Abstract
Aim: Evaluation of the occurrence of glucose intolerance after 34 - 36 weeks in pregnant mothers attending the Teaching Hospital, Peradeniya. Materials & Method: This is a descriptive cross-sectional study carried out from October 2017 to March 2018 among 183 pregnant mothers attending antenatal clinic at Teaching Hospital Peradeniya. After informed consent a repeat Oral Glucose Tolerance Test (OGTT) was done among the pregnant mothers, at period of amenorrhoea of 34 - 36 weeks, whose initial OGTT values were normal. Gestational diabetes was diagnosed according to the NICE guideline cut off values and the percentage of late occurrence of Gestational diabetes (GDM) was analyzed. Results: Mean age of the population was 29.1 years and the age range in this group was 18 to 45 years and the majority (73.9%) of women were primipara. There were 3.3% of teenage pregnancies and 14% of mothers were over 35 years. Majority (59.7%) of mothers underwent repeat OGTT test at 34 weeks of gestation and the rest (40.3%) underwent test between 34 to 36 weeks of gestation. Although the mean BMI was 23.74, 9.7% of mothers were obese (>30 kg/m2), 30.3% of mothers were pre-obese (25.0 - 29.9 kg/m2). 8.2% of mothers were diagnosed with Gestational diabetes at 34 - 36 weeks whose initial OGTT values were normal. Conclusion: In view of reducing feto-maternal morbidity and mortality, considering a repeat OGTT at a later gestation (34 - 36 weeks of gestation) should be considered in mothers, whose initial OGTT values are normal as Sri Lanka is a high risk country for GDM. Clinical Significance: The study may play an important role in guideline alteration process and screening for gestational diabetes in Sri Lankan set-up.
Highlights
Gestational diabetes is glucose intolerance or the occurring of diabetes first recognized in pregnancy and this definition includes women with previously undiagnosed diabetes at one end of the spectrum and those with disturbances of glucose intolerance resulting from the metabolic changes in late pregnancy i.e., those above the upper limit of the normal range [1] at the other end of the spectrum
It is necessary to evaluate and study to understand whether Gestation Diabetes Mellitus (GDM) can present in later gestations the initial Oral Glucose Tolerance Test (OGTT) is normal in order to prevent adverse outcomes of pregnancy. Since this evaluation was not done in the Sri Lankan set-up, this study aims to re-evaluate a pregnant mother with the OGTT test at 34 - 36 weeks whose initial OGTT was negative when it was done around 24 - 32 weeks
The pregnant mothers who had normal OGTT at 24 - 28 weeks were re-evaluated with OGTT at 34 - 36 weeks of period of gestation to detect the late occurrence of Gestational diabetes mellitus
Summary
Gestational diabetes is glucose intolerance or the occurring of diabetes first recognized in pregnancy and this definition includes women with previously undiagnosed diabetes at one end of the spectrum and those with disturbances of glucose intolerance resulting from the metabolic changes in late pregnancy i.e., those above the upper limit of the normal range [1] at the other end of the spectrum. This is a common endocrine condition seen worldwide which can result in fatal neonatal outcomes and major maternal morbidities [2]. Women with GDM have a high risk of developing type 2 diabetes (DM) within five years postpartum with a doubling of the risk after the first five years [5]
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