Abstract
Gestational diabetes (GDM) is a disorder of carbohydrate metabolism which occurs during pregnancy. Timely diagnosis of the disease reduces the incidence of perinatal problems (birth traumas, need for caesarian section) and helps to identify mothers who have a higher risk of developing type 2 diabetes in later life.
Objectives. The aim of the study was to analyse the frequency of gestational diabetes and its risk factors at the Women`s Clinic of Tartu University Hospital and the predictive value of various factors in assessment of the risk for GDM.
Methods. We analysed the clinical data and medical history of women (n=1073) who presented to the Women’s Clinic of Tartu University Hospital for antenatal examination in 2012.The GDM was diagnosed on the basis of the pregnancy monitoring guidelines approved by the Estonian Gynecologists` Society in 2011 based on recommendations of the International Association of Diabetes in Pregnancy Groups.
Results. Of the pregnant women 46% (n=495) had one or more risk factors for GDM. The most common risk factor was overweight (18.5% of the women, BMI 25.0-30kg/m2), obesity (8.6%, BMI ≥30kg/m2).
The GDM during previous pregnancy, baby`s large birth weight (<4.5kg), and elevated fasting blood glucose levels during current pregancy are most often related to the likelihood of developing GDM (p<0.0002, OR>10). Altogether 867 pregnant women (81%) were monitored in accordance to the guidelines. The GDM was diagnosed in 52 (6%) cases by timely using the glucose tolerance test. The GDM was diagnosed on the basis of oral glucose test performed during the second trimester in 36 (4,2%) cases and on the basis of the pathology test already during the first trimester in 16 cases (1.8%).
In addition to dietary treatment, 7 patients needed additional metformin and 5 patients needed insulin (23% of patients with GDM).
Pregnant women with GDM showde higher incidence of fetal macrosomia and premature labour (p<0.05, OR= 4.8 and 2.9, respectively).
Conclusions. The frequency of gestational diabetes has increased after implementing the new guidelines. The most important risk factor for GDM is overweight prior to pregnancy. It is necessary to develop a strategy for postpartum monitoring of mothers with GDM to reduce the risk for development of type II diabetes mellitus.