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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.
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Background: In recent times, gestational diabetes is becoming more common Worldwide and complications are seen in fetal development, growth, labour and delivery due to maternal hyperglycemia. Gestational Diabetes Mellitus(GDM) is associated with adverse maternal and fetal outcomes. Among South Asian Population, Indian Women are at high risk of developing carbohydrate intolerance during pregnancy. Hence this study is undertaken to screen for gestational diabetes mellitus by two step method in Indian Women.Methods: This study was done in 153 nondiabetic pregnant women of gestational age 24-28 weeks, excluding diabetes mellitus diagnosed prior to pregnancy. Two step method was followed in the present study and GDM was diagnosed and the pregnancy outcomes were noted.Results: In our study the prevalence of GDM is 8.1% by two step method. Most of the women diagnosed with GDM were of age 26-30 yrs (41.66%). Among the women who were diagnosed as GDM, (58.33%) cases required Insulin along with diet control. In our study 33.33% had vaginal delivery, 8.33% had Emergency LSCS and 58.33% had Elective LSCS.Conclusion: Indian Women have high prevalence of GDM, hence universal screening is essential to diagnose GDM, which will improve the pregnancy outcome.
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Background: An alarming increase in Gestational diabetes mellitus (GDM) cases worldwide elevates concern regarding the consequences including fetal macrosomia, preeclampsia and many more. Plasma homocysteine levels which has direct impact on to endothelial function of blood vessels. The relationship of homocysteine and GDM is yet to be clarified.Methods: This single centre prospective observational study was conducted in Department of Obstetrics and Gynaecology of Thanjavur medical college hospital among 50 pregnant primi and multi gravida patients with normal pregnancy and gestational diabetes mellitus to assess the association and comparison of serum homocysteine levels in both groups.Results: The mean value of homocysteine in control group was 3.8 ± 0.95 and in gestational diabetes patients was 16.30±6.09. On comparison, found that there was hyperhomocysteinemia among GDM patients with normal pregnancy and results were statistically significant (T= -9.024 Df=48.000 <0.05).Conclusions: In this comparative and correlative study, we found that patients with gestational diabetes mellitus have higher serum homocysteine levels in comparison with normal pregnant women. Hyperhomocysteinemia is found to be an independent risk factor for gestational diabetes mellitus patients. Further investigations are needed to follow up for these patients in the postpartum period and later in their life.
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Background: The prevalence of diabetes mellitus (DM) is increasing worldwide and more in developing countries like India. The diabetic epidemic experienced in India can be due to strong genetic factors coupled with increasing urbanization, sedentary lifestyle, changes in the dietary patterns and increasing obesity. Indians are at an 11-fold increased risk of developing gestational glucose intolerance and hence universal screening is essential. Uric acid is a known marker of oxidative stress. Hyperuricemia in early pregnancy may be an indicator of the existing metabolic disturbance which can hinder the maternal physiological adaptations generally seen in pregnancy thus making the pregnant women more vulnerable to the development of gestational diabetes mellitus. The objective of this study was to investigate the association between elevated uric acid levels in the first trimester of pregnancy with gestational diabetes.Methods: This prospective observational study was conducted in Chinmaya mission hospital, Bangalore from June 2016 to March 2017 (10 months). Three hundred and twelve (312) pregnant women of gestational age less than 12 weeks who attended the OBG outpatient department within this time of period for regular antenatal check-up were enrolled in the study. Along with the other antenatal investigations serum uric acid levels were estimated before 12 weeks and also between 24-28 weeks. At 24-28 weeks screening for GDM was done by OGCT using 75 gms of glucose (IADPISG criteria). Other parameters like age, parity, BMI, family history of diabetes was noted and compared.Results: In our study, among the 312 pregnant women, 88 (28%) developed GDM. Of these 74 Women (84%) with GDM had uric acid levels above 3.5 mg/dl and 14 women (15.9%) with GDM had uric acid levels below 3.5 mg/dl. Women with higher BMI showed high uric acid levels.Conclusions: Elevated serum uric acid in the first trimester has a significant correlation with development of GDM. In present study; the cut-off level of maternal serum uric acid of 3.5 mg/dl in the first trimester appears to have a good sensitivity and specificity in identifying those patients who are most likely to develop GDM later in pregnancy.
