Management of Diabetes Mellitus Complicating Pregnancy:

Gestational Diabetes Mellitus among Pregnant Women Delivering in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction

Gestational diabetes mellitus is increasing globally leading to significant maternal and foetal morbidity. This study aimed to find out the prevalence of gestational diabetes mellitus among pregnant women delivering in a tertiary care hospital.

Methods

A descriptive cross-sectional study on a total of 3034 pregnant women was conducted in a tertiary care hospital from 14th April 2017 to 13th April 2018 with ethical approval from Research and Institutional Review Committee (Reference number: 061-077/078) of the hospital. Pregnant women who met the eligibility criteria were included in the study. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Sciences version 24.0 and Microsoft Excel. Point estimate at 99% Confidence Interval was calculated along with frequency and percentage for binary data.

Results

Among 3034 patients who delivered in the tertiary centre, the prevalence of gestational diabetes mellitus was found to be 104 (3.42%) (2.57-4.26 at 99% Confidence Interval). The majority of women were of maternal age >30 years in 69 (66.34%). Out of which 48 (46.15%) women had family history of diabetes mellitus. Thirty-eight (36.53%) patients required a caesarean section. The most common obstetric complication was polyhydramnios in 35 (35.57%).

Conclusions

The prevalence of gestational diabetes was lower when compared to other studies done in similar settings. The majority of women were of higher maternal age, had family history of diabetes mellitus and were also obese.

Keywords

diabetes mellitus; gestational diabetes; pregnancy in diabetes.

Twenty years of pediatric diabetes surveillance: what do we know and why it matters

SEARCH for Diabetes in Youth (SEARCH) was initiated in 2000 as a multicenter study to address major gaps in the understanding of childhood diabetes in the United States. An active registry of youth diagnosed with diabetes at age <20 years since 2002 assessed prevalence, annual incidence, and trends by age, race/ethnicity, sex, and diabetes type. An observational cohort nested within the population-based registry was established to assess the natural history and risk factors for acute and chronic diabetes-related complications, as well as the quality of care and quality of life of children and adolescents with diabetes from diagnosis into young adulthood. SEARCH findings have contributed to a better understanding of the complex and heterogeneous nature of youth-onset diabetes. Continued surveillance of the burden and risk of type 1 and type 2 diabetes is important to track and monitor incidence and prevalence within the population. SEARCH reported evidence of early diabetes complications highlighting that continuing the long-term follow-up of youth with diabetes is necessary to further our understanding of its natural history and to develop the most appropriate approaches to primary, secondary, and tertiary prevention of diabetes and its complications. This review summarizes two decades of research and suggests avenues for further work.

FREQUENCY OF PRE-GESTATIONAL DIABETES MELLITUS AMONG PREGNANT WOMEN WITH MISCARRIAGE

Background: In developing countries, miscarriage is one of the common and increasing problems of pregnancy. The objectives of this study were to determine the frequency of pre-gestational diabetes mellitus among pregnant women with miscarriage in our population. Materials & Methods: This descriptive, cross-sectional study was conducted in the Department of Gynecology and Obstetrics, Khyber Teaching Hospital, Peshawar, Pakistan from 3rd November 2015 to 2nd May 2016. Sample size was 268 pregnant women with miscarriage selected through consecutive sampling technique. Inclusion criteria were all pregnant women with miscarriage. Exclusion criteria were molar pregnancy, ectopic pregnancy and diabetics. HbA1c levels of ≤6% was taken as normal, whereas a level >6 was taken as raised level or pre-gestational diabetes. Variables were age, pre-gestational diabetes mellitus, number of pregnancies and duration of pregnancy (≤24, >24). Mean and SD were calculated for quantitative while frequency and percentages for qualitative variables. Descriptive analysis was performed by using SPSS version 16. Results: Mean age of the patients was 27.66 ±4.93 years. Out of 268 participants, 81(30.22%) were having pre-gestational diabetes mellitus and 187(69.78) were normal, 234(87.31%) were having first pregnancy whereas 34 were having >1 pregnancies, the pre-gestational age ≤ 24 weeks were 130(48.51%) and >24 weeks were 138(51.49%). Conclusion: One third of the patients with miscarriage were having pre-gestational diabetes mellitus. Almost half of the patients were having gestational age of

Cognitive function and army rejection rate in young adult male offspring of women with diabetes: a Danish population-based cohort study

OBJECTIVE

While maternal diabetes is a known risk factor for perinatal complications, there is little data on long-term intellectual outcome in offspring. We compare the rejection rate and cognitive functioning of military conscripts according to maternal diabetes status during pregnancy.

RESEARCH DESIGN AND METHODS

We identified a cohort of Danish male offspring of diabetic mothers born between 1976 and 1984 and followed this cohort together with population-based control subjects to military conscription. The main outcome was army rejection rate and cognitive function measured with a validated intelligence test.

RESULTS

The army rejection rate was 52.5% among 282 men whose mothers had diabetes during pregnancy and 45.4% among 870 control subjects (risk difference 7.3 [95% CI 0.6-14.0]). Mean cognitive scores were 41.4 units (95% CI 40.2-42.6) in diabetes-exposed conscripts and 42.7 units (42.0-43.4) in control subjects. Stratification by gestational age, Apgar score, and White's class (A-F) did not change the associations. In a subgroup analysis using available data on A1C levels during pregnancy, this variable was inversely associated with cognitive functioning. In men with maternal A1C <7%, cognitive scores were identical to those in control subjects.

CONCLUSIONS

The slightly higher army rejection rate in men with maternal diabetes indicates higher morbidity. The identical cognitive functioning in cases of well-controlled maternal diabetes compared with that in control subjects is reassuring, but the negative association between A1C and cognitive score highlights the importance of striving for optimal metabolic control in diabetic women who are or plan to become pregnant.

Reference intervals for hemoglobin A1c in pregnant women: data from an Italian multicenter study

BACKGROUND

The reference intervals for hemoglobin A1c (Hb A1c) in pregnant women without diabetes are not well defined, and few examples of reference intervals established by networks of different laboratories are available.

METHODS

Five Italian Diabetic Care Units were involved in the study. Data were collected from 445 pregnant women without diabetes, selected on the basis of glucose challenge test results, and from 384 nonpregnant control women. The Hb A1c measurements were performed with HPLC systems aligned to the Diabetes Control and Complications Trial. Plasma glucose measurements were also performed locally. Both Hb A1c and glucose measurements were harmonized by running appropriate external quality assessment schemes. The reference intervals were calculated in terms of nonparametric 2.5th to 97.5th percentiles with 0.90 confidence intervals.

RESULTS

The Hb A1c measurements were reproducible (CV = 2.0%) and accurate [mean (SE) difference from the target values, -0.10 (0.06)%]. Glucose measurements were also reproducible (mean CV = 3.2%) and accurate [difference from the target values, -0.01 (0.04) mmol/L]. To calculate common reference intervals, we merged the data collected in the different centers. The Hb A1c reference intervals were 4.0%-5.5% for pregnant nondiabetic women and 4.8%-6.2% for nonpregnant controls.

CONCLUSIONS

Healthy pregnant women have lower Hb A1c concentrations than nonpregnant women. The reference intervals for Hb A1c in pregnant women should therefore be lower than those currently in use.