(2.02) Screening and Differential Risk Factors Assessment in Development of Gestational Diabetes Mellitus in Different Trimesters

Worldwide, one in 6 pregnancies are associated with diabetes, 85% of which are GDM. Undiagnosed or inadequately treated GDM can lead to significant maternal & fetal complications. Asian Indian ethnicity is associated with a high risk of GDM than Caucasians and need to be screened much earlier to diagnose and optimally manage GDM.

This is a twin center prospective, non-interventional observation study aimed to screen pregnant women at 12-16 weeks,24-28 weeks and 32-36 weeks to estimate prevalence of GDM in each trimester and to identify risk factors in development of GDM.

 

Methods:

All pregnant females were screened by DIPSI One step test with 75 gms oral Glucose administered irrespective of the last meal. GDM was diagnosed if 2-hr post glucose value was more than 140 mg/dl. The first testing was done during the first trimester. For all negatives, repeat testing was done between  24-28 weeks pregnancy & if still negative , a third screening was done at 32-36 wks.

Age, BMI, Gravida status, H/O Menarche, PCOS, Maternal H/O GDM, Diabetes & detailed clinical assessment including presence of HT, Albuminuria and Lipids was done. HBAic  in first trimester was done to R/O Preexisting DM.  

Results:

Total 480 pregnant females were screened for GDM in all three trimesters as per protocol over a period of 1 year . Of these, 90 females (18.7%) were diagnosed with GDM by in all three trimesters.

20 Females were diagnosed in Ist trimester (4.17%), 36(7.5%) in 2^nd and 34(7.08%) in third trimester respectively.

56 females (11.67%) who got diagnosed in first two trimesters (before 28 wks) had higher BMI≥28.8+0.84 /kg/m^2, H/o PCOS, Higher age as primary gravida, Strong family H/O DM & H/O GDM in the mother.

34(7.08%) females diagnosed in third trimester had association only with BMI > 27/Kg/m²  

Discussion/Conclusion:

Pregnant females with H/O PCOS, GDM in the past, H/O GDM or diabetes in the mother, or Higher BMI need to be screened at Ist ANC as early as 12 weeks & subsequently at 20-24 wks to diagnose GDM early so that MNT, Metformin or Insulin if required could be initiated to ensure euglycemia and improved materno-fetal outcomes.