Screening and Re-screening of Gestational Diabetes Mellitus at 24-28 Weeks and 32-34 Weeks of Gestation and Evaluation of Foetal Maternal Outcome: A Longitudinal Study

Abstract

Introduction: Gestational Diabetes Mellitus (GDM) has a great impact on maternal and foetal outcome. Timely diagnosis and proper management have immense importance to prevent adverse outcomes. Aim: To determine the incidence rate of GDM, and its risk factors and also to determine the importance of re-screening for detection of GDM at 32-34 weeks. Materials and Methods: A hospital-based longitudinal study was conducted from April 2020 to June 2021 in the Department of Obstetrics and Gynaecology, Burdwan Medical College, Burdwan, West Bengal, India. Screening and diagnosis for GDM were performed by estimating a 2-hour blood glucose level after intake of 75gm of glucose, irrespective of the meal at 24-28 weeks by one-step procedure i.e., Diabetes in Pregnancy Study groups in India (DIPSI). A total of 300 antenatal mothers were selected serially from antenatal Out Patient Department (OPD). All the screennegative pregnant women were re-screened again at 32-34 weeks. Demographic variables and maternal risk factors like age, parity, Body Mass Index (BMI), family history of diabetes, previous GDM, previous history of foetal loss macrosomia and polyhydramnios were noted. Foeto-maternal complications like hypoglycaemia, Intrauterine Foetal Death (IUFD), preeclampsia and sepsis were recorded. Frequency and percentage of each parameter was calculated. The risk estimates between GDM and without GDM were analysed by odds ratio with 95% confidence interval and p-value were calculated. The p-value <0.05 was considered significant. Results: The screen-positive cases for GDM were 26 (8.7%) at 24- 28 weeks and 8 (2.9%) at 32-34 weeks of gestation. Preeclampsia was noted in 5 (14.7%) cases and 4 (11.8%) GDM mothers suffered from Postpartum Haemorrhage (PPH) (p-value<0.0001). Rate of caesarean section was high 76.5% among GDM mothers (p-value<0.0001). Average birth weight of new born baby of mothers with and without GDM were 2.5324±0.6503 kg and 2.7297± 0.2145 kg, respectively (p-value0.0003). IUFD was noted in 2 (5.9%) cases. Preterm delivery was observed in 25 (73.5%) cases and admission to Neonatal Intensive Care Unit (NICU) was 11 (32.4%) (p-value<0.001). Out of 274 pregnant mothers who had blood sugar <140 mg/dL by DIPSI method at 24-28 weeks were designated as screen negative and they were re-screened at 32-34 weeks of gestation. Eight cases (2.92%) were found screen positive after re-evaluation (odds ratio, 3.1551, 95% CI, 1.4033-7.0938, p-value=0.00358). Conclusion: Pregnancy in women with GDM has an increased risk of maternal and perinatal complications. Timely screening and diagnosis of GDM and appropriate treatment can reduce adverse foeto-maternal outcomes. Re-screening of initial screen negative women is very important, otherwise significant number of cases will be missed.