Managing gestational diabetes – a two year study of 200 patients

Abstract

Introduction: Doubling of the prevalence of Gestational Diabetes Mellitus (GDM) in the last eight years has necessitated a review to evaluate the outcome and complications of these pregnancies in a local perspective, in comparison to the data obtained from the western literature. Objective: To study the outcomes and complications of 200 antenatal mothers diagnosed with GDM at the Teaching Hospital Kandy, Sri Lanka, and to compare these with results obtained from the western literature. Method: 200 antenatal mothers with documented risk factors for GDM were screened by a 75 g standard Oral Glucose Tolerance Test (OGTT) and GDM diagnosed using the 2006 WHO Diabetes criteria. They were managed and delivered at the Teaching Hospital, Kandy, outcomes and complications documented and followed-up where feasible up to a period of two years. Results: Family history as a risk factor was documented in 65% with obesity accounting for only 5%. Only 34% in the series, (31% with a family history of diabetes and 50% with a previous history of GDM) had carried out at least one blood-sugar estimation prior to this conception. A total of 88% required insulin therapy along with dietary regulation but queried later only 58% vouched for the advised dietary restrain, A normal maternal weight gain, a higher average birth weight of 3206 grams is reported with a congenital abnormality rate of 2.5% and three still births. 78% were delivered surgically and 34% of the babies needed to be admitted to the Special Care Baby Unit (SCBU) and the average SCBU stay being 2 to 3 days. 22% were found to have a new diagnosis of Type 2 Diabetes mellitus six-weeks post-partum with 77% of them having had very high blood sugar profiles in their antenatal GTTs. On long- term follow up, 8% of mothers who were normotolerant or with impaired glucose tolerance post-partum were found to be diabetic just 2 years after delivery. Conclusion: A glaring deficiency in pre- pregnancy counselling for diabetes with an inadequate public awareness is highlighted.