BACKGROUND
Despite the growing awareness of the increase in diabetes prevalence in low and middle income countries (LMIC), there has only been limited investigation of GDM, considered a pre-diabetes state. Data from high-income countries suggest women of certain ethnicity, including black Africans are considered at high risk of developing GDM. However, the overall risk of black women living in LMICs and their risk factors for GDM is not known. To address this, we have launched the Stratification of Risk of Diabetes in Early Pregnancy (STRiDE) study, which is a multicenterlongitudinal study in Kenya with the goal of recruiting 4000 women before 20 weeks. Accurate prediction of GDM before the typical screening period of 24-32 weeks could aid in reducing the burden of testing and the maternal and fetal consequences of GDM. The study is part of MRC funded, trilateral study involving UK and India (n=3400) 
AIMS
The primary aim of this study is to assess the different ethnic specific risk factors for the development of GDM in Kenya and India. In addition, we are testing the utility of additional biomarkers (such as HbA1c) to facilitate the early prediction of GDM before 20 weeks. This abstract focuses specifically on the preliminary results from the Kenyan cohort.
METHOD
The cohort involves women between 16 and 50 years of age, attending 5 ante-natal clinics before 20 weeks of gestation from urban, semi-urban and rural areas in Eldoret, Kenya. At their first visit, participants receive a fasting or random blood glucose (point of care and venous), an HbA1c (point of care and venous) and an ultrasound. They are invited to return to perform 75gm oral glucose tolerance test between 24 and 32 weeks. GDM is diagnosed based on International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. Data on their delivery outcomes, with a specific emphasis on GDM related complications are collected.
RESULTS
To date 1145 pregnant mothers have been recruited since the study began. A totalof 350 of the recruited participants have completed the pregnancy. Of those only 8 (2.3%) have been diagnosed with GDM. The mean glucose values for Visit2 is as follows: Venous random glucose (4.67), venous HbA1c (5.52), venous fasting (4.37), point of care glucose (4.81) and point of care HbA1c (5.29). Visit3 fasting (4.07), one hour (5.45) and two hour (5.14).
The demographic characteristics of 667 participants who completed visit 1 showed the mean gestational age 14 weeks (IQR: 4-20), the median age is 25 years (IQR: 22- 46) and 40%, 39% and 19% are from low, medium and high socio economic group respectively. 
BMI in early pregnancy, showed 18% are underweight (<18kg/m2) and 30% are overweight (>25kg/m2). More than half (56.75%) of the participants had at least one or more previous pregnancies.
DISCUSSION
The preliminary results from the STRIDE study highlight several key learning’s related to the care of patients in sub-Saharan Africa. Our initial recruitment of patients has been lower than expected due to late presentation. In addition, many of them are not keen for the follow-up visits, especially the 75gm OGTT. Women have frequently complained about the excessive time the 2 hour OGTT takes as this is not routinely done in the public sector outside of our study. Many women do not seem to exhibit much concern about the possibility of having GDM as awareness around this condition is relatively low.With the current high loss to followfor visit 2 and 3 and low prevalence rates for GDM, the available data is not sufficient to establish accuracy of using point of care for diagnosis. Our finding has led us to modify our recruitment strategies with a view to facilitate greater male involvement in the maternal care process. We are planning to increase the number of sites to meet our enrollment target.

Stratification of Risk of Diabetes in Early Pregnancy (STRiDE) - preliminary results from the Kenya Cohort