Screening of Diabetes Mellitus in Pregnancy by Hemoglobin A1c and Fasting Plasma Glucose at Ramathibodi Hospital

Chutima Yaiyiam; Somsak Suthutvoravut

doi:10.14456/rmj.2018.35

Authors

Chutima Yaiyiam Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Somsak Suthutvoravut Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

DOI:

https://doi.org/10.14456/rmj.2018.35

Keywords:

Diabetes mellitus, Gestational diabetes, Pre-existing diabetes, Abortion, Outcomes of pregnancy

Abstract

Background: Diabetes mellitus (DM) is an important complication during pregnancy. The International Diabetes Federation (IDF) recommended screening for pre-existing or overt DM and gestational diabetes (GDM) by hemoglobin A_1c (HbA_1c) and fasting plasma glucose (FPG) at the first antenatal visit.

Objective: To study the incidence of DM in pregnancy by the new screening program, and its effects on perinatal outcomes in pregnant women who entered for antenatal visits at Ramathibodi Hospital.

Methods: The descriptive study analyzed results of screening DM by HbA_1c and FPG among 421 pregnant women who came for antenatal visits during January 4, 2016, to March 31, 2016. Chi-square test, Fisher’s exact test and logistic regression analysis were used to analyze the association between factors with significance level at P < 0.05.

Results: Among the 421 participants, 4 participants (0.95%) were diagnosed with pre-existing DM and 57 participants (13.54%) were diagnosed with GDM at first antenatal visit. In second screening at 24 - 28 weeks of gestational age another 62 participants (21.99%) among 282 participants were diagnosed GDM. Totally incidence of GDM in this study was 35.53%. Abortion rate (18.03%) was significantly higher among pregnant women with DM compared to normal women (2.01%). There was no significant association between DM in pregnancy and other outcomes of pregnancy.

Conclusions: This study showed that the incidence of pre-existing DM in pregnant women screened by HbA_1c at the first antenatal visit was very low. DM in pregnancy was significantly associated with abortion, but not with other outcomes of pregnancy.

References

Cunningham FG, Leveno KJ, Bloom SL, et al. Williams Obstetrics. 24th ed. New York, NY: McGraw-Hill Education; 2014:1125-1147.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009;32(Suppl 1):S62-S67. doi:10.2337/dc09-S062.

Balaji V, Madhuri BS, Ashalatha S, Sheela S, Suresh S, Seshiah V. A1C in gestational diabetes mellitus in Asian Indian women. Diabetes Care. 2007;30(7):1865-1867. doi:10.2337/dc06-2329.

Deerochanawong C, Ferrario A. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes. Global Health. 2013;9:11. doi:10.1186/1744-8603-9-11.

Bhavadharini B, Uma R, Saravanan P, Mohan V. Screening and diagnosis of gestational diabetes mellitus– relevance to low and middle-income countries. Clin Diabetes Endocrinol. 2016;2:13. doi:10.1186/s40842-016-0031-y.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2004;27(Suppl 1):S5-S10.

International Association of Diabetes and Pregnancy Study Groups, Metzger BE, Gabbe SG, et al. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-682. doi:10.2337/dc09-1848.

Seshiah V, Balaji V, Balaji MS, et al. Gestational diabetes mellitus manifests in all trimesters of pregnancy. Diabetes Res Clin Pract. 2007;77(3):482-484. doi:10.1016/j.diabres.2007.01.001.

Abouzeid M, Versace VL, Janus ED, et al. A population-based observational study of diabetes during pregnancy in Victoria Australia, 1999-2008. BMJ Open. 2014;4(11):e005394. doi:10.1136/bmjopen-2014-005394.

Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008;31(5):899-904. doi:10.2337/dc07-2345.

Renji SR, Lekshmi ST, Chellamma N. Prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center. Int J Reprod Contracept Obstet Gynecol. 2017;6(3):797-801. doi:10.18203/2320-1770.ijrcog20170466.

Chanprapaph P, Sutjarit C. Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital. J Med Assoc Thai. 2004;87(10):1141-1146.

Boriboonhirunsarn D, Sunsaneevithayakul P, Nuchangrid M. Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation. J Med Assoc Thai. 2004;87(9):1017-1021.

Rubeaan K, Manaa HA, Khoja TA, et al. A community-based survey for different abnormal glucose metabolism among pregnant women in a random household study (SAUDI-DM). BMJ Open. 2014;4(8):e005906. doi:10.1136/bmjopen-2014-005906.

Benhalima K, Mathieu C, Damm P, et al. A proposal for the use of uniform diagnostic criteria for gestational diabetes in Europe: an opinion paper by the European Board & College of Obstetrics and Gynaecology (EBCOG). Diabetologia. 2015;58(7):1422-1429. doi:10.1007/s00125-015-3615-7.

Galindo A, Burguillo AG, Azriel S, Fuente Pde L. Outcome of fetuses in women with pregestational diabetes mellitus. J Perinat Med. 2006;34(4):323-331. doi:10.1515/JPM.2006.062.

Dicker D, Feldberg D, Samuel N, Yeshaya A, Karp M, Goldman JA. Spontaneous abortion in patients with insulin-dependent diabetes mellitus: the effect of preconceptional diabetic control. Am J Obstet Gynecol. 1988;158(5):1161-1164. doi:10.1016/0002-9378(88)90245-1.

Wahabi HA, Esmaeil SA, Fayed A, Al-Shaikh G, Alzeidan RA. Pre-existing diabetes mellitus and adverse pregnancy outcomes. BMC Res Notes. 2012;5:496. doi:10.1186/1756-0500-5-496.

Gasim T. Gestational diabetes mellitus: maternal and perinatal outcomes in 220 Saudi women. Oman Med J. 2012;27(2):140-144. doi:10.5001/omj.2012.29.

American Diabetes Association. Classification and diagnosis of diabetes. Diabetes Care. 2016;39(Suppl 1):S13-S22. doi:10.2337/dc16-S005.

Bunak I, Shestakova T. Maternal BMI and age as a risk factors of gestational diabetes mellitus (based on IADPSG criteria). Rome, Italy: The international Academy of Human Reproduction; 2017. https://hr2017.humanrepacademy.org/abstractbook/pdf/abs5960.pdf. Accessed March 14, 2018

National Collaborating Centre for Women's and Children's Health. Diabetes in Pregnancy: Management of Diabetes and Its Complications from Preconception to the Postnatal Period. London, UK: National Institute for Health and Care Excellence; 2015.