Gestational diabetes : screening, diagnosis and outcome

Hatem, Mohamed (1989) Gestational diabetes : screening, diagnosis and outcome. University of Southampton, Doctoral Thesis.

Abstract

The first part of the study comprises the development of a random plasma glucose method for screening for gestational diabetes. Initially the upper limits of normal random plasma glucose were established from 1,426 pregnant women (818 at their booking antenatal visit and 608 at 28 to 30 weeks gestation). Secondly these cut-off plasma glucose values were employed to screen 1,765 pregnant women (943 women at booking and 822 at 28 to 30 weeks) for abnormal glucose tolerance. Women whose random plasma glucose was ≥ the defined cut-off point underwent a standard 75 g oral glucose tolerance test. Random plasma glucose values were not significantly related to maternal age, parity or whether they had any features of potential diabetes. Women who subsequently delivered large infants had significantly higher random plasma glucose at 28 to 30 weeks. Random plasma glucose screening was compared to the conventional screening based on features of potential diabetes and was found to be superior in detecting pregnant women with abnormal glucose tolerance. This was achieved through performing fewer glucose tolerance tests and with a saving of PPP664 for each 1,000 pregnancies tested. Plasma fructosamine was measured in 74 pregnant women who all had a 75 g oral glucose tolerance test in the third trimester. There was a poor correlation between plasma fructosamine and the result of the glucose tolerance test. Plasma fructosamine proved unreliable as a screening test for gestational diabetes. The second part studies the response of pregnant women to the 75 g oral glucose tolerance test. There were statistically significant differences between early and late pregnancy in the plasma glucose values at 1 hour and at 2 hours following the glucose load. These findings were obtained from both the cross-sectional study of 215 women and the longitudinal cohort group of 9 women who were tested at different times during pregnancy. Reference values for the 75 g oral glucose tolerance test were established illustrating the importance of gestational age in correctly interpreting the result of an oral glucose tolerance test during pregnancy. The third part of the study comprises a comprehensive comparative analysis of the pregnancy outcome among 112 women with gestational diabetes and 177 women with pre-gestational insulin-dependent diabetes mellitus. The high perinatal mortality among diabetic women was confirmed. There were no significant differences between gestational diabetic women and insulin-dependent diabetic women with regard to the perinatal mortality and fetal congenital abnormalities. This illustrates the importance of gestational diabetes as a clinical problem particularly with regard to fetal outcome.

This record has no associated files available for download.

Contributors

Download statistics