engleski

The "WHY" behind the GDM pregnancy outcomes?

OBJECTIVE: To determinate whether adverse outcomes of gestational diabetes pregnancy during period studied and to identify reasons of outcome improvement failure in gestational diabetes pregnancies. METHODS: Longitudinal study of 491 women diagnosed with GDM during two study periods 1984-1990 and 1991-1998, of which 473 singleton pregnancies were analysed. The periods reflect changes of the national health insurance system. Oral glucose tolerance test with a standard 75gr glucose load was performed according to WHO protocol between 24th-28th week of gestation. Percents were used to summarise data. Analysis was performed using c2, Fisher exact test, and ANOVA. RESULTS: Gestational age of period I was 38.66ą2.48 vrs. 38.48ą2.60 of II studied period (F=0, 56 ; p>0.05), rate of prematurely born neonates was 21.18% vrs. 17, 49% (c2=0.97 ; p>0.05) ; maternal age 31.07ą5.48 vrs. 31.46ą5.75 (F=0.52 ; p>0.05) ; rate of mothers aged ?35 yrs 25.88% vrs. 34.98% (c2=4.17 ; p<0.05) ; rate of multiparity 60.59% vrs. 57.10% (c2=0.55 ; p>0.05) ; mean number of previous deliveries 1.65ą0.96 vrs. 1.60ą0.93 (F=0.22 ; 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 of stillbirths (1.84ą0.90 vrs. 1.43ą0.57 ; F=3.73, p<0.05). As expected chronic hypertension and ecclampsia rate difference was statistically nonsignificant. Rate of urinary tract infection declined from 18.24% to 11.55% (c2=4.05 ; p<0.05). Rate of women who required insulin was alike 32.94% vrs. 31.35% (c2=0.13 ; p>0.05). Occurrence rates of macrosomia, disproportionate growth, and disproportionate macrosomia of term neonates did not differ significantly (35.82 vrs. 35.20% ; 20.90% vrs. 23.60% ; 29.17% vrs. 34.09%), neither did the mean weight of these subgroups or mean ponderal indices. Mean Apgar score at 1st minute for term neonates for first period was 9.50ą1.07 vrs. 9.62ą1.10 of second studied period (F=0.96 ; p>0.05), rate of <7 score was 4.55% vrs. 2.81% (c2=0.79 ; p>0.05). Still births rate within term deliveries was 1.49% vrs. 0.40% (c2=1.34 ; p>0.05), and within preterm deliveries 5.56% vrs. 3.21% (c2=1.38 ; p>0.05). Differences established for either of variables were insignificant when stratified for therapy mode and age group. CONCLUSION: 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; pregnancy outcomes; audit;

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