Solairajalakshmi, S (2022) A Study on Fetomaternal Outcome in Gestational Diabetes Mellitus Diagnosed by IADPSG (International Association of Diabetes In Pregnancy Study Group) Criteria at Tertiary Care Hospital. Masters thesis, Madras Medical College, Chennai.
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Abstract
BACKGROUND: Gestational Diabetes Mellitus (GDM) has become a global challenge for health and social care. As per the International Diabetes Federation (IDF) Diabetes Atlas Eighth Edition, about one in every four pregnancies in South East Asia is affected by Hyperglycemia of which 90percent is GDM. ❖ Nearly 37 million are in pregnancy each year. Estimates indicate that South Asia accounts for over two fifths of the global burden of hyperglycemia in pregnancy (HIP) and the ongoing nutritional and epidemiological transition may make the situation worse. ❖ There is no adequately powered study which provides evidence that the currently commonly used criteria for GDM (DIPSI and IADPSG) help identify women and inform their management to improve either perinatal or long term outcomes in Indian women. The lack of consensus results in confusion and inconsistent screening and diagnosis. ❖ Therefore, the aim of this prospective study was to evaluate the IADPSG criteria and to determine association between GDM and adverse pregnancy outcomes in pregnant women. AIMS AND OBJECTIVES: 1. To evaluate perinatal and maternal outcomes in women diagnosed with GDM by IADPSG criteria. 2. To highlight for proper antenatal care regarding screening and diagnosis of GDM which will be helpful in identifying the magnitude of the problem & improving the patient care. MATERIALS AND METHODS: It’s a prospective observational study. The study participants will be enrolled as per inclusion and exclusion criteria. Informed consent will be taken. At initial prenatal visit fasting blood glucose will be taken and as recommended by IADPSG criteria,75G OGTT was performed. The women with fasting blood glucose>/=126mg/dl, 2hr blood glucose >/=200mg/dl are diagnosed with overt diabetes and will be excluded from the study. Women with fasting plasma glucose >/=92 mg/dl but <126mg/dl, 1 hr plasma glucose >/=180mg/dl, 2 hr plasma glucose >/=153mg/dl are diagnosed as GDM and included in the study. The management of GDM was consistent with standard clinical practice which consisted of dietary control, proper exercise and insulin therapy accordingly. OUTCOME: Maternal outcome variables include the occurrence of preterm delivery. 1. Requirement For Caesarean Section, 2. Operative vaginal delivery, 3. Preeclampsia, 4. Miscarriage. Fetal outcome: 1. Large for gestation, 2. Stillbirth/IUD, 3. Clinically significant neonatal hypoglycemia, 4. Respiratory distress syndrome, 5. Perinatal mortality, 6. Birth injury/trauma. RESULTS: Age distribution were 14.8% is 21-25 years, 76.8% is 26-30 years, 8.4% is Above 30 years. Parity distribution were 54.0% is Multi, 46.0% is Primi. Gestational Hypertension distribution were 70.0% is Absent, 30.0% is Present. Insulin requirement distribution were 53.6% is Absent, 46.4% is Present. Mode of delivery distribution were 10.0% is Elective, 53.2% is Emergency, 36.8% is Natural labour .NICU Admission distribution were 63.2% is No, 36.8% is Yes. PPH distribution were 96.0% is No, 4.0% is Yes. Term distribution were 24.4% is Preterm, 75.6% is Term. IUGR distribution were 2.0% is FGR, 98.0% is AGA. Body Mass Index distribution were 57.2% is Normal, 24.4% is Overweight, 13.2% is Obesity Class I, 4.8% is Obesity Class II, 0.4% is Obesity Class III. Birth weight distribution were 3.3% is 1.5-2 kgs, 18.8% is 2-2.5 kgs, 32.7% is 2.5-3 kgs, 34.7% is 3-3.5 kgs, 10.6% is > 3.5 kgs. CONCLUSION: The present study shows that highest incidence of GDM occurs at around 29 years and that most of the cases can be managed with diet & exercises as first line of therapy. The study also shows that the incidence of pregnancy complications like PIH, IUGR, IUFD & polyhydramnios are increased significantly in these cases. The study confirms the increased rate of LSCS in GDM cases (more than 50%), the indications being not only GDM but also the associated risk factors like PIH and IUGR, big baby, etc.The intra partum complications like asphyxia, birth trauma, shoulder dystocia, postpartum haemorrhage are noted with increased frequency in these cases. The neonatal metabolic complications like hypoglycemia, hypocalcaemia, RDS, hyperbilirubinemia, low Apgar are increased in babies of GDM mothers. Most of the babies need NICU care either for the morbidity or for observation upto 48-72 hours. Large for gestation babies are common in GDM cases. The incidence of macrosomy is also increased contributing for birth trauma.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221916898 |
| Uncontrolled Keywords: | Fetomaternal Outcome, Gestational Diabetes Mellitus, Diagnosed, International Association of Diabetes In Pregnancy Study Group (IADPSG), Criteria, Tertiary Care Hospital. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology > MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 17 Apr 2022 07:04 |
| Last Modified: | 29 Nov 2023 03:49 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19306 |
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