Gestational diabetes mellitus: does treatment modality predict the obstetric and neonatal outcome?
Keywords:Diet, GDM, Insulin, Outcome
Background: Gestational diabetes mellitus (GDM) may be controlled with dietary modifications alone or may require insulin treatment. This study aims to find out the impact of these two treatment modalities on the maternal and neonatal outcomes.
Methods: This retrospective observational study divided the GDM patients into two groups, A and B, treated with diet and insulin therapy respectively and the maternal and neonatal outcome parameters were compared.
Results: 299 (6.7%) GDM patients over a period of two years were divided into group A (n=222) and group B (n=77). Need for induction of labour was significantly higher in group B (p=0.02). More number of history of previous abortions were seen in group A (p=0.1) and higher number of emergency Caesarean sections were observed in group B (p=0.1). Previous history of intrauterine deaths, gestational hypertension and hypothyroidism in the present pregnancy, meconium stained liquor, large for gestational age babies and need for neonatal intensive care were comparable in the two groups.
Conclusions: There are no significant differences in the pregnancy outcomes of GDM treated with diet therapy alone or insulin except for a higher number of induced labours in the insulin treated group.
Pandey U, Agrawal NK, Agrawal S, Batra S. Outcome of diabetic pregnancies in a tertiary referral centre, Varanasi. J Obstet Gynecol India. 2016 Aug;66(4):226-32.
WHO. Definition, diagnosis and classification of diabetes mellitus and its complications. Geneva:WHO;1999. Available at http://www.who.int/iris/handle/10665/66040
Jovanovič L, Liang Y, Weng W, Hamilton M, Chen L, Wintfeld N. Trends in the incidence of diabetes, its clinical sequelae, and associated costs in pregnancy. Diabetes Metab Res Rev. 2015 Oct;31(7):707-16.
Koning SH, Hoogenberg K, Scheuneman KA, Baas MG, Korteweg FJ, Sollie KM et al. Neonatal and obstetric outcomes in diet- and insulin-treated women with gestational diabetes mellitus: a retrospective study. BMC Endocr Disord. 2016;16(1):52.
Feleke BE. Determinants of gestational diabetes mellitus: a case-control study. J Matern Fetal Neonatal Med. 2017:1-6.
Gasim T. Gestational diabetes mellitus: maternal and perinatal outcomes in 220 saudi women. Oman Med J. 2012 Mar;27(2):140-4.
Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017 Apr;60(4):636-44.
Mannisto T, Mendola P, Grewal J, Xie Y, Chen Z, Laughon SK. Thyroid diseases and adverse pregnancy outcomes in a contemporary US cohort. J Clin Endocrinol Metab. 2013;98(7):2725-33.
Gudovic A, Spremovic- Radjenovic S, Lazovic G, Marinković J, Glišić A, Milićević S. Maternal autoimmune thyroid disease and pregnancy complication. Vojnosanit Pregl. 2010;67(8):617-21.
Wielandt HB, Schønemann-Rigel H, Holst CB, Fenger-Grøn J. High risk of neonatal complications in children of mothers with gestational diabetes mellitus in their first pregnancy. Dan Med J. 2015;62(6):A5093.