Frequency of Uncontrolled Diabetes Mellitus in Late 3rd Trimester and Its Association with Maternal Outcome

Diabetes mellitus is a metabolic disorder characterized by elevated blood and tissue glucose levels due to absolute or relative insulin deficiency. In addition to a number of systemic complications, diabetes in pregnant women is associated with poor perinatal outcome. A recent study claimed that not merely the presence of diabetes but also poor glycemic control during pregnancy is associated with adverse maternal outcome. However, the available evidence was limited while there was no such local published material which necessitated the present study. OBJECTIVE: The objectives of this study were to determine the frequency of uncontrolled diabetes mellitus in late 3rd trimester among diabetic pregnant women presenting at a teaching hospital in Punjab and to compare the maternal outcome among pregnant women with controlled versus uncontrolled diabetes mellitus. STUDY DESIGN: It was a descriptive case series. SETTING: Research was conducted at Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital Lahore. DURATION: Duration of study was 6 months after the approval of synopsis from 01/08/2017 to 31/12/2017 (4 months) and 01/04/2018 to 31/05/2018 (2 months). MATERIAL AND METHODS: This study involved 217 diabetic pregnant women aged between 18-35 years presenting after 34 weeks of gestation. HbA1c levels were acquired and those with ?6% HbA1c levels were labeled to have uncontrolled diabetes. Frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage was noted and compared between women with controlled and uncontrolled diabetes. A written informed consent was obtained from every patient. RESULTS: The mean age of the patients was 30.1±3.9 years while the mean gestational age was 39.6±1.6 weeks.  Majority (n=190, 87.6%) of the patients were aged between 26-35 years followed by 27 (12.4%) patients aged between 18-25 years. There were 75 (34.6%) primiparas and 142 (65.4%) multiparas. 36 (16.6%) patients had pre-pregnancy diabetes while 181 (83.4%) patients had gestational diabetes. 74 (34.1%) patients were taking oral hypoglycemic while 143 (65.9%) patients were on insulin. HbA1c levels ranged from 5.5% to 7.7% with a mean of 6.5±0.66%. Taking a cut-off value of ?6.0%, 146 (67.3%) patients had uncontrolled diabetes. 46 (21.2%) patients had polyhydramnios, 146 (67.3%) patients required cesarean delivery and 31 (14.3%) patients acquired post-partum hemorrhage. The frequency of polyhydramnios (27.4% vs. 8.5%; p-value=0.001), cesarean delivery (84.9% vs. 31.0%; p-value<0.001) and postpartum hemorrhage (21.2% vs. 0.0%; p-value<0.001) was significantly higher in patients with uncontrolled diabetes. CONCLUSION: A substantial proportion of diabetic women in late 3rd trimester had poor glycemic control and had significantly higher frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage than women with good glycemic control which advocates routine monitoring and strict glycemic control in diabetic pregnant women to improve the maternal outcome in future practice.