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FINAL YEAR M.B.B.S

KARACHI MEDICAL AND DENTAL COLLEGE,

ABBASI SHAHEED HOSPITAL,CDGK

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RESEARCHERSSadaf MansoorYusra Midhat

Sumyya GhazalMahak Irfan

Sumera Sohail(Final Year M.B.B.S students Karachi Medical & Dental College)

SUPERVISORS Dr. Farah Asad Mansuri (H.O.D Community Medicine, K.M.D.C)

Dr. Waseem Siddiqui (Community Medicine, K.M.D.C)

Gestational diabetes mellitus (GDM) is defined as glucose intolerance that is first detected during pregnancy .

Siri L. Kjos, M.D., and Thomas A. Buchanan, M.D Gestational diabetes mellitus Volume 341:1749- 1756 at NEJM

Estimated to complicate 3-10% of all pregnancies . Thomas R Moore, MD et al. Diabetes Mellitus and Pregnancy topic3249 at emedicine . Version: Dec 7, 2007 update.

Women with polycystic ovarian syndrome (PCOS) have an increased risk of glucose intolerance during pregnancy and development of type 2 diabetes .

Studies suggest that the risk of gestational diabetes mellitus (GDM) is higher among (PCOS) versus non PCOS women.

PAULA A. RADON, MD, impaired glucose tolerance in women with polycystic ovary syndrome 1999 by The American College of Obstetricians and Gynecologists

Pregnant women with polycystic ovarian syndrome and obesity are highly susceptible to develop gestational diabetes mellitus.

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RISK FACTORS Previous diagnosis and a family history of type 2 diabetes. Prediabetes. Development of Gestational diabetes mellitus in previous pregnancy. Age over 35 years. History of polycystic ovarian syndrome . Having a still birth or a large baby in a previous pregnancy. Hirsutism

RAVI Retnakaran; Philip W. The Impact of Family History of Diabetes on Risk Factors for Gestational Diabetes at medscape

MATERNAL COMPLICATIONS Hypertension. Preeclampsia. Development of Type 2 diabetes

FETAL COMPLICATIONS Macrosomia. Shoulder dystocia. Neonatal hypoglycemia. Hyperbilirubinemia. Respiratory distress syndrome

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“The current study was conducted to determine whether women of gestational diabetes mellitus (GDM) had any history of polycystic ovarian syndrome (PCOS) and its associated symptoms in comparison to the females having no gestational diabetes mellitus, so if women with polycystic ovarian syndrome are treated properly, incidence of development of gestational diabetes mellitus would likewise decrease.”

OBJECTIVES To compare sociodemographic and anthropometric profiles of women

with gestational diabetes mellitus (GDM) to their controls. To relate the occurrence of clinically diagnosed polycystic ovarian

syndrome (PCOS) with gestational diabetes mellitus (GDM). To describe gynecological profile of polycystic ovarian syndrome in

women with gestational diabetes mellitus (GDM) and controls. 5

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:Study design case control study

:Setting Prenatal care clinics of ABBASI SHAHEED and LADY DUFFERIN

.HOSPITAL

:Sample size 140 pregnant ladies, Cases of GDM = 35

controls = 105

:Duration 3 months (28th April to 30th June 2008).

Diagnosis of GDM: GDM was verified by serial blood glucose recording and latest OGTT .

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Verification of PCOS late menarche, prolonged menstrual cycle, obesity, acne, hair growth of male

pattern and an ultrasound showing multiple cyst in ovaries.

:Inclusion criteria Pregnancy, age ranges between 16 to 35 and low and middle socioeconomic

group.

:Exclusion criteria Women who had established diabetes mellitus before pregnancy.

:Sampling technique Purposive non probability.

:Variables Socio-demographic, Anthropometric, Clinical , Obstetrical and Gynecological profiles.

Statistical Analyses: Using SPSS 13.0 version and Chi square test and T test were applied

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9

0

20

40

60

80

16 - 20 21 - 25 26 - 30 31 - 35

13%

44%32%

10%1

26%37%

34%

cases of GDM

controls

COMPARISION OF AGES

Age in Years

It was found that 51% of cases and 15% of controls had weight more than 74kg and it was estimated to be more than their expected weight for gestational period.

