DOI: https://dx.doi.org/10.18203/2320-1770.ijrcog20174057
Published: 2017-08-28

Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Prajakta Ganesh Joshi, Ganesh Arun Joshi

Abstract


Background: Diabetes mellitus (DM) may be present in the patient before the conception or it may appear during pregnancy. Obstetric management shall ensure prevention of diabetic embryopathy and early detection and management of diabetic complications in pregnancy.

Methods: A descriptive observational study was undertaken on participants from a Medical College Hospital. The pre-existing medical disorders, blood sugar, routine antenatal investigations, type of delivery, ultrasound findings, complications of delivery, foetal outcome etc. were recorded. The participants were advised diet, exercise and pharmacotherapy. The intranatal and postnatal events were recorded. The results were compared with related literature.

Results: The study had total 89 participants. Five participants (5.6%) had abnormal blood sugar values. Out of these, 2 participants were having pregestational DM and 3 were having gestational DM. Although all the participants who had abnormal blood sugar levels required caesarean section, two could not be operated. One participant with gestational DM who did not follow management advice delivered a macerated still born baby after shoulder dystocia. Another participant having gestational DM, who complied strictly as per dietary advice and exercise, could be managed well without insulin and delivered a healthy baby. The requirement of insulin increased in pregnancy in patients with pregestational diabetes.

Conclusions: It is essential to ensure compliance on all three pillars of management of diabetes viz. diet, exercise and insulin during pregnancy. Hence health education for diabetes with special emphasis on obstetric care in pregnancy with diabetes should be promoted.

 


Keywords


Gestational diabetes, Obstetric care, Pregnancy in diabetics

Full Text:

PDF

References


World Health Organization.Diabetes country profiles, 2016 - India. Available at http://www.who.int/diabetes/country-profiles/ind_en.pdf?ua=1. Accessed on 2nd July 2017.

ICMR Guidelines for management of Type 2 Diabetes – 2005. Available at http://icmr.nic.in/guidelines_diabetes/section1.pdf. Accessed on 2nd July 2017.

Lumsden MA, A Ang C, Howe D, Lumsden M. Diabetes. In: James DK, Steer PJ, Weiner CP, Goni B editors. High risk pregnancy management options. 3rd Ed. Elsevier; 986-1004.

Daftary SN, Bhide AG. Diabetes and pregnancy. In: Fernando Arias. Practical guide to high-risk pregnancy and delivery: A south Asian perspective. 3rd Ed. Elsevier; 440-64.

Berger H, Crane J, Farine D, Armson A, De La Ronde S, Keenan-Lindsay L et al. Screening for gestational diabetes mellitus. J Obstet Gynecol Can. 2002;24(11):894-912.

Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-73.

Swami SR, Mehetre R, Shivane V, Bandgar TR, Menon PS, Shah NS. Prevalence of carbohydrate intolerance of varying degrees in pregnant females in western India (Maharashtra): a hospital-based study. J Indian Med Assoc. 2008;106(11):712-4.

Raja MW, Baba TA, Hanga AJ, Bilquees S, Rasheed S, Ul Haq I et al. A study to estimate the prevalence of gestational diabetes mellitus in an urban block of Kashmir valley (North India). Int J Med Sci Public Health. 2014;3:191-5.

Jadhao AR, Gawade MD, Ughade SN. Outcome of pregnancy among high risk pregnancies in rural area of Nagpur, Maharashtra, Central India. Int J Community Med Public Health. 2017;4:628-33.

Cyganek K, Klupa T, Szopa M, Katra B, Małecki MT. Medical care of pregnant women with type 1 diabetes: current guidelines and clinical practice. Pol Arch Med Wewn. 2013;123(1-2):59-65.

Weissgerber TL, Mudd LM. Preeclampsia and Diabetes. Curr Diab Rep. 2015;15(3):579.

Gizzo S, Patrelli TS, Rossanese M, Noventa M, Berretta R, Di Gangi S et al. An update on diabetic women obstetrical outcomes linked to preconception and pregnancy glycemic profile: a systematic literature review. Scientific World J. 2013;2013.

Buchanan TA, Xiang AH, Page KA. Gestational diabetes mellitus: risks and management during and after pregnancy. Nat Rev Endocrinol. 2012;8(11):639-649.

Gutaj P, Wender-Ozegowska E. Diagnosis and management of IUGR in pregnancy complicated by type 1 diabetes mellitus. Curr Diab Rep. 2016;16:39.

Kamana KC, Shakya S, Zhang H. Gestational Diabetes Mellitus and Macrosomia: A Literature Review Ann Nutr Metab 2015;66(suppl 2):14-20.

Hall D, Du Toit M, Mason D, Conradie M. Diabetes mellitus in pregnancy, still changing. J Endocrinol, Metab Diab South Africa. 2015;20(3):108-14.