Indian Write- Ups
| Management |
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| Gestational Diabetes – Not An Uncommon Disease |
| Dr. Paulose. K.P., Dr. Rema, S.U.T. Hospital, Pattom, Trivandrum, Kerela |
| When the family history was taken into consideration, it was found that the incidence was high in those with positive family history. However GDM was also present in those without a family history. Thus family history alone should not be a criterion for performing the diagnostic test. |
| In treating women with GDM, many have advocated minimizing fluctuation in blood sugar levels to avert maternal hyperglycaemia and thus decrease the risk of foetal hyperglycaemia and its consequence, foetal hyperinsulinemia and excess foetal growth. However despite early diagnosis and aggressive therapy, perinatal morbidity among infants born to women with GDM remains excessive, a fact that may or may not be attributed to suboptimal glycemic control. Intrauterine growth retardation is known to occur in GDM under two conditions, early foetal growth disturbances may be associated with congenital anomalies and later growth retardation, a complication seen especially when the mother has underlying vascular disease such as PIH. In our study, the incidence of IUGR was higher than in the non-dabetics and all of them had associated PIH. |
| Ten to twenty percent of pregnant diabetic patients have toxaemia or hypertension compared to 5 percent in non-diabetic women. Polyhydramnios is noted in about 20% of patients with GDM. Large for gestational age infants are delivered in 14-45% of pregnancies complicated with diabetes. GDM is strongly associated with maternal obesity and considerable controversy exists as whether macrosomia is attributable to material obesity, poor glycaemic control or both. In this study, we found that good glycaemic control reduced the incidence of macrosomia much below that seen in non-diabetics. |
| Neonatal complications such as hypocalcemia, hyperbilirubinamia, have been described in infants born to women with GDM particularly in whom the glycemic control was poor. With tight glycemic control, the incidence of reported neonatal hypoglycemia is about 15%. In this study, the incidence of hypoglycemia was higher in the GDM than in non-diabetic. In the present study, good glycemic control was achieved by estimating frequent fasting and post prandial blood sugars in all patients during treatment of GDMs. In spite of this, the incidence of certain complications could not be reduced. Thus good glycaemic control does not always ensure normal outcome though outcome which is not far from normal can be achieved. |
| Summary |
| Seven hundred patients who attended the antenatal clinic were studied for detecting the prevalence of Gestational Diabetes Mellitus (GDM) and associated perinatal complications. 36% had a positive family history of diabetes mellitus in the first degree relatives and of these 26% had GDM. Glucose challenge test (GCT) was positive in 65.1% of patients and GDM was detected in 23.1% of the patients with positive GCT. In 91% of patients, GDM could be controlled by diet alone while the rest needed insulin. The prevalence of Intra Uterine Growth Retardation (IUGR), Pregnancy Induced Hypertension (PIH), Bad Obstetric History (BOH) and Hydramnios were more in patients with GDM. Similarly prematurity, hypocalcemia and hypoglycemia in the infant were also high in the GDM group irrespective of proper control irrespective of proper control of the diabetes status as compared to non diabetics . |
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