Introduction Gestational diabetes is defined as the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Gestational glucose intolerance (GGI) is used to indicate pregnant women whose 2-h postprandial glucose is > 120 mg/dl and below 140 mg/dl (Diabetes in Pregnancy Study Group of India, DIPSI criteria). Aim This study was planned to see whether intervention in GGI group helps to improve feto-maternal outcomes.
Methodology This open-label randomized control trial was conducted in Department of Obstetrics and Gynaecology of King George's Medical University, Lucknow. Inclusion criteria were all the antenatal women attending the antenatal clinic and diagnosed as GGI, and exclusion criteria were overt diabetes.
Results Total of 1866 antenatal women were screened, and among them, 220 (11.8%) women were diagnosed as gestational diabetes; 412 (22.1%) women were diagnosed as GGI. The mean fasting blood sugars in the women with GGI who had medical nutrition therapy were much lower than the women with GGI who did not have any intervention. The present study showed the women with GGI had higher complications like polyhydramnios, PPROM, foetal growth restriction, macrosomia, preeclampsia, preterm labour and vaginal candidiasis more in the women with GGI as compared to euglycaemic women.
Conclusion The present study of nutritional intervention in GGI group has shown trend towards lesser complication if we start medical nutrition therapy reflected by delayed development of GDM and less neonatal hypoglycaemia and hyperbilirubinemia.
Keywords : GDM · GGI · Diabetes · Blood sugar · DIPSI · Medical nutrition therapy
Diabetes in pregnancy is a great global concern and a potential emerging public health problem. Gestational diabetes mellitus is defined as the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy [1], and it affects 9–25% of all pregnancies [2]. The prevalence of gestational diabetes varies between different geographical areas and so does the constraints in testing in terms of cost-effectiveness. Test method suggested by Diabetes in Pregnancy Study Group of India (DIPSI) has been considered as best-accepted testing method in Indian perspective and has also been accepted by the FIGO as a country-specific detection model. This is a single-step test measuring blood sugar 2 h after ingestion of 75 g oral glucose [3]. The threshold blood sugar level of ≥ 140 mg/dl is taken as cut-off for diagnosis of GDM. The term gestational glucose intolerance (GGI) is used to indicate pregnant women whose 2-h postprandial glucose is > 120 mg/dl and below 140 mg/dl. Unlike GDM, for gestational glucose intolerance, no intervention is stated by any of the available guidelines. It is important to recognize that the ideal fasting sugar should be less than 95 mg/dl and 2-h postmeal sugar has to be less than120 mg/dl and hence it is important to see whether gestational glucose intolerance might also need intervention [4, 5]. Prospective and retrospective studies have been done which substantiated the observation that the frequency of adverse foetal outcome increases with 2-h postprandial sugar > 120 mg/dl and taking care of these women had resulted in a better foetal outcome. However, whether any trivial intervention in form of medical nutrition therapy in GGI group can alter or improve feto-maternal outcome, needs a randomized control trial which has not been done ever. Enough evidence is available that timely diagnosis and management of GDM is having significant maternal and foetal health benefits. GGI appears to be a milder form of GDM and could be more amenable to simpler interventions. The pathophysiology of the disease appears to vary in different ethnic population, especially South Asian women. Novelty of the study is that present literature and available evidence are essentially lacking in any work or intervention in the GGI. This study was planned to see whether women with GGI have any increased feto-maternal complication compared to euglycaemics and whether any intervention in GGI group helps to improve feto-maternal outcomes in a tertiary care centre of North India.
Declarations
Conflict of interest There is no conflict of interest among the authors. There is no financial relationship with any organizations.
Ethical Approval All procedures followed were in accordance with the ethical standards of the responsible institutional committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed Consent Informed consent was obtained from all patients for being included in the study.
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