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BACKGROUND: Physiological changes during pregnancy, such as dilutional anemia and a reduced half-life of red blood cells, have prevented the use of glycated Hb (HbA1c) as a biomarker for gestational diabetes mellitus (GDM). Nevertheless, increasing evidence supports the use of HbA1c in GDM diagnostic strategies.We studied HbA1c as a biomarker of GDM and its possible use as a screening test to avoid the use of the glucose challenge test (GCT). METHODS: This case-control study involved 607 pregnant women between the 24th and 28th week of gestation. HbA1c level was determined, and GDM was diagnosed according to the National Diabetes Data Group criteria. The area under the ROC curve (AUC) was determined; two low and two high cut-off points were established to rule out GDM and classify high-risk pregnant women, respectively. For each cut-off, sensitivity (S), specificity (SP), and total number and percentage of GCTs avoided were determined. RESULTS: The AUC for HbA1c diagnostic performance was 0.68 (95% confidence interval 0.57–0.79). Using 4.6% HbA1c (27 mmol/mol) as the lower cut-off (S=100%), 14% of participants could avoid the GCT. Using 5.5% HbA1c (36 mmol/mol) as the upper cut-off (SP =94.5%), 6% of participants would be considered at high risk. CONCLUSIONS: HbA1c can be used as a screening test prior to the GCT, thereby reducing the need for the GCT among pregnant women at a low risk of GDM.
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Female , Humans , Pregnancy , Anemia , Area Under Curve , Case-Control Studies , Diabetes, Gestational , Erythrocytes , Glucose , Half-Life , Glycated Hemoglobin , Mass Screening , Pregnant Women , ROC Curve , Sensitivity and SpecificityABSTRACT
Background: Pregnancy is a complex endocrine-metabolic adaptation and diabetogenic condition involving impaired cellular insulin sensitivity, increased β-cell function, and moderate elevation of blood glucose level. The threshold for a positive glucose challenge test (GCT) necessitating further diagnostic testing remains controversial in gestational diabetes mellitus (GDM). Aims & Objective: To find the association of risk factors with GDM, to evaluate the diagnostic value of GCT as compared to oral glucose tolerance test (OGTT) in GDM, and also to determine the optimal cut-off value of GCT with best sensitivity and specificity for the prediction of GDM and also to find the association of GCT between FBS and 2nd hour OGTT glucose level. Material and Methods: The study was conducted at Hanagal Shri Kumareshwara Hospital, Bagalkot, Karnataka, India, from June 2009 to February 2010. 247 pregnant women were selected for the study. Selected women were subjected to screening by GCT. If the blood glucose level was greater than 140 mg/dl, the GCT was considered as positive and these patients were subjected to 75 gm OGTT to confirm the diagnosis of GDM. The diagnosis of GDM was based on WHO criteria. Results: In the present study out of 247 pregnant women selected, 199 women participated, of which 26(13.06%) of the pregnant women were diagnosed to have GDM. Mean age of the study subjects was 24.7±3.51 years. There was a positive association of GDM with age, BMI, glucosuria, polyhydraromnios, obstetrics score, previous GDM, past history of unexplained IUD, family history of DM, recurrent vaginal infection. Area under the curve is 0.994 (p>0.0001) which has best diagnostic accuracy at glucose level of 128 mg/dl, as the best cut off value. Second hour OGTT is more correlated with GCT than FBS. Conclusion: In this ethnic group, the high risk pregnant women for GDM should undergo initial 50 gm. GCT. If GCT value is more than 128 mg/dl, it should be followed by second hour 75 gram OGTT, for the diagnosis of GDM and it reduces the FBS estimation of blood sugar level and an extra prick too.
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Background: Pregnancy is a complex endocrine-metabolic adaptation and diabetogenic condition involving impaired cellular insulin sensitivity, increased β-cell function, and moderate elevation of blood glucose level. The threshold for a positive glucose challenge test (GCT) necessitating further diagnostic testing remains controversial in gestational diabetes mellitus (GDM). Aims & Objective: To find the association of risk factors with GDM, to evaluate the diagnostic value of GCT as compared to oral glucose tolerance test (OGTT) in GDM, and also to determine the optimal cut-off value of GCT with best sensitivity and specificity for the prediction of GDM and also to find the association of GCT between FBS and 2nd hour OGTT glucose level. Material and Methods: The study was conducted at Hanagal Shri Kumareshwara Hospital, Bagalkot, Karnataka, India, from June 2009 to February 2010. 247 pregnant women were selected for the study. Selected women were subjected to screening by GCT. If the blood glucose level was greater than 140 mg/dl, the GCT was considered as positive and these patients were subjected to 75 gm OGTT to confirm the diagnosis of GDM. The diagnosis of GDM was based on WHO criteria. Results: In the present study out of 247 pregnant women selected, 199 women participated, of which 26(13.06%) of the pregnant women were diagnosed to have GDM. Mean age of the study subjects was 24.7±3.51 years. There was a positive association of GDM with age, BMI, glucosuria, polyhydraromnios, obstetrics score, previous GDM, past history of unexplained IUD, family history of DM, recurrent vaginal infection. Area under the curve is 0.994 (p>0.0001) which has best diagnostic accuracy at glucose level of 128 mg/dl, as the best cut off value. Second hour OGTT is more correlated with GCT than FBS. Conclusion: In this ethnic group, the high risk pregnant women for GDM should undergo initial 50 gm. GCT. If GCT value is more than 128 mg/dl, it should be followed by second hour 75 gram OGTT, for the diagnosis of GDM and it reduces the FBS estimation of blood sugar level and an extra prick too.
