Indu Arun Bhargavi, O (2010) Comparative effect of 75 grams glucose challenge test with fasting and post prandial plasma glucose values in the screening of gestational diabetes mellites. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Pregnancy is a time when serial metabolic adaptations in maternal fuel metabolism and hormones occur, in order to accommodate a rapidly growing tissue transplant, the conceptus. Subtle perturbation in these changes can have implication not only for the index pregnancy but also for the future generation. Diabetes is the most common medical complication of pregnancy. Women can be separated into those who were known to have diabetes before pregnancy - PRE GESTATIONAL / OVERT DIABETES and those diagnosed during pregnancy - GESTATIONAL DIABETES MELLITES (GDM). GDM as a concept began in 1964 when O’Sullivan and Mahan performed the oral glucose tolerance test. Ethnically Indian women have high prevalence of diabetes and the relative risk of developing GDM in Indian women is 11.3 times compared to white women, necessitating universal screening for glucose intolerance during pregnancy in India. Screening for GDM is an example of how timely intervention that costs very little and enables easy management of the condition can help in reducing the risk of both mother and child becoming diabetic at a later stage. Several studies have established that elevated glucose levels can be detected through screening even as early as 16th week of pregnancy and that the condition shows up at all the trimesters. 2 to 2.5 % of GDM prevalence was found in the 16th week, 2.5 to 3 % cases were detected during the 24th week and 3% in the 32nd week, recorded during the Tamil Nadu programme. This is being reviewed in this study. AIM OF THIS STUDY: This study compares the efficacy of 75 grams glucose challenge test with fasting and postprandial blood glucose values in the screening of gestational diabetes mellitus in the general population. MATERIALS AND METHODS: The study was conducted in the high risk unit of the antenatal clinic outpatient department of the Institute of Social Obstetrics & Govt. Kasturba Gandhi Hospital for Women and Children, Triplicane, Chennai. Study Group: The study group included 300 pregnant women in GCT group and 300 pregnant women in fasting & post prandial group. The group allotment was random. They have been followed up from the time of confirmation of pregnancy through delivery until one week post partum. GDM patients were followed up to 6 weeks post partum at which time OGTT was done to find out their glycemic status. Duration of Study: September 2008 to August 2009. Inclusion Criteria: Women with singleton gestation, • Women with no past history of GDM / DM, • Not on any long term treatment for other medical illness, • No previous history of treatment for GDM/DM including on meal plan. Exclusion Criteria: Women with diabetes mellitus, • Women with multiple gestation, • Women with other risk factors like anemia, heart disease, epilepsy, thyroid disorders, bad obstetric history, jaundice and auto immune disorders. • Women with past history of GDM. Those on long term medical treatment for any illness SUMMARY: This is a comparative study of the efficacy of 75 grams glucose challenge test with fasting and postprandial blood glucose values in the screening of gestational diabetes mellitus in the general population, carried out in the high risk unit of the antenatal clinic outpatient department of the Institute of Social Obstetrics & Govt. Kasturba Gandhi Hospital for Women and Children, Triplicane, Chennai. The study group consisted of 600 apparently normal pregnant women, randomly allotted to FBS / PPBS or 75 grams GCT group, 300 each. The respective tests were done on 4 visits. 1st visit – 8 to 10 wks, 2nd visit – 16 to 20 wks, 3rd visit – 24 to 28 wks and 4th visit – 32 to 36 wks. Patients who have GDM were given appropriate treatment. The prevalence of GDM was 2.4% in FBS / PPBS group and 5.4% in GCT group. GCT has identified 25% of cases prior to 24 weeks gestation, 50% of cases at between 24 to 28 weeks and 25% of cases after 32 weeks. Hence the earlier diagnosis allows better and effective management, thereby preventing adverse obstetric and perinatal outcomes. Also this is indicative that GDM reveals itself at all 3 trimesters. The mean age of the pregnant women screened was 24.2 ± 4.5 yrs in FBS / PPBS group and 24.3 ± 4.5 yrs in GCT group. Highest prevalence of GDM was observed in the age group of 26 to 30 yrs in both the groups. The pattern of significant increase in prevalence (p < 0.001) of GDM as the age increases was observed in both the groups. Among the GDM women, the highest prevalence was observed in women with BMI ≥ 26 kg/m2 and it was 87.5% in FBS / PPBS group and 56.3% in GCT group. Hence in both the groups, there was a significant (p < 0.001) increase in the risk of acquiring GDM as the BMI increases beyond 26. The incidence of GDM was more in Primigravida. Higher prevalence was also noted in women belonging to class 4 socioeconomic status and in those with higher secondary education. They were managed with either meal plan or insulin according to their glucose levels. Most of the patients with GDM delivered at term by labor natural or by caesarean section. There were no assisted vaginal deliveries in this group. There was no significant difference in the birth weight of babies between normal women and in those with GDM in both groups. Hence for 100 patients in group 1, GCT was done at 28 weeks and the sensitivity of screening with fasting and post prandial plasma glucose was only 60% when compared to screening with 75 grams glucose challenge test. CONCLUSION: To conclude, 75 grams glucose challenge test done as per WHO criteria serves both as one step screening and diagnostic procedure, is easy to perform and also economical and has detected more number of GDM cases. The same has been recommended for screening in all pregnant women by “THE MINISTRY OF HEALTH and FAMILY WELFARE, GOVERNMENT OF TAMIL NADU”. SCREENING AND SUBSEQUENT TREATMENT STARTED IN THE EARLY WEEKS OF PREGNANCY HAS THE POTENTIAL TO DETECT CASES EARLY AND CAN PREVENT OR MINIMIZE ADVERSE OBSTETRIC AND PERINATAL OUTCOMES. As the age increases, the risk of acquiring GDM also increases. Similarly when BMI is ≥ 26, GDM risk increases. Screening with fasting and post prandial plasma glucose has only 60% sensitivity when compared to screening with 75 grams glucose challenge test. Hence Glucose Challenge Test with 75 grams oral glucose irrespective of last meal for all pregnant women appear to be a simple, effective and easily reproducible screening method for early diagnosis of GDM.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Comparative effect ; 75 grams glucose challenge test ; fasting ; post prandial plasma glucose values ; screening ; gestational diabetes mellites |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 25 Nov 2017 11:50 |
| Last Modified: | 09 Dec 2017 12:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4096 |
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