Prevalence and Determinants for Gestational Diabetes Mellitus (GDM) in Pregnant Females at high risk for GDM in a teritiary care center

Background: GDM represents a high risk factor in pregnancy. Prevalence of GDM is increasing globally. Aims & Objectives: To evaluate the prevalence and risk factors for gestational diabetes mellitus among pregnant females at high risk for GDM attending a tertiary care hospital. Methods: The present study was a prospective Observational study. Pregnant women between 24-28 weeks of gestation irrespective of the age and parity with risk factors like overweight, history of diabetes mellitus in first degree relatives, previous history of macrosomic baby or congenital malformations, history of difficult instrumental deliveries, polyhydramnios were included . Detailed history, physical examination and routine investigations were carried out. The screening was done by Glucose challenge test using 50gms of oral glucose .The women found positive on screening test were subjected to 3 hours, 100gm glucose tolerance test (GTT). Results: A total of 350 randomly selected pregnant females who met the inclusion criteria were included. Out of 350 women, 74 (21.1%) turned out to be positive for screening test. The screening test positive women when subjected to confirmatory test of GDM by oral glucose tolerance test, 22 (6.3%) women were found to have GDM. Factors associated with increased prevalence were increasing age(1.8% vs 5% vs 16% p=0.001 in age groups <25 , 25-29 and > 30 years respectively) , parity (10.6% vs 4.2% p=0.03 more than two children and less than or equal to two children respectively) , obesity(25% vs 2.6% p<0.05 Obese vs non obese ), those with history of previous abortion(5.2% vs 10.7% vs 25% p=0.013 ,no abortion, one abortion ,two or more abortion respectively), those with history of GDM in previous pregnancy( 57.1% vs 5.2 % p=0.001) and those with history of diabetes mellitus in first degree relatives(37.5 vs 5.6% p=0.001). Conclusion: The prevalence of GDM was 6.3%. GDM was found more commonly in those with higher age, parity, women with history of abortions during previous pregnancy, obese, those with history of GDM in previous pregnancy and those with history of diabetes mellitus in first degree relatives. Screening should be offered to all pregnant women especially women with risk factors.

Fetomaternal Outcome in Gestational Diabetes Mellitus at a Tertiary Care Hospital

Introduction: Gestational diabetes mellitus (GDM) is a common medical problem that results from an increased severityof insulin resistance as well as impairment of the compensatory increase in insulin secretion. GDM has profound effects onfetomaternal outcome.Aims and Objectives: This study aims to evaluate the impact of GDM on pregnancy and fetal outcome.Materials and Methods: The present study was a prospective observational study. The screening was done by glucosechallenge test and 3 h, 100 g glucose tolerance test. The study population was divided into two groups, cases and controls. Allthe patients were followed up for maternal complications, fetal complications, mode of delivery, and neonatal complications.Results: A total of 350 randomly selected pregnant females who met the inclusion criteria were subjected to oral glucosechallenge test. Of 350 women, 22 women were found to have GDM and were compared with non-GDM patients. GDM patientshad significantly higher percentage of pregnancy-induced hypertension (13.6% vs. 2.6%, P = 0.031), polyhydramnios (22.7%vs. 4.3%, P = 0.004), urinary tract infection (40.9% vs. 14.5%, P = 0.003), and excess weight gain (36.4% vs. 6.3%, P = 0.001).GDM patients had higher cesarean deliveries in 13 (59.1%) and assisted vaginal deliveries in 2 (9.1%) as compared to non-GDM(110 [36.3%] and 6 [2%], P = 0.006, respectively). Among the fetal outcome, GDM patients had higher macrosomia (31.8%vs. 8.3% in non-GDM group [P = 0.003]), neonatal convulsions (18.2% vs. 2.3% in non-GDM group [P = 0.003]), respiratorydistress (22.7% vs. 3.3% [P = 0.002]), and neonatal intensive care unit admission (72.7% vs. 12.9% [P = 0.001]).Conclusion: GDM is associated with both maternal and fetal complications, most notably macrosomia leading to increasedcesarean section rate and instrumental deliveries.

Prevalence of Viral Infections in High Risk Pregnancies

Introduction: Prevalence of viral infections in high riskpregnancies has not been studied so far in our population.Current research aimed to study the prevalence of viralinfections in high risk pregnancies.Material and methods: The Study was prospective fora period of one and a half year. Hundred high risk patientswith hundred controls were studied. The viral infectionsstudied included Rubella, Herpes Simplex Type 1 and Type 2,Cytomegalovirus (CMV), HBsAg, HCV, HIV-1 and 2Results: The mean age of the women in the study group was25.2+4 years and in the controls was 25.2+4 years Out of100 cases studied 29% were positive for CMV, vs 6% controlgroup (p < 0.05), 19% were positive for Rubella IgM, vs 1% incontrols. 21% cases were positive for HSV-1/ HSV-2 IgM, vs7% in controls, 5% were positive for HbsAg, vs nil in controls.7% were positive for HEV IgM, vs nil in controls. No case ofHCV IgM was found in study or control group. One case ofHIV IgM was found in study group and none in control group.Conclusion: The seroprevalence of viral infections issignificantly higher in high risk pregnancies as compared tocontrols. CMV infection was the most prevalent viral infectionin our studied population.