Prevalence of Gestational Diabetes Mellitus among pregnant women attending for antenatal care- A Hospital based study

Fathima Habeeba T E*1, Revikumar K G2, Jaideep Mahendra3, Mumtaz P4, Jithesh T K5, Mohammed Muneersha T K6 1Research Scholar, Meenakshi Academy of Higher Education and Research, West K.K Nagar, Chennai600078, Tamil Nadu, India 2Kerala Institute of Drug Studies, Kavaradi Road, Pettah, Thiruvananthapuram-695024, Kerala, India 3Department of Periodontics, Meenakshi Ammal Dental College, Chennai6000095, Tamil Nadu, India 4Department of Obstetrics & Gynecology, MES Academy of Medical Sciences, Perinthalmanna679338, Kerala, India 5Department of Biochemistry, MES Academy of Medical Sciences, Perinthalmanna679338, Kerala, India 6Department of Pharmacy, Annamalai University, Annamalai Nagar, Chidambaram– 608002, Tamil Nadu, India


INTRODUCTION
Gestational Diabetes Mellitus (GDM) is a condition in which a conceived women experiences high blood sugar level that begins with the gestation or recognized for the irst time during pregnancy (Mack and Tomich, 2017). GDM is de ined by the American Diabetes Association as the glucose intolerance of any degree with onset or recognition during pregnancy (Karagiannis et al., 2010). It may be caused by pancreatic dysfunction or Insulin resistant state, probably due to the placental produc-tion of progesterone, cortisol, prolactin and other hormones which might interfere with normal glucose metabolism (Lain and Catalano, 2007). Obesity, previous history of GDM, family history of Type 2 Diabetes, ethnicity, increased maternal age, previous macrosomic baby, polycystic ovary syndrome and multiple pregnancy are considered as main risk factors for developing GDM (McIntyre et al., 2019). Pregnancy induced Hypertension, polyhydramnios, preterm labour, recurrent urinary tract infections, candidal vaginitis, preeclampsia, increased rate of instrumental vaginal and cesarean section are considered as immediate maternal complications associated with GDM whereas the increased risk of developing type 2 Diabetes Mellitus is the main long term maternal complication (Yogev and Visser, 2009). The complications seen in fetus carried by GDM women include macrosomia, neonatal hypoglycemia, perinatal mortality, congenital anomalies, hyperbilirubinemia, polycythemia, hypocalcaemia and respiratory distress syndrome, whereas the long term complications to the offspring include an increased risk of diabetes and obesity (Bianco and Josefson, 2019).
GDM is one of the most frequently occurring metabolic diseases of pregnancy (Herrera and Ortega-Senovilla, 2010). The prevalence of GDM is a variable statistics depending on the population in which the study was carried out and the screening strategies or diagnostic criteria were used (Eades et al., 2017). According to the data from the International Diabetes Federation, 16% of live births in 2013 were complicated by maternal hyperglycemia. In the Indian scenario, the prevalence of GDM varies from 3.8 to 21% in different parts of the country (Raja et al., 2014) and prevalence in South India has dramatically increased recently to 16 % (Shriraam et al., 2013). The rise in prevalence of GDM in the south Indian population is mainly due to obesity, family history of Diabetes Mellitus, sedentary lifestyle, Genetic Predisposition and dietary Habits (Seshiah et al., 2006).

METHODOLOGY
A prospective observational study was carried out in the Obstetrics and Gynecology Department of a Postgraduate level Teaching Hospital after obtaining approval from the Institutional Ethics Committee (IEC). The main objective of this study was to ind out the prevalence of GDM among women attending the Obstetrics and Gynecology Department of Tertiary Care Hospital for antenatal care. During the study period, all pregnant women with 24-28 weeks of gestation attending the OBG department for ante-natal care were included in the study (Thathagari et al., 2016). Women with a previous history of Diabetes Mellitus were excluded from the study (Balaji et al., 2007). This study was initiated after obtaining written informed consent in vernacular language from each participant. During the entire study, 650 pregnant women attended the OBG Department for antenatal care were enrolled. Sociodemographic data were collected by direct patient interview. Demographic details including age, body weight, height and BMI at diagnosis and clinical details like Fasting Blood Sugar and Post Prandial Blood Sugar also were recorded. After detailed clinical examination, all participants underwent Glucose Challenge Test (GCT) and those who were positive then send for Oral Glucose Tolerance Test (OGTT) to con irm the diagnosis of Gestational Diabetes Mellitus (Hosseini et al., 2018).

RESULTS AND DISCUSSION
Graph 1: Prevalence of GDM cases among total Antenatal cases Graph 2: Distribution of antenatal cases according to age In this study, a total of 650 pregnant ladies attended Obstetrics and Gynecology Department of the study center; among of which 104 pregnant women found to have Pregnancy induced Diabetes Mellitus. This means the prevalence of GDM was found to be 16%    Graph 3: Distribution of antenatal cases according to family history of Diabetes mellitus in the study center, which is at par with South Indian prevalence (Rajput et al., 2013). The prevalence of GDM can be plotted in Graph 1. Table 1 explains the distribution antenatal cases according to the age of the patients who were enrolled in the study. It indi-Graph 4: Distribution of antenatal cases according to the diet pattern cates one important thing from the study that age speci ic prevalence in 25-29 years group was found to be 22.3% and that is very higher when compared to all other age groups.  Table 3 explains the distribution of antenatal cases according to the diet pattern (Buchanan et al., 2012). It found that pregnant women following a non-vegetarian diet (61.5%) are more prone to develop abnormal glucose tolerance. It may be due to high fat, high calorie and low iber in their dietary habit. The study depicted high incidence of GDM among ladies who were obese before conception (46.3%) and followed by women who were overweight before conception (19.8%) with respect to women with ideal BMI (5.8%) as shown in Table 4. It is found that 104 out of 650 pregnant ladies attended the OBG Department of the study set up for antenatal care were diagnosed with Gestational Diabetes Mellitus. The prevalence of GDM was found to be 16% in the study setting, which is borderline high of the national average and very much close to regional prevalence.

CONCLUSIONS
Advancing maternal age, obesity and family history of diabetes mellitus were found to have a strong association with GDM. Lifestyle modi ication and proper medications are the essential modalities in maintaining the blood sugar level within the normal range and thus to minimize the maternal as well as neonatal complications. GDM can be considered as a predicting tool for the development of type 2 diabetes mellitus in future.

Funding Support
The authors declare that they had no funding support for this study.