DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20220892

Maternal and fetal outcomes in diabetes mellitus in hospitalized women at a tertiary care institute in South India

Papa Dasari, Nithya Ravichandran

Abstract


Background: Objectives of current study were to find out the proportion of types of diabetes and to know the factors for adverse maternal and fetal outcome in pre-gestational diabetes and gestational diabetes at a tertiary care Institute and to compare the outcomes between pre-gestational diabetes and GDM.

Methods: Prospective descriptive study conducted in the department of obstetrics and gynaecology, at a tertiary care center over a period of 1 year. The inclusion criteria were: pre-gestational diabetes (pregnant women with type 1 & type 2 diabetes mellitus) and gestational diabetes mellitus. Exclusion criteria were steroid induced diabetes, tuberculosis, heart disease, autoimmune disorder, chronic renal failure. Statistical analysis: Maternal & fetal outcomes, presence of complications were expressed as proportions and comparison between the 2 groups is done using Chi-square test.

Results: Majority of the women (81.5%) were GDM and 18.5% were pre-gestational diabetics (type I DM-5% and Type II-13.5% of total). Past history of GDM was present in 29% of GDM and 31% of type II DM. Sixty percent of GDM and 40% of PGDM were primigravidae. Significantly a greater number of women were obese in PGDM than GDM. Blood sugars were uncontrolled in 20% more so in women with PGDM. Pregnancy loss was more in PGDM when compared to GDM (17.5% vs. 9.1%). Statistically significantly more number with PGDM suffered from hypertension and preterm labour.

Conclusions: Obesity, uncontrolled blood sugars, development of hypertension and pre-term labour are the significant factors resulting in adverse maternal and fetal outcomes and these are more common in women with PGDM.


Keywords


Gestational diabetes, Pre-gestational diabetes, Caesarean Section, Macrosomia, Stillbirth, Glycaemic control

Full Text:

PDF

References


Seshiah V, Magnon N. Gestational diabetes mellitus: Non-insulin management. Indian J Endocrinol Metab. 2011;15(4):284-93.

Hellmuth E, Damm P, Molsted-Pedersen L. Oral hypoglycaemic agents in 118 diabetic pregnancies. Diabet Med. 2000;17:507-11.

American Diabetes Association. Standard of medical care in diabetes 2013. Diabetes Care. 2013;36:11-66.

Landon MB, Catalano MP, Gabbe SG. Diabetes mellitus complicating pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, Landon MB, Galan HL, Jauniaux RM, Driscoll DA. Obstetrics: Normal and problem pregnancies. 6th ed. Phiadelphia: Elsevier; 2013:887-921.

Patil S, Pallavi DP, Kshirsagar NS. Comparison of pregnancy outcomes in indian women complicated with pregestational and gestational diabetes mellitus. International J Recent Trends Sci Technol. 2014;9: 457-60.

Ray JG, Vermeulen MJ, Shapiro JL, Kenshole AB. Maternal and neonatal outcomes in pregestational and gestational diabetes mellitus and influence of maternal obesity and weight gain: the DEPOSIT study. QJ Med. 2001;94:347-56.

WHO expert consultation. Appropriate body mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004; 363:157-63.

Sullivan SD, Umans JG, Ratner R. Hypertension complicating diabetic pregnancies: pathophysiology, management, and controversies. J Clin Hypertens (Greenwich). 2011;13(4):275-84.

Uddin MN, Beeram MR, Kuehl TJ. Diabetes mellitus and preeclampsia. Med J Obstet Gynecol. 2013;1(3): 1016.

Shefali AK, Kavitha M, Deepa R, Mohan V. Pregnancy outcomes in pre-gestational and gestational diabetic women in comparison to non-diabetic women. A prospective study in asian indian mothers (CURES-35). J Assoc Physicians India. 2006;54:613-8.

Jovonac L, Knopp RH. Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy. Diabetes Care. 2005;28(5):1113-7.

Nili F, Madhaviani A. Comparison of morbidities between infants of pregestational & gestational diabetic mothers. MJIRI. 2004;18:13-9.

Wahabi HA, Fayed A, Esmaeil SA. Maternal and perinatal outcomes of pregnancies complicated with pre-gestational and gestational diabetes mellitus in Saudi Arabia. J Diabetes Metab. 2014;5:7.

Chauhan SP, Perry KG, McLaughlin BN. Diabetic ketoacidosis complicating pregnancy. J Perinatol. 1996;16:173-5.

Cullen MT, Reece EA, Homko CJ. The changing presentations of diabetic ketoacidosis during pregnancy. Am J Perinatol. 1996;13:449-51.

Mohan M, Baagar KAM, Lindow S. Management of diabetic ketoacidosis in pregnancy. Obstet Gynaecol. 2017;19.