FREQUENCY OF GESTATIONAL DIABETES MELLITUS IN PATIENTS WITH OBESITY DURING PREGNANCY

Abstract

Introduction: Gestational Diabetes Mellitus (GDM) refers to any degree of glucose intolerance that is first identified during pregnancy, regardless of whether it persists postpartum. GDM has been associated with a higher risk of maternal and fetal complications, making early detection and management crucial. Obesity is considered a significant risk factor for the development of GDM, as it can lead to insulin resistance and other metabolic disturbances that increase the likelihood of glucose intolerance during pregnancy. The findings of this study aim to raise awareness about the impact of maternal obesity on the prevalence of GDM and emphasize the need for early diagnosis and appropriate management strategies by healthcare professionals.

Objective: The primary objective of this study was to determine the frequency of Gestational Diabetes Mellitus (GDM) in pregnant women with obesity attending antenatal care at the Department of Gynecology and Obstetrics, Nowshera Medical College, Qazi Hussain Ahmad Medical Complex, Nowshera, Pakistan.

Methods: This was a descriptive cross-sectional study conducted at the Gynecology and Obstetrics outpatient department (OPD) of Nowshera Medical College, Qazi Hussain Ahmad Medical Complex. The study enrolled all pregnant women between the ages of 20 and 34 years who attended the antenatal clinic for the first time and met the inclusion criteria. After explaining the purpose and benefits of the study, informed written consent was obtained from each participant or their attendant. A detailed history, physical examination, BMI measurement, abdominal examination, and assessment of gestational age were conducted using either last menstrual period (LMP) or ultrasound examination. Baseline investigations, including Complete Blood Count (CBC), urine routine examination (R/E), Random Blood Sugar (RBS), virology tests, and oral glucose tolerance test (OGTT), were performed. Obstetrical ultrasound was carried out to assess gestational age, amniotic fluid index (AFI), and fetal growth. A two-step diagnostic procedure, consisting of a 50g glucose challenge test followed by a 100g OGTT, was employed for diagnosing GDM. The OGTT was conducted between 24 to 28 weeks of gestation. A plasma glucose level ≥140mg/dl on the 50g glucose challenge test was considered positive, prompting referral for the 100g OGTT. GDM was diagnosed if more than two plasma glucose values met or exceeded the National Diabetes Data Group (NDDG) cut-off values (105, 190, 165, and 145mg/dl). GDM diagnosis was confirmed based on the OGTT results, and management was conducted by a senior obstetrician, considering gestational age, glucose profile, and other relevant risk factors. Delivery was also managed by a senior obstetrician.

Results: Among the 166 participants enrolled in the study, the mean age of the patients was 29 years (SD ±6.194), with a mean weight of 58.99 kg (SD ±6.068), and a mean BMI of 23.295 kg/m² (SD ±2.68). The mean gestational age was 33.97 weeks (SD ±0.999). Out of the 166 patients, 39 women (23.5%) were diagnosed with GDM and had obesity, while the remaining 127 women (76.5%) did not have GDM.

Conclusion: In conclusion, our study found that the prevalence of GDM in overweight and obese patients was 23.5% among pregnant women presenting at the tertiary care hospital in Nowshera. Overweight and obesity could be prevented through the implementation of healthy lifestyle interventions, including physical activity and nutritional counseling, prior to pregnancy. This study provides valuable evidence of a high prevalence of GDM in women with elevated mid-pregnancy BMI, especially among obese and overweight women. Our findings underline the importance of early diagnosis and management of GDM in high-risk populations and can be used to develop targeted programs aimed at supporting high-risk mothers in antenatal care.