To study the clinical profile, management and outcome of diabetic pregnancies in a rural tertiary care institute of Punjab
Keywords:Diabetes mellitus, Outcome, Pregnancy, Treatment
Background: Diabetes mellitus is a disorder of carbohydrate metabolism. In India, about 50.9 million people suffer from diabetes, and this figure is likely to go up to 80 million by 2025, making it the 'diabetes capital' of the world. GDM develops due to an inability to compensate for physiological increase in insulin resistance that develops progressively throughout pregnancy as a consequence of multiple factors including placental hormones, increased caloric intake and reduced physical activity. Many studies report increased incidence of adverse foetal and maternal outcome in diabetic pregnancy.
Methods: The present study is a retrospective cum prospective analysis carried out in SGRDIMSAR from 1st May 2015 to 30th April 2017. Patients with diabetic pregnancies who had delivery in our institution were included.
Results: Total number of diabetic pregnancies during the study period were 76. Out of 76 patients 15 were PGDM and 61 were GDM. Maximum no of patients in PG group were in age group of 31-35 years, while in GDM group were upto 30 years of age. Gestational age at diagnosis in PGDM group is 13.42±1.2 weeks versus 29.62±4.53 weeks. Maximum patients (70.5%) in GDM group were managed by diet and exercise, while in PGDM group maximum patients (93.3%) needed insulin for glycemic control. Maternal complications were maximum in PGDM group. Most common complication was hypertensive disorders of pregnancy. Mean gestational age at delivery was 35.15±1.42 weeks and 37.06±1.29 weeks in PGDM and GDM respectively (p value= 0.00). 11.8% neonates had a birth weight of >4 kg (macrosomia). 77% of neonates in GDM group had an uneventful outcome.
Conclusions: Considering rising incidence and magnitude of the problem and its complications, identification and treatment of diabetic pregnancy is the need of hour.
World Health Organization, World Health Day Diabetes, 2016. Available at www.searo.who.int/india/mediacentre/events/2016/en/.
Diabetes Foundation India – DFI. Available at www.diabetesfoundationindia.org/about.htm.
Rajput M, Bairwa M, Rajput R. Prevalence of gestational diabetes mellitus in rural Haryana: A community-based study. Indian J Endocrinol Metabol. 2014;18(3):350.
Studd J, Tan SL, Chervenak FA. India:Tree Life Media. Current Progress in Obstetr Gynaecol. 2012;1:37.
Bhide A, Arulkumaran S, Damania K, Daftary S. Arias’ Practical Guide to High Risk Pregnancy and Delivery - A South Asian Perspective. Elsevier; 2016:254.
International Association of Diabetes and Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations of the diagnosis and classification of hyperglycaemia in pregnancy. Diabetes Care. 2010;33:676-82.
Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015;66 Suppl 2:14-20.
Fenton T, Kim J. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.
Buchanan T, Xiang A. Gestational diabetes mellitus. J Clin Investigat. 2005;115(3):485-91.
Vincent declaration on the treatment of diabetes - Management Available at https://www.diapedia.org › Management › Monitoring and organisation of diabetes care.
Seshiah V, Balaji V, Balaji MS. Gestational diabetes mellitus in India. J Assoc Physicians India. 2004;52:707-11.
Bhavadharini B, Mahalakshmi MM, Anjana RM, Maheswari K, Uma R, Deepa M, et al. Prevalence of gestational diabetes mellitus in urban and rural Tamil Nadu using IADPSG and WHO 1999 criteria (WINGS 6). Clin Diabetes Endocrinol. 2016;5(2):8.
Pandey U, Agrawal N, Agrawal S, Batra S. Outcome of diabetic pregnancies in a tertiary referral centre, Varanasi. J Obstet Gynecol India. 2015;66(4):226-32.
Shefali AK, Kavitha M, Deepa R. Preganacy outcomes in pregestational and gesatational diabetic women in comparison to non- diabetic women. Aprospectivetudy in Asian Indian mothers. J Assoc Physicians India. 2006;54:613-8.
Saxena P, Tyagi S, Prakash A. Pregnancy outcome of women with gestational diabetes in a tertiary level hospital of North India. Indian J Community Med. 2011;36(2):120-3.
Bhat M, Ramesha K, Sarma S, Menon S, Ganesh Kumar S. Outcome of gestational diabetes mellitus from a tertiary referral center in South India: a case-control study. J Obstet Gynecol India. 2012;62(6):644-649.
Magon N, Seshiah V. Gestational diabetes mellitus: Non-insulin management. Indian J Endocrinol Metabol. 2011;15(4):284.
Mayo K, Melamed N, Vandenberghe H, Berger H. The impact of adoption of the International Association of Diabetes in Pregnancy Study Group criteria for the screening and diagnosis of gestational diabetes. Am J Obstetr Gynecol. 2015;212(2):224.e1-224.e9.
Landon M. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339-48.
Boney C. Metabolic syndrome in childhood: association with birth weight, maternal obesity, and gestational diabetes mellitus. Pediatr. 2005;115(3):e290-296.
Tobias D, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus. Diabetes Care. 2011;34(1):223-9.