were registered. Diagnosed GDM was first
treated with diet and exercise, thereafter with Met-
formin, and if necessary with insulin. For other (nor-
mal) women data remained blinded until confinement.
Maternal and infant’s adverse outcomes such as ma-
ternal urinary infection, preeclampsia, cesarean sec-
tion, intrauterine growth retardation, birth weight <
2500 g, birth weight ≥ 3800 g (as stated > percentile
90 in our milieu), Apgar score at the first minute < 7,
shoulder dystocia or other birth injury, neonatal hy-
poglycemia and fetal alcohol syndrome (FAS) were
compared and analyzed according to GDM diagnosis
as well to alcohol status. Results: Up to 240 pregnant
women accepted to enroll into the study. Alcohol con-
sumption concerned 78 (32.5%) of the women, most
of them (61 = 25.42%) being heavy consumers. Risk
factors for GDM and Physical and blood glucose
characteristics were alike (p not significant) in both
consumers and non consumers, except for history of
HTA in the family that was significantly more fre-
quent (p = 0.02) among drinkers. GDM’s prevalence
was 9%. No adverse outcome was more prominent in
any subgroup, except Apgar score < 7 at the first
minute that was more frequent (p = 0.038) among
neonates of GDM mothers. No FAS, neither shoulder
dystocia nor neonatal hypoglycemia were diagnosed.
When alcohol status was considered, Birthweight ≥
3800 g was found more frequent (p = 0.0284) in alco-
hol consumers than in abstainers. Risk of this out-
come was three times higher when history of family
hypertension was present (odds ratio 2.694; CI: 0.536
- 13.544). Conclusions: The prevalence of alcohol con-
sumption by pregnant women of our series (32.5%)
seems not to impact the detection of GDM (9%). FAS
was not diagnosed. Lack of significant differences in
adverse outcomes between GDM and non GDM could
be attributed to huge follow-up of GDM women. In-
fluence of alcohol consumption on birth weight mo-
stly in setting of familial history of hypertension re-
mains to be addressed.
Keywords: Pregnancy; Alcohol Consumption; GDM;
Mother-Infant’s Outcomes
1. INTRODUCTION
Alcohol is a potent teratogen in humans and both mode-
rate and high levels of alcohol intake during early preg-
nancy may result in alterations of growth and morpho-
genesis in the fetus, including the so called fetal alcohol
syndrome (FAS) [1-5]. In neonates this syndrome is known
as microcephaly associating characteristic face made of
short palpebral fissures, sunken nasal bridge, short nose,
flattening of the cheekbones and midface, smoothing and
elongation of the ridged area (the philtrum) between the
nose and lips, and smooth, thin upper lip.
Previously, it has been suggested that moderate drin-
king would increase insulin sensitivity [6], but no study
questioned it as protective or adverse factor on either de-
tection or survey of Gestational Diabetes Mellitus (GDM)
T.-U. Barthélémy et al. / Open Journal of Obstetrics and Gynecology 1 (2011) 208-212 209
which is known as a situation of low insulin sensitivity.
This study aims at three issues: to evaluate the impor-
tance of alcohol consumption by pregnant women in our
milieu; to determine whether alcohol consumption dur-
ing pregnancy influences GDM detection; to determine
its influences on maternal and infant’s outcomes among
GDM women.
2. MATERIALS AND METHODS
This observational study was approved by the institu-
tional review board of the faculty of medicine, Univer-
sity of Kinshasa. Women with already known diabetes
were excluded. Multiple pregnancies were also excluded.
All other pregnant women attending antenatal care unit
of the university clinics, Kinshasa, DR Congo during the
period from 1 March throughout 31 October 2010, were
invited to enroll in 50-gram glucose O’Sullivan testing at
24-week gestation (calculated from the last menstrual
period and early ultrasound examination data). Venous
blood glucose was assayed by use of One Touch Profile
Meters (Lifescan, Johnson & Johnson, High Wycombe,
U.K.). Based on this testing GDM was defined as blood
glucose ≥ 200 mg/dL. Women with values between 140
mg/dL and 199 mg/dL (n = 38) were encouraged to join
a 100-gram oral glucose tolerance test (OGTT).
