Gestational Diabetes Mellitus And Impaired Glucose Tolerance Biology Essay

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A prospective cohort study with a nested case control design was undertaken among antenatal women registered at all Sub-centres, tea garden hospitals, VHNDs celebrated in outreach areas, PHCs, SD and CHCs of Khowang block of Assam..

From the cohort, 3 controls against each case i.e. a total of 193 cases and 579 matched controls were taken with age and gestational week matching.

Results: From 930 enrolled; 858 (92.3%) followed in second trimester, 777 (83.5%) in third trimester with outcome measurements. Mean age was 23 years. Incidence of GDM was 3%; while IGT was 23.2%. Family history of DM was more in cases (2.1%) than controls (0.5%)(OR 4.06, 95%, CI 0.90 - 18.32). Obesity was more amongst the cases (OR 2.40, 95% CI 1.21 - 4.73, p=0.01). Amongst cases 20.2% developed gestational hypertension as against 26.4% of controls (OR: 0.70, 95% CI 0.474 - 1.04). A significantly higher number of cases delivered by LSCS (p=0.009). Preterm delivery occurred in 30.9% of cases and 29.7% of controls. A higher number of macrosomic babies were delivered by the cases (OR 9.74, 95% CI 2.85 - 33.30). Baby care in NICU for >2 days was required for cases (3.1%) as against controls (0.9%) (OR 0.27, 95% CI 0.08 - 0.91).

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Conclusion: The population living in rural areas are mostly at low risk to develop GDM. There is increased maternal and foetal morbidity in terms of caesarean section rate, admission to a NICU among women who had GDM during pregnancy.

Results:

Table1: Different characteristics of cases and controls

Characteristics of the study participants

Case (n=193)

Control (n=579)

P* value

Age (in years)

22.60 ± 4.487

22.61 ± 4.495

NS

Height (in cm)

149.79 ± 3.795

150.02 ± 4.220

NS

Weight (in kg)

50.96 ± 10.136

49.96 ± 8.353

NS

Birth Weight (kg)

2.91 ± 0.541

2.76 ± 0.451

<0.001

Religion

Hinduism

182 (94.3%)

571 (98.6%)

0.001

Islam

11 (5.7%)

8 (1.4%)

Educational status

Literate

155 (80.3%)

438 (75.6%)

NS

Illiterate

38 (19.7%)

141 (24.4%)

Occupational status

Business

4 (2.1%)

9 (1.6%)

NS

Housewife

178 (92.2%)

524 (90.5%)

General labour

11 (5.7%)

46 (7.9%)

*For case vs control subjects by c2 tests

Mean age of cases and controls are same and is 23 years. Mean weight of cases and controls are 51 kg and 50 kg respectively where the mean height for both group is same and is 150 cm. There is a significant difference between birth weight of cases and controls. Maximum study participants of control group belong to Hindu religion 571, (98.6%). The literacy rate in cases is more and is 155(80.3%) and highest number of cases is housewife 178, (92.2%).

Table2: Family history, BMI and behavioral risk factor distribution amongst cases and controls of study cohort

Variables

Case (n=193)

Control (n=579)

OR (95% CI)

p value

Family history of Diabetes mellitus

No

189 (97.9%)

576 (99.5%)

1

Yes

4 (2.1%)

3 (0.5%)

4.06 (0.901 - 18.320)

0.068

Chewing of beetle nut

No

122 (63.2%)

410 (70.8%)

1

Yes

71 (36.8%)

169 (29.2%)

1.41 (1.002 - 1.990)

0.049

Tobacco chewers

No

125 (64.8%)

321 (55.4%)

1

Yes

68 (35.2%)

258 (44.6%)

0.66 (0.483 - 0.949)

0.024

Alcohol consumers

No

59 (30.6%)

132 (22.8%)

1

Yes

134 (69.4%)

447 (77.2%)

0.67 (0.467 - 0.964)

0.031

BMI

Normal

93 (48.2%)

321 (55.4%)

1

Underweight

58 (30.1%)

167 (28.8%)

1.19 (0.822 - 1.749)

0.347

Overweight

26 (13.5%)

68 (11.7%)

1.32 (0.795 - 2.192)

0.284

Obese

16 (8.3%)

23 (4%)

2.40 (1.218 - 4.732)

0.011

Family history of DM was more in cases (2.1%) than controls (0.5%), (OR 4.06, 95%, CI 0.90 - 18.32). Beetle nut chewers have 1.4 times more risk to have gestational diabetes mellitus and IGT than non consumers with 95% CI 1.002 - 1.990. There is a significant association between tobacco and alcohol consumers with GDM & IGT. Obesity was more amongst the cases (OR 2.40, 95% CI 1.21 - 4.73, p=0.01).

Fig1: Comparison of maternal outcome of cases (n=193) and controls (n= 576)

Acknowledgement - ICMR for funding under seed grant.