The mean weight gain of gestational diabetic ladies during same period of gestation was 10.2kg as compared to 6.7kg of controls showing a significant difference of <.000.

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AMONG CASES

Almost 51% of cases and 56% of controls belonged to lower middle socioeconomic status

(p<0.761)

SOCIOECONOMIC DISTRIBUTION

31.4%

12.4%

56.6%

Socioeconomic distribution among controls

upper middle

low

lower middle

56.6

31.4

12.4

31.9

51.417.1

Upper middleLowLower middle

AMONG CONTROLS

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Out of 35 cases, 22% (08) gave clinical history of PCOS. 46% had family history of diabetes. 49% were found to be obese.

Out of 105 controls, 4.7% (05) gave clinical history of PCOS. 6% had family history of diabetes. 19% were found to be obese.

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OBSTETRICAL PROFILE OF CASES & CONTROLS

COMPARISON OF WEIGHT OF PREVIOUSLY DELIVERED CHILD

31.4%37.1%

14.3% 17.1%

WEIGHT OF PREVIOUSLY DELEVIRED CHILD IN CASES

not delivered

normal wt

under wt

over wt

36.2%53.3%

2.9% 7.6%

WEIGHT OF PREVIOUSLY DELIVERED CHILD IN CONTROLS

not delivered

normal wt

under wt

over wt

15

0%

10%

20%

30%

40%

50%

60%

70%

80%

0 1 2 3 4 5

28%

17%

2.9%5.7%

71.4%

21.9%

3.8%1% 1.9%

cases of GDM

controls

COMPARISON OF MISCARRAIGES

No of miscarriages

GYNAECOLOGICAL PROFILE OF CASES & CONTROLS

AGE OF MENARCHEMean age of menarche In cases=15 years In controls=13 years

Mean age of menarche was found to be significantly higher (p<.004) among cases of GDM as compared to their controls.

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GROUP OF PREGNANT LADIES

TOTAL O.R

CASES OFGDM

CONTROLS

WITH PCOS 8 5 13

5.92WITHOUT PCOS 27 100 127

TOTAL 35 105 140

22% of cases of GDM were proved to be suffering

from PCOS in comparison to 4.6% of controls with Odds

ratio of 5.92

Gestational diabetes mellitus is 5.9 times more associated with clinically diagnosed polycystic ovarian syndrome as compared to their controls. Age

of 30 and more along with obesity were found to be the covariates.”

It is also necessary to carry out different studies to high light other risk factors for GDM.

It is necessary to perform a prospective controlled study dealing with the risk of pathological pregnancies in women with PCOS.

Further studies regarding role of conservative treatment in management of PCOS for better pregnancy outcome, need to be conducted.

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1: Siri L. Kjos, M.D., and Thomas A. Buchanan, M.D Gestational diabetes mellitus Volume 341:1749- 1756 at nejm

2: Thomas R Moore, MD et al. Diabetes Mellitus and Pregnancy topic3249 at eMedicine. Version: Dec 7, 2007 update.

3: PAULA A. RADON, MD, impaired glucose tolerance in women with polycystic ovary syndrome 1999 by The American College of Obstetricians and Gynecologists

4: Kousta e, Cela e, the prevalence of polycystic ovaries in women with a history of gestational diabetes at pubmed 2000 Oct; 53(4):501-7

5: Richard X Davey and P Shane Hamblin. Selective versus universal screening for gestational diabetes mellitus: an evaluation of predictive risk factors EMJA 2001; 174: 118-121

6: Linda Hoffman, Chris Nolan, Gestational diabetes mellitus -- management Guidelines at eMJA 1998; 169: 93-97

7: Ravi Retnakaran; Philip W. The Impact of Family History of Diabetes on Risk Factors for Gestational Diabetes at medscape

8; Jennifer M, Perspectives in Gestational Diabetes Mellitus: A Review of Screening, Diagnosis, and Treatment, 25:57-62, 2007

9. DOI: 10.2337/diaclin.25.2.57© 2007 by the American Diabetes Association

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