Glycosylated Haemoglobin (HbA1c) as a Diagnostic Criterion for Hyperglycaemia First Detected in Pregnancy.

Background: The study was prompted by the high prevalence of hyperglycaemia first detected in pregnancy (HIP) which is classified into diabetes mellitus in pregnancy (DIP) and gestational diabetes mellitus (GDM). This study aimed to determine the usefulness of Glycosylated Haemoglobin (HBA1c) in the diagnosis of HIP in the first trimester of pregnancy. Methodology: The study was of a prospective cross-sectional design carried out between January 2020 and August 2020 at the University of Port Harcourt Teaching (UPTH) and Rivers State University Teaching Hospital (RSUTH). Three hundred and five consecutive pregnant women attending the antenatal clinic at 8 to 13 +6 weeks of pregnancy were recruited for the study. Patients' socio-demographic information, anthropometric measurements, and medical, obstetric, and gynaecological history were recorded on a predesigned proforma. Blood was taken for an oral glucose tolerance test (OGTT) and glycosylated haemoglobin (HBA1c) levels. Ethical approval for the study was obtained from the Research Ethics Committee of the UPTH and RSUTH. Results: The prevalence of DIP, GDM, and HIP in the study was 2.62%, 28.85%, and 31.48% respectively. The ROC curve for HbA1c in the study showed a significant area under the Curve (AUC) value of 0.653%, 95% CI = 0.59 - 0.72, p = 0.001. The Youden index reached 2.50 and the optimal cut-off for HBA1c for diagnosis of diabetes was 5.25%. The sensitivity, specificity, PPV, and NPV for HbA1c against the Gold standard OGTT in the diagnosis of GDM were 36.5%, 88.5%, 59.3, %, and 75.2% respectively. HbA1c had high specificity and moderately high NPV. Conclusion: Glycosylated haemoglobin was a fairly good tool for diagnosis of HIP in the first trimester, but it could not replace OGTT which is the gold standard.

Coronavirus disease 2019 (COVID-19) and individuals with intellectual and developmental disabilities in Nigeria.

This article chronicles the present situation of coronavirus disease 2019 (COVID-19) on individuals with intellectual and developmental disabilities (IDD) in Nigeria. A systematic search was conducted on three bibliographic databases: MEDLINE Complete, Web of Science and Scopus, and supplemented with grey literature searches to assess studies on the effect of COVID-19 on these individuals in Nigeria with data on this group from December 2019 to July 2020. There were no studies found concerning individuals with IDD in Nigeria. This article argues for an urgent call to action by Nigerian policymakers to make data available to help understand the impact of COVID-19 and to develop and implement appropriate interventions. This article provides steps to support and care for these individuals in Nigeria. Forecasting models are recommended which offer better approaches in yielding accurate predictions and provide valuable decisions in the event of future threats and infectious disease outbreak in Nigeria.

Fetal nuchal translucency scan in Nigeria.

INTRODUCTION: To evaluate the performance of first trimester nuchal translucency scan screening among pregnant women in Nigeria. METHODS: A prospective observational and questionnaire based study involving 510 pregnant women between 11(+0) and 13(+6) weeks. Routine counselling and nuchal translucency measurement was conducted using the FMF, London guidelines. Chorionic villous sampling was done at NT ≥ 2.5 mm or ≥ 95th centile. RESULTS: Five hundred and ten out of 542 (94.1%) were analysed, mainly referred by health care workers (87.2%) and from predominantly private facilities (94.3%). The number of NT scans performed increased in successive years with corresponding decrease in the mean scanning time. Scan was successfully completed at first attempt in (96.5%), with mean scanning time of 28.3 minutes. Nuchal translucency increases with gestational but not maternal age. The median and 95th centile at 11(+0) week was 1.2mm and 1.7 mm and at 13(+6) weeks was 1.5 mm and 2.2 mm. Using a cut-off of ≥ 2.5 mm or ≥ 95th centile, 17 (3.3%) screened positive. Three out of the 17 had invasive testing and 2 (DR = 66.7%) were confirmed trisomy 21, with a false positive rate of 5.9%. Although majority (86.4%) were willing to have invasive testing, only few (3 or 17.6%) of the high risk group had testing. CONCLUSION: The study demonstrated that NT scan is feasible as a screening tool in pregnancy in Nigeria. Measures of improving utilization include wider dissemination of information, provision of dedicated NT clinics and manpower training.

Uterine artery Doppler study in second trimester of pregnancy.

INTRODUCTION: The uterine artery Doppler has potentials for screening for complications of impaired placentation. This study examines the indices of uterine artery impedance at 22-23 weeks gestation and their relationship with maternal age and parity. METHODS: Uterine artery colour imaging and pulsed wave Doppler ultrasound was conducted between 22nd and 23rd weeks in 430 pregnancies. The pregnancies were classified into 2 groups: normal and abnormal outcomes. The indices of impedance recorded were pulsatility index, resistance index and the systolic/diastolic ratio. Relevant obstetric information was retrieved from the antenatal records. The student t- test and Pearson's product moment were used for statistical analysis. RESULTS: Fifty eight (13.5%) out of 430 pregnancies had complications of impaired placentation, mainly intrauterine growth restriction and preterm birth (24 or 41.4% each). The indices in normal pregnancies were similar to presently used values. There was no statistically significant difference in the 2 pregnancies groups. The Pulsatility Index (PI) in the right uterine artery was statistically different from the left (t-test 32.8, p < 0.05). Maternal age and parity demonstrate statistically significant positive correlation with PI (r =0.9, p < 0.05; r =0.8, p < 0.05). CONCLUSION: The indices in normal pregnancies were similar to values from previous studies. The values are however not significantly different in pregnancies with abnormal outcome.