Maternal and fetal outcome in gestational diabetes mellitus

Abstract

INTRODUCTIONPregnancy induces progressive changes in maternal carbohydrate metabolism. As the pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate, gestational diabetes mellitus (GDM) develops. Indian women have high prevalence of diabetes and their relative risk of developing GDM is 11.3 times compared to white women. 1A universal recommendation for the ideal approach for screening and diagnosis of GDM remains elusive. Significant questions remain regarding the implications of GDM diagnosis on the pregnant woman and her family, the effect of diagnosis on obstetric interventions, and whether the early identification and treatment of GDM will improve perinatal, neonatal, and maternal outcomes besides overall health care costs. 2Abnormal glucose tolerance during pregnancy is not only associated with pregnancy morbidity but also increases the likelihood of subsequent diabetes in the mother. As such GDM has implications beyond the index pregnancy, identifying two generations (mother and her offspring) at risk of future diabetes. Better identification and treatment of mothers and foetuses at risk may have far-reaching implications for maternal and child health.3 Thus a short term intensive care not only results in safe motherhood but also gives a long term pay off in the primary prevention of obesity and diabetes in the offspring. ABSTRACTBackground: Indian women have high prevalence of diabetes and their relative risk of developing gestational diabetes mellitus (GDM) is 11.3 times compared to white women. As such GDM has implications beyond the index pregnancy, identifying two generations (mother and her offspring) at risk of future diabetes. Limited studies in India have compared the outcome and control of GDM. Methods: Patients attending the antenatal OPD or medicine OPD or were admitted in the medicine or obstetric wards were screened for gestational diabetes according to the ADA criteria. Maternal and fetal outcome was studied. Results: The incidence of GDM in the population studied was 4.2%. Pre-eclampsia complicating pregnancy was noted in 26% patients. 46% patients delivered vaginally. 2% deliveries were vacuum assisted. In this study 52% patients underwent LSCS. 40% babies were macrosomic at birth. 8% had congenital anomalies while 2% patients had fresh still birth. Maternal diabetes on follow up was seen in 16.2% patients. Conclusions: Gestational diabetes complicating pregnancy has adverse maternal and fetal outcome. Better identification and treatment of mothers and fetuses at risk may have far-reaching implications for maternal and child health. In conclusion, a short term intensive care gives a long term pay off in the primary prevention of obesity, impaired glucose tolerance and diabetes in the offspring, as preventive medicine starts before birth.

Gestational diabetes and fetal outcome: a study in a tertiary care centre

“…[18][19][20][21] Primi gravida was seen in 41,1% of the patients, while it was observed that on increase in the parity, the risk of GDM increases. Similar reports were observed by Dudhwadkar et al and Rajput et al 14,17 35.6% of the patients in our study had normal vaginal delivery, while 29.9% had elective surgery. Most if the patients who went in for caesarian section had babies with macrosomia.…”

Obstetrical outcome in gestational diabetes mellitus: a retrospective study

“…30 years. 21,22 In present study the occurrence of GDM among women ≥31 years was 18.6%. A study by Seshiah et al reported age more than 25 years is a risk factor for GDM.…”

Overview of Gestational Diabetes Mellitus and Its Effect on Maternal, Foetal and Neonatal Outcome

“…In present study, incidence of GDM in 25 -30 years old women was 70%, Amey Dudhwadkar et al study 5 it was 56% in 26 -30 years age. Incidence of GDM was 88% in women > 25 years age in Saima Yasmin Qadir et al study.…”

“…In present study GDM was detected in 64% multigravida, it was 72% in Amey Dudhwadkar et al study, 5 it was 76% in Saima Yasmin Qadir et al study, 6 while Randhawa et al 15 reported 80% GDM in multiparous women. So it indicates increasing parity is a risk factor for developing GDM.…”

“…14,15 In present study, 28% patient had positive family and past history. In Amey Dudhwadkar et al study, 5 it was 20%. In Nanda et al study, 16 positive family history was found in 23.9% patients.…”