[Dietary management of gestational diabetes: effectiveness and adherence to dietary recommendations, a cross-sectional comparative study between public and private healthcare sectors in the Marrakech-Safi region, Morocco].

INTRODUCTION

gestational diabetes is a frequent complication of pregnancy, associated with risks for both mother and child. Its management relies on adherence to dietary recommendations, the effectiveness of which may vary according to the socio-economic context and the type of healthcare system. In Morocco, few studies have compared the public and private sectors.

METHODS

a retrospective cross-sectional study included 331 women with GDM in the Marrakech-Safi region (266 public, 65 private). Data were collected using a standardised questionnaire. Multivariable logistic regression was performed to identify factors associated with management and therapeutic outcomes. Results are presented as adjusted odds ratios (aOR), 95% confidence intervals, and p-values.

RESULTS

family income above the minimum wage (aOR: 8.99, 95% CI 1.92-42.13; p= 0.005) and social security coverage (aOR: 25.5, 95% CI 5.06-128.6; p< 0.001) were associated with follow-up in the private sector. Dietary adherence was higher among women in the private sector (aOR: 2.08, 95% CI 1.04-4.19; p= 0.040). Physical activity was favoured by private follow-up (aOR: 2.18, 95% CI 1.18-4.04; p= 0.013). Glycemic control was better in the private sector (aOR: 0.20, 95% CI 0.09-0.43; p< 0.001). Regular medical follow-up was more frequent in the private sector (aOR: 0.33, 95% CI 0.12-0.91; p= 0.031).

CONCLUSION

this study reveals marked disparities between public and private sectors in the management of GDM in Morocco, largely influenced by economic resources. Strengthening public sector capacity is necessary to enhance the equity and efficiency of care.