AI Insight
This retrospective audit of 1,050 antenatal records from three public hospitals in Addis Ababa, Ethiopia found that only 13.2% of pregnant women were screened for gestational diabetes mellitus (GDM), with most screening occurring late in pregnancy (median 34 weeks versus the recommended 24-28 weeks). Screening was almost entirely risk-based rather than universal, and among those screened, 41% were diagnosed with GDM. Factors associated with higher screening rates included attending specific hospital sites, older maternal age, higher parity, and earlier initiation of antenatal care.
Why it matters
These findings reveal critical gaps in GDM screening implementation in Ethiopian public hospitals, where late and selective screening likely results in missed diagnoses and preventable adverse pregnancy outcomes. The high GDM prevalence among those screened (41%) suggests substantial undetected disease burden, highlighting the urgent need for systematic, universal screening protocols in low- and middle-income country healthcare settings.
Understand the Science
by Meselech Assegid Roro, Melaku Taye Amogne, Mistire Wolde Gebre, Elizabeth C. Rhodes, Leslie C. M. Johnson, Rebecca Gary, Saria Hassan, Rosette Chakkalakal, Workeabeba Abebe
Introduction
Gestational diabetes mellitus (GDM) is a major contributor to adverse perinatal outcomes. Most guidelines recommend universal GDM screening using standardized testing protocols, yet implementation in low- and middle-income countries remains limited. This study evaluated GDM screening uptake and guideline-concordant testing in routine antenatal care in Addis Ababa, Ethiopia.
Methods
We conducted a facility-based, cross-sectional study of pregnant women receiving antenatal care in three public hospitals in Addis Ababa, Ethiopia. A sample of 1,050 antenatal records was abstracted for women who were ≥28 weeks of gestation and/or had delivered during March to May 2025. Using a structured checklist, we extracted maternal and obstetric characteristics, documentation of any GDM screening, risk-based indications for screening, gestational age at testing, screening methods, and GDM diagnosis. We described uptake and adherence to guideline-recommended GDM screening. Logistic regression was used to estimate crude odds ratios (COR) and adjusted odds ratios (AOR) with 95% confidence intervals (CI) for factors associated with being screened.
Results
The mean (±SD) age of participants was 27.7 (± 5.0) years. Approximately one-third (29.4%) were pregnant for the first time. Overall, 139/1050 women were screened for GDM, yielding a screening rate of 13.2%. Median gestational age at screening was 34 weeks [IQR 30–37]; only 8.6% of screened women were tested in the recommended 24–28-weeks window. The oral glucose tolerance test was the predominant method (87.8%). Screening was almost exclusively risk-based (99.3%), where testing was prompted by clinical indications including polyhydramnios, advanced maternal age, and a prior history of macrosomic birth. Among screened women, 57/139 (41.0%) were diagnosed with GDM. In adjusted analysis, facility site (hospital C), older maternal age, higher parity and earlier gestational age at first antenatal care were independently associated with higher odds of being screened.
Conclusion
In three public hospitals in Addis Ababa, GDM screening uptake was low. The screening practice was also delayed, and risk-based. Being screened was associated with hospital site, older maternal age, higher parity, and earlier first antenatal care attendance. These findings suggest addressing patient-level factors and facility-tailored implementation strategies to achieve universal, timely GDM screening in routine antenatal care workflows.