Orginal Article Medical Journal of Pokhara Academy of Health Sciences (MJPAHS) Vol. 1 Issue 2 Jul-Dec 2018 Evaluation of Pregnancy Outcomes in Gestational Diabetes Mellitus Lakshmi Sunar1, Zhu Yan2 1Department of Obstetrics and Gynaecology, Western Regional Hospital, Pokhara Academy of Health Sciences, Pokhara, Gandaki, Nepal 2Department of Obstetrics and Gynaecology, First Affiliated Hospital of Liaoning Medical University,Jinzhou, Liaoning, P.R.China ABSTRACT Corresponding author: Objectives: To evaluate the pregnancy outcomes in the Dr. Lakshmi Sunar, MD patients diagnosed with Gestational Diabetes Mellitus. Obstetrician & Gynaecologist Materials and Methods: A retrospective study conducted Department of Obstetrics and Gynaecology on ninety-two patients, delivered in the First Affiliated Hospital Pokhara Academy of Health Sciences of Liaoning Medical University, China from February 2014 to Western Regional Hospital June 2015. [email protected] Results: The rate of Cesarean section was 36.95%, polyhydramnios 27.17%, macrosomia 21.73% and preterm delivery was14.13% respectively. Article recived : 17th Jan. 2018 Conclusion: Gestational Diabetes Mellitus is recognized Article accepted : 4thOct. 2018 to be associated with increased rate of adverse pregnancy outcomes. This study demonstrated that the GDM has higher risk for polyhydramnios and macrosomia. Key words : Blood glucose, Gestational Diabetes Mellitus, Pregnancy outcome. INTRODUCTION MATERIALS AND METHODS Gestational Diabetes Mellitus (GDM) is defined as A retrospective study conducted on ninety-two “onset or first recognition of any degree of glucose patients, delivered in the First Affiliated Hospital of 1 intolerance of variable severity during pregnancy”. Liaoning Medical University, China from February Recently in 2012, American Diabetes Association 2014 to June 2015. Selected patients were Chinese (ADA) described GDM as “diabetes diagnosed during Asian with the mean age of 28.98±3.23. All the 2 pregnancy that is not clearly overt diabetes“. GDM medical records, increased blood glucose levels and has health consequences not only in the short term the pregnancy outcomes such as Cesarean section, but also in the long term for both mother and baby. preterm delivery, polyhydramnios and macrosomia Mothers with history of GDM have significantly higher were thoroughly reviewed. If the Fasting blood sugar 3 risk of GDM during subsequent pregnancies and level >5.55 mmol/L (>100mg/dl) and Postprandial risk of type-2 diabetes and premature cardiovascular sugar level >7.77 mmol/L (>140mg/dl) then the patient disease in the near future. Whereas in the children, was confirmed as GDM and selected for the study. risk of developing obesity, diabetes, hypertension, Inclusion criteria: cardiovascular disease is much higher in later life.4 Singleton GDM is associated with increased risk for adverse Gestational week >28 weeks pregnancy outcomes, such as macrosomia, preterm Fasting blood sugar level >5.55 mmol/L (>100mg/dl) delivery, primary cesarean delivery, shoulder dystocia, Postprandial sugar level >7.77 mmol/L (>140mg/dl) birth injury, preeclampsia, hyperbilirubinemia and fetal Exclusion criteria: and neonatal mortality.5,6 In this study, we evaluate the Multiple gestations pregnancy outcomes in the patients diagnosed with Previously known history of DM Gestational Diabetes Mellitus. 66 Orginal Article Medical JournalEvaluation of Pokhara of Academy Pregnancy of OutcomesHealth Sciences in Gestational (MJPAHS) Diabetes Vol. 1 IssueMellitus 2 Jul-Dec Sunar L 2018 et al. The collected data were compiled, tabulated and public health has become the major concern.9 The analyzed using appropriated statistical test. All Hyperglycemia and Adverse Pregnancy Outcome statistical analyses were performed using SPSS (HAPO) study has shown significant independent version 22 software. The different study variables association of higher maternal glucose concentrations were analyzed using descriptive statistics. with adverse pregnancy outcomes.10 Women with GDM in the present study were found to have higher RESULTS proportion of obstetric complications including In this study ninety-two patients, who meet the inclusion Cesarean section, preterm delivery, polyhydramnios, criteria were selected, with mean age of 28.98±3.23 and macrosomic babies. years. Among these population 61.95% (57/92) were Various studies have reported that the rate of primi gravida and 38.04% (35/92) were multi gravida. Cesarean section in GDM patients is very high despite The mean week of gestation was 36.41±2.13. GDM maternal blood glucose control during pregnancy.11,12 was diagnosed on 25.5 ±1.6 week of gestation. Mean Meanwhile, this study revealed that the rate of Fasting blood sugar level was 5.4 ±1.13 