Background: Gestational Diabetes Mellitus (GDM) poses significant risks to both mothers and fetuses, with an escalating global prevalence. GDM is becoming more prevalent in recent years. Women who are usually diagnosed with GDM have normal glucose tolerance following delivery. But during the next 20 years of life, the majority of them may suffer from chronic diabetes, making GDM one of the most predictive factors for the development of chronic diabetes later in life.
Aim: This study addresses the critical need for timely GDM
detection in high-risk pregnancies. By comparing the efficacy of the standard
28-week oral glucose tolerance test with an early 20-week screening, the
research aims to enhance preventive interventions and minimise complications,
contributing valuable insights for optimal GDM management in high-risk
populations.
Methodology: Conducted at Teaching Hospital Peradeniya, Sri Lanka,
this prospective cohort study investigated early GDM diagnosis using a 20-week
OGTT in high-risk pregnancies with negative booking screens. The research
involved 385 singleton pregnancies, assessing risk factors such as GDM history,
family history of diabetes, macrosomia, BMI > 30 kg/m2,
polycystic ovary syndrome, and advanced maternal age. The study included
evaluating GDM incidence at 20 and 28 weeks, analysing risk factor
associations, and determining the efficacy of early OGTT compared to routine
testing. The data analysis aimed to establish the significance of a 20-week
OGTT, identify the main contributory risk factors, and propose an optimal timing
for GDM screening in high-risk pregnancies. The data analysis for this study
employed the Statistical Package for the Social Sciences (SPSS) software.
Descriptive statistics were used to outline the incidence of GDM at 20 weeks,
28 weeks, and the absence of GDM within the study cohort.
Results: In the study involving 385 high-risk pregnant women, the
incidence of gestational diabetes mellitus (GDM) was 7.27% at 20 weeks, 10.91%
at 28 weeks, and 81.82% without GDM. Significant associations were found between
GDM at 20 weeks, a history of GDM (78.57%), and a family history of diabetes
(28.57%) (p = 0.011, 0.010, respectively). Polycystic ovarian syndrome and
advanced maternal age were significantly associated with GDM at 28 weeks (p =
0.016, 0.008, respectively). Previous macrosomia or body mass index was not
associated with GDM at 20 or 28 weeks. Notably, the McNemar test revealed no
significant association between GDM cases at 20 and 28 weeks.
Discussion and Conclusion: This study emphasizes the need for
early diagnosis of GDM at 20 weeks in high-risk pregnancies. Effective GDM
management mitigates short-term complications but raises concern about
long-term impacts on offspring. Risk factors for early GDM include family
history and prior GDM. The study’s strengths lie in its comprehensive analysis.
However, the single-cohort nature and lack of data on maternal and fetal
outcomes following early vs. standard diagnosis of GDM limits the
generalizability of study findings. Limited evidence prompts a call for further
well-designed research to determine the optimal intervention window focusing on
personalised screening approaches and improving gestational age assessments.
Overall, this study contributes to the ongoing discourse on early GDM
management, highlighting the need for tailored prenatal care.
Author
(s) Details
Madugalle Edirisinghe
Mudiyanselage Yasassri Devinda Bandara Madugalle
Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Rathnayake
Mudiyanselage Chathura Rathnayake
Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Tharunya Rajayohan
Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
Dhanushka Srikantha
Kotigala
De Soysa Hospital for Women, Colombo, Sri Lanka.
Susil Anura
Ruwanpathirana
De Soysa Hospital for Women, Colombo, Sri Lanka.
Please see the book here:- https://doi.org/10.9734/bpi/msti/v9/4395
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