Gestational diabetes mellitus: the effects of diagnosis time and implementation of diabetic care on management of glycemia

Abstract

Introduction: Pregnancy is considered diabetogenic condition related to increased requirements for insulin, its increased secretion and ongoing insulin resistance. In pregnancy increased insulin secretion cannot compensate increased requirements which leads to gestational diabetes mellitus (GDM). If diagnosed too late or ill-treated diabetes can cause serious complications in the course of pregnancy and delivery as well as late complications in neonate. Aim of the research: To assess if time of diagnosis of gestational diabetes mellitus and implementation of diabetic care influence glycemia management and clinical condition of neonate after birth. Material and methods: The survey was carried out in the group of 300 pregnant women with GDM. The patients were divided into 3 groups: group A-patients with GDM diagnosed between 10-12 week hbd, group B-patients who had GDM diagnosed between 24-28 week hbd and group C-GDM diagnosed between 29 week hbd and delivery. Results: The analysis revealed correlation between the frequency of GDM and patient's age and body mass index. Time of GDM diagnosis and following recommendations for GDM management depend on patient's place of living and socioeconomic status. Neonate's condition is affected by proper glycemia management. Conclusions: There is a correlation between place of living, poor socioeconomic status and managing glycemia, which should contribute to developing effective methods of care for women living in those areas. Patients' body mass index significantly correlated with fetus macrosomy, which significantly affected the way pregnancy was terminated and neonate's condition after birth. Time of GDM diagnosis has a big influence on glycemia management which is essential for mother's and neonate's health. Streszczenie Wprowadzenie: Ciąża uznawana jest za stan diabetogenny związany ze wzrostem zapotrzebowania na insulinę, zwiększonym jej wydzielaniem i narastającą insulinoopornością. W ciąży wzrost wydzielania insuliny nie jest w stanie skompensować wzrostu zapotrzebowania, co powoduje rozwój cukrzycy ciążowej. Cukrzyca późno rozpoznana lub nieprawidłowo leczona wiąże się ze zwiększonym ryzykiem występowania powikłań w przebiegu ciąży i porodu, a także późnych powikłań u dziecka. Cel pracy: Ocena, czy czas rozpoznania cukrzycy ciążowej i wdrożenia programu opieki diabetologicznej u kobiet z cukrzycą wpływają na wyrównanie stężeń glikemii oraz stan kliniczny noworodka po porodzie. Materiał i metody: Do badania zakwalifikowano 300 pacjentek w ciąży z rozpoznaną cukrzycą ciążową. Pacjentki podzielono na 3 grupy: grupa A-pacjentki z rozpoznaną cukrzycą między 10. a 12. tygodniem ciąży, grupa B-pacjentki, u których rozpoznano cukrzycę między 24. a 28. tygodniem ciąży, i grupa C-pacjentki z rozpoznaną cukrzycą od 29. tygodnia do rozwiązania.

Maternal Diabetes Mellitus – Risk Factor for Fetus and Infant

“…[30,31] Gruszka et al presented the results of the study in a group of 300 pregnant women with GDM. [32] According to these authors, maternal body mass index correlated significantly with fetal macrosomia, which significantly influenced the method of termination of pregnancy and neonatal status at birth. [33,34,35,36] Fetal growth disorders Hyperglycemia of pregnant women and fetal hyperinsulinism are the major determinants of macrosomia (LGA: large for gestational age) of newborn which is a significant risk factor for obstetric complications.…”