Diabetes mellitus in pregnancy, still changing

Hall, David; Toit, Monique du; Mason, Deidre

doi:10.1080/16089677.2015.1069015

Cited by 7 publications

(10 citation statements)

References 17 publications

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“…1% patients of Type 1 and Type 2 DM each reported to them for preconception counselling. 16 Present study also gave the same results with 60% gestational diabetes and 40% pregestational diabetes. There was only one still birth in present study that may be attributed to non-compliance of the participant to ideal management of DM during pregnancy.…”

Section: Discussionsupporting

confidence: 85%

Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Joshi¹,

Joshi²

2017

Int J Reprod Contracept Obstet Gynecol

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INTRODUCTIONDiabetes mellitus (DM) presents as an important disease condition with 8.5% prevalence according to global report given by the World Health Organization. In India, it affected 7.8% population in year 2014, affecting men more than women and contributed to 2% of all deaths. 1 Indian Council of Medical Research has taken it on top priority for research in India identifying rapid increase in incidence of DM from 2% to 12 % in urban areas over 30 years by turn of the twenty first Century. It estimated that there were 37.8 million diabetics with 4% rural and 12 % urban prevalence in India in year 2004 with 15% prevalence of abnormal 3 hour oral glucose tolerance test (OGTT) and hyperglycaemia in urban India. 2Diabetes may be present in the patient before the conception in the form of Type 1 or Type 2 DM or it may ABSTRACT Background: Diabetes mellitus (DM) may be present in the patient before the conception or it may appear during pregnancy. Obstetric management shall ensure prevention of diabetic embryopathy and early detection and management of diabetic complications in pregnancy. Methods: A descriptive observational study was undertaken on participants from a Medical College Hospital. The pre-existing medical disorders, blood sugar, routine antenatal investigations, type of delivery, ultrasound findings, complications of delivery, foetal outcome etc. were recorded. The participants were advised diet, exercise and pharmacotherapy. The intranatal and postnatal events were recorded. The results were compared with related literature. Results: The study had total 89 participants. Five participants (5.6%) had abnormal blood sugar values. Out of these, 2 participants were having pregestational DM and 3 were having gestational DM. Although all the participants who had abnormal blood sugar levels required caesarean section, two could not be operated. One participant with gestational DM who did not follow management advice delivered a macerated still born baby after shoulder dystocia. Another participant having gestational DM, who complied strictly as per dietary advice and exercise, could be managed well without insulin and delivered a healthy baby. The requirement of insulin increased in pregnancy in patients with pregestational diabetes. Conclusions: It is essential to ensure compliance on all three pillars of management of diabetes viz. diet, exercise and insulin during pregnancy. Hence health education for diabetes with special emphasis on obstetric care in pregnancy with diabetes should be promoted.

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Section: Discussionsupporting

confidence: 85%

Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Joshi¹,

Joshi²

2017

Int J Reprod Contracept Obstet Gynecol

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“…A more recent publication by Hall et al from Tygerberg Hospital, Cape Town found no stillbirths amongst women with Type I diabetes, as well as 6.5% and 12% stillbirths amongst women with Types II and gestational diabetes respectively. 6 The latter study covered only 12 months and less attention was given to differentiating undiagnosed pre-gestational diabetes from true GDM.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] The management of patients with diabetes in pregnancy at Tygerberg Hospital has previously been carefully described and the guidelines are on a par with international recommendations. [6][7][8] All inborn perinatal deaths at Tygerberg Hospital are discussed at a weekly, multidisciplinary meeting. Apart from a primary cause of death, associated patient-related, medical and administrative avoidable factors are identified.…”

Section: Introductionmentioning

confidence: 99%

An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Rossouw

Hall

Mason

et al. 2017

Journal of Endocrinology, Metabolism and Diabetes of South Afri

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This study is a retrospective audit spanning six years following the implementation of a new guideline on the management of diabetes in pregnancy. It aims to describe the patient profile of pregnancies complicated by diabetes and stillbirth. Setting: The study was performed in Tygerberg Hospital, Cape Town, a secondary and tertiary referral centre. Subjects: Fifty-eight pregnancies were complicated by stillbirth (> 500 g). Outcome measures: the patient profile, gestational age, co-morbidities, foetal/placental monitoring and avoidable factors were described. Results: Many patients (32%) booked after 24 weeks' gestation and missed appointments were common (26.2%). Stillbirths ascribed to diabetes constituted 2.3% of all stillbirths at the hospital during the study period. Of the stillbirths 28.1% had Type I diabetes mellitus (DM), 64.9% had Type II and 7.0% were in patients with gestational diabetes. The median HbA1c at delivery was 8.4% (range 6.0-14.1%). In the Type II group, 31 (77.5%) of the stillbirths occurred after 36 weeks, while those among the Type I cases ranged from 26 to 38 weeks. Conclusion: Stillbirths amongst pregnant women with diabetes constituted a small percentage of the total stillbirth burden. Emphasising the importance of appropriate antenatal care to women with diabetes and increased surveillance from 36 weeks' gestation may lower the number of stillbirths.

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“…[1][2][3][4] In current literature both universal and selective screening are still debated, as is the capacity of obstetric services to carry the everincreasing burden of patients with gestational diabetes mellitus. [5][6][7][8] One of the central issues that has received less attention is the screening and/or diagnostic test. In a review on screening for gestational diabetes, Petrović recommends combining the screening and diagnostic test using a 75 g oral glucose tolerance test (OGTT).…”

Section: Introductionmentioning

confidence: 99%

“…10 The local application of this policy has recently been described. 6 The guideline provides two options for testing. The first is a 75 g OGTT with fasting and twohour blood glucose sampling.…”

Section: Introductionmentioning

confidence: 99%

Screening for gestational diabetes: examining a breakfast meal test

Marais

Wyk

Conradie

2016

South African Journal of Clinical Nutrition

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Objective: This study was performed to analyse the carbohydrate quantity of the non-standardised breakfast meal test consumed as part of a screening test for gestational diabetes. Design: A prospective descriptive design was utilised. Setting: Screening for gestational diabetes was performed in the High-Risk Antenatal Clinic at Tygerberg Academic Hospital, Cape Town, South Africa. Subjects: Fifty pregnant women who met the local selection criteria for diabetes screening. Outcome measures: The contents of the patient-provided breakfast meal tests were evaluated individually for total carbohydrate amount and compared with the 75 grams of carbohydrate provided by the oral glucose tolerance test (OGTT). Results: The median carbohydrate amount was 71 g but the range (55-145 g) was wide. Only seven meals (14%) fell within 10% of the 75 g carbohydrate target. Conclusion:The patient-provided breakfast meal showed wide variation in carbohydrate amount. If a meal test is to be used instead of the formal OGTT a carefully measured, prepared, palatable, readily available product would need to be sourced and provided. Layman's summary: It is necessary to screen for the development of diabetes during pregnancy. The standard test with 75 g of glucose is unpalatable and is sometimes replaced by a meal test. However, when this meal test is provided by the women themselves without standardisation, the sugar and starch quantities are too variable. Careful consideration needs to be given to an alternative screening test if it is to be reliable. Strong lay message: Non-standardised screening meal tests for gestational diabetes should not be used.

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Diabetes mellitus in pregnancy, still changing

Cited by 7 publications

References 17 publications

Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

An audit of stillborn babies in mothers with diabetes mellitus at a tertiary South African Hospital

Screening for gestational diabetes: examining a breakfast meal test

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