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Maternal and neonatal outcomes in patients with gestational diabetes mellitus in Naresuan University Hospital. T. Ua-areechit, K. Supakosol, K. Tengtrisorn, 5 th year medical student Advisors: P. Amatyakul, M.D., S. Sritippayawan, M.D. Obstetrics and Gynecologics department

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Maternal and neonatal outcomes in patients with gestational diabetes mellitus in Naresuan University Hospital

T. Ua-areechit, K. Supakosol, K. Tengtrisorn, 5th year medical student

Advisors: P. Amatyakul, M.D., S. Sritippayawan, M.D. Obstetrics and Gynecologics department

Faculty of medicine, Naresuan university hospital, Phitsanulok, Thailand


Outline

  • Backgound diabetes mellitus in Naresuan University Hospital

  • Objective

  • Materials and Methods

  • Results and Discussion

  • Conclusions

Outline


Background
BACKGROUND diabetes mellitus in Naresuan University Hospital


Background1
Background diabetes mellitus in Naresuan University Hospital

  • Gestational diabetes mellitus is carbohydrate intolerance with onset or first recognition during pregnancy.

  • About 1-14 percent of pregnancy develops this condition depend on the nation2

  • In thailand, from faculty of medicine, Mahidol University in 2550 found that the incidence of GDM about 2-3%


Background2
Background diabetes mellitus in Naresuan University Hospital

  • GDM is linked to several maternal and fetal complications and has morbidity and mortality. 5-8

  • GDM is one of the most common pregnancy complications that affects as many as 5% of all pregnancy women.9

  • Maternal complications : Increase rate of cesarean section, Postpartum hemorrhage, Pregnancy induced hypertension, Preterm labor, Polyhydramnios. 5-8

  • Fetal complications : Macrosomia, Large-for-gestational age (LGA), Respiratory distress syndrome, Hypoglycemia, Hyperbilirubinemia, Polycythemia, Low APGAR score. 5-8


Background3
Background diabetes mellitus in Naresuan University Hospital

GDM frequently resolves after delivery but 1/3 cases will have diabetes or impaired glucose metabolism at postpartum screening and 15-50% will develop diabetes in the decades following the pregnancy making it one of the most common health problems in pregnancy.

Therefore, the data collection on the pregnancy outcomes in Naresuan University Hospital should be made


Objective
OBJECTIVE diabetes mellitus in Naresuan University Hospital


Objective1
Objective diabetes mellitus in Naresuan University Hospital

To determine maternal and neonatal outcomes in patients with GDM in Naresuan University Hospital comparing with non-diabetic pregnancy clients.


Materials and methods
MATERIALS AND METHODS diabetes mellitus in Naresuan University Hospital


Materials and methods1
Materials and diabetes mellitus in Naresuan University HospitalMethods

Retrospective cross sectional study

Maternal

General characteristics

Fetal

GDM pregnancy woman

Pregnancy outcome

Maternal

Fetal

Data collecting

From medical records regarding baseline characteristics, maternal and neonatal outcomes, route of delivery, glycemic control and diabetic management.


Materials and methods2
Materials and diabetes mellitus in Naresuan University HospitalMethods

Study population

  • Subject group

    • Inclusion criteria

      GDM who delivered at Naresuan University Hospital during June 1, 1999, to May 31, 2012

    • Exclusion criteria

      Overt DM


Materials and methods3
Materials and diabetes mellitus in Naresuan University HospitalMethods

  • Control group

    • Inclusion criteria

      Non-diabetic women who delivered during June 1, 1999, to May 31, 2012 by using Systematic Random Sampling

    • Exclusion criteria

      History of DM, GDM, congenital anomalies related to DM


Results and discussion
RESULTS diabetes mellitus in Naresuan University HospitalANDDISCUSSION


Figure 1. Demographic comparison of patient with GDM diabetes mellitus in Naresuan University Hospital

and a control group without GDM


Figure 2 comparison of maternal outcomes in patients with gdm and a control group without gdm
Figure 2. Comparison of maternal outcomes in patients with GDM and a control group without GDM

24 cases

40.68%

★ Significant

11 cases

18.64%

9 cases

15.25%

Premature

contraction

GHT

primary C/S

PPH (Tear)


Figure 3. Comparison of fetal outcomes in patients with GDM and a control group without GDM

21 cases

35.49%

17 cases

28.81%

12 cases

20.34%

★ Significant

16


Figure 4 maternal and fetal outcome among women with gdm well controlled and poorly controlled gdm
Figure 4. Maternal and fetal outcome among women with GDM well controlled and poorly controlled GDM

LGA

LOS

Hypoglycemia


Conclusions
CONCLUSIONS well controlled and poorly controlled GDM


Conclusion

  • Neonatal well controlled and poorly controlled GDM

  • Hypoglycemia

  • LGA

  • NICU

Poor control

Well control

Conclusion

Treatment

  • -Preterm

  • Macrosomia

  • Hypoglycemia

Maternal and fetal outcome

GDM Pregnancy

  • Maternal

  • Primary C/S

  • Preterm

  • GHT


References
References well controlled and poorly controlled GDM

1. National Diabetes Data Group Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance Diabetes 1979; 28: 1039-57.

2. Hadden DR Geogrphic, ethnic, and racial variations in the incidence of gestational diabetes mellitus Diabetes 1985; 34 (suppl 2): 8-12.

3. Hunt KJ,Schuller KL. The increasing prevalence of diabetes in pregnancy. Obstet Gynecol Clin North Am 2007; 34:173-99,vii

4. Serirt S, Derrochanawong C, Sunthornthepvarakul T, Jinayon P Gestational diabetes mellitus J Med Assoc Thai 1992; 75: 315-8.

5. Cunnungham FG, Leveno KJ, Bloom SL, Hauth JC, Gilstrap III, Wenstrom KD, Diabetes. Williams Obstetrics. 22nd ed. New York: McGraw-Hill; 2005: 1169-84


Thank you for your attention
Thank you for your attention well controlled and poorly controlled GDM


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