Epidemiology, diagnostics, treatments, and pregnancy outcomes of gestational diabetes mellitus in Africa: a systematic review, meta-analysis, and bibliometric study

Abstract

Background: Gestational diabetes mellitus (GDM) is an increasingly important contributor to maternal and neonatal morbidity in Africa, yet the evidence base remains fragmented across settings and research domains. This study integrates systematic review and meta-analysis with bibliometric analysis to synthesize epidemiological evidence, characterize research activity, and examine risk factors, diagnostic practices, management strategies, and pregnancy outcomes related to GDM in Africa. Methods: Publications reporting on GDM in African populations were retrieved from major scholarly databases. Bibliometric techniques were applied to evaluate publication trends, collaboration networks, and thematic structures. In parallel, 241 studies from 33 countries were systematically reviewed. Study quality was assessed, demonstrating gradual improvement over time (Spearman's ρ = 0.307). A random-effects meta-analysis was conducted to estimate pooled GDM prevalence. Results: Research output increased steadily over time but remained concentrated in a limited number of countries, with minimal regional collaboration. Dominant research themes focused on metabolic risk, diagnostic testing, and pregnancy outcomes, while health-systems and implementation research were comparatively scarce. Across 44 prevalence studies, the pooled GDM prevalence was 12.62% (95% CI: 10.23%-15.21%) using a Freeman-Tukey-transformed and DerSimonian-Laird random-effects model. Heterogeneity was considerable (I² = 98.4%), with a wide 95% prediction interval (1.18%-33.50%), indicating substantial contextual variability. Prevalence estimates ranged from 0.7% to 45.9%. Common risk factors included advanced maternal age, elevated body mass index, family history of diabetes, and prior obstetric complications. Diagnostic and management approaches varied widely, with increasing adoption of the 75 g OGTT and IADPSG/WHO 2013 criteria. Conclusions: GDM prevalence in Africa is substantial and highly heterogeneous, reflecting uneven diagnostic practices and research capacity. Strengthened regional collaboration, greater harmonization screening, and improved health-system integration are essential to inform effective and contextually appropriate maternal health policies.