Vijaya Meenakshi, D (2008) Universal screening for gestational diabetes mellitus by single step procedure. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
200200408vijayameenakshi.pdf Download (253kB) | Preview |
Abstract
INTRODUCTION: Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate GDM develops. Magnitude of complications are equal in GDM than in women with pre GDM. Universal Screening is strongly recommended for the population ethnically proven to high prevalence of type 2DM. In much of the world, GDM is diagnosed if 2 hrs Blood glucose ≥ 140 mg/dl. GDM woman has increased incidence of caesarian section, pre eclampsia and macrosomia. A short term intensive care not only results in the safe motherhood but also gives a long term pay off in the primary prevention of obesity, IGT, and diabetes in the off spring as the “Preventive Measures Starts in Intrauterine Life”. Metabolic adaptations that occur during pregnancy are to accommodate a rapidly growing tissue transplant, the conceptus. The conceptus brings about alterations in maternal fuel metabolism and hormones. AIM OF STUDY: 1. To know the Incidence of GDM in our population. 2. Effectiveness of screening using single step procedure with 75 gm oral glucose. 3. To substantiate that universal screening is necessary in our population. 4. To analyse maternal and perinatal outcome in GTT positive and GTT negative patients. MATERIALS AND METHODS: Prospective Study was done in, Kilpauk Medical College and Hospital, having deliveries of about 7500 to 8500 per annum, with daily antenatal patient attendance of 120 – 130. Randomly selected 500 patients in gestational age 14 – 36 weeks by clinical examination height, 1st trimester weight, general examination, obstetric examination of the patient, from June 2006 to August 2007 of 14 months duration. These women were booked for delivery at KMCH. A detailed history was taken regarding family history, past history and about current pregnancy. Selected patients for study was given dates to come in fasting state, FBS taken and 75 gm oral glucose was given in 200 ml of water. 2 hours later blood sugar was taken. Glucose estimation done at diabetology department. Test sample was collected in glass tube with sodium fluoride for inhibiting glucose utilization and EDTA for anti coagulation. Criteria for diagnosing GDM by WHO criteria of 2 hours blood sugar level 140 mg % and above is to be diagnosed as GDM. Patients diagnosed as GDM were closely monitored with frequent antenatal checkup. Intrapartum monitoring, mode of delivery, details regarding neonatal complications were observed. INCLUSION CRITERIA - All pregnant women irrespective of age and parity. Gestational age between 14 and36 weeks. EXCLUSION CRITERIA - Known Diabetes mellitus. Gestational age more than 36 weeks and less than 14 weeks. Patients on drugs steroids, Calcium Channel blockers, Thiazides. SUMMARY: Incidence of GDM is 6.06%. Mean age group is 24years. Elderly women > 30 years are more Prone to GDM. P < 0.000014. Obese women with BMI > 25 were prone to GDM then non obese women, P < 0.000027. 66.67% GDM diagnosed women has no family history of diabetes. 60.6% were multigravida, no fetal wastage in 66.67%. 9.09% diagnosed to have GDM in less than 20 weeks of gestational age. 66.67% had no associated risk factor. 21.21% has FBS > than 125mg% and 18.75% had PPBS more than 200mg %. 84.85% of GDM patients had treated with meal plan. 27.27% among meal plane group has been switched over to insulin after MNT. CONCLUSION: Incidence of GDM is 6.6% in the study conducted. Universal screening by single step procedure is convenient, economical and suitable alternative screening test with out sacrificing these sensitivity expected for screening test. Thereby early detection and effective management to maintain optimal blood glucose concentration will reduce perinatal mortality and morbidity and adverse effect for the mother in future. Despite years of meticulous study, paucity of information still exits regarding the optimal maternal glucose levels that should be aimed for in order to reduce the embryonic, fetal and perinatal morbidity and yet not cause any harm to intra uterine development. The goal is to encourage early referral of both pre gestational and gestational diabetic women so that the tight glycemic control will be instituted at the proper time in order to prevent maternal hyperglycemia complications. The key finding here is that the risk of overweight and obese children rises in step with higher levels of blood sugar during pregnancy. By treating Gestational Diabetes, future risk of children becoming overweight, obese, PCOS, Diabetes drops considerably. To help expectant women to enjoy the arrival of their sweet ones, the Government of Tamil Nadu has planned the GDM screening project in all Government Hospitals from March 08, 2007 (GO No. 356 Health and Family welfare), on Women’s Day since “Women Health is Nation’s Wealth” in order to ensure the early diagnosis of GDM, to reduce infant mortality rate in the state.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Universal screening ; gestational diabetes mellitus ; single step procedure. |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Subramani R |
| Date Deposited: | 08 Dec 2017 02:05 |
| Last Modified: | 08 Dec 2017 02:05 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/4278 |
Actions (login required)
 |
View Item |
