Diabetes in pregnancy: diagnosis, management, outcome and complications

European Journal of Obstetrics & Gynecology and Reproductive Biology(2016)

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Abstract
Introduction: Numerous perinatal complications of diabetes in pregnancy have been recognised. Maternal post-partum complications can be equally devastating. Aim: Single firm audit of pregnant patients diagnosed with diabetes, their subsequent follow up, maternal and fetal complications and long term outcome. Method: In this study a cohort of known type 1 and type 2 pregnant diabetics and newly diagnosed Gestational Diabetes Mellitus (GDM) patients were analysed. All consecutive pregnancies (n = 79) randomly referred to the index firm, between 2010 and 2014 were included. Data collected was analysed in terms of method of diagnosis, gestational age at diagnosis for GDM, relevant medical or obstetric history, subsequent management, follow up during pregnancy, perinatal outcome and long term follow up. Results: Out of 79 viable pregnancies, 69.6% of patients were diagnosed with GDM, 13.9% with type 2 DM and 16.5% with type 1 DM. The median gestational age at which a GDM diagnosis was made was 29 weeks (IQR 28–32). Mean gestational age for the GDM cohort was 37.9 (±1.6) weeks, 35.5 (±3.7) weeks in Type 2 and 37.1 (±0.7) weeks in the Type 1 cohort (P = 0.010). Mean maternal age was highest in the Type 2 cohort and lowest in the Type 1 group (31.5 years and 27 years respectively (P = 0.031)). A statistically significant difference (P = 0.041) in mean birth weight of the offspring between the GDM cohort (3.5 ± 0.7 kg) and Type 1 and Type 2 diabetics (3.2 ± 0.6 kg) grouped together was noticed. 20.3% of all cohort and specifically 23.6% of GDM pregnancies had a fetus which was classified as large for gestational age during pregnancy. From the GDM cohort 32.7% were on insulin and 50.9% were on oral hypoglycaemic agents. 72.7% of type 2 DM patients were on insulin while 63.6% on oral hypoglycaemic agents. All type 1 DM patients were on insulin and none on OHA's. 30% of GDM patients, 25.5% of Type 2 DM patients and 84.6% of Type 1 DM patients, had their blood glucose controlled by an insulin infusion pump peri-partum. Mean HbA1C in the third trimester was 6.0%, 6.3% and 7.1% in GDM, Type 2 and Type 1 diabetics respectively (P = 0.004). A negative correlation was seen between HbA1C levels in third trimester and delivery gestational age (Spearman correlation coefficient −0.495; P < 0.001). Neonatal complications included macrosomia and polyhydramnios (9 GDM and 4 Type 1 DM patients respectively) and 2 severe congenital anomalies in Type 2 DM patients. 52% of GDM patients had an OGTT 6 weeks post partum, 21.8% of whom developed Type 2 DM, 5.5% impaired glucose tolerance and 23.6% had a normal OGTT. Conclusion: Our findings emphasize the need for close follow up of these patients. Implementing a structured and holistic multidisciplinary team may have an impact on outcome, especially maternal education preconceptionally, during pregnancy and post partum, in particular in GDM patients and their risk of developing type 2 DM in the future.
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Key words
diabetes,pregnancy
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