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Effect of Different Types of Diabetes Mellitus on Pregnant Outcomes on Well Controlled Pregnant 002 Women: Across Sectional Study

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Effect of Different Types of Diabetes Mellitus on Pregnant Outcomes on Well Controlled Pregnant 002 Women: Across Sectional Study Journal of Gynecology and Women’s Health ISSN 2474-7602 Research Article J Gynecol Women’s Health Volume 18 Issue 1- January 2020 Copyright © All rights are reserved by Elsayed Hamdi Noureldin DOI: 10.19080/JGWH.2020.18.555976 Effect of Different Types of Diabetes Mellitus on pregnancy outcomes on Well Controlled Pregnant Women: A cross Sectional Study Elsayed Hamdi Noureldin* Department of Obstetrics and Gynecology, Zagazig University, Egypt Submission: December 19, 2019; Published: January 07, 2020 *Corresponding author: Elsayed Hamdi Noureldin, Department of Obstetrics and Gynecology, Zagazig University, Egypt Abstract Introduction: Diabetes Mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both. It is the most common metabolic disorder that occurs during pregnancy. It has two clinical patterns; either gestational or pregestational diabetes. Pregnancy in women with diabetes mellitus is associated with an increased risk of congenital malformations, obstetric complications and neonatal morbidity. These adverse outcomes are at least in part related to periconceptional care, especially the level of glycemic control. Adequate preconceptional care reduces the frequency of congenital malformations and improves outcome of pregnancy. The current perinatal mortality rates among women who are diabetic remain approximately twice those observed in the non-diabetic population Congenital malformations, respiratory distress syndrome (RDS) and extreme prematurity account for most perinatal deaths in contemporary diabetic pregnancies. The aim of this work to assess the effect of different types of diabetes mellitus without vascular changes on maternal and fetal outcomes. Methods: The study was done at Al Zahraa Hospital, Jeddah. KSA, during the period from September 2017 to September 2019 and included 200 cases of gestational and pregestational diabetic pregnant women. Cases were selected according to the following criteria (pregnant diabetic women at gestational age 28 to 40 weeks, whitout any chronic disease). Verbal consent and full history taking with baseline data were collected during antenatal visits including age, parity and gravdity, past medical history, family history and obstetric history including previous history of gestational diabetes mellitus, previous high birth weight babies (more than4kg), previous unexplained IUFD, previous history of recurrent pregnancy loss. Fasting &2 h postprandial blood glucose level was done and HbA1c. Complete general and abdominal examination, Obstetric Gestational diabetes and pregestational diabetes, the two groups were compared according to mode of delivery (normal vaginal delivery or caesarianUltrasonography section),gestational was done for age all patients at delivery, with maternal Umbilical complications, and middle cerebral fetal (IUFD artery and doppler macrosomia) if needed. and Patientsneonatal(respiratory were classified distress into two syndrome groups, and birth injuries) complications. Result: The age of the studied group was (27.5±7.1) ranged from (19 to 43) years and the BMI of the studied group was (26.5±4.7) ranged previous history of congenital fetal malformation, Intra Uterine Fetal Death and gestational diabetes mellitus between the two groups. There was from (19 to 35) and 44% of PGDM patients was obese. There was no statistically significant difference in positive family history of diabetes and diabetes was gestational or pregestational there was no statistical difference between maternal and fetal outcome. no statistically significant difference in gestational age at delivery and mode of delivery in current pregnancy between the two groups. Either Conclusion: We concluded that either diabetes was gestational or pregestational there was no statistical difference between maternal and fetal outcomes. Optimal control of blood glucose resulted in lower neonatal and maternal complications. Further studies on large geographical scale and larger sample size are required to support our conclusion. Keywords: Pregestational diabetes; Gestational diabetes; Maternal; Fetal outcomes Abbreviatations: GDM: Gestational diabetes mellitus; ADA: American Diabetes Assoctiation; GA: Gestational Age; OGTT: Oral Glucose Tolerance Test Introduction B cells of the pancreas also called (juvenile onset diabetes). In Diabetes is disorder in which the body doesn’t produce insulin Type 2 diabetes the body doesn’t respond to insulin due to insulin or there is resistance to it. In Type 1 diabetes the body produces resistance also called (adult onset diabetes) [1]. Overt Diabetes little or doesn’t produce insulin at all due to auto destruction of J Gynecol Women’s Health 18(1): JGWH.MS.ID.555976 (2020) 001 Journal of Gynecology and Women’s Health diabetic women, 27 cases were excluded from the study due level greater than 200mg/dl plus classic signs and symptoms to missing during follow up (11 cases), and 16 cases refused Mellitus is defined as women with a random plasma glucose such as polydipsia, polyuria and unexplained weight loss or a participation. 