Abstract title	Comparism of Glycated Haemoglobin and OGTT protocol in Diagnosis of Gestational Diabetes Mellitus in Northern Nigeria
Co-authors	S. Muazu1, A. Tajudeen2, H. Bako3, M.B. Ahmad4.
1Ahmadu Bello University, Internal Medicine, Zaria, Nigeria.
2Rasheed Shekoni Specialist Hospital, Obstetrics and Gynaecology, Dutse, Nigeria.
3Rasheed Shekoni Specialist Hospital, Chemical pathology, Dutse- Jigawa state, Nigeria.
4Bayero University Kano, Chemical pathology, Kano, Nigeria.
Abstract body	Background
Gestational diabetes mellitus is any degree  of glucose intolerance that occurs for the first time in a pregnant woman with complete resolution  after delivery. Most women with GDM revert to normal glucose metabolism after delivery however, there is a risk of developing type 2 diabetes later in life as are their children. The diagnosis of GDM requires determination of both fasting and post prandial blood glucose in an OGGT protocol. This method is resource consuming, inconvenient and cumbersome as such the need to devise or develop a new simple and effective technique.
Aim
The aim of this study is to determining the prevalence and find out if glycated haemoglobin determination  can be used to diagnose GDM in this community.
Methods
The survey was conducted in an antenatal outpatient clinic within secondary health facility in north western Nigeria. It involved 174 pregnant non diabetic consenting women selected consecutively as they register with the clinic. They are mostly from the rural areas and are peasants or housewives at their third trimester of pregnancy. Ethical approval was sought and approved by the Ethics committee of the hospital.
A detailed history was sought and documented. Physicals conducted, the weight, height, blood pressure and fundal height were determined.
During next visit subjects were instructed to fast and venous blood was taken to determine FBG. Immediately a 75mg glucose anhydrous was administered to the subjects and blood glucose determine at one hour and two hours (OGGT method). Thereafter HBA1c was measured using a point of care Glover A1c metre 
Modified WHO criteria (2003) for diagnosis of GDM; FBG 5.1-7.0 with either 1 hour blood glucose ≥ 10.0 or 2 hours blood glucose 8.5-11.0 following OGTT or HbA1c value of 5.7-6.5% was used.
SPPS 23 was used to analysed the data with p value at <0.05
Results
A total of 174 pregnant women at third trimester were screened with means for age, gestational age and parity  24.5±6.5 years, 23±4.3 weeks and 3.0±2.0 respectively. Prevalence of gestational diabetes was found to be 10.3% (18/174) using the fasting and 2 hour post OGTT glucose. Only 4.6% or (8/174) subjects of those diagnosed turn out to be GDM with HbA1c testing.
The means of age, parity, last child birth, PCV, total cholesterol and HDL were lower in GDM group than in normal group p>0.05.
The duration of last child birth 1.2±1.1 years in GDM was shorter than in normal group 1.9±1.4 years while HbA1c was higher 5.3±0.6% p<0.05.
Regression analysis showed shorter duration of last childbirth and increasing HbA1c as predictors of GDM, chi2  >1.0  p<0.05.
Discussion
The  prevalence of GDM among this local community is high (10.3) as reported in a systemic review of GDM in sub-Saharan Africa [1]. In this study however it was found that shorter period in between pregnancies and high HbA1c levels predict GDM better than parity, age, obesity and other poor previous obstetric outcome. [2] This may be attributed to the fact that the subjects involved were of  less obese with lower  mean age and parity. 
The percentage of subjects diagnosed GDM using HbA1c levels were far less than those diagnosed with OGTT protocol. This is in concordance with similar recent survey by Hanna FW et al. [3] which showed that glycated haemoglobin in isolation is unlikely to replace the OGTT in GDM diagnosis.  
In this study it is concluded that the use of HbA1c level alone, as a diagnostic tool, is insufficient and not cost effective. There is need to create awareness and improve education on good health practices among this community so as to tackle this scourge and prevent the long term negative consequences of GDM. 
References
1. Mwanri AW, Kinabo J, Ramaiya K, Feskens EJ. Gestational diabetes mellitus in sub-saharan africa: a systemic review and metaregression on prevalence and risk factors. Trop Med Int Health. 2015 Aug;20(8):983-1002.
2. Olagbuji BN, Atiba AS, Olofinbiyi BA et al. Prevalence of and risk factors for gestational diabetes using 1999, 2003 WHO and IADPSG criteria upon implementation of a universal one step screening and diagnostic strategy in a sub-Saharan African population. Eur J Obstet Gynecol Reprod Biol. 2005 Jun;189:27-32.
3.Hanna FW, Duff CJ, Shelley-Hitchen A et al. Diagnosing GDM: Implication of recent changes in diagnostic criteria and role of glycated haemoglobin (HbA1c). Clin Med(Lond). 2017 Apr;17(2):108-13.
 
Conflict of Interest	I have no potential conflict of interest to disclose

Comparism of glycated haemoglobin and OGTT protocol in diagnosis of gestational diabetes mellitus in Northern Nigeria