Gestational diabetes mellitus: an audit at Tygerberg Academic Hospital
Thesis (MMed)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Aim: To describe the profile of patients with gestational diabetes mellitus (GDM) at Tygerberg Academic Hospital, managed according to the new Provincial Guidelines. Methods: There was the performance of a retrospective audit of all pregnant patients with GDM, seen at the Special Care Clinic of Tygerberg Academic Hospital over a period of 12 months. Dictation of the size of the study sample was by the time interval and the number of patients diagnosed with GDM and seen at the clinic during the period of study. Patient data were extracted from the files and loaded into a spreadsheet in a strictly anonymous fashion. Within the patient profile the study sought to identify the mode of diagnosis, interventions required, as well as the courses of the pregnancies for both the women and their foetuses. There was the use of descriptive statistics for analysis, and logistic regression was employed to investigate continuous variables (age and body mass index). Results: One hundred and forty-seven women had the diagnosis of GDM from August 2010 to July 2011. Fifty-eight percent of women had a positive family history of diabetes; 57% developed glycosuria, and 38% underwent diagnostic testing due to morbid obesity. Previous GDM and previous unexplained IUD were present in 8% of women. The median age of the women in this group was 32 years and 80% were found to be obese. The median gestational age at diagnosis was 28 weeks with a median glycosylated haemoglobin of 6.3%. The upper range of glycosylated haemoglobin (13.3%) and the lower range of gestational age at diagnosis (7 weeks) indicate that cases of undiagnosed, pre-existing diabetes mellitus were also present in this group of women with “gestational diabetes”. Concerning glycemic control during pregnancy 23% responded to lifestyle modification alone, 68% required additional metformin and 9% insulin as a final addition to therapy. It is noteworthy that despite the diagnosis of GDM, 29% of women still required metformin at discharge. Twenty-nine percent of the group delivered before 38 weeks’ gestation with hypertensive complications (14%) and spontaneous pre-term labour (8%) featuring prominently. The median birth weight was 3280 grams. There was a high incidence of peripartum foetal distress (26%) reflected in the caesarean rate of 55%. Conclusion: A positive family history, obesity and glycosuria are useful to diagnose GDM. Although approximately one-quarter of women achieved glycemic control on lifestyle modification alone; most required metformin but avoided insulin therapy. Despite the goal of elective delivery at 38 weeks’ gestation, hypertensive complications and spontaneous pre-term labour resulted in many earlier deliveries. The overall rate of caesarean section was high but during vaginal delivery shoulder dystocia was rare. The policy of screening using history and selective clinical findings, together with the addition of metformin to the management programme (as advocated by the provincial guidelines) appears to be fulfilling its purpose within the specific context of public health care within the Western Cape Province of South Africa.
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