Diabetes in pregnancy : diagnosis, management, outcome and complications

Abstract

Introduction: Numerous perinatal complications of diabetes in pregnancy have been recognised. Maternal post-partum complications can be equally devastating.

Method: In this study, a cohort of known type 1 and type 2 pregnant diabetics and newly diagnosed Gestational Diabetes Mellitus (GDM) patients were analysed. Data collected was analysed in terms of method of diagnosis, gestational age at diagnosis for GDM, relevant medical or obstetric history, subsequent management and follow up.

Results: Out of 79 viable pregnancies, 69.6% of patients were diagnosed with GDM, 13.9% with type 2 DM and 16.5% with type 1 DM. Mean gestational age for the GDM cohort was 37.9 (±1.6) weeks, 35.5 (±3.7) weeks in Type 2 and 37.1 (±0.7) weeks in the Type 1 cohort (p = 0.010). 20.3% of all cohort and specifically 23.6% of GDM pregnancies had a fetus which was large for gestational age. 30% of GDM patients, 25.5% of Type 2 DM patients and 84.6% of Type 1 DM patients, had their blood glucose controlled by an insulin infusion pump peri-partum. Mean HbA1C in the third trimester was 6.0%, 6.3% and 7.1% in GDM, Type 2 and Type 1 diabetics respectively (p = 0.004). A negative correlation was seen between HbA1C levels in third trimester and delivery gestational age (p < 0.001).

Conclusion: Our findings emphasize the need for close follow up of these patients. Implementing a structured and holistic multidisciplinary team may have an impact on outcome, focusing on maternal education, in particular in GDM patients and their risk of developing type 2 DM in the future.