Occurrence of diabetogenic changes in pregnancy among black women in an urban setting.

OBJECTIVE: To find out if pregnancy in black Zimbabwean women is a diabetogenic state using basal blood levels of cortisol, insulin, C-peptide and glucose. METHODS: 111 women (28 non-pregnant, 29 first trimester, 26 second trimester and 28 third trimester) aged between 18 and 35 years were recruited for the study. Fasting plasma cortisol, insulin, C-peptide and glucose were determined by standard methods. The glucose/insulin ratio was used as an index of insulin sensitivity and the C-peptide/glucose ratio as well as the homeostasis assessment model (HOMA) as an index of insulin resistance. RESULTS: The means of fasting plasma cortisol levels were significantly elevated, p < 0.0001 among the four groups (non-pregnant, first, second and third trimester women). Fasting plasma insulin levels peaked during the third trimester and significant differences were noted among all women, p < 0.05. Similar data was obtained for C-peptide levels (a better indicator of beta-cell insulin secretory activity) among the groups, p < 0.01. The means of fasting plasma glucose levels were significantly decreased with advancing gestation, p < 0.0001. Significantly lower glucose/insulin ratios, a measure of insulin sensitivity and elevated C-peptide/glucose ratios, an index of insulin resistance, were demonstrated among the women, (p < 0.05 and < 0.01 respectively). CONCLUSION: The basal data presented in this paper clearly demonstrates that the diabetogenic effects of pregnancy are also expressed by Zimbabwean black women, especially in late gestation.

Evaluation of a combined oral contraceptive pill in black Zimbabwean women.

A prospective exploratory study was carried out on lipid metabolism (41 women); as well as efficacy, acceptability and safety on another 190 women who all were using a combined oral contraceptive pill (OC) containing 30 micrograms Ethinyl oestradiol and 150mg Desogestrel (Marvelon) over a period of twelve months. The 41 women had blood analysis of triglycerides, cholesterol and high density lipoproteins (HDL) before treatment and at each of follow-up visits scheduled at 3, 6, 9 and 12 months following admission. Triglycerides, cholesterol and HDL levels were computed and there were no significant changes in any of the measured levels except HDL which was increased. No pregnancy was reported in one year of use in both groups. Cycle control was good, with a very low incidence of breakthrough bleeding and spotting being reported. The pill did not affect body weight and blood pressure significantly. It was concluded that the Marvelon formulation does not have adverse effect on lipid metabolism and is an efficacious and well tolerated contraceptive amongst Zimbabwean women.

PIP: Health workers took blood samples from 41 black women living in the greater Harare area of Zimbabwe before they began taking a combines oral contraceptive (OC) with 30 mcg ethinyl estradiol and 150 mg desogestrel (Marvelon formulation) and 3, 6, 9, and 12 months after taking it to conduct metabolic tests. They also recruited 190 other black women from Harare and rural Chiweshe, Mazowe, and Domboshawa populations taking the same new generation progestogen-containing OC to determine the efficacy, acceptability, and safety of the OC. Only high density lipid (HDL) cholesterol levels rose considerably between pretreatment and 12 months (0.94-1.3 mmol/ml; p.05). Low density lipid (LDL) cholesterol levels remained basically the same. This accounted for the significant rise of the HDL cholesterol/LDL cholesterol ratio over 12 months from 0.41 to 0.61. Triglyceride levels did not rise significantly and always stayed within the normal range. No woman became pregnant during the clinical trial. 2% experienced minor side effects including backache, spotting, headache, and nausea. Body weight and blood pressure did not change significantly. Sociodemographic reasons accounted for the high dropout rate (60%). The leading reason was change of address since many women were migrant farm workers. Since HDL levels rose and LDL levels were the same, this OC appears to have a reduced risk of atherosclerosis and cardiovascular disease. The findings indicated that the Marvelon formulation OC did not adversely affect lipid metabolism and therefore did not increase the risk of atherosclerosis or cardiovascular disease among these women. It also effectively protected them from pregnancy and induced minimal side effects.

Insulin secretion, clearance and sensitivity in black pregnant and non-pregnant women in Harare, Zimbabwe.

