Pregnancy Outcome in Gestational Diabetes Mellitus - A Prospective Observational Study
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K.Ramalingam, Devisrimurari, Mounica. Bollu, Shaik. Faizan Ali
Volume : 2
Issue : 3
Online ISSN : 2394-2754
Print ISSN : 2394-2746
Article First Page : 137
Article End Page : 148
Background: Gestational diabetes is associated with significant metabolic alterations, increased maternal and perinatal morbidity and mortality. Indians fall into high risk ethnic group for diabetes mellitus.
Objectives: The objective of this study is early detection and treatment of gestational diabetes mellitus(GDM) in pregnant women and to assess perinatal outcome in a well controlled and poorly controlled gestational diabetes mellitus patients.
Materials and Methods:
Sample: All pregnant women attending to outpatient department in obstetrics and gynaecology department at NRI medical college hospital in Chinakakani Guntur(Dt) universally screened for GDM in all three trimesters.
Methods: single step oral glucose tolerance test(OGTT) with 75 grams glucose. This test is performed by asking the patient to come with overnight fasting. after collecting fasting venous sample from patient, solution made of 75 grams glucose mixed with 150 ml water is given. patients with fasting plasma glucose value ≥90 mg/dl and 2nd hour plasma glucose value≥140mg/dl are diagnosed to have gestational diabetes.
Results: Out of 71 pregnant women diagnosed as GDM, the commonest risk factors are age≥25 years(61.9%),followed by past history of abortion(33.8%), obesity(32.39%), overweight(32.39%), past history of GDM(16.9%), family history of diabetes to mother(22.5%),father(19.7%),both parents(4.2%). 9.8% of GDM patients were diagnosed ≤ 12 weeks, 61.9% between 13-28 weeks,22.5% between 29-34 weeks and 5.6%≥35 weeks. OGTT was carried out in all three trimesters for all antenatal women, so that GDM cases diagnosed in late weeks of gestation are not missed.GDM patients were followed up with 75 grams OGTT after 6 weeks, and 16.9% of women were positive for the test.
Conclusion: Single step OGTT with 75 grams glucose with cut-off values of fasting plasma sugar≥90mg/dl and 2nd hour plasma sugar≥140 mg/dl is very useful in diagnosing GDM. Universal screening for GDM is superior to selective screening(based on risk factors) for detecting more cases, facilitating early diagnosis and treatment of a disorder that carries an adverse prognosis in antenatal women with no symptoms of GDM.
The criteria recommended by WHO are simple and cost effective and it is practised in many centres. Further assuming that effective treatment is available, WHO criteria of 2nd hour plasma sugar levels≥140mg is useful in identifying a large number of cases and may have greater potential for prevention.one step procedure of WHO serves dual purpose for screening and diagnosis.