pilot study, gestational diabetes mellitus, screening by post glucose blood sugar DIPSI test fetal and maternal outcome

1. Dr. Preksha Jain, Junior resident
Dr. Sunita Ghike, Professor
Dept. of ObGy, Nkp salve institute of Medical Sciences

2. Motherhood is a joy of living
life once again

3. DEFINITION
Gestational diabetes mellitus (GDM) is
carbohydrate intolerance with recognition or
onset first time during pregnancy,
irrespective of the treatment with diet or
insulin.

4. One of major causes of complications during
pregnancy
Good glycemic control-improves perinatal
outcome

5. IMPORTANCE OF GDM
2 GENERATIONS AT RISK
TYPE 2 DM
CHILDHOOD
OBESITY
TYPE 2 DM

6. In the Indian context, there is 11 fold increased risk of
developing glucose intolerance during pregnancy
compared to Caucasian women.
16.55% prevalence of GDM
Urban 17.8%
Rural 9.91%.

7. EFFECT ON PREGNANCY
Insulin resistance :
Production of placental HPL.
Increased production of cortisol, estriol, progesterone.
Increased insulin destruction by kidney and placenta.
Increased lipolysis: For her caloric needs and saves
glucose for fetal needs.
Changes in gluconeogenesis: Fetus uses preferentially
alanine and other amino acids and deprives the mother
of a major gluconeogenic source.

8. Hormonal events during early Pregnancy
Early pregnancy Estrogen
Progesterone
Pancreatic B-cell
hyperplasia
Insulin secretion
Peripheral utilization of
glucose
Maternal FBS
Hepatic glucose
production
Glycogen storage

9. Hormonal events during mid pregnancy
Mid-trimester pregnancy
HPL
Cortisol
Prolactin
Progesterone
Estrogen
Insulin resistance in peripheral tissues

10. COMPLICATIONS
• NICU
admission

11. SCREENING
Selective & Universal
Selective screening approach will miss a
proportion of GDM, 30%.
45% unscreened.

12. Various screening tests
Blood tests
Fasting blood glucose
(FBG) test
DIPSI 75gm glucose
Glycosylated hemoglobin

13. AIMS & OBJECTIVES
The objective is to estimate
PGBS in antenatal women
and follow up them till
delivery for fetomaternal
outcomes.
1. To screen for GDM & GGI as
early as possible.
2. Determine fetomaternal
outcome.

14. MATERIAL & METHODS
STUDY DESIGN: Prospective Longitudinal Observational Time bound
hospital based study.
DURATION: 07 months.
SETTINGS: Dept. of ObGy, NKP Salve Institute Of Medical Sciences
Nagpur
STUDY POPULATION: Women attending antenatal OPD.
SAMPLE SIZE : 400
SELECTION: Consecutive
Institutional Ethical committee permission

15. INCLUSION CRITERIA:
Singleton pregnancies.
Patients willing to
comply.
Patients willing to deliver
at LMH
EXCLUSION CRITERIA:
Multiple pregnancies.
History of previous GDM.
Patients not willing for any
intervention.
Patients not willing to
deliver at LMH

16. Demographic data, Medical, Obstetric &
Surgical history, antepartum, intra partum &
postpartum data was collected.
Analysis was done regarding number of
patients with GDM & GGI, distribution
according to age, parity & their fetomaternal
outcomes . Statistical evaluation was done.

17. OUTCOME MEASURES
MATERNAL
Age
Parity
Preeclampsia/PIH
Polyhydramnios
BOH
Mode of delivery
FETAL
Preterm
IUGR
Baby weight
NICU Admissions
Respiratory distress
Perinatal mortality

18. METHODOLOGY
Detailed history, consent, examination done
DIPSI TEST was done
75gm of glucose dissolved in 200ml of water, consumed
over period of 15min (regardless of day or time of last
meal)
Venous blood samples taken at 2hrs.

