Foetal outcome and postpartum maternal metabolic status in South Indian women in relation to the Antepartum glycaemic status

Abstract

The effect of gestational glycaemia on foetal and maternal outcome was studied in 126 women who reported for postpartum check up within a year of delivery. The classification of the maternal glucose tolerance in the postpartum period was made according to the WHO criteria, based on an oral glucose tolerance test (OGTT) with 75 gms of glucose. Subjects were divided into four groups according to gestational plasma glucose values (GPG) (mg/dl), namely FPG < 105 and 2-h PG < 140 (group I), FPG ≥ 105 PG ≥ 140 (group II), FPG≥140 and/or 2-h PG≥ 200. The overall occurrence of foetal abnormalities increased with higher GPG values (x² = 8.2, p = 0.04). The prevalence of abnormalities was higher in the other groups compared to group I (x² = 4.9, p< 0.05), but the groups II, III and IV had similar occurrence of foetal complications. The occurrence of postpartum IGT was not different in the various groups whereas the development of postpartum diabetes in the mothers increased with higher GPG values (x² = 36.2, p < 0.001). Significant difference was noted between the groups I and II (x² = 16.9. p < 0.001) with respect to the prevalence of diabetes. The highest percentage of diabetes was found in the group with FPG≥140 mg/dl and 2-h PG ≥mg/dl during gestation. However, the differences in the development of diabetes in the groups II,III and IV were not statistically different from each other. The 2-h GPG values were higher in women (p < 0.001) who developed postpartum hyperglycaemia compared to those who had normal plasma glucose values after the delivery. Parameters such as the age, body mass index and the presence of family history of diabetes did not vary between the two groups. The study shows that even mild degree of gestational hyperglycaemia causes considerable foetal and maternal complications and that the occurrence of postpartum diabetes is high in South Indian women with gestational diabetes mellitus (GDM). It is also likely that a few women have had undetected hyperglycaemia even before conception.