An evaluation in the screening and diagnosis of gestational diabetes mellitus among low and high risk obstetrics population
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Date
2001-11
Authors
Mat Sidek, Asmah Yun
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
The study is aimed to determine the prevalence, maternal and fotal outcome
of gestational diabetes mellitus among low and high risk hospital base obstetric
population using MOGTT WH0-1985 and 1998 criteria. Secondly we aimed to
determine the predictive value of three different methods of GDM screening (namely
the GCT, potential diabetic picture and fasting plasma glucose). Lastly, we planned to
determine the prevalence of persistent diabetes at 6 weeks post-partum among studied
GDM patients. A prospective cohort and observational study was conducted from July
till November 1999 in an Obstetric Unit Hospital Kuala Terengganu. An antenatal
patient between 22 to 36 weeks gestations were divided into two groups depending on
presence of clinical risk factors for developing GDM (i.e. low and high risk). GCT was
performed upon low risk patients followed by MOGTT one to two weeks later. All
patients in high-risk group were given appointment for MOGTT. GCT of 7.2 mmoll/ or
more were considered positive. MOGTT results were analysed by using WH0-1985
and 1998 criteria. Those patients with GDM were managed according to hospital
protocol. They were followed-up till delivery or admitted at 38 weeks for induction of
labour. Babies notes were recorded and lastly, those patients with GDM were given
appointment to repeat MOGTT at 6 weeks post-partum. Data were analysed by SPSS
version 9. Chi-square and Student t test used to assess the significance. P value of<
0.05 considered significant. Out of 757 women, only 671 completed the study. The prevalence of
gestational diabetes mellitus in this studied population is 9.5%(64 out of671) by WHO 1985 and 10.3% (69 out of671) by WH0-1998 (P value <0.05). There were 199low
risk patients in which 22 were positive for GCT and 10 of them (6. 0%) were GDM
Fifty-four (11.4%) out of 472 high-risk patients were GDM using WH0-1985 and
59(12.5%) by using WH0-1998. Their characteristics are not significantly different.
GDM patients were significantly associated with PIH, induced labour and increased
risk of caesarean section. Offspring of GDM tend to be heavier and increased
incidence to developed macrosomia. No difference in the incidence of premature
delivery, stillbirth rates congenital abnormality, shoulder dystocia or prenatal
mortality. The incidence of persistent diabetes 6 weeks post-partum is 26.9% in the
diabetic picture GDM paitents. The sensitivity for the GCT (Blood sugar > 7.2 mmoVl),
single risk factor, multiple riskfactors and the FPG are 90.0%, 68.8%, 76.2%, _14.5%
respectively. The specificity for them is 93.6%, 35.6%, 75.9% and 100% respectively.
The positive predictive values are 42.8%, 6.0%, 26.9% and 95.0% respectively. The
negative predictive values are 99. 4%, 100%, 100% and 91.9% respectively. The prevalence of gestational diabetes mellitus in this studied population
is comparable to other local studies. It shows slightly higher when using MOGTI'
WH0-1998 compared to WH0-1985 criteria. However there is no difference in all
characteristics and outcome measures unless when compared to non-GDM patients.
The predictive values of three methods ofGDM screening varied greatly, with the GCT
being the best overall. Persistent diabetes 6 weeks post-partum were slightly lower to
comparable study probably because poor turn-up for repeat MOG'IT among previously
diagnosed as GDM
Description
Keywords
Diabetes