mmol/L and Cesarean section is 36.95%. In this study the main postprandial sugar level 8.53 ±1.18 mmol/L. indications for caesarean Section were macrosomia, polyhydramnios and patients choice. Caesarean Table 1. Patients demographic features and outcomes delivery has been a common practice in China, local Details n (%) / Mean ±SD attitudes towards the caesarean delivery was better Total number of patients 92 (100%) for baby and mother. Besides, social factors such as Age in year 28.98 ±3.23 not bing able to bear the labor pain, worrying about Gravidity: the incision in perineum, misconception that vaginal Primi 87(61.95%) delivery might affect sexual life, and fear of delivery Multi 35(38.04%) failure leads to increased rate of Cesarean section. Gestational week 36.41 ±2.13 Especially following the implementation of the “One GDM Diagnosed gestational week 25.5 ±1.6 Child Policy” in China, the rate of Cesarean section is Fasting blood sugar level (normal 4-5.5 mmol/L) 5.4 ±1.13 highly increased. Postprandial sugar level (normal <7.8 mmol/L) 8.53 ±1.18 In this study, we found that GDM was associated with Outcomes: an increased risk of polyhydramnios and preterm Cesarean section 34 (36.95%) birth. Inadequately managed GDM is associated Preterm delivery 13 (14.13%) with macrosomic fetus and polyhydramnios, but Polyhydramnios 25 (27.17%) the pathogenesis has not been elucidated yet.13 Macrosomia 20 (21.73%) One likely cause is fetal hyperglycemia resulting in increased osmotic diuresis which later leads to This study showed the rate of polyhydramnios was polyuria and afterward leading to polyhydramnios. 27.17% (25/92), macrosomia was 21.73% (20/92), This phenomenon is supported by a strong preterm delivery was 14.13% (13/92) and Cesarean association with high glycosylated hemoglobin values section was 36.95% (34/92). in cases with polyhydramnios.13,14 According to Dutta, polyhydramnios may lead to preterm delivery,15 and in DISCUSSION this study we found most preterm delivery is closely The term GDM was first coined by Pedersen in 1951.7 associated with polyhydramnios. The mechanisms GDM remains an area of controversy and debate in behind these findings are unclear. This finding might spite of extensive investigation into the condition. The just be a coincidence due to small sample size so most recent research relating to GDM, determines further studies with large sample is required to verify the association of maternal hyperglycaemia with our findings. an increased risk of adverse pregnancy outcome Glucose is transported freely across the placenta. In and ascertaining whether treatment of the condition the case of increased level of blood glucose in mother, can decrease perinatal morbidity.8 The increasing large amount of glucose is transported to the fetus, prevalence of gestational diabetes and its effects causing fetal hyperinsulinemia, which leads to fetal for individual mothers and infants and its impact on overgrowth and/or macrosomia.16 Macrosomia is 67 Orginal Article Medical Journal of Pokhara Academy of Health Sciences (MJPAHS) Vol. 1 Issue 2 Jul-Dec 2018 associated with many obstetric complications, such levels remain elevated despite of dietary or exercise as higher rate of Cesarean section, shoulder dystocia, management.24 The treatment of choice for any type chorioamnionitis, severe perineal lacerations, of diabetes in pregnancy is insulin. Most of insulin and postpartum hemorrhage.17 It is possible that, preparations used today has been proved to be safe fasting blood glucose is difficult to be maintained and help good glycemic control during pregnancy. below the threshold which persistently increases Some studies showed that even minimal changes in and large amount of glucose is transported to the glucose tolerance can result in abnormal fetal growth fetus ultimately lead to macrosomia. Some authors which can be prevented by simple control of blood showed a very strong correlation exist between the glucose.23,25 It is worth mentioning that, many studies fasting glucose concentration above 5.82mmol/L showed that diet or exercise can be used to reduce and maternal–perinatal complications, such as adverse outcomes. Barakat et al. reported that the fetal macrosomia, cesarean delivery, neonatal exercise intervention can reduce macrosomia by hypoglycemia, hypertensive syndromes.18 Sacks 58%.26 We should actively use insulin, and health and colleagues were among the first to describe the education to improve maternal compliance so as to relationship between maternal glucose levels and avoid severe maternal-fetal complications. birth weight centiles.19 However, these authors could This study elucidates that GDM adverse outcome is not establish any significant threshold for diagnosis. inevitable but could