Gestational diabetes: Perinatal and maternal complication in 24-28 weeks

Abstract

Background: Gestational diabetes mellitus (GDM) is a glucose tolerance disorder that occurs or is diagnosed for the first time during pregnancy. Perinatal morbidity is more and women with GDM have more risk of developing diabetes. Uttar Pradesh is a state of India with one of the highest rate of infant as well as maternal mortality which might be, at least partially, due to GDM. Thus, appropriate assessment and management of GDM can improve the outcomes. Aims & Objectives: Primary objective of this study was to determine the prevalence of GDM and evaluate the maternal and fetal outcome in and around Kanpur. Thus, this study was undertaken to know the extent of burden on the healthcare, before scope of intervention could be defined. Materials and Methods: A prospective study (September, 2012 - October, 2014) was done at 198 healthcare facilities. 24,656 mothers were screened (24th- 28th weeks of pregnancy) as per guidelines of Diabetes in Pregnancy Study Group India (DIPSI) and Federation of Obstetric and Gynecological Societies of India (FOGSI). Results: > 94% pregnant women did not know about GDM. Prevalence of GDM was 14.42%. Stillbirth, Perinatal & neonatal mortality were respectively 2, 3.3 & 6 times higher in GDM. Most of the GDM were diagnosed in primigravida (62%). Congenital Malformation was 8 times higher. Low Birth Weight (LBW) was 35% in GDM (16% in Non GDM). GDM positive cases had 20.6% positive family history of diabetes (compared to 6.5% in non-GDM). Relative risks for PBU (post birth unit), LGA (large for gestational age), LBW (low birth weight), pre-eclampsia and jaundice were also higher. Conclusion: A well predictive screening criteria is needed. As the ignorance about GDM among pregnant ladies is high, to reduce the risk, awareness can be an area of thrust.