Maternal and fetal outcome among gestational diabetes mellitus mothers treated at a tertiary care maternity hospital

Indra Priyadharsini Sarimala S.; Vinayagamoorthy Venugopal

doi:10.18203/2320-1770.ijrcog20230810

Authors

Indra Priyadharsini Sarimala S. General Duty Medical Officer, Rajiv Gandhi Government Women and Children Hospital, Puducherry, India
Vinayagamoorthy Venugopal Department of Community and Family Medicine, All India Institute of Medical Sciences Deoghar, Jharkhand, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20230810

Keywords:

Fetal, Gestational diabetes, Glycemic status, Maternal, Outcome

Abstract

Background: Incidence of gestational diabetes mellitus (GDM) in India is alarming. The present study was designed to determine the association between the maternal and fetal outcome with the blood sugar control status at the time of delivery.

Methods: It was an analytical follow up study that included 180 antenatal women who met the criteria for GDM with singleton pregnancy irrespective of age, gestational period, parity were included into the study. Those with pre-existing diabetes mellitus, scarred uterus, multiple pregnancy, chronic medical disease and ante partum hemorrhage were excluded. Based on the blood sugar level at the time of delivery GDM mothers were classified into four groups excellent control, optimal control, poor control and no control group. The maternal and fetal outcomes were compared between groups.

Results: Nearly 7500 antenatal women were screened and 198 eligible GDM women were selected. Of which 180 cases were successfully completed the follow up. Among the 180 cases of GDM, 74 (41.1%) were in excellent control group, 40 (22.2%) under optimal control, 41 (22.8%) belonged to poor control and 25 (13.8%) were not controlled at the time of delivery. There was statistically significant positive association between poor glycemic control and bad maternal and fetal outcome.

Conclusions: Bad maternal and fetal outcomes were statistically higher among mothers with poor and no glycemic control. Strict glycemic control during antenatal period is mandate to avoid bad outcomes. Neonatal care center needs to be well equipped where GDM mothers seek care for delivery.

Metrics

Metrics Loading ...

References

Garrison A. Screening, diagnosis, and management of gestational diabetes mellitus. Am Fam Phys. 2015;91:460-7.

Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26(1):S5-20.

Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. J Assoc Phys India. 2004;52:707-11.

Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, et al. High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med J Br Diabetes Assoc. 1992;9:820-5.

O’Sullivan JB, Charles D, Mahan CM, Dandrow RV. Gestational diabetes and perinatal mortality rate. Am J Obstet Gynecol. 1973;116:901-4.

Sermer M, Naylor CD, Gare DJ, Kenshole AB, Ritchie JW, Farine D, et al. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes. The Toronto Tri-Hospital Gestational Diabetes Project. Am J Obstet Gynecol. 1995;173:146-56.

Schaefer UM, Songster G, Xiang A, Berkowitz K, Buchanan TA, Kjos SL. Congenital malformations in offspring of women with hyperglycemia first detected during pregnancy. Am J Obstet Gynecol. 1997;177:1165-71.

Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care. 1998;21(2):B79-84.

Williams CB, Iqbal S, Zawacki CM, Yu D, Brown MB, Herman WH. Effect of selective screening for gestational diabetes. Diabetes Care. 1999;22:418-21.

Langer O, Rodriguez DA, Xenakis EM, McFarland MB, Berkus MD, Arrendondo F. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol. 1994;170:1036-47.

HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002.

Drexel H, Bichler A, Sailer S, Breier C, Lisch HJ, Braunsteiner H, et al. Prevention of perinatal morbidity by tight metabolic control in gestational diabetes mellitus. Diabetes Care. 1988;11:761-8.

Homko CJ, Sivan E, Reece EA. The impact of self-monitoring of blood glucose on self-efficacy and pregnancy outcomes in women with diet-controlled gestational diabetes. Diabetes Educ. 2002;28:435-43.

Rae A, Bond D, Evans S, North F, Roberman B, Walters B. A randomised controlled trial of dietary energy restriction in the management of obese women with gestational diabetes. Aust N Z J Obstet Gynaecol. 2000;40:416-22.

Odar E, Wandabwa J, Kiondo P. Maternal and fetal outcome of gestational diabetes mellitus in Mulago Hospital, Uganda. Afr Health Sci. 2004;4:9-14.

Jiménez-Moleón JJ, Bueno-Cavanillas A, Luna-del-Castillo J de D, García-Martín M, Lardelli-Claret P, Gálvez-Vargas R. Impact of different levels of carbohydrate intolerance on neonatal outcomes classically associated with gestational diabetes mellitus. Eur J Obstet Gynecol Reprod Biol. 2002;102:36-41.

Hedderson MM, Ferrara A, Sacks DA. Gestational diabetes mellitus and lesser degrees of pregnancy hyperglycemia: association with increased risk of spontaneous preterm birth. Obstet Gynecol. 2003;102:850-6.

Balsells M, García-Patterson A, Gich I, Corcoy R. Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2009;94:4284-91.

Landon MB, Spong CY, Thom E, Carpenter MW, Ramin SM, Casey B, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339-48.

Negrato CA, Mattar R, Gomes MB. Adverse pregnancy outcomes in women with diabetes. Diabetol Metab Syndr. 2012;4:41.

Priyanka. Maternal and foetal outcome in patients of gestational diabetes mellitus. Int J Reprod Contracept Obstet Gynecol. 2018;7:3831-6.

Makwana M, Bhimwal RK, Ram C, Mathur SL, Lal K, Mourya H. Gestational diabetes mellitus with its maternal and foetal outcome: a clinical study. Int J Adv Med. 2017;4:919-25.

Dudhwadkar AR, Fonseca MN. Maternal and fetal outcome in gestational diabetes mellitus. Int J Reprod Contracept Obstet Gynecol. 2016;5:3317-21.

Morlando M, Savoia F, Conte A, Schiattarella A, La Verde M, Petrizzo M, et al. Maternal and fetal outcomes in women with diabetes in pregnancy treated before and after the introduction of a standardized multidisciplinary management protocol. J Diabetes Res. 2021;2021:e9959606.

Sajani TT, Rahman MT, Karim MR. Maternal and fetal outcome of mothers with gestational diabetes mellitus attending BIRDEM Hospital. Mymensingh Med J MMJ. 2014;23:290-8.

Reece SW, Parihar HS, Martinez M. Retrospective review of maternal and fetal outcomes in patients with gestational diabetes mellitus in an indigent prenatal clinic. Diabetes Spectr. 2018;31:200-5.