Outcome in gestational diabetes mellitus after various treatment modality: A tertiary center experience in North India

Abstract

Background: Gestational diabetes mellitus (GDM) is a potential risk factor for pregnant women because it leads to various complications during pregnancy and childbirth; thus, GDM directly increases the risk of maternal and neonatal mortality and morbidity. Aim: To estimate the prevalence of GDM and evaluate maternal and fetal outcome in pregnant women with GDM. Materials and Methods: This was a prospective study carried out over a period of 1 year. After informed consent and ethical clearance, a total of 8970 pregnant women were recruited and followed; they underwent universal screening for diabetes as per the Diabetes in Pregnancy Study Group India criteria. Three-hundred and eighty women were diagnosed with diabetes, of this 29 were found to be type 2 diabetes and 351 pregnant women were diagnosed as gestational diabetes. Women with gestational diabetes were followed till 6 weeks of postpartum. After enrollment, 290 women were treated with regular insulin and neutral protamine Hagedorn insulin and only 61 women were kept on medical nutrition therapy. Results: About 76.1% of women underwent cesarean section, whereas 23.9% women delivered vaginally. Elective (LSCS) Lower segment caesarean section was done in 22% of women while emergency cesarean section in 54.1%. Preeclampsia was observed in 13.7%, 45.3% women delivered preterm baby, polyhydramnios was found in 3.41%, and oligohydramnios was found in 2% women. Candida vaginal infection was observed in 2.50% and intrauterine growth restriction present in 11.90% women. 8.3% babies were macrosomic and 3.1% babies were admitted in Neonatal intensive care unit. Stillbirth was noted in 4.3%. Congenital malformation was seen in 1.7% babies of GDM mothers who did not receive any antenatal care. About 26.5% of total GDM cases were unbooked. Conclusion: Gestational diabetes is a rising complication of pregnancy. If women receive proper medical nutritional therapy and insulin therapy during pregnancy, better maternal and fetal outcome could be achieved.