| Management |
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| Gestational Diabetes – Not An Uncommon Disease |
Dr. Paulose. K.P., Dr. Rema, S.U.T. Hospital, Pattom, Trivandrum, Kerela
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| Introduction |
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| Gestational diabetes is a high risk problem from conception till well past delivery. Diagnosis and prompt management at the right time during pregnancy is absolutely essential for a favorable outcome for both mother and the foetus. The primary objective is to achieve normoglycemia and associated normal metabolic environment for the developing foetus though this does not always ensure a normal outcome. The aim of this study was to assess the prevalence of GDM, its relation to family history and the perinatal outcome in these patients. |
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| Materials and Methods |
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| A total of 700 who attended the antenatal clinic of the SUT hospital, Trivandurm during 1994 and 1995 were included in the study. Patients with history of pregestational diabetes were excluded. Two tests were done during the study. One was the glucose challenge test. A value of more than 140mg% was taken as abnormal. The other test was the O’Sullivan test. This study was done in two phases. In phase I (450 patients) the selection criteria was a positive family history of diabetes mellitus (DM) in the first degree relatives. All the patients with a positive family history (121) were subjected to O’Sullivan test. In phase 2 (250 patients), GCT test was done in all. |
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| There were a total of 78 patients with GDM (39 in each phase). The non diabetic patients were taken as controls. All these patients were followed upto delievery and the perinatal outcome analysed. Complications such as PHIUGR, hydramnios, macrosomia and intra uterine death, during antental period; prematurity, shoulder dystocia, hypoglycemia, hypocalcemia, jaundice and neonatal death during the post natal period were the parameters analysed. Statistical analysis for determining the significance was also done using the chi-square test. |
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| Results |
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| The relation between family history of DM in the first degree relatives and GDM was analysed. Of the total of 78 GDMs, 93% had a positive family history of DM. Thus a very high incidence of positive family history is seen with DM. |
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| When the total number of patients with family history of DM were analysed, GDM was found in 26% cases, GDM was seen in patients without a positive history also. Thus family history of patients alone should not be a criteria for testing for GDM. |
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| For determining the prevalence of GDM in the patients attending our hospital, only phase 2 study was taken into consideration. Of the 250 patients, 163 had a positive GCT, of which 39 had GDM, a prevalence of 15.6%. |
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| Of the 78 GDMs, 71 of them (91%) could be controlled by diet alone while the rest were treated with human insulin. Antenatal complications such as IUGR, hydramnious and PIH were found to be higher in the GDMs, than in the control group. The difference was found to be statistically significant. Shoulder systocia, hypoglycaemia and hypocalcaemia were also seen to be higher in the diabetic group. |
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| The incidence of other complications such as macrosomia, prematurity did not have any statistical significance between diabetic and non-diabetics. There were two cases of congenital anomalies-prune belly syndrome and Down’s syndrome – both in the control group. There were no cases of intrauterine death or neonatal death in both the groups. |
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| Discussion |
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| Approximately 5% of all pregnancies are complicated by GDM. In this study, the prevalence was found to be 15.6% which was quite high compared to different studies. Our study group comprised of patients who belonged to the higher socio-economic strata which could be one of the reasons for this high prevalence. |
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Table – I: Antental complications |
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GDM % |
Control % |
Signifiance |
| IUGR |
16.7 |
5.5 |
S |
| PIH |
38.5 |
9.9 |
S |
| Hydramnios |
5.1 |
0.5 |
S |
| Macrosomia |
14.10 |
7.4 |
NS |
| Congenital anomalies |
- |
2.0 |
- |
| S : Significant, NS : Not significant |
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Table – II: International / Postnatal complications |
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GDM % |
Control % |
Signifiance |
| Prematurity |
5.3 |
1.5 |
NS |
| Shoulder dystocia |
3.9 |
- |
S |
| Hypoglycemia |
9.0 |
1.0 |
S |
| Hypocalceamia |
2.6 |
0 |
NS |
| Hyoerbilirubinemia |
5.1 |
1.5 |
NS |
| S : Significant, NS : Not significant |
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