A Prospective Study on Single Step 75 Grams Oral Glucose Tolerance Test for Screening and Diagnosis of Gestational Diabetes Mellitus and its Fetomaternal Outcome at a Tertiary Care Centre
Author(s): Mortha Sulochana, N Swetha Goud and O Balajojamma*
Abstract
Gestational diabetes is defined as “carbohydrate intolerance of variable severity with onset or first recognition during pregnancy irrespective of the treatment with diet or insulin”. The prevalence of GDM in India varies from 3.8 to 21% in different parts of the country. The incidence of GDM is expected to increase to 20% i.e., one in every 5 pregnant women is likely to have GDM. The pregnancy is believed to unmask the tendency toward type 2 diabetes, and it should be noted that the 5-year risk of developing type 2 diabetes in women with GDM is as high as 60%. Women with GDM are at an increased risk for hypertensive disorders during pregnancy compared to those without GDM. It is evident from several studies that GDM per se is an independent risk factor for hypertensive disorders during pregnancy, with an increased relative risk ranging from 1.4 to 2. Clinical recognition of GDM is important because timely intervention can reduce the well-described associated maternal and fetal complications. The study was conducted at Department of Obstetrics & Gynaecology, Ayaan Institute of Medical Sciences, Kanakamamidi, Telangana conducted with sample size of 400. All the antenatal women attending outpatient department during the study period are included as per the Inclusion & Exclusion criteria. 400 women had undergone 75 grams OGTT test at 24 weeks of gestational age and were followed up till 7 days of postpartum for maternal and fetal outcome. In initial screening, 19 women had GDM out of 400 women accounting for 4.7%. After rescreening in 183 high risk women for GDM, 2 had GDM out of accounting for 1%. Out of 400 cases, 21 had GDM. GDM incidence was 5.2% using the DIPSI method. The mean maternal age of women in the study with GDM was years 26 ± 2 years (mean ± 2SD). Youngest woman with GDM was 22 years old and the oldest woman with GDM was 32 years old. There was significant correlation between age >26 years and GDM. Incidence of GDM among primigravida was 5% and among multigravida was 5.4%. There was no significant correlation between gravida and incidence of GDM. Number of women who had pregnancy complications like gest. HTN, polyhydramnios, preterm labour, PPH in GDM group were 6(28.5%), 3(14.2%), 3(14.2%), 3(14.2%), Whereas in the non GDM women number of women having these complications were 27(7.1%), 10(2.6%), 17(4.4%), 15(3.9%). There was a significant correlation between GDM and developing pregnancy complications. Pregnancy is a diabetogenic state manifested by insulin resistance and hyperglycemia. In our study out of 400 patients, 21 mothers were diagnosed as GDM; its prevalence is 5.2% in our hospital. Similarly, diabetes complicates 3-4 % of pregnancies in most World Series, but where intensive screening has become a part of routine antenatal care; more cases are being detected with a range of 1-14%. However, it varies among different populations of different geographical origins and ethnic backgrounds. Some of the local factors contributing to this high incidence are poverty and ignorance. People are usually not aware of the nutritional and caloric values of food and its implication on body weight and health.