Alcohol consumption was quoted as light (less than 1
litre but more than 30 cl/day) or heavy (more than 1
l/day) [3-5] and no counseling was initiated for drinkers.
Maternal characteristics included age, parity, gestity,
body mass index (BMI calculated as [weight (kg)/height
(m)2]), and fat mass according to impedancimetry (with
an OMRON BF 300 impedance meter). Risk factors for
GDM were also registered: obesity (BMI > 25), family-
history of diabetes (grandparents, parents, brothers, sis-
ters), or of arterial hypertension (HTA), previous history
of polyhydramnios, infant’s birth weight ≥ 3800 g (>
90th percentile in our milieu), stillbirth and congenital
malformation. Diagnosed GDM was first treated with
diet and exercise, aiming to achieve a fasting blood glu-
cose lower than 95 mg/dL, thereafter with MetforminR,
and if necessary with insulin. For other (normal) women
data remained blinded until confinement. Weight of the
newborn was measured immediately after birth. Infants
were examined, and judged clinically as having or not
signs of effect of alcohol on morphogenesis.
2.1. Maternal and Infant’s Adverse Outcomes
Such as maternal urinary infection, preeclampsia, cesar-
ean section, intrauterine growth retardation (IUGR), bir-
th weight ≥ 3800 g, Apgar score < 7 at the first minute,
shoulder dystocia or other birth injury, clinical neonatal
hypoglycemia and FAS were compared according to
both GDM and alcohol status.
2.2. Statistical Analysis (p < 0.05 Significant)
Differences between means were calculated using Stu-
dent’s t test (for normally distributed results) or other-
wise according to Mann-Whitney test. Differences be-
tween proportions were calculated according to chi-
square or Fischer’s exact test where appropriate. Multi-
variate adjusted odds ratios (95% confidence interval)
were used to eliminate influence of variables that could
modify effect of alcohol consumption on GDM diagno-
sis as well as on maternal and infant’s adverse outcomes.
3. RESULTS
Up to 240 pregnant women accepted to enroll into the
study. Their gestational age at delivery ranged from 37
to 41 weeks. Gestational age at recruitment was 30.78 ±
4.6 weeks. The birth weight at term was 3132.97 ± 470.1
g. Other characteristics means at recruitment are pre-
sented in Tab l e 1.
Table 1. Maternal characteristics according to alcohol status (Mean ± Standard deviation).
Overall
g
r
oup
(n =
240) A
lc
oho
l
absta
i
n
er
s
(n =
162) A
lc
oho
l
d
ri
nk
er
s
(n =
78)
p values
Age (yrs) 31.25 ± 4.9 30.94 ± 5.03 31.88 ± 4.6 0.1699
Parity 1.99 ± 1.84 1.93 ± 1.89 2.1 ± 1.7 0.5041
Gestity 3.0 ± 2.08 2.85 ± 2.17 3.29 ± 1.8 0.1244
BMI (kg/m2) 24.73 ± 4.4 24.65 ± 4.3 24.88 ± 4.6 0.7051
Fat mass (kg) 19.88 ± 7.7 19.6 ± 7.6 20.45 ± 7.8 0.4326
Fat mass (%) 27.5 ± 6.5 27.5 ± 6.2 27.8 ± 7 0.7190
Plasma glucose during O’Sullivan (mg/dL) 121.10 ± 30.7 122.2 ± 31.2 121.9 ± 30.8 0.4071
GDM after O’Sullivan 6 5 (3.1%) 1 (1.3%) 0.7190
GDM after OGTT 15 10 (6.2%) 5 (6.4%) 0.4071
GDM 21 13 (8%) 8 (10.2%) 0.6071
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210
Alcohol consumption concerned 78 (32.5%) of the
women attending our antenatal care unit, most of them
(61 = 25.42% of the overall series) being heavy con-
sumers. Beer was the only type of beverage reported.
The most invoked reason for alcohol consumption was
the prevention of discomforting nausea and vomiting.