OBJECTIVE: To assess whether reported gestational differences in glucose tolerance in Caucasian and Black women could be due to alterations in insulin secretion, clearance or sensitivity. DESIGN: Cross sectional survey. SETTING: Antenatal Clinic, Harare; Department of Medical Laboratory Sciences, University of Zimbabwe. SUBJECTS: 90 healthy women in all the trimesters of pregnancy and 30 healthy non-pregnant women of reproductive age. MAIN OUTCOME MEASURES: Fasting (basal) plasma insulin, C-peptide and glucose concentration. Fasting plasma C-peptide, C-peptide to insulin ratio and glucose to insulin ratio were used as indices of insulin secretion, hepatic insulin clearance and insulin sensitivity respectively. RESULTS: Not all means of the fasting plasma glucose levels amongst the four groups of women were equal (p < 0.001), with all possible comparisons being significant except for the first and second trimester groups. Among the comparisons of the means of the glucose:insulin ratio in the four groups of women, only the means of the first and second trimester women differed (mean difference = 0.23, honestly significance difference = 0.20). All groups were comparable in the means of plasma insulin, C-peptide levels and the C-peptide:insulin ratio. CONCLUSION: Since fasting plasma insulin, C-peptide and C-peptide:insulin ratio were not significantly altered in all trimesters of pregnancy, these data suggest normal basal insulin secretion and clearance during gestation in these sub-Saharan African women.

Liver and kidney function tests in normal and pre-eclamptic gestation--a comparison with non-gestational reference values.

OBJECTIVE: To compare liver and kidney function tests in pre-eclampsia and in uncomplicated pregnancy and to relate the results to physiological reference values. DESIGN: Prospective cross sectional study. SETTING: Antenatal clinic and antenatal labour wards, Harare Hospital, Zimbabwe. SUBJECTS: 38 pre-eclamptic and 72 normal women of similar parity, gravida and gestational age. MAIN OUTCOME MEASURES: Serum albumin, total bilirubin, alkaline phosphatase (ALP), aspartate transaminase (AST), alanine transaminase (ALT) and gamma-glutamyl transaminase (GGT) were used as indices of hepatic function. Serum creatinine, urea and uric acid were used to assess renal function. RESULTS: Albumin, bilirubin and ALT did not show any differences between the pre-eclamptic and normotensive pregnant women. The activities of the following enzymes, ALP (p < 0.001), AST (p = 0.001) and GGT (p < 0.01) were significantly elevated in pre-eclamptic women. The renal indices, creatinine, urea and uric acid were significantly raised in pre-eclampsia (p < 0.001). No significant differences were observed in the haematological parameters, haemoglobin (Hb), white blood cell count (WBC), red blood cell count (RBC), mean corpuscular volume (MCV) and platelet count. Almost all the biochemical and haematological parameters were lower in normal pregnancy compared to the physiological reference values used in our maternity unit. CONCLUSION: Liver and kidney function is modified by normal pregnancy. However, the majority of the liver and kidney function tests between pre-eclamptic and normal pregnancy exhibited significant differences. The physiological reference values that are currently in use are different from those of women with uncomplicated pregnancies and may not be entirely suitable for management of pre-eclampsia which has hepatic and renal involvement.

Asymptomatic bacteriuria among outpatients with diabetes mellitus in an urban black population.

OBJECTIVE: To determine the prevalence of asymptomatic bacteriuria (ASB) in individuals afflicted by Diabetes mellitus; the antibiotic susceptibility of the microbial isolates and the association of host factors with ASB. DESIGN: This was a prospective cross sectional study. SETTING: Attendants of outpatient polyclinics at three main tertiary hospitals; namely, Harare, Chitungwiza and Parirenyatwa Hospitals. SUBJECTS: 176 participants. MAIN OUTCOME MEASURES: Patients attending the polyclinics between 6.30 am and 9.30 am from Monday to Friday were randomly selected. Demographic data was obtained at enrollment using a standardized questionnaire. Fasting venous blood was withdrawn from the participants for glucose analysis. Clean-catch midstream urine samples from all men and women were cultured and the causal organisms were isolated and identified by standard microbiological methods. Antibiotic susceptibility testing was performed using a disc diffusion method. Potential host factors included age, type of diabetes, duration of diabetes, glucosuria and leukocyturia. RESULTS: The prevalence of ASB was 32% in the diabetics and 11% in nondiabetic participants. The commonest bacterial organism isolated in participants afflicted by Diabetes mellitus was Escherichia coli (26%) followed by Staphylococcus aureus (21%), Streptococcus group B (14%), Streptococcus group D and non-lactose fermenting coliforms (7% respectively). Other isolates were Micrococcus and Pseudomonas (5% respectively), Klebsiella and Proteus (2% respectively). Gentamicin, nitrofurantoin, ampicillin and nicene were the most effective antimicrobials in the majority of isolates. Certain isolates exhibited some bacterial resistance to conventional antibiotics. Of the host factors, an association was found between bacteriuria and glucosuria (p < 0.001) and between leukocyturia and bacteriuria (p = 0.005). CONCLUSION: The prevalence of ASB is increased in diabetes and the rather high blood glucose levels exhibited by these individuals may further complicate this condition. As some bacterial species exhibited resistance to some common antimicrobials, these results raise questions regarding future clinical reliability of some conventional antimicrobials when considering therapy for asymptomatic bacteriuria.

