Risk factors and pregnancy outcomes among gestational diabetic mothers

Abstract

Background: Gestational diabetes mellitus (GDM) most of which progress to type 2 diabetes mellitus (T2DM) is increasing world wide. An apprehensive increase of GDM is also observed in Bangladesh in line with growing prevalence of T2DM. GDM predisposes mother and offspring to increased risk of complication during pregnancy. Identification of GDM and control of glucose in pregnancy can reduce such complications and improve maternal and neonatal health. A standard guideline on screening of GDM is yet to be developed in Bangladesh.

Objectives: To identify risk factors and to examine the relationship of maternal and neonatal complications associated with GDM in a group of hospital population.

Methods: A case control study was carried out in BIRDEM and MCHTI hospital from 1st of July to 15th October 2004. 106 pregnant women with a diagnosis of GDM and 196 without GDM were included in this study. Data on risk factors and pregnancy outcomes were collected through a face to face interview with the mothers and checking antenatal and delivery records at postnatal word.

Results: Maternal age >25 years, pregnancy BMI >23 kg/m2, positive family history of diabetes were found to be independent risk factor for GDM in multivariate analysis. Women who were diagnosed in the first half of the pregnancy were most likely to be treated with insulin [OR 3.7; 95% CI (1.6-8.9)]. Prevalence of hypertension was higher in GDM compared to NonGDM (12.3% vs. 4.1%). Anaemia was less prevalent in the GDM group. Preterm delivery, caesarean section, birth weight >3.5 kg were seen to be independently associated with GDM. No significant difference was found in maternal, fetal or neonatal complications either according to time of diagnosis of GDM or type of treatment they received. Only the occurrence of hypoglycemia in the neonates born to mothers with GDM has been seen to be higher in the women who were diagnosed early (75.8% vs. 52%) and also who received insulin (74.5% vs. 36.7%). Hypertension in pregnancy appeared to be significantly associated (p value <0.01) with the women who were diagnosed of GDM in early stage of pregnancy. Women who were treated with insulin had higher prevalence of birth weight more than 3.5 kg.

Conclusion: This study suggests that relatively older woman; woman with a family history of diabetes or increased BMI possess independent risk for GDM in the study population. Women with GDM have increased risk of preterm birth, caesarean section and larger baby. GDM diagnosed early or treated with insulin in pregnancy predict higher risk of adverse effects in mother and newborn. Therefore, these findings should be given particular importance during antenatal period to initiate a screening programme and treatment protocol for GDM.