Pregnancy Outcomes in Pre-gestational and Gestational Diabetic Women in Comparison To Non-diabetic Women – A Prospective Study in Asian Indian Mothers (CURES -35)

摘要

Background and objective : Diabetes can complicate pregnancy but it is not the major complication of pregnancy.Though prevalence of diabetes is alarmingly high among Indians there have been very few studies assessingthe effect of diabetes on pregnancy outcomes, particularly comparing pre-gestational diabetes mellitus [PGDM]and gestational diabetes [GDM] with non-diabetic mothers. Methods : Pregnant women attending the Dr. Mohan's Diabetes Specialities Centre, a tertiary care centre fordiabetes in Chennai in southern India were selected for the study. PGDM and GDM were defined usingstandard criteria. Out of the 245 pregnant women with diabetes registered at the centre, follow up data wasavailable for 225, which included 79 PGDM and 146 GDM subjects. Non-diabetic controls (n=30) wererecruited from the ongoing population based study the Chennai Urban Rural Epidemiology Study (CURES).Details of outcome variables including abortions, mode of delivery, congenital anomalies and neonate’s birthweight were documented. Results : Women with PGDM had significantly higher fasting plasma glucose [p Conclusion : Women with diabetes have worse pregnancy outcomes compared to non-diabetic mothers withand those with pre-gestational diabetes fare worse than those with gestational diabetes. The study emphasizesthe fact that strict glycemic control is extremely important during pregnancy. ? Diabetes complicates between 1-20% of allpregnancies worldwide, which includes pre-gestational diabetes mellitus (PGDM – also referred toas diabetes complicating pregnancy) and gestationaldiabetes mellitus (GDM).1 There are several studies inthe west demonstrating that diabetes during pregnancy is associated with a number of adverse effects on themother and the neonate.2-4 Ethnic differences have beendemonstrated not only in the prevalence of PGDM andGDM but also with respect to the outcomes of thepregnancy.2,3 Migrant Indians who are well known tohave a greater predisposition to diabetes compared toEuropeans have also been shown to have a higherprevalence of diabetes during pregnancy.4 However thereare only a few Indian studies on diabetes inpregnancy.5 -8 This is of interest given that India has thelargest number of diabetic patients in the world with31.4 million diabetic subjects in the year 2000.8,9 Further, it is estimated that nearly 2.5 million women in thereproductive age [20-44 years] are affected by diabetes.10This translates to a huge number of PGDM and probablyeven higher number of GDM. In this context, data on theoutcomes of pregnancies in Indian diabetic women(PGDM and GDM) is very important. *Dr. Mohan's Diabetes Specialities Centre and Madras DiabetesResearch Foundation Gopalapuram, Chennai, India.**University of Auckland, New Zealand.Received : 7.9.2004; Revised : 16.11.2004;Re-revised : 15.10.2005; Accepted : 7.7.2006