OVERVIEW OF GESTATIONAL DIABETES MELLITUS AND ITS EFFECT ON MATERNAL, FOETAL AND NEONATAL OUTCOME

BACKGROUND The incidence varies considerably from 1 - 14%, depending upon ethnicity, selection criteria and diagnostic tests performed. GDM affects the index pregnancy as well as two generations, mother and her child. Short-term intensive care in pregnancy, early detection and timely management will improve the good pregnancy outcome. The objectives of the present study are 1. to evaluate incidence of GDM in present tertiary care centre, Southern Maharashtra population 2. to evaluate maternal, foetal and neonatal complications; and 3. to evaluate risk factors for GDM. MATERIALS AND METHODS The present prospective study was conducted in OBG Department, KIMSDU, Karad from January 2017 to May 2018. A total of 3960 booked patients delivered in Krishna Hospital from January 2017 to May 2018. All these included patients in the present study underwent OGTT around 24 - 28 weeks of gestation. Those whose glucose levels were normal again underwent repeat OGTT at around 32 - 34 wks. Those with at least two readings abnormal from OGTT were considered as GDM patients. 120 patients were diagnosed as GDM, 20 were lost for follow-up. 100 patients were considered in the study. These patients were observed throughout the pregnancy, delivery and 6 weeks postpartum for development of maternal, and foetal and neonatal complications related to GDM and data collected for maternal foetal complications (antenatal, intrapartum, postpartum), gestational age at detection of GDM, delivery, mode of delivery and need for NICU etc. RESULTS Incidence of GDM in Krishna Hospital was 3%. In the present study, incidence of GDM in 25 - 30 yrs. old women was 70%. In present study, 28% patients had positive family and past history. In the present study, GDM was detected in 64% multigravida. It indicates increasing parity as a risk factor for developing GDM. 74% patients delivered after 37 weeks of gestation and 20% had preterm deliveries. 6% patients aborted before 24 weeks of gestation, 36% underwent elective LSCS and 16% of the patients underwent emergency LSCS. In the present study 6 patients had abortion, 20 had preterm labour (24 weeks to 36 weeks) and 10 patients had PPROM. 10 patients had polyhydramnios, out of these, one required therapeutic amniotic fluid tapping (as amniotic fluid index was 32 at gestational age of 28 weeks and due to maternal discomfort), 18 patients had recurrent UTI, vaginal candidiasis or both which was treated conservatively. 16 patients had PIH, out of which 10 were on medications-Tb. Nifedipine 10mg or Tb. Labetalol 100 mg or combination of these drugs according to severity. Out of 100 GDM patients, 4 patients were known or diagnosed with hypothyroidism during present pregnancy. LBW babies <2.5 kg was 8.4% in the present study. In the present study, 50.5% live babies required NICU admissions. Out of 100 women, 66 women followed up till 6 weeks post-partum. Out of these, 10 were diagnosed with glucose intolerance on GTT and 3 as DM. CONCLUSION Preventive measures for type 2 diabetes should start before birth and should be continued lifelong in children born to GDM mothers. To achieve this, what is needed is a small screening test for GDM in antenatal period, timely diagnosis and good glycaemic control. These preventive measures decrease neonatal morbidity and mortality and chances of developing diabetes in these children in their life. This will reduce the financial and social burden of managing complications of untreated diabetes.