Prevalence, clinical presentation and complications of diabetes mellitus in obstetric patients attending a medical college hospital

Abstract

INTRODUCTIONDiabetes mellitus (DM) presents as an important disease condition with 8.5% prevalence according to global report given by the World Health Organization. In India, it affected 7.8% population in year 2014, affecting men more than women and contributed to 2% of all deaths. 1 Indian Council of Medical Research has taken it on top priority for research in India identifying rapid increase in incidence of DM from 2% to 12 % in urban areas over 30 years by turn of the twenty first Century. It estimated that there were 37.8 million diabetics with 4% rural and 12 % urban prevalence in India in year 2004 with 15% prevalence of abnormal 3 hour oral glucose tolerance test (OGTT) and hyperglycaemia in urban India. 2Diabetes may be present in the patient before the conception in the form of Type 1 or Type 2 DM or it may ABSTRACT Background: Diabetes mellitus (DM) may be present in the patient before the conception or it may appear during pregnancy. Obstetric management shall ensure prevention of diabetic embryopathy and early detection and management of diabetic complications in pregnancy. Methods: A descriptive observational study was undertaken on participants from a Medical College Hospital. The pre-existing medical disorders, blood sugar, routine antenatal investigations, type of delivery, ultrasound findings, complications of delivery, foetal outcome etc. were recorded. The participants were advised diet, exercise and pharmacotherapy. The intranatal and postnatal events were recorded. The results were compared with related literature. Results: The study had total 89 participants. Five participants (5.6%) had abnormal blood sugar values. Out of these, 2 participants were having pregestational DM and 3 were having gestational DM. Although all the participants who had abnormal blood sugar levels required caesarean section, two could not be operated. One participant with gestational DM who did not follow management advice delivered a macerated still born baby after shoulder dystocia. Another participant having gestational DM, who complied strictly as per dietary advice and exercise, could be managed well without insulin and delivered a healthy baby. The requirement of insulin increased in pregnancy in patients with pregestational diabetes. Conclusions: It is essential to ensure compliance on all three pillars of management of diabetes viz. diet, exercise and insulin during pregnancy. Hence health education for diabetes with special emphasis on obstetric care in pregnancy with diabetes should be promoted.