Maternal and Foetal Outcomes of Gestational Diabetes Mothers Treated with Human Insulin

  • G Prakash Associate Professor and Head, Department of Diabetology, Govt Mohan Kumaramangalam Medical College Hospital, Salem, TN, India.
  • JA Vasanthakumar Assistant Professor in Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, TN, India.
  • JA Elanchezhian Assistant Professor in Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, TN, India.
  • D Vijayaraju Associate Professor in Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, TN, India.
  • T Yoganandh Assistant Professor in Medicine, Govt. Mohan Kumaramangalam Medical College Hospital, Salem, TN, India.
  • R Shankar Associate Professor, Dept. of Preventive Medicine, VMKVMCH, Salem. TN, India
Keywords: gestational diabetes mellitus, insulin, maternal outcome, foetal outcome

Abstract

Background: The most common adverse event that is associated with GDM is that it has led to higher incidence of maternal diabetes mellitus later in life and the major morbidities among the infants born to the diabetic mothers include respiratory distress, macrosomia, polycythaemia, hypoglycaemia, hypocalcaemia, hypomagnesemia, and congenital malformations. As most of the oral hypoglycaemic agents is prone to cause teratogenic effects the most preferred was the insulin therapy and the subcutaneous insulin therapy has been considered as the standard therapy in the management of GDM. Aim: To assess the factors associated in the incidence of diabetes among the gestational diabetes mothers and to assess the effect of insulin on them in terms of maternal and foetal outcome. Methodology: A prospective study was undertaken among the gestational mothers with diabetes for a period of one year during Jan 2015 – Dec 2015 at the Government Medical College Hospital, Salem. A total of 150 maternal mothers with more than 24 weeks of gestation were included in the study and who had been diagnosed as gestational diabetes mellitus. The insulin used for majority of the patients was novo rapid and it was used four times a day. The outcome parameters which were used for antenatal mothers were their weight gain and the type of complications at the time of delivery whereas for the neonates their birth weight and the necessity for NICU admission were considered as the outcome parameters. Results: the risk factors found to be associated with the gestational diabetes among the study population were age more than 30 years, BMI of more than 25, family history both father and mother being diabetic, having a bad obstetric history, primigravida and the mothers who had gained more than 7 kgs in the first two trimesters. majority of the mothers delivered macrosomia babies (29.3%), hypoglycaemia and hypothyroidism was found only in 6% and 5.3% of the new-born babies and 4 were still births and 15 babies were got admitted to NICU for respiratory distress. The pearson’s correlation had shown a strong positive correlation between the dose of the insulin given to the antenatal mother and their increase in the weight (r=0.819) and a strong negative correlation with the weight of the neonate (r= -0.532). Conclusions: Gestational diabetes mellitus being associated with maternal and neonatal adverse outcomes, so maintaining adequate blood glucose levels in GDM helps in reducing the morbidity for both the mother and baby. Insulin would be a right choice for treating GDM and when initiated early it prevents most of the complications due to GDM both in the mother and the neonate.

Downloads

Download data is not yet available.

