Abstract
Background It is well known that both pre-excising and gestational diabetes mellitus in pregnancy is associated with multiple maternal and fetal complications. There are various guidelines developed to reduce these complications, yet there is no universal agreement regarding the ideal management. For those with pre-exciting or gestational diabetes mellitus, the control of blood sugar is assessed either with 1st-hour post-prandial blood sugar values or with the 2nd-hour post-prandial blood sugar values. Objective To compare the long-term blood glucose control (HbA1c values) of pregnant women by utilizing results of 1-hour postprandial blood sugar values against 2-hour post-prandial blood sugar values, in the antenatal ward at the professorial unit, Teaching Hospital Peradeniya. Materials and Methods A prospective cohort study was carried out among 138 pregnant women with diabetes mellitus, who were managed in two different clinics at the professorial unit, Teaching Hospital Peradeniya. The blood glucose control in group 1 (n = 69) was assessed and optimized with 1st-hour postprandial blood sugar values and group 2 (n = 69) was evaluated with 2nd-hour postprandial values throughout the pregnancies. Following delivery, all subjects were reassessed with blood HbA1c and analyzed with the independent t-test. Feto-maternal complications were analyzed and evaluated using descriptive statistics and Chi-Square tests. Results Of the subjects, 97.1% were diagnosed with gestational diabetes mellitus. The mean value of HbA1c for group 1, managed with 1st-hour blood glucose values was 5.73 and 6.04 (p = 0.02) respectively for group 2. Fetal macrosomia was also significantly (p < 0.01) low in the 1-hour blood sugar control group. Conclusion Long-term control of blood sugar was significantly superior among the subjects managed with 1st-hour postprandial blood sugars with a statistically significant reduction in foetal macrosomia.
Highlights
Diabetes during pregnancy is a leading cause of maternal and fetal complications during pregnancy [1]
Basic characteristics of the study population A total of 69 pregnant women were recruited for group-1 where blood sugar control was optimized depending on the 1st-hour post-prandial blood glucose levels
There were 4.3% teenage pregnancies and the majority (40.2%) comprised of women aged over 35 (Figure 1). Another 69 pregnancies were used in group-2 where the blood sugar control was optimized depending on the 2nd-hour post-prandial blood glucose levels
Summary
Diabetes during pregnancy (pregestational or gestational) is a leading cause of maternal and fetal complications during pregnancy [1]. Self-monitoring of blood glucose and insulin therapy have shown to reduce adverse perinatal outcomes in mothers diagnosed with diabetes at 24 th - 28th week of gestation [2] [3]. It is well known that both pre-excising and gestational diabetes mellitus in pregnancy is associated with multiple maternal and fetal complications. There are various guidelines developed to reduce these complications, yet there is no universal agreement regarding the ideal management. For those with pre-exciting or gestational diabetes mellitus, the control of blood sugar is assessed either with 1st-hour post-prandial blood sugar values or with the 2nd-hour post-prandial blood sugar values
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