200 diabetic pregnant women were included in the fasting glucose exceeding 125mg/dl are considered by the ADA (American Diabetes Assoctiation-2004) to have overt diabetes [2]. studyThe and study were protocol eligible was for theapproved final analysis. by Al Zahraa Hospital Ethical Committee. Counseling of participating women, clear caption of the intervention, and an informed written consent was then Gestational diabetes mellitus (GDM) is operationally defined during pregnancy. Its diagnosis is based on single step procedure. taken from all of them. During the ANC visit enrolment, medical, as impaired glucose tolerance with onset or first recognition In accordance to World Health Organization recommendations, the past, surgical and obstetric histories were reviewed, general and guideline endorses 2h 75g oral glucose tolerance test, irrespective abdominal examinations were carried out, FHR was checked, and plasma standardized glucometer [3].The pre-existing diabetes in of last meal timings with a cutoff value of ≥140 mg/dL using a findingsEstimation were recorded. of gestational age (GA) was done from the date of pregnancy refers to diabetes diagnosed before pregnancy. The prevalence of pre-existing diabetes has increased in the past decade primarily as a result of the increase in type 2 diabetes. LMP in women with prior regular periods or estimated from early the 13th week USS. Fetal anomaly scan was arranged at around Studies of women with preexisting diabetes show higher rates of ultrasound scan (USS) at 7 weeks’ gestation. GA was verified by 20 weeks’ gestation. Then women were followed up as per the complications compared to the general population [4]. standard pregnancy care for diabetes where they attended every Maternal complications of diabetes mellitus include increase in 2 weeks until 28 weeks’ gestation, every 1 weeks until 36 weeks’ asymptomatic bacteriuria, urinary tract infections, preeclampsia, gestation then twice weekly thereafter until delivery. Targeting a polyhydramnios which may lead to preterm labor, abruption fasting glucose level of 60-100mg/dl, 1-hour postprandial glucose placenta, postpartum hemorrhage which in turn increases below 120mg/dl, and glycosylated hemoglobin (HbA1c) below operational delivery. Fetal outcomes include intra uterine fetal 6.1% [8]. All women were on insulin therapy. death, respiratory distress syndrome, hypoglycemia, congenital Inclusion criteria malformations and hyperbilirubinaemia [5]. a) Pregnant women with pregestational diabetes mellitus (type All women of childbearing age with diabetes should be 1 or type 2 diabetes) without vasculopathy. counseled about the importance of tight glycemic control prior to conception. Observational studies show an increased risk of b) Pregnant women diagnosed with gestational diabetes diabetic embryopathy, especially anencephaly, microcephaly, mellitus (GDM) by using the 75gm 2-hour oral glucose congenital heart disease, and caudal regression, directly tolerance test (OGTT). c) singleton pregnancy. pregnancy [6]. proportional to elevations in HbA1C during the first 10 weeks of Exclusion criteria a) Women with hypertension, thyroid or connective tissue Glycemic Targets: (Fasting < 95mg/dL, 1-hour PP (post prandial monitoring of blood glucose are recommended in both GDM and disorders < 140mg/dL,2 hr PP <120mg/dL). Fasting and postprandial self- preexisting diabetes in pregnancy to achieve glycemic control. b) Multifetal gestations. Due to increased red blood cell turnover, HbA1C is slightly lower in normal pregnancy than in normal nonpregnant women. The c) Uncontrolled diabetics. HbA1C target in pregnancy is 6-6.5%; <6% may be optimal if this d) Abnormal glycosylated hemoglobin (HbA1c) level, above 6.1%. may be relaxed to <7% if necessary, to prevent hypoglycemia [7]. can be achieved without significant hypoglycemia, but the target Cases are divided into two main groups Aim of the Work The aim of this work to assess the effect of different types of a) Group I included 100 pregnant women with diabetes mellitus without vascular changes on maternal and fetal pregestational diabetes mellitus (Type 1and Type 2 DM) without outcomes. vascular changes. Patients and Methods b) Group II included 100 pregnant women with gestational diabetes. GDM was generally diagnosed by OGTT in the second This cross-sectional study of pregnant diabetic women half of pregnancy. The OGTT was
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