References

1. Sicree R, Shaw J, Zimmet P. Diabetes and impaired glucose tolerance in India. In: Gan D, editor. Diabetes atlas. Belgium: International Diabetes Federation; 2006. pp. 15–103.
2. Ahuja MM, Sivaji L, Garg VK, Mitroo P. Prevalence of diabetes in northern India (Delhi area) Horn Metab Res. 1974;4:321. doi: 10.1055/s-0028-1094024.
3. Gupta OP, Joshi MH, Dave SK. Prevalence of diabetes in India. Adv Metab Disord. 1978;9:147–165.
4. American Diabetes Association, Gestational Diabetes Mellitus (Position Statement) Diabetes Care. 2004;27(Suppl 2):S88–90.
5. Schmidt MI, Ducan BB, Reichelt AJ, Branchtein L, Matos MC, Costa e Forti A, et al. For the Brazilian Gestational Diabetes Study Group. Gestational diabetes mellitus diagnosed with a 2-h 75 gm oral glucose tolerance test and adverse pregnancy outcomes. Diabetes Care. 2001;24:1151–5.
6. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu) - a community based study. J Assoc Physicians India. 2008;56:329–33.
7. Davey RX, Hamblin PS. Selective versus universal screening for gestational diabetes mellitus: An evaluation of predictive risk factors. Med J Aust. 2001;174:118–21.
8. Opara PI, Jaja T, Onubogu UC. Morbidity and mortality amongst infants of diabetic mothers admitted into a special care baby unit in Port Harcourt, Nigeria. Ital J Pediatr. 2010;36:77.
9. Otolorin EO, Famuyiwa OO, Bella AF, Dawodu AH, Adelusi B. Reproductive performance following active management of diabetic pregnancies at the university college hospital, Ibadan, Nigeria. Afr J Med Med Sci. 1985;14:155–60.
10. Glueck CJ, Goldenberg N, Streicher P, Wang P (2002) The contentious nature of gestational diabetes: diet, insulin, glyburide and metformin. Expert Opin Pharmacother 3: 1557–1568.
11. Association AD (2009) Standards of medical care in diabetes–2009. Diabetes Care 32 Suppl 1S13–61.
12. Nicholson W, Baptiste-Roberts K (2011) Oral hypoglycaemic agents during pregnancy: The evidence for effectiveness and safety. Best Pract Res Clin Obstet Gynaecol 25: 51–63.
13. Seshiah V, Balaji V, Balaji MS, Sanjeevi CB, Green A. Gestational diabetes mellitus in India. J Assoc Physicians India. 2004;52:707–11.
14. Priyanka Kalra, Chetan Prakash Kachhwaha, and Hilda Victoria Singh. Prevalence of gestational diabetes mellitus and its outcome in western Rajasthan. Indian J Endocrinol Metab. 2013 Jul-Aug; 17(4): 677–680.
15. Rajesh Rajput, Yogesh Yadav, Smiti Nanda, and Meena Rajput. Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. Indian J Med Res. 2013 Apr; 137(4): 728–733.
16. Seshiah V, Balaji V, Balaji MS, Paneerselvam A, Arthi T, Thamizharasi M, et al. Prevalence of gestational diabetes mellitus in South India (Tamil Nadu) - a community based study. J Assoc Physicians India. 2008;56:329–33.
17. Swami SR, Mehetre R, Shivane V, Bandgar TR, Menon PS, Shah NS. Prevalence of carbohydrate intolerance of varying degrees in pregnant females in western India (Maharashtra) - A hospital-based study. J Indian Med Assoc. 2008;106:712
18. Zargar AH, Sheikh MI, Bashir MI, Masoodi SR, Laway BA, Wani AI, et al. Prevalence of gestational diabetes mellitus in Kashmiri women from the Indian Subcontinent. Diabetes Res Clin Pract. 2004;66:139–45.
19. Kim C, Liu T, Valdez R, Beckles GL. Does frank diabetes in first degree relatives of a pregnant woman affect the likelihood of her developing gestational diabetes mellitus or nongestational diabetes? Am J Obstet Gynecol. 2009;201(576):e1–6.
20. Gajjar F, Maitra K. Intrapartum and perinatal outcomes in women with gestational diabetes and mild gestational hyperglycemia. J Obstet Gynaecol India. 2005;55:135–7.
21. Hong JU, Rumbold AR, Wilson KJ, Crowther CA. Borderline gestational diabetes mellitus and pregnancy outcomes. BMC Pregnancy Childbirth. 2008;8:31.
22. Juan Gui, Qing Liu, and Ling Feng. Metformin vs Insulin in the Management of Gestational Diabetes: A Meta-Analysis. PLoS One. 2013; 8(5): e64585.
23. Veciana M, Major CA, Morgan MA, Asrat T, Toohey JS, Lien JM, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy.N Engl J Med. 1995;333:1237–1241.
24. Jovanovič L, Savas H, Mehta M, Trujillo A, Pettitt DJ. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Diabetes Care. 2011;34:53–54.
Published
2016-09-28
How to Cite
1.
Prakash G, Vasanthakumar J, Elanchezhian J, Vijayaraju D, Yoganandh T, Shankar R. Maternal and Foetal Outcomes of Gestational Diabetes Mothers Treated with Human Insulin. IABCR [Internet]. 28Sep.2016 [cited 18Jul.2019];2(3):75-9. Available from: https://iabcr.org/index.php/iabcr/article/view/176