The prevalence of gestational diabetes in a Sri Lankan antenatal clinic

Abstract

Introduction: Early diagnosis of gestational diabetes mellitus (GDM) is a prerequisite to reducing fetal and neonatal complications of GDM.

Objectives: (a) To ascertain the prevalence of GDM in a Sri Lankan pregnant population. Using the 75 g oral glucose tolerance test (GTT) and WHO criteria. (b) To establish the predictive value of a 50 g glucose challenge test (GCT) compared to the GTT (c) To compare the outcome of pregnancy in GDM with 'non-diabetic pregnancy' (NDP) STUDY DESIGN: Prospective study on a cohort of pregnant women attending antenatal clinics.

Setting: Sri Jayawardenepura General Hospital (SJGH) RESULTS: Of the 721 patients, 131 (18%) had a positive GCT. 40 (5.5%) patients had GDM. If a one-hour GCT of 7.8 mmol/l was considered suspicious of GDM the sensitivity of the glucose challenge test was 63% and the specificity 84%. Statistically significant differences in the prevalence was found when the women were > 35 years [Relative risk (RR) = 3.87 (95% CI-2.06 to 7.27)] or the body mass index > or = 25. (RR = 2.45 (95 CI-1.30 to 4.61) Presence or absence of high parity, family history of diabetes or recurrent abortions had no significant impact on the prevalence of GDM. Mean birth weight was higher (p < 0.05) in GDM (3615 SD 103) than in NDP (2898 SD 143.6). The likelihood of having a caesarean section was higher (p < 0.01, Relative risk (RR) 2.50, 95% CI 1.56-3.95) in GDM when compared to NDP. A higher incidence of hydramnios (p < 0.01 RR 3.41 95% CI 1.44-8.05) was recorded in GDM when compared to NDP.

Conclusion: The prevalence of GDM in the antenatal clinics at SJGH is 5.5%. Traditional risk factors did not predict GDM. GDM is associated with a higher risk of caesarean section, hydramnios and macrosomia. Hence screening for GDM should be performed in all pregnant women at 24 to 28 weeks of pregnancy using a GCT.

PIP: A prospective cohort study was conducted to ascertain the prevalence of glucose diabetes mellitus (GDM) using the 75 g oral glucose tolerance test (GTT) and WHO criteria, and to compare pregnancy outcomes in GDM with 'nondiabetic pregnancy' (NDP) in Sri Lanka. Furthermore, the study was also aimed to establish the predictive value of a 50 g glucose challenge test (GCT) compared to GTT. The study sample consisted of 721 pregnant women attending antenatal clinics at Sri Jayawardenepura General Hospital. Results revealed that of the 721 patients, 131 (18%) had a positive GCT and 40 (5.5%) patients had GDM. Significant differences in prevalence rates were noted when women were older than 35 years. Moreover, mean birth weight was reportedly higher (p 0.05) in GDM than NDP. Findings also showed that GDM was associated with a higher risk of cesarean section (p 0.01), hydramnios (p 0.01), and macrosomia. Considering the risks of GDM to both maternal and fetal well-being, routine screening of all pregnant women at 24-28 weeks of pregnancy was recommended.