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

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.