19. DIPSI CRITERIA
PLASMA GLUCOSE IN PREGNANCY
<120 gm/dl Normal
120-139 gm/dl Gestational glucose Intolerance
140-199 gm/dl Gestational Diabetes Mellitus
>200 gm/dl Overt diabetes

20. OBSERVATION & RESULTS

21. TOTAL PATIENTS SCREENED & DISTRIBUTION
ACCORDING TO INTOLERANCE
GGI GDM OVERT
54(13.5%) 37(9.25%) 6(1.5%)
TOTAL
SCREENED
TOTAL
NORMAL
DERANGED PGBS
400 303 97(24.25%)
 13.5% patients had normal PGBS in early trimester but later diagnosed
with GDM by repeat screening.

22. AGE DISTRIBUTION TABLE
AGE GGI GDM OVERT
<19 8% 8.3% 0%
20-25 13.52% 8.6% 0%
26-30 12% 10.93% 2.3%
>31 31% 12.5% 6.25%
Advancing age was associated with increasing trend of
GGI & GDM

23. Distribution by gravidity
12.55%
14.47%
22.60%
9.76%
6.50%
9.40%
54.40%
25.08%
11.22%
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
G1 G2 G3
GGI
GDM
OVERT
NORMAL
Prevalence of glucose intolerance increased with gravidity

24. Gestational Age
GGI GDM OVERT
<24wk 6.1% 2.06% 0
24-32 11.34% 8.24% 1.03%
>32 41.23% 27.80% 5.10%
Increased incidence was noted in third trimester
because maximum patients presented in third trimester

25. Maternal Complications
NORMAL GDM+GGI
PIH 14% 18.55%
POLY 2.3% 3%
CPD 0.3% 2.06%
PROM 2.6% 5.1%
BOH 20.46% 24.74%

26. Fetal Complications

27. Fetal Complications
NORMAL GDM+GGI
RESP DISTRESS 7.9% 9.2%
PRETERM 2.3% 3%
IUGR 5.9% 6.1%
NICU 4.9% 6%
PERINATAL
MORTALITY 1.05% 1.09%
CONG ANOMALY 0.3% 1.03%
MOST COMMAN COMPLICATION FOUND TO BE RESPIRATORY
DISTRESS

28. HbA1c
HbA1c% GDM & GGI
<5.7 4.10%
5.7-6.1 1%
>6.1 8.20%
MAXIMUM PATIENTS WITH GDM HAD HbA1c MORE THAN 6.1%

29. MODE OF DELIVERY
NORMAL GDM+GGI
NVD 21.10% 19.5%
LSCS 32% 44.5%
INSTRUMENTAL 1.9% 1.3%
S&E 0.6% 1.03%
INCIDENCE OF CESAREAN SECTION WAS MAXIMUM
AMONG GDM PATIENTS

30. MANAGEMENT
MODALITY GDM & GGI
DIET 91.7%
DIET & INSULIN 8.3%

31. BLOOD SUGAR
FBS
80-90
PMBS
110-120
MNT
2 Wk
GGI
120-139
MNT+INSULIN
BLOOD SUGAR
FBS
80-90
PMBS
110-120
MNT
2Wk
GDM
140-199

32. SUMMARY
Out of 400 antenatal women,
54 had GGI (13.5%)
37 had GDM (9.25 %) according to screening by DIPSI
Prevalence rate of GDM was 9.25% which was significant
Advancing age was associated with increasing trend of GGI &
GDM

33. o Pregnancy complications noted in the present study in patients
with GDM were -- PIH in 18.55%,Poly in 3%, PROM in 5%, CPD
in 2.06%
o Operative deliveries were found more in GDM patients 44.5%
o Fetal complications noted were 9.2% of neonates had
respiratory distress, 6% had NICU admissions
o Perinatal mortality rate 1.09% were high in GDM patients
o 8.3% patients managed by insulin & diet

34. ROLE OF OBSTETRICIAN
PRIMARY PREVENTION:
Obesity, PCOS- lifestyle
modification
SECONDARY PREVENTION:
GDM screening & care
TERTIARY PREVENTION:
Future long term complication

35. Obstetrician
Diabetologist
Dietician
Pediatrician
&
Patient

36. TAKE HOME MESSAGE
GDM continues to be an important obstetrical condition
with significant feto maternal morbidity.
This study thus recommends screening of all antenatal
women for GGI & GDM as early as possible & proper
management to ameliorate morbidity & mortality
associated with it.