Abstract

Research Article

Maternal and fetal outcome of comparative study between old & adopted new value of screening of Gestational Diabetes Mellitus in tertiary centre in Saudi Arabia

Gehan Farid*, Reem Mohammed Kamal*, Mohamed AH Swaraldahab and Sarah Rabie Ali

Published: 18 May, 2018 | Volume 1 - Issue 1 | Pages: 026-034

Objectives: To check if there is any significant difference in the immediate outcome of pregnancy with diabetes using the new values of FBS & 2hrs post prandial with 75g OGTT for 1 year (from 1st June 2013-31st May 2014) in comparison to the previous data done in the same institute with other values and with international figures.

The data in our study included fetal, maternal morbidities, intra partum and postnatal outcomes, in order to help, if possible, on deciding the best values to use for screening for gestational diabetes mellitus. Furthermore, to know the new percentages of gestational diabetes mellitus in SFH by utilizing the new values of Blood Sugar readings.

Design: Retrospective cohort study

Setting: Security Forces Hospital-Riyadh-Saudi Arabia

Patients: Done (from 1st June 2013 – 31st May 2014), on patients who had attended Security Forces Hospital, Riyadh, Saudi Arabia. This chosen year’s data was compared with data collected in the three previous years using different figures.

Main Outcome measured: Average age of mother, maternal aspects of parity, history of GDM, number of abortions``````````````````````````````, estimated blood loss in labor, associated medical disorder, complications of previous pregnancies, methods of control of GDM, gestational age for IOL and associated intrapartum complications. Immediate neonatal outcome in cases of GDM, comparison of birth weights of babies & any specific congenital abnormalities and delayed causes of admission to NICU in the 4 years studied were also reviewed.

Results: The percentage of diagnosed cases of gestational diabetes mellitus (GDM) after screening was 24 % as compared with 14.5% in previous study of 2003-2004 & with the number of screened patients amounting to 93% out of the total number of deliveries between 2013-2014 (in both years universal method of screening was used). The multidisciplinary set up of our GDM specialized clinic which was composed of dieticians, diabetic educators, endocrinologists and obstetric physicians operating together, helped to reduced the use of insulin in combination with diet to only 24% in comparison to 76% of patient using diet and exercise alone. The study showed a mean age of 33years and weight of 77kg. It was also noted that 16% of the patients diagnosed with GDM were multiparous averaging 1-5 deliveries. Almost 62% of patient didn’t give any history of GDM and no history of previous medical diseases. The majority of the patient with GDM delivered without complications during labor, with 30% having vaginal lacerations & 73% of patient had an estimated blood loss of less than 500cc. NICU admissions secondary to hyperbilirubinaemia averaged almost 17% in comparison to previous studies and only one baby expired in a GDM patient. Our study revealed a good fetal and maternal out come with less delivery complications and less incidence of postpartum hemorrhage (5.7%).

Conclusion: It is concluded that Universal Screening of Pregnant women whether with previously used glucose value or new ones for gestational diabetes mellitus is a better option, which has proven to improve both maternal and fetal outcomes. The 75 OGTT test is a cost effective test and with both easy accessibility and good screening pick up number (92.5%) of the patients in Security Forces Hospital, Riyadh.

Recommendation: We recommend annual follow up for patients, both the mother and the baby after postpartum, to prevent the development of type 2 diabetes.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001005 Cite this Article Read Full Article PDF

