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Absence of Fasting Hyperglycemia in Gestational Diabetics as a Predictor of Good Perinatal
Outcome in High Risk Population – A Study from Northern India

Smita Nanda¹,Umber Agarwal¹,Harbans Lal²,Krishna Sangwan¹,Ritu Aggarwal¹

- Departments of Obstetrics & Gynaecology¹ and Biochemistry²
Pt. B.D. Sharma PGIMS, Rohtak – 124 001, Haryana
Source: Indian Medical Gazette, Vol. CXXXVI, No 3

Abstract

Objective : To correlate the fasting plasma glucose values with perinatal outcome in women with gestational diabetes.

Design : Prospective population based study.

Setting : Outpatient department in a Medical Collage Hospital in Haryana.

Participants : Four hundred pregnant women with potential diabetic features in their history or clinical presentation, all underwent a glucose challenge test with 50 gram glucose between 24-38 weeks of gestation followed by diagnostic 100 gram oral glucose tolerance test within fifteen days. This was done irrespective of the result of the challenge test.

Main outcome measures : Perinatal morbidity and mortality in form of unexplained stills births, macrosomia, cesarean section rate and neonatal hypoglycemia and hyperbilirubinemia.

Conclusions : Absence of fasting hyperglycemia in gestational diabetics was associated with good perinatal outcome except for increased cesarean section rate.

Key words : Gestational diabetes mellitus, Complications, Fasting hyperglycemia

Introduction

Pregnancy is a diabetogenic state characterized by fasting hypoglycemia and post prandial hyperglycemia. Gestational diabetes mellitus is a common medical complication and metabolic disorder in pregnancy occurring in 1-4% of patients depending on the population described and the criteria used for diagnosis1-4. Increasing pregnant women’s carbohydrate intolerance is associated with a graded increase in adverse material and fetal outcomes. The Toronto tri-hospital gestational diabetes project showed an unequivocal graded relation between the fasting plasma glucose concentration and a wide variety of adverse outcomes5.

Early neonatal consequence of gestational diabetes mellitus include metabolic derangements as hypoglycemia, hypocalcemia and hyperbilirubinemia, fetal morbidity includes macrosomia which is 3 to 4 times more likely to occur in a pregnancy complicated by gestational diabetes. The fasting blood glucose on the oral glucose tolerance test (OGTT) performed in women with a positive glucose challenge test (GCT) has been reported to correlated with macrosomia6.

We aimed to evaluate whether measuring fasting plasma glucose concentration on OGTT in women with positive GCT correlates with perinatal outcome.

Material and Methods

Study group comprised of 400 women between 24-38 weeks period of gestation with potential diabetic factors in their history, like family history of diabetes in first degree relative, obstetrical history (recurrent abortions, gestational diabetes, pre-eclampsia, macrosomic infant, congenital malformations, polyhydramnios, unexplained still birth / neonatal dealth/, age > 30 years and history of hypertension or latent diabetes). These patients underwent 50 gm, 1 hour plasma oral GCT and a 100 gm, 3 hour oral GTT at median interval of 15 days along with other routine antenatal investigations. The plasma glucose was estimated by glucose oxidase-peroxidase method. The cut off value for glucose challenge test was taken to be 130 mg%. For OGTT gestational diabetes was diagnosed if two or more values equalled or exceeded the thresholds proposed by Carpenter and Couston and adopted by the fourth international working conference on gestational diabetes4: fasting – 105 mg%, 1 hour-190mg%, 2 hour-165 mg% and 3 hour – 145 mg%.

All patients were followed up till delivery. Patients with maternal complications in present pregnancy and those found diabetic were managed accordingly. Maternal and perinatal outcome were noted in all. The statistical test used was the chi-square test. Results were deemed statistically significantly at 5% level of significance.

Results

Screening for gestational diabetes was performed consecutively in 400 high risk gravidas. The 130 mg% threshold was met or exceeded in 22 (5.5%) cases. Of these 22, 10 (45.5% or 2.5% of the total) met the criteria for gestational diabetes with OGTT. Among these the fasting plasma glucose ranged from 56-105 mg% (mean 86.2 + 4.83 mg%). None of the gestational diabetics had fasting hyperglycemia (i.e. plasma blood sugar > 105 mg%). All were controlled on diet and none required insulin therapy or developed hypertensive complications. All went up to term. Four had successful vaginal deliveries while six underwent cesarean section. The indications of cesarean section were mid pelvic contraction in two, unstable lie in two, precious pregnancy in one and chronic nephritis with decreased fetal movements with failed induction in one case.

Table – 1 Comparison of mode of delivery amongst the diabetics and non diabetics
	Cesarean section (%)	Vaginal delivery (%)	Total
Gestation	6 (60%)	4(40%)	10
Non diabetics	111(36.3%)	195 (63.7%)	306

Table 1 shows the comparison of mode of delivery amongst the diabetics and non-diabetics

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