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PURPOSE: The purpose of the study was to compare obstetric and perinatal outcomes according to glucose challenge test (GCT) in a single institution. METHODS: One thousand six women, who were underwent antepartum gestational diabetes mellitus (GDM) screening by a GCT in mid-pregnancy and delivered at National Health Service between January 1, 2007 and July 31, 2012, were included in the study. The medical records of patients were analyzed retrospectively. The Subjects were categorized into three groups according to the results of 50 g oral GTC and 100 g oral GTC; normal glucose tolerance (NGT, n=826), less than 140 mg/dL; gestational impaired glucose tolerance (GIGT, n=128), more than 140 mg/dL but non-GDM ; gestational diabetes mellitus (GDM, n=52). Pre-existed maternal DM or hypertension and twin pregnancy were excluded. Obstetric and perinatal outcomes were compared among the three groups. RESULTS: Maternal age, parity, and pre-pregnancy body mass index were higher in the GDM. The preterm delivery and gestational hypertension increased across the groups from NGT to GIGT to GDM (13.9% vs. 18.8% vs. 25.0%, P<0.01, and 1.9% vs.5.5% vs. 13.5%, P<0.01, respectively). Large for gestational age (LGA) and Neonatal Intensive Care Unit admission rate were higher in order in NGT, GIGT, and GDM (6.2% vs. 15.6% vs. 15.4%, P<0.01, and 12.3% vs. 24.2% vs. 38.5%, P<0.01), but other complications requiring intensive care were not different among the groups, including meconium aspiration syndrome and birth asphyxia. CONCLUSION: GDM was a risk factor of cesarean section, preterm delivery, and gestational hypertension. In addition, GIGT was positively correlated with gestational hypertension, preterm labor, cesarean section rate, and LGA. This study suggests that there is a need to develop a guideline for Korean pregnant women who were diagnosed with GIGT.
Subject(s)
Female , Humans , Infant, Newborn , Pregnancy , Asphyxia , Body Mass Index , Cesarean Section , Diabetes, Gestational , Gestational Age , Glucose , Hypertension , Hypertension, Pregnancy-Induced , Critical Care , Intensive Care, Neonatal , Mass Screening , Maternal Age , Meconium Aspiration Syndrome , Medical Records , National Health Programs , Obstetric Labor, Premature , Parity , Parturition , Pregnancy Outcome , Pregnancy, Twin , Pregnant Women , Retrospective Studies , Risk FactorsABSTRACT
The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance occurring for the first time during pregnancy. The prevalence of GDM varies in direct proportion to the prevalence of Type 2 diabetes for a given ethnic group or population. It is crucial to detect women with GDM as the condition is associated with diverse range of adverse maternal and neonatal outcomes. In addition, having a history of GDM puts the mother at risk for the development of Type 2 diabetes mellitus or recurrent GDM. Various screening guidelines have been introduced depending upon the suitability of test to the population characteristics, cost and screening accuracy. Still there are lots of controversies to which test to be used, when should the screening be done and who should be screened. However, recognizing GDM is becomimg a major health challenge for clinicians, and treating it results in lowering of both maternal and fetal complications. Also, clinicians must followup women with GDM postpartum so that the prevalence of Type 2 diabetes may start declining.
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OBJECTIVE: The purpose of this study was to compare the clinical efficiency of 75 g oral glucose tolerance test (OGTT) with those of 100 g OGTT for diagnosing gestational diabetes mellitus (GDM) after abnormal 50 g oral glucose challenge test (OGCT). METHODS: Data of 616 pregnant women delivered at Ewha Womans University Dongdaemoon hospital from January, 2003 to June, 2007 was reviewed and analyzed retrospectively. The positive diagnostic rate of GDM for the group resulted in the range of 130 and 140 mg/dl and in 140 mg/dl and higher on the 50 g OGCT group was analyzed. Pregnancy and fetal outcomes were compared for the women who showed positive results in the 75 g and 100 g OGTT. RESULTS: Of the 28 pregnant women whose results were in the range of 130 and 140 mg/dL on the 50 g OGCT, three women (10.7%) were diagnosed as GDM. Among women who showed the results of 140 mg/dL and higher, positive rate of GDM by 75 g OGTT (51.6%) was significantly higher than those by 100 g OGTT (31.6%) (p=0.047). The positive result group of 75 g and 100 g OGTT did not show significant differences in pregnancy and fetal outcomes except that BMI of 100 g OGTT positive group was more increased at early pregnancy (25.2+/-3.53 kg/m2 vs 22.9+/-3.26 kg/m2, p=0.043). CONCLUSION: 75 g OGTT may be a more convenient and useful tool in the diagnosis of GDM to protect for adverse outcomes in untreated gravidas with minimal hyperglycemia.