To study effects of early screening for gestational diabetes mellitus on maternal and fetal outcome

Abstract

Background and Method: This study, observational non-randomized clinical study to evaluate the Effect of early screening for GDM on maternal and fetal outcome. The study was conducted in the Department of Obstetrics and Gynecology at a Multi-specialty Tertiary Care Centre Sri Aurobindo Medical College & P.G. Institute, Indore M.P. Pregnant women attending the ante natal clinic at a tertiary care hospital before 16 weeks, and follow up at 24 weeks to 28 weeks and 32 weeks to 34 weeks of pregnancy. Registration details of all the patients including their OPD number, name, age, sex were noted. Consent of each patient was taken. Result: It was observed that women with positive family history of diabetes were significantly associated with increased risk of GDM as out of 19 patients (18.8%) with positive family history of diabetes 9 were GDM. Family history plays an important role for predicting occurrence of GDM significantly (p-value < 0.05, Chi square -12.4953). The rate of detection of GDM by the 75g GCT during 16 -18 weeks gestation was 23 and at 24 -28 weeks was 19. The decrease in detection of blood glucose level by DIPSI test reflects those cases which were managed by lifestyle modification alone. At 32 -34 weeks, the case detection rate was 17 which was still comparatively less than the 23 detected at 16 -18 weeks and also included two new cases of abnormal GCT which were earlier observed to be normal. It is also to be noted, that there were 2 cases in which the GCT was not performed at 32 -34 weeks as these two were already on insulin therapy for glucose control. Conclusion: Diabetes mellitus is one of the most common endocrine disorder found during pregnancy. It is associated with various maternal and fetal complications if untreated. Compared to selective screening, universal screening for GDM detects more cases and improves maternal and neonatal prognosis if done early. Hence, universal screening for GDM is essential, as it is generally accepted that women of Asian origin and especially ethnic Indians are at a higher risk of developing GDM and subsequent type 2 diabetes.