Glycemic Status and Maternal Outcome among Women with Gestational Diabetes Mellitus

Introduction

Gestational diabetes mellitus (GDM) refers to any degree of blood glucose intolerance that occurs or is discovered for the first time during pregnancy.¹ In recent years, the incidence of GDM has been increasing year by year. There are an estimated 223 million women (20–79 years) living with diabetes. This number is projected to increase to 343 million by 2045. Out of the above statistics, 20 million had some form of hyperglycemia in pregnancy.² GDM is a well-known risk factor for adverse maternal outcomes such as big baby, prolonged labor, macrosomia, and neonatal hypoglycemia.³⁴⁵ It is a common high-risk⁶ metabolic complication. A case–control study was conducted in a tertiary care maternity hospital in coastal South India. The study results depicted that women from rural areas and those with a monthly income ≤international normalized ratio 20,000, body mass index (BMI) >23 kg/m², polyhydramnios, pregnancy-induced hypertension, oligohydramnios, and a gap between pregnancies of <2 years had a higher risk to develop GDM.⁷ Exploring the risk factors of GDM, analyzing the adverse effects on pregnancy outcomes, and proposing corresponding preventive measures are of great significance for reducing the presence and progression of GDM and ensuring the safety of mothers and infants. The study aims to determine the association between maternal glycemic parameters and adverse maternal outcomes of GDM among women.

Materials and Methods

This is a prospective observational study conducted among 66 pregnant women diagnosed with GDM. These women were recruited from the outpatient department of the selected tertiary care hospital. Data were collected from January to December 2020. Ethical clearance was obtained from the Institutional Ethics Committee and due permission was taken from concerned authorities in the hospital. Informed written consent was taken from the study participants. Subjects were recruited at 24 weeks of pregnancy. Baseline data were collected by interview method and the glycemic parameters were collected by sending the blood to the laboratory. These women continued to visit the antenatal clinic and received routine care. Maternal outcomes were obtained from the mother's case sheet at 24 hours of delivery.

Statistical analysis: Quantitative data were presented as mean ± standard deviation, and categorical data were presented as percentages. The test of significance used was the analysis of variance test. A p-value < 0.05 was considered statistically significant.

Results

Baseline characteristics of the women were discussed in Table 1 in which 54.5% of the women belonged to 26 to 30 years of age. Among the subjects, 59.1% of them were multigravida. A family history of DM was presented by 47% of the women and 28.8% of them had a family history of hypertension. In the prepregnancy period, BMI indicated 39.4% of them as overweight.

The distribution of the glycemic parameters was depicted in Table 2. The mean fasting blood sugar (FBS) was 108.61 ± 31.41, postprandial blood sugar (PPBS) was 163.94 ± 39.98, and mean hemoglobin A1c (HbA1c) was 6.52 ± 1.35.

Maternal outcomes of the women were discussed in Table 3, in which 30.30% underwent lower segment cesarean section (LSCS), 18.18% had preeclampsia, and weight gain found to be more than 11 kg during pregnancy among 15.16% of the subjects.

Fig. 1 depicted the association between glycemic parameters with the maternal outcome, which showed that there was a significant association between glycemic scores and maternal outcome of preeclampsia, p =0.044.

Close

Fig. 1 Percentage distribution of mothers with gestational diabetes as per their maternal outcomes. LSCS, lower segment cesarean section.

Export to PPT

Association of glycemic parameters with selected baseline variables was analyzed and it showed a significant association between FBS scores and family history of hypertension, p = 0.010 and family history of DM, p =0.002.

Discussion

The maternal outcome is comparatively poor among GDM women. Present study showed that mean FBS, PPBS and HbA1c values as 108.61 ± 31.41, 163.94 ± 39.98, and 6.52 ± 1.35 respectively. As a results of increased glycmic values 30.30% of the women underwent LSCS and 18.18% had preedampcia. Ma and Zhang noted that during pregnancy, 28.0% patients were with pregnancy-induced hypertension, 24.0% with polyhydramnios, and 26.0% with preeclampsia.⁸ Study conducted by Muche et al depicted that GDM mothers had a higher risk for a poor maternal outcome like cesarean section, pregnancy-induced hypertension, premature rupture of membranes, antepartum hemorrhage, and postpartum hemorrhage.⁹ Other studies reported that 40.1% of GDM mothers were delivered by cesarean section.¹⁰ A prospective study on the maternal and perinatal outcome of GDM showed a higher incidence of pregnancy-induced hypertension (11.9%), induction of labor (37.2%), cesarean section (58.96%) preterm delivery (2.99%), and macrosomia (2.9%).¹¹ Zheng et al's multivariable-adjusted model showed only fasting glucose was significantly associated with total and individual adverse pregnancy outcomes.¹² In the current study, there was a significant association between HbA1c scores and maternal outcome of preeclampsia, p =0.044. The study conducted by Buhary et al reported that patients with higher HbA1c were older (p = 0.0077), had significantly higher blood pressure, proteinuria (p < 0.0001), and were multiparous (p = 0.0269).¹³

This study found a significant association between FBS scores and family history of hypertension, p = .010, and family history of DM, p = .002. The study done by Nicolosi et al found that family history of DM (169, 1.16–2.16) and hypertension (2.00, 1.36–2.98) were independent risk factors for cesarean section.¹⁴

Limitations of the Study

The sample size of the study was comparatively small, so generalization was found to be difficult. Further studies can be done to assess the risk factors of GDM and relative risk can be measured.

Conclusions

GDM has many adverse outcomes in maternal and fetal life. Early screening and timely intervention will help us to reduce future complications and maternal and neonatal mortality and morbidity. The present study highlights that there is an influence of glycemic status on maternal outcomes.

Clinical Significance

GDM is increasing worldwide. During the antenatal period among GDM mothers, glycemic control is very essential. Any variation in the glycemic parameters of the mother will lead to poor maternal outcomes. Therefore, it is vital to prevent complications by achieving good control of glycemic parameters.