Importance of universal screening-DIPSI for ANC cases

Abstract

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance with varying degree, onset or first recognition during pregnancy. The study was done to assess the feasibility of DIPSI for screening and diagnosis of gestational diabetes mellitus.

Methods: Pregnant women at 24-28weeks gestation were given 75 grams of glucose in 300 ml of water, irrespective of last meal. If 2 hours plasma glucose levels are >200mg/dl were diagnosed as GDM, if it was >140 mg/dl and <200 mg/dl these patients were subjected to OGTT according to WHO criteria (1999) (FBS>126 mg/dl, 2-hour PG>140 mg/dl, one should be positive). After 8-12 hours fasting, FBS measured, 7 5gm of glucose in 300-400 ml water was given orally, later 2-hour plasma glucose measured. Those diagnosed as GDM followed up throughout pregnancy till delivery.

Results: Among 100 pregnant women, 5 were DIPSI+ and out of 5, 3 were OGTT+, making DIPSI 100% sensitive, 97.9% specific and NPV of 100% PPV of 60%. Mean age of GDM positive women was 28.8 years, mean BMI 24 kg/m². Out of 5 DIPSI+ 3(60%) of them had c-section, 2 (40%) had FTVD. 2 babies had birthweight between 2.5-3 kg, 2 of them 3-3.5 kg and 1 had 3.8 kg (no macrosomia). Out of 5 women with GDM, 1 managed with insulin and others MNT. There was statistically significant association between mean BMI, birth weight of neonate among GDM and non GDM group. No association between parity and mode of delivery.

Conclusions: The DIPSI test used in screening of GDM proved to be simple, less cumbersome, cost effective and easily acceptable to the patients. GDM can be present in patients without risk factors, hence the need for universal screening. Timely intervention with diet, insulin therapy, patient education is required to prevent maternal and neonatal complications.