DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20193028

Fetomaternal outcome in patients with diabetes mellitus in pregnancy

Kaveri D. Shingala, Sapana R. Shah, Rupa C. Vyas, Purvi M. Parikh

Abstract


Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.

Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.

Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.

Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome.


Keywords


: Feto maternal outcome, Glucose intolerance, Gestational diabetes mellitus, Glycemic control, Insulin, Oral glucose tolerance test

Full Text:

PDF

References


Williams JW, Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams obstetrics. 25th Edition. New York: McGrow - Hill; 2018:1107.

O’sullivan JB, Mahan CM. Criteria for the oral glucose tolerance test in pregnancy. Diabetes. 1964;13:278-85.

Landon MB, Mele L, Sc M, Spong CY, Carpenter MW, Ramin SM, et al. NIH Public Access. 2014;117:218-24.

Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet (London, England). 2009;373(9677):1773-9.

Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S5-20.

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002.

Fareed P, Siraj F, Lone K. Fetomaternal outcome in women with gestational diabetes mellitus. Int J Res Med Sci. 2017;5(9):4151.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS. Effect of treatment of gestational diabetes mellitus on pregnancy outcome. N Engl J Med. 2005;352:2477-8.

Wong T, Ross GP, Jalaludin BB, Flack JR. The clinical significance of overt diabetes in pregnancy. Diabet Med. 2013;30(4):468-74.

Kalra P, Kachhwaha CP, Singh HV. Original article prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. 2013;17(4):677-80.

Thomas B. The prevalence, risk factors, maternal and fetal outcomes in gestational diabetes mellitus. Int J Drug Develop Res. 2012;4(3).

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu): a community based study. J Assoc Physicians India. 2008;56:329-33.

Di Cianni G, Volpe L, Lencioni C, Miccoli R, Cuccuru I, Ghio A, et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract. 2003;62(2):131-7.

Clausen TD, Mathiesen ER, Hansen T, Pedersen O, Jensen DM, Lauenborg J, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes: the role of intrauterine hyperglycemia. Diabetes Care. 2008;31(2):340-6.

Saxena P, Tyagi S, Prakash A, Nigam A, Trivedi SS. Pregnancy outcome of women with gestational diabetes in a tertiary level hospital of north India. Indian J Community Med. 2011;36(2):120-3.