Presented at the Neonatal Society 2007 Autumn Meeting.
Dunne JA
Medical Student, University of Bristol, Bristol, UK
Background: Over 31 million people in India are currently diagnosed with diabetes, more than any other country in the world. The World Health Organisation states that 80% of all new diabetes cases are expected to be in developing nations by 2025 (1). Complications in pregnancy due to maternal diabetes are well recognised, however the scarcity of data from developing countries (2,3) must change to investigate ethnic differences (4) and challenge the expected progression of the problem. The objective was to compare pregnancy outcomes in women with gestational diabetes mellitus to those with normal glucose tolerance.
Methods: This case-control study identified singleton pregnancies at a hospital in Delhi, prior to September 1st 2007. A total of 200 mothers were identified from the birth register, the last 100 who had gestational diabetes mellitus and the last 100 control births (normal glucose tolerance). Oral glucose tolerance tests with a 75g glucose load were performed to identify gestational diabetes mellitus, and diagnosis was based on WHO criteria. Fasting and post prandial plasma glucose values were monitored antenatally in the diabetic cohort. Pregnancy induced hypertension and spontaneous preterm delivery were recorded for the mother, while fetal outcomes included congenital anomalies, neonatal hypoglycaemia, macrosomia, admission to special care (SCBU) and mortality prior to discharge.
Results: Initial analysis of results determined that pregnancy induced hypertension, neonatal admission to SCBU and LSCS were significantly more likely in the diabetic cohort. 64% of all patients were university graduates.
Conclusions: Early examination of the results demonstrates that women with gestational diabetes mellitus have worse pregnancy outcomes than non – diabetic controls. In a Christian missionary hospital in Delhi, the proportion of mothers who are graduates receiving hospitalbased obstetric care is disproportionate to that of the population. This suggests that those most in need may not be receiving care, exacerbating health inequalities.
Acknowledgements: I would like to thank Professor M. Thoresen for her continued assistance and supervision throughout the project. In addition, I would like to acknowledge Mr. J. Kumar and Mr. V. Thomas from the medical records department in Delhi.
References
1. World Health Organisation www.who.int
2. Banerjee, S, Ghosh, U. S and Banerjee, D. Effect of Tight Glycaemic Control on Fetal Complications in Diabetic Pregnancies. J Assoc Phys India. 2004. 52: 109 – 113.
3. Ramachandran, A, Snehalatha, C, Clementina, M. et al. Foetal Outcome in Gestational Diabetes in South Indians. Diabetes Res Clin Practice. 1998. 41: 185 – 189.
4. Berkowitz, G. S, Lapinski, R. H, Wein, R. et al. Race/Ethnicity and Other Risk Factors for Gestational Diabetes. Am J Epi. 1992. 135: 965 – 973.