No significant difference was found between alcohol
consumers and abstainers. Out of 240 women registered
for O’Sullivan testing 6 were recognized GDM (≥200
mg/dL of blood glucose value) and 188 were O’Sullivan
negative (glucose values less than 140 mg/dL). Among
46 women who had glucose values ranging from 140
mg/dL and 199 mg/dL 11 failed to join OGTT and were
excluded for the calculation of GDM’s prevalence which
thus concerned 6 women diagnosed after O’Sullivan
testing and 15 after OGTT (21/229 = 9%).
Risk factors for GDM were alike (p not significant) in
both alcohol consumers and non consumers, except for
familial history of HTA that was more frequent (p = 0.02)
among drinkers (Tab l e 2 ).
Eight women who delivered before term or at another
maternity were excluded for mother/infant’s outcomes
assessment, which thus restricted further calculations to
221 mother/infant couples (Tab l e s 3 - 4 ).
No adverse outcome was more prominent in any sub-
group, except Apgar score < 7 at the first minute that
was more frequent (p = 0.038) among neonates of GDM
mothers. No FAS, neither shoulder dystocia nor neonatal
hypoglycemia were diagnosed. When alcohol status was
considered (Tabl e 4 ), birth weight ≥ 3800 g was found
more frequent in alcohol consumers than in abstainers (p
= 0.0284). Since maternal history of HTA in the family
was the only risk factor for GDM more frequent (p =
0.02) among drinkers, its influence on prominent APO
(Preeclampsia, Apgar at the first minute < 7, birth weight
≥ 3800 g) according to alcohol consumption was as-
sessed using multivariate adjusted odds ratios (95% con-
fidence interval): odds ratio of 1.067 (CI: 0.129 - 8.813),
0.975 (CI: 0.057 - 3.061) and 2.694 (CI: 0.536 - 13.544)
for Preeclampsia, Apgar 1’ < 7, and birth weight ≥ 3800
g respectively. This means that a history of hypertension
in the family multiplies by three the risk of having an
infant ≥ 3800 g in alcohol drinkers.
Table 2 . Risk factors for GDM according to alcohol status.
Overall
g
r
oup
(n =
240)
Abstainers (n = 162) Drinkers (n = 78) p values
Maternal age ≥ 35 years 64 (26.7%) 42 (25.9%) 22 (34.4%) 0.139
History of diabetes in the family 79 (32.9%) 51 (31.5%) 28 (35.9%) 0.594
History of HTA in the family 19 (7.9%) 8 (4.9%) 11 (14%) 0.026
History of Macrosomia 31 (12.9%) 22 (13.6%) 9 (12%) 0.803
History of stillbirth 15 (6.3%) 13 (8%) 2 (3%) 0.182
History of polyhydramnios 4 (1.7%) 3 (1.9%) 1 (1.5%)
0.844
History of congenital malformation 0 0 0
BMI > 25 kg/m2 91 (37.9%) 58 (35.8%) 5 (6%) 0.406
Table 3 . Mother/infant’s adverse outcomes according to GDM status (N = 221).
Preeclampsia GDM (n = 20) 2 (10%) Non GDM (n = 201) 17 (8.5%) p values 0.814
Cesarean section 9 (45%) 55 (27.4%) 0.097
Apgar score 1’ < 7 3 (15%) 6 (3%) 0.038
Birthweight < 2500 gr 1 (5%) 10 (4.9%) 0.657
Birthweight ≥ 3800 gr 2 (10%) 16 (7.9%) 0.502
Shoulder dystocia or 0 0 -
other birth injury
Neonatal hypoglycemia 0 0 -
FAS 0 0 -
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Table 4 . GDM diagnosis and mother/infant’s adverse outcomes according to alcohol status (N = 221).