Seroprevalence of HIV infection amongst antenatal women in greater Harare, Zimbabwe.

Prevalence of HIV infection appears to be rising in many African countries. HIV infection in the pregnant woman poses a dilemma for the mother as well as for her unborn child. There are no data on HIV prevalence in Zimbabwe. This prospective study designed to determine HIV prevalence, enrolled pregnant women booking for antenatal care at Harare hospital and two of its peripheral municipal clinic. Two Elisa and a confirmatory Western Blot test on 1008 blood samples provided an HIV sero-prevalence rate in the studied population of 18 pc. High groups included unskilled labourers who were unbooked, single, divorced or cohabiting and below 30 years of age. Regarding education and income, women with over 11 years of education or earning over $600 per month constituted a lower risk category. Implications of this high prevalence rate are discussed and the urgency to examine feto maternal transmission and the effect of pregnancy on HIV status is expressed. Further more, intensification of preventive information and education programmes is recommended.

PIP: In May-October 1990, microbiologists perform AIDS serodiagnostic tests on blood samples from 1008 pregnant women attending the maternity clinic at Harare Hospital, the Edith Opperman Clinic, or the Glenview Clinic in Greater Harare in Zimbabwe to determine HIV seroprevalence among these women and HIV risk factors. The overall HIV seroprevalence stood at 18%. Pregnant women who were booked were at a significantly lower risk of HIV infection than were those not booked (16% vs. 25.9%; odds ratio [OR] = 0.54). Characteristics of those significantly most likely to be HIV seropositive were being divorced (OR = 3.8), cohabiting (PR = 1.8), or being single (OR = 2.2) being married for less than 3 years (OR = 1.5). Pregnant women who had more than 3 children had a significantly lower HIV infection rate than those with 3 or fewer children (OR for 0 parity = 2.5; OR for 1-3 parity = 6.8). In terms of age, 30 year old women had the lowest HIV infection rate (8.8% vs. 20.4% for 20-29 years olds and 19% for 20 year olds) and were at least risk of acquiring HIV infection (OR = 0.4). In terms of education and income, women who attended formal schools for more than 11 years (OR = 0.6) or who made more than $300/month (OR = 0-0.6) were the lowest risk groups. Yet, education and income did not significantly affect HIV risk. Unskilled workers had the highest HIV seroprevalence rate (28.6% vs. 17% for unemployed workers [the next highest group]) and constituted the greatest risk category (OR = 5.1). Presumably HIV was transmitted to the HIV seropositive pregnant women via sexual intercourse. These results indicated a need for an information and education program to prevent transmission of HIV and longitudinal studies to examine fetomaternal transmission obstetric outcomes, and the effect of pregnancy on progression of HIV disease.

Metabolic syndrome disorders in urban black Zimbabweans with type 2 Diabetes mellitus.

OBJECTIVE: The main aim of the study was to determine the prevalence of metabolic syndrome disorders and their interrelations in black Zimbabwean type 2 diabetic patients. STUDY DESIGN: Prospective cross sectional study. SETTING: Outpatient diabetic clinics at Harare and Parirenyatwa tertiary hospitals. MAIN OUTCOME MEASURES: We recruited 109 adult diabetic subjects attending a tertiary hospital Diabetic Clinic. Anthropometric and metabolic parameters were measured by standard methods. Eighty percent of the patients were hypertensive, 32% dyslipidaemic, 32% obese, 50% hyperinsulinaemic, 61% had poor glycaemic control and 43% of the participants had the metabolic syndrome. The means of BMI and triglycerides were significantly different in hyperinsulinaemic versus non-hyperinsulinaemic patients (p < 0.001 and 0.041 respectively), and diastolic blood pressure was significantly raised in the obese group (p = 0.043). The following significant associations were observed, hyperinsulinaemia with the metabolic syndrome (odds ratio = 3.9, p < 0.001) as well with obesity (odds ratio = 4.8, p < 0.001), however, only a weak association was observed between hypertension and hyperinsulinaemia (odds ratio = 2.5, p = 0.064). Patients exhibiting three metabolic disorders (dyslipidaemia, hypertension and obesity) were five times more likely to be hyperinsulinaemic (p = 0.025) and hypertensive patients were almost three times more likely to be hyperinsulinaemic. CONCLUSION: In comparison to their counterparts from certain ethnic groups, this urban diabetic population is also burdened with a variety of metabolic disorders which are risk factors for coronary artery disease. In this population, hyperinsulinaemia has a relatively weak association with hypertension and the relationship between obesity versus diastolic blood pressure as well as hypertriglyceridaemia versus serum insulin levels requires further investigation.