Neonatal outcome in pregnancies complicated by gestational diabetes mellitus: a hospital based study

Authors

  • Masaraddi Sanjay K. Department of Paediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India
  • Saranya Andal Kishore Department of Obstetrics and Gynecology, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India
  • Nedunchezian P. Department of Paediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India
  • Sulekha C. Department of Paediatrics, Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20180948

Keywords:

75 g Oral glucose tolerance test, BMI, Gestational diabetes mellitus, Hypoglycaemia, Pre-eclampsia, WHO

Abstract

Background: Gestational diabetes mellitus (GDM) is amongst the most common medical complications of pregnancy associated with adverse maternal and perinatal outcomes. The prevalence of GDM is increasing worldwide especially in India with increasing obesity and lifestyle and dietary changes. Hence this study was undertaken to study the prevalence of GDM and to evaluate its neonatal outcomes.

Methods: This was a prospective study. During the study period, 205 pregnant women between 24 to 28 weeks of gestation were screened for GDM using 75 g oral glucose tolerance test (OGTT) and were diagnosed to have GDM based on WHO criteria. Risk factors for GDM, maternal and neonatal outcomes were studied.

Results: The prevalence of GDM in the study population was 7.8%. Prevalence of GDM cases was significantly associated with body mass index (BMI) >25 kg/m2, family history of diabetes, previous macrosomia/large for gestational age (LGA) baby and past history of GDM with p <0.001 and with multiparity (p = 0.024). Maternal age >25 years was not statistically associated with prevalence of GDM (p = 0.358). Incidence of pre-eclampsia and polyhydramnios were significantly higher among GDM cases. Operative delivery and assisted (forceps) delivery had strongly significant association with GDM (p <0.001). GDM cases were significantly associated with higher birth weight (>3.5 kg) in the neonates (p <0.001). Hypoglycemia was the most common complication noted in neonates of GDM women. Incidence of respiratory distress, transient tachypnea of the newborn (TTN), polycythemia and neonatal hyperbilirubinemia were also significantly more common among neonates born to GDM women.

Conclusions: BMI >25 kg/m2, family history of diabetes, past GDM and previous LGA baby were important risk factors for GDM. The study emphasizes the need to screen all pregnant women for GDM, so that timely diagnosis and intervention will reduce both maternal and perinatal complications.

References

Gestational Diabetes Mellitus. ACOG Practice Bulletin #137. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;122:406-16.

Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25:1862-8.

American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2004;27(l):88-90.

Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Kapur A. Pregnancy and diabetes scenario around the world: India. Int J Gynaecol Obstet. 2009;104(1):35-8.

Ferrara A. Increasing prevalence of gestational diabetes mellitus - a public health perspective. Diabetes Care. 2007;30(2):141-6.

Griffin ME, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J, et al. Universal versus risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med. 2000;17(1):26-32.

Dornhorst A, Paterson CM, Nicholls JS, Wadsworth J, Chiu DC, Elkeles RS, et al. High prevalence of gestational diabetes in women from ethnic minority groups. Diabet Med. 1992;9:820-5.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. The Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Eng J Med. 2005;352(24):2477-86.

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002.

Trindler P. Determination of glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem. 1969;6:24-7.

Narendra J, Munichoodappa C, Gurudas A, Ram Prasad AV, Madhav T, Vijayalakshmi, et al. Prevalence of glucose intolerance during pregnancy. Int J Diab Dev Countries. 1991;11:2-4.

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.

Jang HC, Cho NH, Jung KB, Oh KS, Dooley SL, Metzger BE. Screening for gestational diabetes mellitus in Korea. Int J Gynecol Obstet 1995;51:115-22.

Capula C, Chiefari E, Vero A, Arcidiacono B, Iiritano S, Puccio L, et al. Gestational diabetes mellitus: screening and outcomes in southern Italian pregnant women. ISRN Endocrinol. 2013;5:387495.

Sermer M, Naylor D, Gare DJ, Kenshole AB, Ritchie JWK, Farine D, et al. The Toronto Tri-hopital gestational diabetes investigators: impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3,637 women without gestational diabetes. Am J Obstet Gynecol. 1995;173:146-56.

Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 1997;20:1183‑97.

Kalra P, Kachhwaha CP, Singh HV. Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. Indian J Endocrinol Metab. 2013;17(4):677-80.

Downloads

Published

2018-04-20

Issue

Section

Original Research Articles