DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20180306

Screening for GDM in first trimester of pregnancy and its outcome

Mamata Soren, Sudhanshu Sekhar Nath, Debananda Tudu, Polaki Srilekha

Abstract


Background: GDM is associated with increased risk of complications for both mother and fetus both during pregnancy as well as in the postpartum period. Screening for GDM is important to improve short and long term maternal and fetal outcomes. The main purpose of this review is to provide an update on screening for GDM. As per DIPSI criteria women can be diagnosed to have GDM in the first trimester, if the 2hour 75gms OGTT IS 140-199 mg/dL. A prospective observational study with 300 cases was conducted for a period of 1year and 11months (December 2012-2014) in VIMSAR Burla, Sambalpur.

Methods: Universal screening was applied by means of DIPSI. Analysis was done by means of t-test, Odd’s ratio, chi squire test. P<.05 was taken as significant.

Results: In the present study, 25 cases were diagnosed as GDM with an incidence of 8.33%. Hypertensive disorders of pregnancy (HDP) was found significantly associated with GDM cases (p value 0.02). The mean birth weight in women with GDM (3.05±0.47Kg) was higher than in women with non-GDM (2.65±0.43 Kg). Overall the macrosomia (≥4Kg) rate was 0.67% with 8% in case of GDM mothers. Not a single case of congenital fetal anomaly was detected in the GDM group under our study 20% of the GDM group had their babies admitted to NICU as compared to 17.65% of the non-GDM group (p value 0.76).

Conclusions: Women with GDM are at an increased risk for adverse obstetrics and perinatal outcomes. Due to high prevalence of GDM in India early universal screening is essential. Screening for glucose intolerance during the early weeks of pregnancy is beneficial as this policy would help in identifying undiagnosed diabetes prior to conception and to render appropriate care. Screening and diagnosis of GDM with a single test procedure of 75g 2hr PGBS in a non-fasting woman i.e. following DIPSI guidelines is found to be effective, simple, economical and feasible.

 


Keywords


GDM, Maternal and Perinatal outcome, Screening

Full Text:

PDF

References


Diana R Danilenko-Dixon, Van Winter, Roger L Nelson, Paul L Ogurn. Universal Versus Selective gestational diabetes survey: Application Recommendation. AM J Obslet Gynecol. 1999;181:789-802.

O’Sullivan JB. Gestational diabetes, unsuspected, asymptomatic diabetes in pregnancy. N Eng J Med. 1961;264:1082-85.

Metzger BE, Coustan DR. Summary and recommendations of the Fourth International Workshop-conference on Gestational Diabetes Mellitus. The Organizing Committee. Diabetes Care. 1998;21 Suppl 2:B161-B167.

Albert RE. Diabetes in pregnancy obstetrics and gynecology. Clinics of North America. WB Saunders Company. 1996;23(1):10.

Kjos S, Buchanan T. Gestational diabetes mellitus. N Eng J Med. 1999;341(23):1749-54.

Jovanovic L, Pettitt D. Gestational Diabetes Mellitus. JAMA. 2001;286:2516-8.

Ben Haroush A, Yogev Y, Hod M. Epidemiology of gestational diabetes mellitus and its association with Type 2 diabetes. Diabet Med. 2004;21(2):103-13.

Glueck C, Goldenberg N, Streicher P, Wang P. Metformin and gestational diabetes mellitus. Curr Diabet Rep. 2003;3:303-12.

Kim C, Newton K, Knopp R. Gestational diabetes and the incidence of type 2 diabetes. Diabetes Care. 2002;25:1862-8

American Diabetes Association. Gestational diabetes mellitus. Diabetes care. 2004;27(suppl 1):s88-90.

Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of pre-existing diabetes gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31:899-904.

Caughey AB, Cheng YW, Stotland NE, Washington AE, Escobar GJ. Maternal and paternal race/ethnicity are both associated with gestational diabetes. Am J Obstetrics Gynecol. 2010;202(6):616-e1.

American Diabetes Association. Gestational Diabetes Mellitus. Diabetes Care. 2004;27:S88-90.

Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Ame J Obstetrics Gynecol. 1998;179(2):476-80.

