Assessment of risk factors and glucose tolerance in diagnosis of gestational diabetes mellitus

Dissertant

Abd Allah, Abd al-Latif Taha

Thesis advisor

Muhyi al-Din, Abd al-Maruf Hasan
al-Amin, Babekir

University

Omdurman Islamic University

Faculty

Faculty of Medicine and Health Sciences

Department

Department of Biochemistry

University Country

Sudan

Degree

Master

Degree Date

2006

English Abstract

The study was conducted for assessment of the different risk factors for gestational diabetes mellitus and glucose tolerance during pregnancy in diagnosis of GDM.

About 51 pregnant women enrolled in this study, 40 of them complete the requested questionnaire and blood testing (20 control cases with no gestational diabetes and 20 gestational diabetes cases) , the studied group were aged (20–39) yrs.

All women were Arabian, and were attending polyclinics in Aloroba Medical Company during the period from June 2004 to April 2006 .

All women were invited to do fasting and two hours post prandial blood glucose every two weeks, 2 hr.

75g OGTT every trimester and GCT once in their third trimester of pregnancy, cases with hyperglycemia indicative of diabetes outside pregnancy were excluded.

They were then followed through delivery.

Statistical analysis of the data was then performed using the Statistical Analysis System (SAS), version 9.1, 2002, SAS Institute Inc.

Regarding the risk factors, we study 14 risk factors for GDM.

We put them into three categories (high, moderate and low risk factors) according to their sensitivity and specificity in detecting GDM cases, the less false negative cases percentage when using the specific risk factor (high sensitivity), and the less false positive cases percentage (high specificity), put the risk factor as a high risk factor and vice versa.

According to this, we found that advanced maternal age, family history of diabetes mellitus and previous pregnancy with GDM are high risk factors, with sensitivities and specificities of (55 %,70 %), (65 %, 85 %) and (70 %, 100 %) respectively.

We find also that risk factors with sensitivity or specificity of less than 50 % which represent the moderate risk factors include: obesity, PCOS (Polycystic ovary syndrome), polyhydramnios, hypertension, and previous child over 4 kg., multiparity and the use of contraception.

Risk factors with sensitivity or specificity of less than or equal to 10 % which are said to be low risk factors include: multiple pregnancy, chronic steroid use, smoking and the skin, urinary tract or genital infection.

Oral glucose tolerance results show progressive increment throughout pregnancy, especially in the third trimester where it is : Fasting : 85.15 ± 1.66, 1 hr : 128.75 ± 4.22 and 2 hr : 96.85 ±3.54 mg / dl.

For normal cases, While that for GDM cases are: fasting: 97.158 ± 5.15, 1 hr : 173.58 ± 12.62 and 2 hr : 140.74 ± 9.60 mg / dl.

140.74 ±9.60 mg / dl.

The study concluded that : 1.

Both normal and GDM cases have normal glucose tolerance in early weeks of pregnancy.

However, this will not exclude starting hyperglycemia in the first trimester in some of GDM cases.

2.

We can see also that the progressive increment of hyperglycemia is more clearly observed in GDM cases particularly after 24 weeks of gestation.

And pregnant women should be tested for glucose tolerance at that time.

3.

The suitable cutoff in diagnosis of GDM according to the mean values for GDM cases in the third trimester is: fasting of 97 mg / dl., 1 hour of 174 mg/dl.

and 2 hour value of 141 mg / dl.

4.

No one risk factor is so powerful that it stands alone as a good predictor of GDM.

However, several risk factors used in combination may generally give a better prediction.

Synergism or a multiplicative relationship between risk factors may considerably enhance their value.

5.

Having a detailed idea about each one of these risk factors regarding it is strength and biochemical bases by which it is involved in development of GDM, is of great value towards the scope of better understanding of GDM.

Main Subjects

Medicine

Topics

• Woman
• Pregnancy
• Diabetes

No. of Pages

46

Table of Contents

• APA
• MLA
• AMA

Language

English

Data Type

Arab Theses

Record ID

BIM-392870