Adverse Pregnancy Outcomes in Gestational Diabetes Mellitus - Study in an Apex Hospital

Diabetes is the most common medical complication of pregnancy (3 to 5% of all pregnancies). The aim of the present study was to evaluate maternal and fetal risks associated with gestational diabetes mellitus, so that we can reduce those risks by early diagnosis and active intervention. This was a retrospective case control study conducted in the Department of Gynecology and Obstetrics, Medical College and Hospital, Kolkata. 200 pregnant women with GDM were taken as cases and matched for age, parity and body mass index with 200 non diabetic pregnant women who acted as controls. Both the groups were compared on the basis of some maternal and fetal and neonatal complications. Maternal complications taken into account were pre-eclampsia, preterm delivery; induction of labour ,caesarean section; and foetal and neonatal complications taken into account were macrosomia, shoulder dystocia, admission to the neonatal intensive care unit (NICU), Apgar score <7 at 5 minutes, respiratory distress syndrome (RDS), neonatal hypoglycaemia, hyperbilirubinaemia, need for phototherapy, congenital anomalies and perinatal mortality. Two-proportion z-test, pooled for was used to derive z value, from which p value was calculated (CI 95%). p‹ 0.05 was considered as statistically significant. The incidence of preeclampsia, preterm delivery and occurrence of cesarean delivery were more in GDM group and the association was extremely significant. The incidence of labour induction was also more in this group. Macrosomia, NICU admission, RDS and neonatal hypoglycaemia were significantly more in GDM group. (p< 0.0001). Evidence suggests that early diagnosis and strict control of blood sugar levels throughout the pregnancy can significantly reduce complications associated with gestational diabetes. A multicenter, randomized controlled trial, based on universally accepted criteria for GDM screening test, standardized diagnostic OGTT and management of all patients with GDM versus the standard obstetric management of the control is warranted.