Detection and care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age

Abstract

The policy of screening for gestational diabetes mellitus (GDM) between 24 and 28 weeks of gestation and care has resulted in a few women delivering big babies despite good glycemic control. Hence we undertook a study to assess the merits of care given to women in whom GDM was diagnosed in different weeks of gestation and to find out the ideal period of screening in women with history of high-risk pregnancies. A total of 207 consecutive pregnant women irrespective of trimester referred to our referral clinic for diabetes in pregnancy, underwent a 75 g oral glucose tolerance test (OGTT) and GDM was diagnosed if 2 h plasma glucose (PG) ≥140 mg/dl. A1c was estimated in all of them. Women who failed to respond to medical nutrition therapy were advised insulin and the dose titrated to maintain fasting PG (FPG) <90 mg/dl and 2 h PG <120 mg/dl. The mean age of the population screened was 28.38 ± 4.31 years and the mean gestational age of screening was 20.05 ± 10.71 weeks. Among them, 87 were diagnosed as GDM. The gestational week at diagnosis was ≤12 in 36 (41.4%) women (group 1), between 13 and 23 in 18 (20.7%) (group 2), between 24 and 30 in 15 (17.2%) (group 3) and beyond 30 weeks of gestation in 18 (20.7%) (group 4). The A1c was 5.34 ± 0.43% in normal glucose tolerance (NGT) women, while it was 6.93 ± 1.62% in group 1, 6.03 ± 0.79% in group 2, 6.14 ± 0.93% in group 3 and 6.20 ± 0.31% in group 4, respectively. The birth weight of babies born to women with NGT was 3.28 ± 0.50 kg. The birth weight of babies born to GDM women in group 1, group 2, group 3 and group 4 was 3.15 ± 0.48, 3.09 ± 0.68, 3.32 ± 0.51 and 3.51 ± 0.63 kg, respectively. Group 1 women in spite of the history of high-risk pregnancies, delivered babies appropriate for gestational age like NGT women. Screening in the first trimester of pregnancy and institution of therapy is advisable in women with high-risk pregnancies.