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Management of gestational diabetes mellitus: how well are we doing?
  1. V N Sivalingam,
  2. R A Armstrong,
  3. C D B Love
  1. Simpson's Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK

Abstract

Gestational diabetes mellitus (GDM) affects up to 14% of women annually. Abnormal glucose tolerance leads to fetal hyperinsulinaemia and macrosomia, thus increasing perinatal morbidity. Randomized controlled trials have shown that intervention in women with GDM is effective in reducing birth weight and the rate of large for gestational age infants.

Aim To review antenatal care and pregnancy outcomes of women affected by GDM at the Simpson's Centre for Reproductive Health between 2005 and 2008.

Methods A retrospective casenote review of women with newly diagnosed or a past history of GDM.

Results Data were available for 94 pregnancies.

Glycaemic control 51.5% required insulin treatment with average blood sugars <6.0 or <8.0 achieved by 53.1% and 45.7%.

Labour Labour onset was spontaneous in 41.5% and induced in 39.4%. Elective and pre-labour emergency caesarean section (C/S) rates were 17.0% and 2.1%.

Delivery Of women who laboured, rates of spontaneous delivery, assisted vaginal delivery and emergency C/S were 35.5%, 17.1% and 47.4% respectively.

Complications Anal sphincter injury, shoulder dystocia (birthweight 3.22 g & 3.54 g) and postpartum haemorrhage rates were 2%, 2% and 10.6%.

Birthweight The mean birthweight was 3.591 g with 22% being macrosomic that is, >4000 g.

Neonatal complications 12.8% of babies required admission to the neonatal unit because of hypoglycaemia (n=7), prematurity (n=3) and transient tachypnoea of the newborn (n=2).

Conclusions GDM is associated with increased perinatal morbidity. Despite multidisciplinary care and good glycaemia control, macrosomia and its resultant complications remain an issue. With continually increasing prevalence, optimization of antenatal care is essential.

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