Alcohol drinkers (n = 71) Alcohol abstainers (n = 150) p values
GDM 7 (9.9%) 13 (8.7%) 0.773
Preeclampsia 6 (8.5%) 13 (8.7%) 0.957
Cesarean section 23 (32.4%) 41 (27.3%) 0.439
Apgar score 1’ < 7 4 (5.6%) 5 (3.3%) 0.419
Birthweight < 2500 g 2 (2.8%) 9 (6%) 0.310
Birthweight ≥ 3800 g 10 (14.1%) 8 (5.3%) 0.0284
4. COMMENTS
When compared to the prevalence found five years ago
(5.2%) in a multicentre study in Kinshasa [7] the rate of
this one-hospital-based study (9%) is much higher,
probably due to differences in study population sampling,
but a real rise should be questioned. Nevertheless, it is
expected to rise with use of lower blood glucose stan-
dards recently recommended by the 6th Symposium on
Pregnancy & Diabetes held in Salzburg, Austria, in
March 2011, which emphasized the HAPO study [8] and
seems to have got global agreement on the “one-step
diagnosis” of gestational diabetes mellitus (GDM). This
makes GDM range among epidemic problems to be fa-
ced in our milieu, not only for pregnancy outcomes but
mostly for prevention strategies, since GDM is likely to
announce type 2 diabetes.
In respect of alcohol consumption during pregnancy, it
is known that South Africa has the highest rate of FAS in
the world [9], but data from other African countries are
scarce to find. The rate of drinkers among pregnant wo-
men of our series (32.5%) is much higher than that of
4.4% reported in an Indian series [10]) and in North
America (10% in USA and 17% - 25% in Canada [11]).
Rates reported in Europe vary considerably from 34% in
France [12] to 81% in Ireland [13]. Due to feeling of
guilt or shame likely to accompany self-reporting of al-
cohol consumption by pregnant women [14], the actual
rate of our study might have to be higher.
Side effects related to alcohol consumption have been
reportedly noticeable even with light drinking, which led
to the “no alcohol at all during pregnancy” recommen-
dation [15,16]. Since most consumers of our series were
heavy ones, many fetuses were expected to be at risk.
Literature related to influences of alcohol consumption
on pregnancy generally refers to evaluation of consump-
tion during the first half of pregnancy [1-5]. Our study
deals with the second half but we have supposed that
drinking habits might be similar months before. This
supposition is supported by the fact that the most in-
voked reason for alcohol consumption was the preven-
tion of discomforting nausea and vomiting.
Lack of FAS in our series could thus be linked to fail-
ure to diagnose this condition in newborns, or to a lesser
sensibility of fetuses of our milieu, which remains to be
addressed. Mullally et al. [13] also observed only 3
cases (0.005%) of FAS among women whose up to 81%
were alcohol consumers.
As of GDM related mother/infant’s adverse outcomes
lack of significant differences between GDM and non
GDM women (except for Apgar score < 7 at the first
minute) could be attributed to huge follow-up of GDM
women while results remained blinded for others. This
finding is consistent with the need to actively treat GDM
in order to improve mother-infant’s outcomes. Increased
risk of Birth weight ≥ 3800 g by alcohol consumption
mostly among women having familial history of HTA is
difficult to interpret. Previously, protective effects of
moderate drinking on the development of type 2 diabetes
in elders has been evidenced mostly when compared
with heavy drinkers but not with abstainers [17]. No
favorable alcohol effect however has been claimed either
on GDM detection or survey or on APO in diabetic pa-
tients although it has been suggested that moderate
drinking would be associated with increased insulin sen-
sitivity [6].
5. CONCLUSIONS
The prevalence of alcohol consumption by pregnant
women in our milieu is as high as 32.5%, most of them
being heavy drinkers. The prevalence of GDM (9%)
seems not to be impacted by alcohol consumption. As of
mother/infant’s adverse outcomes (including FAS) lack
of significant differences between GDM and non GDM
(except for Apgar score < 7 at the first minute) is con-
sistent with the need to actively treat GDM. Influence of
alcohol consumption on Birth weight ≥ 3800 g mostly in
setting of familial history of HTA remains to be ad-
dressed.
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212
6. ACKNOWLEDGEMENTS
We are grateful to colleagues and collaborators from the department of
OB-GYN, University Clinics, Kinshasa, DR Congo for invaluable assi-
stance in collecting data and caring for pregnant women.
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