engleski

The "WHY" behind the GDM pregnancy outcomes

Background was tTo determinate and compare adverse outcomes of gestational diabetes pregnancy during two studied periods and to identify reasons for failure in achieving better outcome. 491 women diagnosed with GDM, of which 473 singleton pregnancies, were analyzed in longitudinal study during two periods: (1) 1984-1990 and (2) 1993-2000. The periods reflect changes in the national health insurance system. Oral glucose tolerance test, with standard 75-gr glucose loads, was performed according to WHO protocol between 24th and 28th week of gestation. Analysis was performed using chi-square test, Fisher exact test, and ANOVA. Mean gestational age of the first period was 38.66 +/- 2.48 vs. 38.48 +/- 2.60 of the second studied period (p>0.05) ; mean maternal age 31.07 +/- 5.48 vs. 31.46 +/- 5.75, (p>0.05.) ; rate of mothers aged >35 years 25.88% vs. 34.98%, (p<0.05) ; rate of multiparity 60.59% vs. 57.1%, (p>0.05) ; mean number of previous deliveries 1.65 +/- 0.96 vs. 1.60 +/- 0.93, (p>0.05). Rates of prior spontaneous abortions, prior stillbirths and prior neonatal deaths did not differ significantly between the periods ; however, women with history of stillbirths during period I had higher mean value of stillbirths (1.84 +/- 0.90 vs. 1.43 +/- 0.57, p<0.05). Rates of women who required insulin were similar: 32.94% vs. 31.35%, (p>0.05). Occurrence rates of macrosomia did not differ significantly (35.82 vs. 35.2%) ; neither did the mean weight of these subgroups or mean ponderal indices. Mean Apgar score in 1st minute for term neonates for the first period was 9.5 +/- 1.07 vs. 9.62 +/- 1.10 for the second studied period (p>0.05) ; rate of <7 score was 4.6% vs. 2.8% (p>0.05). Stillbirths rate for term deliveries was 1.49% vs. 0.4% (p>0.05), and for preterm deliveries 5.56% vs. 3.21% (p>0.05). Differences established for either of variables were insignificant when stratified for therapy mode and age group. In spite of increased efforts and comprehensive care, treatment and management of gestational diabetes mellitus may have little effect on birth weight, ponderal index, operative delivery or neonatal complications.

gestational diabetes

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