The proportion of women with caesarean (53, 27.5%, n=193)section was higher in case than among the control subjects while normal delivery is more in control group (450, 78.1%, n=576). Majority deliveries took place at institution while only 33(4.3%) at home.

Fig2: Pregnancy outcome of cases (n=193) and controls (n= 576)

Prevalence of anaemia was 84 %( 646); which is found higher amongst controls (488, 84.3%) compared to Cases (158, 81.9%). As per gestational age preterm delivery was more common amongst Cases (59, 30.9%) as compared to Control (171, 29.7%) group. Preterm delivery occurred in 30.9% of cases and 29.7% of controls. Gestational hypertension, pre eclampsia, Cephalopelvic Disproportion, Premature rupture of membrane, Prolonged labour, Fetal distress, Antepartum Haemorrhage, Postpartum haemorrhage were more in control group as compared to case only eclampsia is more in cases.

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Table: 3: Comparison of baby weight and baby care in NICU of cases and controls

Case (n=192)

Control (n=570)

OR (95% CI)

p value

Weight Category (kg)

<2.5 (142, 18.6%, n=762)

29 (15.1%)

113 (19.8%)

1

2.500 - 2.999 (315, 41.3%, n=762)

74 (38.5%)

241 (42.3%)

1.19 (0.737 - 1.941)

0.468

3.000 - 3.499 (237, 31.1%, n=762)

60 (31.3%)

177 (31.1%)

1.32 (0.799 - 2.182)

0.277

3.500 - 3.999 (54, 7.1%, n=762)

19 (9.9%)

35 (6.1%)

2.11 (1.059 - 4.224)

0.034

>4.000 (14, 1.8%, n=762)

10 (5.2%)

4 (0.7%)

9.74 (2.850 - 33.301)

0.000

Baby care in NICU>2 days

No (754, 98.6%, n=762)

186 (96.9%)

565 (99.1%)

1

Yes (11, 1.4%, n=762)

6 (3.1%)

5 (0.9%)

3.64 (1.100 - 12.082 )

0.034

A higher number of macrosomic babies were delivered by the cases (OR: 9.74, 95% CI 2.85 - 33.30). Baby care in NICU for >2 days was required for cases (3.1%) as against controls (0.9%) with OR: 3.64, 95% CI 1.100-12.082.

Table4: Comparison of Fetal outcome of cases and controls

Fetal outcome

Case

Control

c2

p value

Foetal Outcome

Live Birth (762, 99.1%)

192 (99.5%, n=193)

570 (99%, n=576)

0.743

0.690

IUD (2, 0.3%)

0

2 (0.3%, n=576)

Still Birth (5, 0.7%)

1 (0.5%, n=193)

4 (0.7%, n=576)

Neonatal Outcome

Alive (748, 98.2%,n=762)

190 (99%, n=192)

558 (97.9%,n=570)

1.31

0.518

Early neonatal death (11, 1.4%, n=762)

2 (1%, n=192)

9 (1.6%, n=570)

Late Neonatal death (3, 0.4%, n=762)

0

3 (0.5%, n=570)

Maturity

Premature (77, 10.1%, n=762)

18 (9.4%, n=192)

59 (10.4%,n=570)

0.151

0.698

Normal (685, 89.9%, n=762)

174 (90.6%, n=192)

511 (89.6%,n=570)

Newborn resuscitation

Routine care (659, 90.2%, n=731))

167 (88.8%, n=188)

492 (90.6%,n=543)

0.497

0.481

Initial stage (72, 9.8%, n=731)

21 (11.2%, n=188)

51 (9.4%, n=543)

Neonatal hypoglycemia (2, 0.3%, n=731 )

No

186 (98.9%, n=188)

543 (100%, n=543)

5.79

0.016

Yes

2 (1.1%, n=188)

0

Neonatal Jaundice (22, 3%, n=731)

No

180 (95.7%, n=188)

529 (97.4%,n=543)

1.34

0.246

Yes

8 (4.3%, n=188)

14 (2.6%, n=543)

Fig:3 a)Apgar score in 1 minute

Fig:3 b)Apgar score in 5 minutes

For cases: mean= 8.05, median= 8, var=1.25, s.d.=1.21, min=2, max=10, range=8, interquartile range=2, skewness= -2.09, kurtosis=8.55

For controls: mean= 8.19, median= 8, var=0.87, s.d.=0.933, min=2, max=10, range= 8, interquartile range=1, skewness= -2.06, kurtosis=9.63

For cases: mean= 9.20, median= 9, var=0.66, s.d.=0.82, min=5, max=10, range=5, interquartile range=1, skewness= -1.47, kurtosis=5.26

For controls: mean= 9.30, median= 9, var=0.52, s.d.=0.722, min=5, max=10, range= 5, interquartile range=1, skewness= -1.34, kurtosis=4.59

Acknowledgement - ICMR for funding under seed grant.