Gestational Diabetes Mellitus and Feto-Maternal Outcomes in Federal Medical Centre, Yenagoa, Bayelsa State-A Comparative Study of Two Diagnostic Criteria
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Keywords
Gestational Diabetes Mellitus, Foeto-Maternal Outcomes, IADPSG criteria, WHO 1999 criteria.
Abstract
Background: The prevalence of gestational diabetes mellitus (GDM) is dependent on the diagnostic criteria used and there is no consensus on screening methods and diagnostic criteria. The International Association for Diabetes in Pregnancy Study Group (IADPSG) recently put forward new diagnostic criteria and encourages its adoption worldwide. The aim of this study was to determine the incidence of GDM and to compare the foeto-maternal outcomes of women diagnosed with GDM in the Federal Medical Centre, Yenagoa using the WHO 1999 and IADPSG criteria.
Methodology: This was a cohort study of 340 women who were booked for antenatal care at the Federal Medical Centre, Yenagoa. Women who gave consent to participate in this study took part in a 75-gram, 2-hour oral glucose tolerance test (OGTT). The diagnosis of GDM was sought in each participant using both the WHO 1999 and the IADPSG criteria. The incidence and the foeto-maternal outcomes in women diagnosed with GDM using different criteria were compared.
Results: The incidence of GDM was 5.3% in the IADPSG (case) group and 3.8% in the WHO (control) group. This difference was not statistically significant (p = 0.18). There was no significant difference between the groups for foetal and maternal outcomes that were assessed. Maternal outcomes were pre-eclampsia (p = 0.48), polyhydramnios (p = 0.31), insulin therapy (p = 0.35), caesarean section (p = 0.28), genital tract laceration (p = 0.18) and instrumental vaginal delivery (p = 0.34). Foetal outcomes were birth weight ≥ 4kg (p = 0.07), neonatal jaundice (p = 0.38), hypoglycaemia (p = 0.46), birth injuries (p = 0.42) and shoulder dystocia (p = 0.23).
Conclusion: The application of the IADPSG criteria in our environment may lead to an increase in the number of women being managed for GDM without any appreciable improvement in foetal and maternal outcomes.
References
2. Fawole AO, Ezeasor C, Bello FA, Roberts A et al. Effectiveness of a structured checklist of risk factors in identifying pregnant women at risk of gestational diabetes mellitus: A cross-sectional study. Niger J Clin Pract. 2014;17(4):495-501.
3. Chukwunyere CF, Awonuga DO, Igwe U. Gestational Diabetes in a Tertiary Healthcare Centre at Abeokuta, South Western Nigeria: A Five Year Retrospective Review. IJTDH 2015;7(1):23-31.
4. Colagiuri S, Falavigna M, Agarwal MM, Boulvain M et al. Strategies for implementing the WHO diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Diabetes Res Clin Pract. 2014; 103:364-372.
5. Olagbuji BN, Atiba AS, Olofinbiyi BA, Akintayo AA et al. Prevalence of and risk factors for gestational diabetes using 1999, 2013 WHO and IADPSG criteria upon implementation of a universal one-step screening and diagnostic strategy in a sub-Saharan African population. Eur J Obstet Gynecol 2015; 189:27-32.
6. Crowther AC, Hiller EJ, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes.N Engl J Med. 2005:2477-2486.
7. Oputa RN, Nzeribe EA. Gestational diabetes mellitus: A clinical challenge in Africa. African Journal of Diabetes Medicine 2013;21(2):29-31.
8. Macaulay S, Dunger DB, Norris SA. Gestational Diabetes Mellitus in Africa: A Systematic Review. PLoS ONE. 2014;9(6). doi:10.1371/journal.pone.0097871
9. Kuti MA, Abbiyesuku FM, Akinlade KS, Akinosun OM, Adedapo KS, Adeleye JO, Adesina OA. Oral glucose tolerance testing outcomes
among women at high risk for gestational diabetes mellitus. J Clin Pathol 2011; 64:718e721.
10. Knopp RH. John B. O’ Sullivan: A Pioneer in the Study of Gestational Diabetes. Diabetes Care. 2002; 25(2):943-944.
11. Agarwal MM. Gestational diabetes mellitus: An update on the current international diagnostic criteria. World J Diabetes. 2015;6(6):782-791.
12. The HAPO study cooperative research group. Hyperglycemia and Adverse Pregnancy Outcomes. N Engl J Med 2008; 358:1991-2002.
13. Benhalima K, Hanssens M, Devlieger R, Verhaeghe J, Mathieu C. Analysis of pregnancy outcomes using the new IADPSG recommendation compared with the Carpenter and Coustan criteria in an area with a low prevalence of Gestational Diabetes. Int J Endocrinol.2013 Article ID 248121, 6 pages. http://dx.doi.org/10.1155/2013/2481212013.s
14. Duran A, Sáenz S, Torrejón MJ, Bordu E et al. Introduction of IADPSG criteria for the screening and diagnosis of gestational diabetes mellitus results in improved pregnancy outcomes at a lower cost in a large cohort of pregnant women: the St. Carlos Gestational Diabetes Study. Diabetes Care 2014;37(9):2442-50.
15. American College of Obstetricians and Gynecologists. Gestational diabetes mellitus. Practice Bulletin No. 137. Obstet Gynecol 2013; 122:406–16.
16. Visser GHA, Valk HW De. Is the evidence strong enough to change the diagnostic criteria for gestational diabetes now? YMOB 2013;208(4):260-264.
17. Diabetes Association of Nigeria. Clinical Practice Guidelines for Diabetes Management in Nigeria.2nd ed. Port Harcourt: Diabetes Association of Nigeria, 2013.
18. Catalano PM. Obesity, insulin resistance, and pregnancy outcome. Focus review on obesity. Reproduction. 2010;140: 365-371.
19. Meek CL, Lewis HB, Patient C, Murphy HR, Simmons D. Diagnosis of gestational diabetes mellitus: falling through the net. Diabetalogia 2015. doi:10.1007/s00125-015-3647-z.
20. Imoh LC, Ogunkeye OO, Isichei CO, Gadzama AA, Ekwempu CC. Combining the IADPSG criteria with the WHO diagnostic criteria for gestational diabetes mellitus optimizes predictability of adverse pregnancy outcomes. Trop J Obstet Gynaecol 2016; 33:185-9.
21. World Health Organisation. Diagnostic Criteria and Classification of Hyperglycaemia First Detected in Pregnancy. Geneva. 2013.
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