Prevalence and factors associated to gestational diabetes mellitus among pregnant women in Libreville: a cross-sectional study.

Introduction: mainly occurring in low and middle income countries, gestational diabetes mellitus (GDM) represents 84% of hyperglycemia during pregnancy throughout the world. Moreover, being black is a risk factor to develop the disease. Our objective was to determine the prevalence and the associated factors of GDM in Libreville (Gabon). Methods: a cross-sectional study was carried out. Known diabetic women were excluded from the study and we had submitted asymptomatic pregnant women to a 2 steps 75g oral glucose tolerance test (T0-T2H), regardless of the stage of pregnancy at the moment of recruitment. The threshold for positivity was set at blood glucose level ≥ 8.5mmol/L World Health Organization (WHO 2013 threshold) and ≥ 7.8mmol/L (WHO 1999 threshold). Data were analyzed using Statview® for descriptive statistics, for both bivariate and multivariate analysis. Results: among 245 participants, we have found a GDM prevalence of 10.2% according to WHO 1999 threshold and 4.5% according to WHO 2013 threshold. Applying the WHO 1999 threshold, the associated factors were high maternal weight (p= 0.0498), overweight at recruitment (p=0.0246), personal history of GDM (p< 0.0001), age becomes an associated factor only if it is combined with high parity (p=0.0061). ceaserian-section and macrosomia were the two outcomes of GDM. Conclusion: Libreville has a high prevalence of GDM when the WHO 1999 criteria is compared to the WHO 2013 criteria. Discordance is also found with the identified associated factors. Further studies are needed to better appreciate gestational diabetes in Gabon.

[Profile of immunoglobulins A, G, and M during breast milk maturation in a tropical area (Gabon)]. / Profil des immunoglobulines A, G et M au cours de la maturation du lait maternel en milieu tropical (Gabon).

OBJECTIVES: To study the maturation of breast milk by the course of immunoglobulins A, G and M during the first three weeks of breast feeding. MATERIAL AND METHODS: This longitudinal and prospective survey took place from August to October, 2007, in Libreville, the capital of Gabon. The population comprised women with no significant medical history who had given birth in the obstetrics department of Center Hospital of Libreville. Women who delivered at home, had stillbirths, or infants positive for HIV hepatitis B virus were excluded. Three samples were taken, on D1 for colostrum, D7 for the transitional milk and D21 for mature milk. Immunoglobulins were determined by nephelometry, with the Turbox Plus(®) system from Diagnostica Orion. Variables were compared with Spearman's non-parametric test. The survey of the kinetic has been made from the test of Friedman's test was used to assess the kinetics. Significance was set at p<0.05. RESULTS: This survey included 60 mother-child pairs. The mean IgA concentration on D1 was 13.4 ± 5.9 g/L. This concentration fell very quickly by the end of the first week, to 2.3 ±â€Š2.0 g/L on D8, and then stabilized through D21. This rapid drop explains the need for early breast feeding after birth. On the other hand, IgG and IgM concentrations varied less and about one-sixth as high as the IgA. This finding confirms that they were minor components of breast milk. CONCLUSION: This work shows the importance of the early immune protection provided by the mother to her child during the first week of life.