SCREENING OF PREGNANT WOMEN FOR GESTATIONAL DIABETES MELLITUS
AbstractBackground: Gestational diabetes mellitus is associated with significant fetal and neonatal morbidity and mortality. It is a definitive risk factor for the future development of type – II diabetes mellitus in the mother. Our objective was to evaluate the effectiveness of screening by 50gm oral glucose challenge test to detect the gestational diabetes mellitus and impaired glucose tolerance in pregnant women. Methods: This study was conducted in the Department of Gynaecology at Lady Reading Hospital, Peshawar. A total of 1000 women were screened in antenatal clinic by giving them 50 gm oral glucose solution and estimation of plasma glucose level 1 hour after glucose intake. Those with plasma glucose in excess of 130mg/dl (cut off value for screen positive) were subjected to 3 hours oral glucose tolerance test to confirm the diagnosis of gestational diabetes mellitus. Result: Out of 1000 cases tested, 43 were found to have Gestational Diabetes Mellitus and 17 cases had impaired glucose tolerance. The mean age of the patients ranged between 21 and 42 years. Most of the positive patients carried medical and obstetric historic risk factors for diabetes mellitus like obesity, advanced age and parity and bad obstetric history. They also had associated complications of gestational diabetes mellitus like pre eclampsia and polyhydramnios in current pregnancy. Also more than 80% of the patients had family history of risk factors like diabetics mellitus obesity, hypertension etc. Conclusions: 50gm Oral Glucose Challenge Test can be used in pregnant ladies from 24 weeks onward to detect the common disorders of Gestational Diabetes Mellitus and Impaired Glucose Tolerance.Key Words: Gestational Diabetes Mellitus, Impaired Glucose Tolerance, Oral Glucose Challenge Test, Full Oral Glucose Tolerance test
Sunsanee Vitha Yakul P, Singkiratana D, Bunyawant Chkuls. Risk factor based selective screening program for Gestational Diabetes Mellitus. Siriraj Hosptial: result from clinical practice guideline. J Med Assoc Thai 2003; 86(8): 708-14.
Zargar AH, Sheikh MI, Bashi MI. Prevalence of Gestational Diabetes Mellitus in Kashmiri women for the Indian Subcontinent. Diabetes Research Clin Pract 2004;66(2):139-45.
Yogev Y, Langer O, Xenakis Em, Rosenn B. Glucose screening in Mexican – American women. Obstet Gynaecol 2004; 103(6): 1241-5.
Tyrala EE, Reeece E. The infant of diabetic mother. Obst Gynaecol Clinics of North America 1996;23(1):5.
Ben Haroush A, Yogew Y, Hod M. Epidemiology of Gestational Diabetes Mellitus and its associate with type II l Diabetes Mellitus. Diabet Med 2004; 21(2):103-13.
Turok DK, Ratcliffe SD, Baxley EG. Patients do not need to fast before a 50gm, one-hour glucose challenge test. Am Fam Physician 2003;68:1768 –72.
Jarett RJ. should we screen for gestational diabetes? BMJ 1997;315:736–7.
Cousins L, Dattel BJ, Zettner A. Glycosylated haemoglobine as a screening test for carbohydrate intolerance in pregnancy. Am J Obst Gynaecol 1984;150: 455–60.
Nasrat AA, Johnstone FD, Hasan SAM. Is random plasma glucose an efficient screening test for abnormal glucose tolerance in pregnancy? Br J Obstet Gynaecol 1988;95:855- 60.
Kauntzky–Willer A, Bancher–Todesca D. Gestational Diabetes. Wien Med Wochenschr. 2003,153(21-22);478 - 84.
Lolemans K, Caluwaets S, Van Assche FA. Diet induced Obesity in the rats; A model for Gestational Diabetes Mellitus. Am J Obstet Gynaecol 2004;190(3): 858-65.
King H, Rewers M. Diabetes in adults is now a third world problem. The WHO adhoc Diabetes reporting group. Bull WHO 1991;69:643-8
Lu YP, Sun GS, Weng XY, Mao L, LI LA. Evaluation of glucose screening. Retest during pregnancy. Zhonghua Fuchan Ke Za Zhi 2003;38(12):729-32.
Di Cianni G, Volpe L, Benzil. Prevelance and risk factors for Gestational Diabetes assessed by universal screening. Diabetes Res Clin Pract 2003;62(2):131-7.
Caliskan E, Kayikcioglu F, Oxturk N, Koc S, Haberal A. A population based risk factor scoring will decrease unnecessary testing for the diagnosis of Gestational Diabetes Mellitus. Acta Obstet Gynacol Scand 2004;83(6): 524-30.
O’ Sullivan JB. Diabetes mellitus after GDM. Diabetes 1991;40:131-5.