Thesis Topic 6c3i6a

Thesis topic DIAGNOSIS OF DIABETES IN PREGNANCY AS PER THE INTERNATIONAL ASSOCIATION OF DIABETES AND PREGNANCY STUDY GROUP(IADPSG) CRITERIA AND TO ASSESS THE MATERNAL AND PERINATAL OUTCOME

DIABETES IN PREGNANCY OVERT DIABETES:--- 10%  Diabetes that existed prior to pregnancy  End organ complications are more  Insulin requirements increase  Organogenesis affected

GESTATIONAL DIABETES:---90%  Glucose intolerance of variable severity, with onset or first recognition during the present pregnancy, whether insulin or only dietary modification is used for treatement,whether or not the condition persists after delivery  Main problem is macrosomia

significance and incidence Associated with increase maternal,foetal and neonatal complications Maternal: Pre eclampsia  Polyhydramnios  Infections  Risk of operative delivery  Genital tract trauma  Puerperal sepsis &  Wound infection  Keto acidosis

Foetal: Miscarriage  Congenital malformations  Macrosomia  Prematurity  IUGR

Neonatal: Hypoglycaemia  Respiratory distress syndrome  Polycythaemia  Hyperbilirubinaemia  Hyperviscosity syndrome  Cardiomyopathy  Birth trauma

Long term complications Obesity  Early onset type 2 diabetes  Cardiovascular diseases 

Magnitude of the problem 

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India now became the diabetes capital of the world with maximum number of diabetic subjects According to the Diabetes Atlas 2009 published by the International Diabetes Federation, the number of people with diabetes in India in year 2010 was reported to be around 50.8 million which is expected to rise to 69.9 million by 2025 unless urgent preventive steps are taken.

The importance of GDM is that two generations are at risk of developing diabetes in the future. Women with a history of GDM are at increased risk of future diabetes, predominantly type 2 diabetes, as are their children . Besides, any abnormal glucose intolerance during pregnancy also has adverse fetal outcome.  Increasing maternal carbohydrate intolerance in pregnant women without GDM is associated with a graded increase in adverse maternal and fetal outcomes, both short term and long term. Thus, emerges the relevance of identifying glucose intolerance in pregnancy. 

Detecting the evidence of diabetes mellitus in pregnancy is a major challenge as the condition is associated with diverse range of adverse maternal and neonatal outcomes.  Various screening guidelines have been introduced depending upon the suitability of test to the population characteristics, cost and screening accuracy. Still there are lots of controversies as to which test to be used, when should the screening be done and on whom it should be applied. 

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In countries like india, where the prevalence of diabetes is very high, universal screening is needed. There are different criteria for the screening and diagnosis of diabetes in pregnancy Routine recommendation for screening of diabetes is at 24-28 weeks of gestation, so there is possibility of missing overt diabetes and GDM upto that period and the adverse foetal effect will be started by that time

IADPSG Diagnosing diabetes complicating pregnancy as per IADPSG criteria solves the above problem  The 1st antenatal visit measure fasting plasma glucose and HbA1c in all pregnant woman Overt diabetes : if any of the following are found  FBS >126mg/dl  HbA1c >_6.5%  RBS >200mg % 

GDM  FBS>92mg/dl but <126mg/dl  If these values are normal, perform oral glucose tolerance test with 75 gm glucose at 24-28 weeks  Patient is advised to come ovedrnight fasting and measure fasting plasma glucose ,then 75 gm glucose is given dissolved in water or juice and measure one hour ,two hour plasma glucose values

Diagnose as  Overt diabetes: FBS >126mg/dl  GDM: Fasting pl glucose>_92mg/dl(5.1mmol/L) 1 hr pl glucose>_180mg/dl(10mmol/L) 2 hrpl glucose >_153mg/dl(>_8.5mmol/L) Normal all 3 values less the thresholds 

Main outcome measures Development of gestational hypertension /pre eclampsia  Preterm delivery  Mode of delivery  Delivery of macrosomic (>3.5kgs) babies  Shoulder dystocia  Birth injury  Neonatal hypoglycaemia  ission in NICU  Postpartum maternal complications 

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