Maternal and Fetal Outcome in Pregnancy with diabetes mellitus: Study in a district hospital, Jamalpur, Bangladesh

Abstract

Cardiac disease is an important cause of maternal mortality and morbidity in antepartum and postpartum period. Objectives of our study was to determine maternal and fetal outcome in pregnant women in Bangladesh.This was a cross-sectional analytical study was conducted in the department of Obstretics & Gynecology in 250 bedded General Hospital, Jamalpur, Bangladesh during the period from January 2018 to in December 2018. The aim of this study was to find out the maternal and fetal outcome of the pregnancies complicated by pre-gestational and gestational diabetes mellitus. In this study, a total of 225 patients were selected using purposive sampling technique. There were three groups of pre-gestational diabetic, gestational diabetic and non-diabetic control, designated as Group A, Group B, Group C accordingly; and each consists of 75 patients. Information collected from all pregnant women (After 28 weeks of gestation) with diagnosed GDM and Pre-GDM and symptoms signs suggestive of GDM and Pre-GDM later confirmed by relevant investigation (FBS, 2h PPBS & HbA1C) using a questionnaire made for recoding all relevant parameters under study, after proper counseling and taking written consent of the patient or her legal guardian admitted during the study period in obstetric ward in Rangpur Medical College & Hospital, Rangpur. Results: History of GDM was significantly more common among patients with pre-GDM (38%) and GDM (18%) compared to controls. History of abortion, IUFD and congenital anomaly were significantly higher among pre-GDM mothers than GDM mothers and controls (p<0.05). History of deliveries with macrosomia and still birth was distributed similarly across the groups (p>0.05). Pre–GDM and GDM patients had significantly higher number of patients with HbA1C >6.5% than controls. Mean FBS and PPBS was significantly higher in pre-GDM & GDM patients than control (p<0.05). APGAR score was <7 in significantly higher number of pre–GDM and GDM babies than controls (p <0.05). Mean Weight of the babies was significantly lower among pre–GDM patients than GDM patients (p <0.05). Among pre–GDM patients and GDM patient’s cases of birth asphyxia, Hypoglycemia, hyperbilirubinemia and congenital anomalies were significantly higher than controls (p< 0.05). Conclusion: Interventions such as preconception care for women with pre-gestational diabetes, screening for early diagnosis, patient education, multidisciplinary approach and good metabolic control maintained throughout the pregnancy is the key to successful fetomaternal outcome.