Pregnancy outcome in women with gestational diabetes mellitus – a study from Eastern India

Abstract

Introduction: Hyperglycemia first detected in pregnancy during screening test (often between 24-28 weeks) which does not meet the criteria for overt diabetes is called gestational diabetes mellitus (GDM). The International Association of Diabetes in Pregnancy Study group (IADPSG) recommended a new diagnostic criteria and protocol.

Objective: To find out the prevalence, the need for insulin therapy, any short term maternal or fetal adverse effect of metformin therapy and maternal and fetal outcome of gestational diabetes mellitus in eastern part of India. 

Methods: This observational study was conducted in a tertiary care semi urban private hospital from October 2018 to September 2019 for a period of twelve months. All women with normal fasting blood sugar at booking underwent oral glucose tolerance test between 24-28 weeks using 75 grams glucose drink. All GDM cases were managed by a multidisciplinary team. Pregnancies complicated with known type 1 or type 2 DM, preexisting hypertension and multiple pregnancies, were excluded from this study.

Results: Out of 581 total deliveries 70 cases was GDM (12%). All cases received dietary modifications; metformin was needed in 62 (88.5%) and insulin required in 8 (11.5%) cases. 7 cases (10%) detected to have growth between 50 th and 90 th centile, interestingly 3(4.2%) cases growth was between 5^th and 50^th centile. 4 patients (5.7. %) delivered between 32 to 34 weeks and 15 (21.4%) between 34-36 weeks. 67 (95.7%) were delivered by caesarean section. There was no perinatal loss.

Conclusion: This study indicates that majority of the patients with GDM can be managed without insulin. Metformin use has reduced the need for insulin therapy. Universal screening and proper vigilance can result in optimal outcome