Retnakaran R, Qi Y, Connelly PW, Sermer M, Hanley AJ, Zinman B. Risk of early progression to pre-diabetes or diabetes in women with recent gestational dysglycemia but normal glucose tolerance at 3-month postpartum. Clin Endocrinol. 2010;73(4):476-83.

Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Invest. 2005;115(3):485-91.

Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. CMAJ. 2008;179(3):229-34.

Retnakaran R, Qi Y, Connelly PW, Sermer M, Hanley AJ, Zinman B. An abnormal screening glucose challenge test in pregnancy predicts postpartum metabolic dysfunction, even when the antepartum oral glucose tolerance test is normal. Clin Endocrinol. 2009;71(2):208-14.

Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009;373(9677):1773-9.

Cheung NW, Byth K. Population health significance of gestational diabetes. Diabetes Care. 2003;26(7):2005-9.

Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005;352(24):2477-86.

HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl j Med. 2008(358):1991-2002.

Reiher H, Fuhramann K, Noack S, Woltanski KP, Jutzi E, Hahn von Dorsche H, et al. Age-dependent insulin secretion of the endocrine pancreas in vitro from fetuses of diabetic and non-diabetic patients. Diabetes Care. 1983;6(5): 446-51.

Nahum GG, Wilson SB, Stanislaw H. Early-pregnancy glucose screening for gestational diabetes mellitus. J Reprod Med. 2002;47(8):656-62.

Carpenter MW, Canick JA, Hogan JW, Shellum C, Somers M, Star JA. Amniotic fluid insulin at 14-20 weeks’ gestation: association with later maternal glucose intolerance and birth macrosomia. Diabetes Care. 2001;24(7):1259-63.

Schwartz R, Gruppuso PA, Petzold K, Brambilla D, Hiilesmaa V, Teramo KA. Hyperinsulinemia and macrosomia in the fetus of the diabetic mother. Diabetes Care. 1994;17(7):640-8.

Seshiah V, Cynthia A, Balaji V, Balaji MS, Ashalata S, Sheela R, et al. Detection and Care of women with gestational diabetes mellitus from early weeks of pregnancy results in birth weight of newborn babies appropriate for gestational age. Diab Res Clin Pract. 2008;80(2):199-202.

Zargar AH, Sheikh MI, Bashir MI, Masoodi SR, Laway BA, Wani AI, et al. Prevalence of gestational diabetes mellitus in Kashmiri women form the Indian subcontinent. Diabetes Res Clin Pract. 2004;66:139-45.

Casey BM, Lucas MJ, McIntire DD, Leveno KJ. Pregnancy outcomes in women with gestational diabetes compared with the general obstetric population. Obstet Gynecol.1997;90:869-73.

Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. HAPO Study Cooperative Research Group. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991-2002.

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;275:1165-70.

Dornhorst A, Rossi M. Risk and Prevention of Type 2 Diabetes in women with Gestational Diabetes. Diabetes Care. 1998;21(suppl 2):B43-9.

Cosson E. Screening and insulin sensitivity in gestational diabetes. Abstract volume of the 40th Annual Meeting of the EASD, 2004:A350.

Griffin ME, Coffey M, Johnson H, Scanlon P, Foley M, Stronge J, et al. Universal vs risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med. 2000;17(1):26-32.

Rajput R, Yadav Y, Nanada S, Rajput M. Prevalence of gestational diabetes mellitus and associated risk factors at a tertiary care hospital in Haryana. Indian J Med Red. 2013;137:728-33.

Seshiah V, Balaji V, Shah SN, Joshi S, Das AK, Sahay BK, et al. Diagnosis of gestational diabetes mellitus in the community. J Assoc Physicians India. 2012;60:15-7.

Saxena P, Tyagi S, Prakash A, Nigam A, Trivedi SS. Pregnancy outcome of women with gestational diabetes in a tertiary level hospital of north India. Ind J com medicine: official publication of Ind Association Preventive So Med. 2011;36(2):120.

Bener A, Saleh NM, Al-Hamaq A. Prevalence of gestational diabetes and associated maternal and neonatal complications in a fast-developing community: global comparisons. Inter J Women's Health. 2011;3:367.