WHO OGCT as a Diagnostic Test For Gestational Diabetes Mellitus

Preethi, D (2007) WHO OGCT as a Diagnostic Test For Gestational Diabetes Mellitus. Masters thesis, Madras Medical College, Chennai.

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Abstract

INTRODUCTION: Diabetes Mellitus is a clinical syndrome characterized by hyperglycemia due to absolute or relative deficiency of insulin. Lack of insulin whether absolute or relative affects the metabolism of carbohydrate, protein, fat. Pregnancy is characterised by mild fasting hypoglycemia, post prandial hyperglycemia, hyper insulinism and insulin resistance- a diabetogenic stress. Normally pregnant woman elaborates an increased insulin production by 30% above her non pregnant state. A woman who is unable to achieve adequate insulinogenic compensation develops Gestational Diabetes. Pregnancy unmasks the minor intolerance of carbohydrate metabolism in subjects with reduced pancreatic islet cell reserve. Gestational Diabetes was defined as carbohydrate intolerance of variable severity with its onset or first recognition during pregnancy. Use of this term was encouraged in order to communicate the need for increased surveillance and to convince the woman of the need for further testing postpartum. Gestational Diabetes is often asymptomatic and associated with increased fetal and neonatal morbidity and mortality. Good glycemic control reduces the risk of complication. AIM OF THE STUDY: 1. To find out whether 2 hours 75g WHO OG CT is as efficacious as 2 hours 75g WHO OGTT in detecting gestational diabetes mellitus in antenatal population between 16 – 32 weeks. 2. To analyse fetal outcome in GDM patients. MATERIALS AND METHODS: Place of Study : Institute of Obstetrics and Gynaecology, Egmore. Year of Study : 2005 – 2006. Nature of Study : Prospective Study. Selection of Cases : 800 pregnant women between 16 – 32 weeks were randomly Selected irrespective of parity, age Previous obstetric outcome. Inclusion Criteria : 1. All the women with gestational age by history and clinical examination between 16 to 32 weeks were included in this study. 2. Women who were not sure of the last menstrual period and whose clinical examination was inappropriate had an ultrasound examination and when the period of gestation was between 16 – 32 weeks were included in this study. Exclusion Criteria : 1. Women who were not within 16-32 weeks of gestation were excluded from the study. 2. Women who were already pregestational diabetes were excluded. Method : Pregnant women who were selected with the above criteria had urine glucose and albumin estimation done.Complete and careful clinical history was taken with regard to menstrual cycles, previous obstetric history, family history. Complete clinical examination was done. Ultrasound examination was done to ruleout congenital anomalies, to detect hydramnios and macrosomia. Patients were subjected to WHO OGCT .75g glucose was given in 200ml of water. 2 hour later 1 cc of venous blood was drawn in a test tube containing EDTA and immediately sample was taken for plasma glucose analysis. Following the glucose drink patients were prohibited from eating food or drinking except water. Same patients were instructed to come 2 days later after regular diet consumption with over night fasting of 8 hours and 2 hrs 75g WHO OGTT was done. The sensitivity and specificity of WHO OGCT in diagnosing GDM is estimated by statistical analysis of plasma glucose values. SUMMARY: 1) In 800 Randomly selected patients who attended our antenatal clinic prevalence of GDM was found to be 10.89% by WHO criteria. 2) 2 hr 75g WHO OGCT was performed on all 800 patients attending our antenatal clinic between 16-32 weeks since ethnically Indian belong to a high risk group. 3) Out of 100 non GDM patients between 16-20 weeks only 51 reported reassessment at 24-28 weeks and 30 reported for reassessment at 32 weeks. Out of 154 non GDM patients at 21-24 weeks, 100 reported for reassessment at 24 weeks and 57 reported for reassessment at 32 weeks. Out of 196 non GDM patients at 25-28 weeks only 97 came for reassessment at 32 weeks. This demonstrates the phenomenon of no show. 4) In our study it was found that all the patients who were diagnosed as GDM by WHO OGTT gave positive results with WHO OGCT. Thus sensitivity and specificity of WHO OGCT is 100%. WHO OGCT is useful as a diagnostic test for GDM. No show is not possible in first visit. 5) In our study it was found that i) As age increases the prevalence of GDM increases, ii) As number of gravida increases prevalence of GDM increases, iii) As BMI increases prevalence of GDM increases, iv) Positive family history predicts the higher risk of developing GDM, v) Macrosomia was seen in 20.69% of GDM patients. Hydramnios 2.3% in GDM Patients, PIH 16.09% in GDM Patients, Macrosomia 20.69% in GDM Patients Caesarean section rate 49.23% in GDM Patients, Hypoglycemia 29.23% in GDM Patients, Hypocalcemia 20% in GDM Patients, Hyperbilirubinemia 15.38% in GDM Patients, RDS 9.2% in GDM Patients. Among mothers whose babies had macrosomia 13 were on insulin and 5 were on medical nutrition therapy. 6) Hence early detection of gestational diabetes and effective management to maintain optimal blood glucose levels will drastically reduce maternal morbidity due to gestational diabetes and bring about a definite reduction in perinatal mortality rate. CONCLUSION: 1) Screen pregnant women universally for gestational diabetes. 2) 2 hr 75g WHO OGCT can be used to diagnose GDM and is as efficacious as 2 hr 75g WHO OGTT. More studies are needed before clinical application can be made. 3) To detect Gestational Diabetes Mellitus early. 4) Inspite of treatment 20.69% of GDM patients had macrosomic babies. In infants of GDM patients RDS was seen in 9.2%, hypoglycemia was seen in 29.23%,. hyperbilirubinemia was seen in 15.38%. So more stringent treatment of GDM will improve perinatal outcome. Screening universally for GDM improves the perinatal outcome, postpones the onset of diabetes in mother and also has a role in primary prevention of diabetes in offspring.

Item Type: Thesis (Masters)
Uncontrolled Keywords: World Health Organisation ; Oral Glucose Challenge Test ; Diagnostic Test ; Gestational Diabetes Mellitus.
Subjects: MEDICAL > Obstetrics and Gynaecology
Depositing User: Subramani R
Date Deposited: 03 Dec 2017 10:59
Last Modified: 09 Dec 2017 01:47
URI: http://repository-tnmgrmu.ac.in/id/eprint/4166

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