Pre-pregnancy weight, the rate of gestational weight gain, and the risk of early gestational diabetes mellitus among women registered in a tertiary care hospital in India.

BACKGROUND: The impact of pre-pregnancy weight and the rate of gestational weight gain (GWG) together on the risk of early GDM (< 24 weeks gestation; eGDM) has not been studied in the Indian context. We aimed to study the influence of (1) pre-pregnancy weight on the risk of eGDM diagnosed in two time intervals; and (2) in addition, the rate of GWG by 12 weeks on the risk of eGDM diagnosed in 19-24 weeks. METHOD: Our study utilized real-world clinical data on pregnant women routinely collected at an antenatal care clinic at a private tertiary hospital, in Pune, India. Women registering before 12 weeks of gestation (v1), with a singleton pregnancy, and having a follow-up visit between 19-24 weeks (v2) were included (n = 600). The oral glucose tolerance test was conducted universally as per Indian guidelines (DIPSI) at v1 and v2 for diagnosing eGDM. The data on the onset time of eGDM were interval censored; hence, we modeled the risk of eGDM using binomial regression to assess the influence of pre-pregnancy weight on the risk of eGDM in the two intervals. The rate of GWG by 12 weeks was added to assess its impact on the risk of eGDM diagnosed in v2. RESULT: Overall, 89 (14.8%) women (age 32 ± 4 years) were diagnosed with eGDM by 24 weeks, of which 59 (9.8%) were diagnosed before 12 weeks and 30 of 541 (5.5%) women were diagnosed between 19-24 weeks. Two-thirds (66%) of eGDM were diagnosed before 12 weeks of gestation. Women's pre-pregnancy weight was positively associated with the risk of GDM in both time intervals though the lower confidence limit was below zero in v1. The rate of GWG by 12 weeks was not observed to be associated with the risk of eGDM diagnosed between 19-24 weeks of gestation. These associations were independent of age, height, and parity. CONCLUSION: Health workers may focus on pre-pregnancy weight, a modifiable risk factor for eGDM. A larger community-based study measuring weight and GDM status more frequently may be warranted to deepen the understanding of the role of GWG as a risk factor for GDM.

Purple Urine Bag Syndrome: A Scary but Easily Manageable Condition in a Patient with Prolonged indwelling Urinary Catheter.

"Purple urine bag syndrome" (PUBS) is a rare but distressing presentation of urinary tract infection (UTI) among moribund patients on indwelling urinary catheter. A 56-year-old woman with carcinoma of the left breast and metastasis in vertebrae and liver was bed ridden. She was on Foley's catheter for 9 months, with the last catheter changed 3 weeks back. A 75-year-old woman presented with non-Hodgkin's lymphoma for 2 years and moderately differentiated squamous cell carcinoma of the right parotid region (8 months). She experienced fall and fracture of femur, bed ridden, and on Foley's catheter for 7 years. She had facial wound with maggots for 3 days. Both the women developed purple-colored urine with no other symptoms of UTI. No investigations were carried out and they were empirically treated with nitrofurantoin, catheter change reassurance, and increased fluid intake. Urine color was normal by a week. PUBS can be managed easily at home with simple antibiotics, adequate hydration, and family/patient counseling in palliative care settings.