References

  1. Schmidt A, Sivaraman J, Li Y, Larocque R, Barbosa JA, et al. Three-dimensional structure of 2-amino-3-ketobutyrate CoA ligase from Escherichia coli complexed with a PLP-substrate intermediate: inferred reaction mechanism. Biochemistry. 2001; 40: 5151-5160. Ref.: https://goo.gl/vG2tFJ
  2. Yin-Wong Cheung, Menzie D Chinn, Antonio Garcia Pascual. Empirical exchange rate models of the nineties: Are any fit to survive?. J Int Money Finance. 2005; 24: 1150-1175. Ref.: https://goo.gl/8bLCrj
  3. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009; 373: 1773-1779. Ref.: https://goo.gl/v34PJX
  4. Naylor CD, Sermer M, Chen E, Sykora K. Cesarean delivery in relation to birth weight and gestational glucose tolerance: pathophysiology or practice style? Toronto Trihospital Gestational Diabetes Investigators. JAMA. 1996; 275: 1165-1170. Ref.: https://goo.gl/XydYDz
  5. Gillman MW, Oakey H, Baghurst PA, Volkmer RE, Robinson JS, et al. Effect of treatment of gestational diabetes mellitus on obesity in the next generation. Diabetes Care. 2010; 33: 964-968. Ref.: https://goo.gl/x8Rk3k
  6. Hillier TA, Ogasawara KK, Pedula KL, Vesco KK. Markedly different rates of incident insulin treatment based on universal gestational diabetes mellitus screening in a diverse HMO population. Am J Obstetric Gynecol. 2013; 209: 1-9. Ref.: https://goo.gl/KKZgec
  7. Langer O, Rodriguez DA, Xenakis EMJ, McFarland MB, Berkus MD, et al. Intensified versus conventional management of gestational diabetes. AM J Obstetrics Gynecol. 1994; 170: 1036-1047. Ref.: https://goo.gl/VdL2gM
  8. Rehder PM, Pereira BG, Pinto e Silva JL. The prognostic value of a normal oral glucose tolerance test in pregnant women who tested positive at screening: A validation study. Diabetology & Metabolic Syndrome. 2012; 4: 10. Ref.: https://goo.gl/f4RSUj
  9. Wendland EM, Duncan BB, Mengue SS, Schmidt MI. Lesser than diabetes hypoglycemia in pregnancy is releated to perinatal mortality: a cohort study in Brazil. BMC Pregnancy and Childbirth. 2011; 11: 92. Ref.: https://goo.gl/WrbgyK
  10. Ramtoola S, Home P, Damry H, Husnoo A, Ah-Kion S. Gestational impaired glucose, tolenace does not increase perinatal mortality in a developing country: cohort study. BMJ. 2001; 322: 1025. Ref.: https://goo.gl/iSrjmb
  11. Griffin ME, Coffey M, Johnson H, Scanlon P, Foley M, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med. 2000; 17: 26-32. Ref.: https://goo.gl/xuyydj
  12. Farrar D, Fairley L, Wright J, Tuffnell D, Whitelaw D, et al. Evaluation of the Impact of universal testing for gestational diabetes mellitus on maternal and neonatal health outcomes: A retrospective analysis. BMC Pregnancy and Childbirth. 2014; 14: 317. Ref.: https://goo.gl/zhafpx
  13. Danyliv A, Gillespie P, O’Neill C, Tierney M, O’Dea A, et al. The cost-effectiveness of screening for gestational diabetes mellitus in primary and secondary care in the Republic of Ireland. Diabetologia. 2015; 59: 436-444. Ref.: https://goo.gl/LZtmRU
  14. Yang X, Tian H, Zhang F, Zhang C, Li Y, et al. A randomized translational trial of lifestyle intervention using a 3 tier shared care approach on pregnancy outcomes in Chinese women with gestational diabetes mellitus but without diabetes. J Transl Med. 2014; 12: 290. Ref.: https://goo.gl/dDwxvG
  15. Werner EF, Pettker CM, Zuckerwise L, Reel M, Funai EF, et al. Screening for Gestational Diabetes Mellitus: Are the criteria Proposed by the International Association of the Diabetes and Pregnancy Study Groups Cost-Effective?. Diabetes Care. 2012; 35: 529-535. Ref.: https://goo.gl/dqEPnf
  16. Turok DK, Ratcliffe SD, Baxley EG. Management of Gestational Diabetes Mellitus. American Family Physician. 2003; 68: 1767-1772. Ref.: https://goo.gl/dkTx6C
  17. Karagiannis T, Bekiari E, Manolopoulos K, Paletas K, Tsapas A. Gestational Diabetes Mellitus: Why screen and how to diagnose. Hippokratia. 2010; 14: 151-154. Ref.: https://goo.gl/C4XkCC
  18. National Diabetes Data Group. Diabetes in America, 2nd ed. Behesda, MD: National Institute of Health. 1995. Ref.: https://goo.gl/Lcw14L
  19. Metzger BE, Lowe LP, Dyer AR. Hyperglycemia and Adverse Pregnancy Outcomes. The HAPO Study Cooperative Research Group. N Engl J Med. 2008; 358: 1991-2002. Ref.: https://goo.gl/BcZPJT
  20. American Diabetes Association. Position statement: Standards of Medical Care in Diabetes- 2012. Diabetes Care. 2012; 35: 511-563.
  21. Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2010; 33: 62-69. Ref.: https://goo.gl/BnxWC8

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