Clinical presentation and management of diabetes mellitus in pregnancy

Figures & data

Table 1 Clinical characteristics of the patients studied: study and control population

Event	Study population (n=171)	Control population (n=171)	P-value
Ethnicity
Kuwaiti	31 (18.1)	30 (17.5)	NS
Non-Kuwaitis
Arabs	65 (38.0)	71 (41.5)	NS
Indians	40 (23.4)	30 (17.5)	NS
Filipinos	11 (6.4)	7 (4.1)	NS
Pakistanis	7 (4.1)	7 (4.1)	NS
Others	17 (9.9)	26 (15.2)	NS
Age, years (range)	31.92±5.625 (21–43)	28.31±5.651 (19–31)	<0.0001
Parity (range)	2.14±1.971 (0–8)	1.26±1.469 (0–5)	<0.0001
Miscarriages	0.54±0.315	0.46±0.342	<0.0001
Mean weight, kg	81.58±16.212	72.47±15.485	<0.0001
Total weight gained, kg	9.90±5.757	11.52±5.643	<0.009
Body mass index, kg/m^2 (range)	32.00±6.160 (21–57)	28.20±5.885 (20–38)	<0.0001
*Kuwaiti	60.5	56.7	NS
*Non-Kuwaiti	39.5	43.3	NS

Notes: For age, parity, miscarriages, mean weight, total weight gained, and body mass index, data are expressed as mean ± standard deviation. All other data are expressed as number and percentage. Mean weight is the mean weight at the first booking visit.

* These data were arrived at using a modified analysis and re-arrangement of the Ethnic groups.

Abbreviation: NS, not significant.

Table 2 Clinical characteristics of the diabetic subgroups and control population

Event	Group A, gestational DM (n=123)	Group B, type 1 DM (n=21)	Group C, IGT (n=27)	Group D, control (n=171)	P-value
Age, years (range)	32.15±5.507 (21–45)	31.24±6.663 (21–43)	31.41±5.458 (21–42)	28.31±5.651 (19–31)	1. 0.498 2. 0.527 3. <0.0001* 4. 0.923 5. 0.029* 6. 0.008*
Parity (range)	2.19±2.128 (0–8)	2.43±1.363 (0–5)	1.70±1.564 (0–5)	1.26±1.469	1. 0.501 2. 0.263 3. <0.0001* 4. 0.109 5. <0.0006* 6. 0.156
Mean weight, kg (range)	82.29±15.596 (21–49)	77.38±14.541 (20–40)	81.59±19.947 (21–57)	72.47±15.485	1. 0.181 2. 0.865 3. <0.0001* 4. 0.420 5. 0.169 6. 0.030*
Body mass index, kg/m^2	32.45±5.828	30.15±6.669	31.7±6.899	28.20±8.885	1. 0.104 2. 0.559 3. <0.0001* 4. 0.438 5. 0.159 6. 0.005*
Mean weight gained, kg	10.17±6.008	10.00±5.568	8.33±4.848	11.52±5.643	1. 0.903 2. 0.139 3. 0.049* 4. 0.273 5. 0.244 6. 0.006*
Mean glycosylated hemoglobin A1c (range)	5.56±1.147 (5.2–6.72)	6.13±0.734 (5.1–7.11)	6.65±0.6 (6.1–7.231)	–	1. 2.990 2. <0.0001* 3. 0.009*A versus C

Notes: 1, A versus B; 2, A versus C; 3, A versus D; 4, B versus C; 5, B versus D; and 6, C versus D. All data are mean ± standard deviation.

* Indicates statistically significant.

Abbreviations: DM, diabetes mellitus; IGT, impaired glucose tolerance.

Table 4 Type of diabetes mellitus and treatment adminis- tered (n=171)

Event	Cases (n)	Percentage
Type of diabetes mellitus
Gestational diabetes mellitus	123	71.9
Insulin-dependent diabetes mellitus	21	12.3
Impaired glucose metabolism	27	15.8
Treatment offered
Insulin injections and diet*	61	35.7
Dietary control only*	110	64.3

Notes: All patients with insulin-dependent diabetes mellitus (type 1 diabetes mellitus) were managed with insulin injections and diet. Forty patients with gestational diabetes mellitus were managed with insulin injections and diet, and the other 83 patient with gestational diabetes mellitus were managed with diet. All patients with impaired glucose tolerance were managed with diet only.

* Increased physical activity was emphasized as part of the treatment in all patients with diabetes mellitus (both gestational diabetes mellitus and type 1 diabetes mellitus) and impaired glucose tolerance (impaired glucose metabolism). In this table, insulin-dependent diabetes mellitus is the same as type 1 diabetes mellitus.

Table 3 Significant events in the past obstetric history of the study population (n=171)

Event	Cases (n)	Percentage
Previous GDM	39	22.8
Previous NIDDM	107	62.6
Previous IDDM	19	11.1
Previous big babies	18	10.5
Previous SB	4	2.3
Previous NND	3	1.8
History of recurrent moniliasis	9	5.3
History of infertility	13	7.6

Note: Some patients who gave a past history of GDM also had a past history of previous NIDDM.

Abbreviations: GDM, gestational diabetes mellitus; IDDM, insulin-dependent diabetes mellitus (type 1 diabetes mellitus); NIDDM, non–insulin dependent diabetes mellitus (type 2 diabetes mellitus); NND, neonatal fetal death; SB, still birth.

Table 5 Antenatal/intrapartum complications: study and control population

Complication	Study (n=171)	Control (n=171)	P-value
Premature rupture of membranes	26 (15.2)	14 (8.2)	NS
Oligohydramnios	12 (7.0)	3 (1.8)	NS
Preeclampsia	4 (2.3)	2 (1.2)	NS
Polyhydramnios	8 (4.7)	2 (1.2)	NS
Placenta previa	8 (4.7)	0 (0.0)	0.007*
Intrauterine growth restriction	6 (3.5)	0 (0.0)	0.03*
Threatened miscarriage	4 (2.3)	2 (1.2)	NS
Urinary tract infection	4 (2.3)	2 (1.2)	NS
Postpartum hemorrhage	6 (3.5)	3 (1.8)	NS
Post dates	0 (0.0)	31 (18.1)	NS

Notes: Data are expressed as number (%). Five of the patients with placenta previa gave a history of previous multiple cesarean sections. Intrauterine growth restriction was recorded mainly in patients with type 1 diabetes mellitus and preeclampsia.

* Indicates statistically significant.

Abbreviation: NS, not significant.

Table 6 Events at delivery and fetal outcome: study and control population

Events	Study population (n=171)	Control population (n=171)	P-value
Mode of delivery
SVD	80 (46.8)	99 (57.9)	0.051*
LSCS	76 (44.4)	57 (33.3)	0.046*
Ventouse	15 (8.8)	10 (5.9)	0.047*
Forceps	0 (0.0)	5 (2.9)
Gestational age at delivery	38.62±1.773	*39.02±1.834	<0.0001*
Fetal outcome
Mean birth weight, g	3,317.49±620.042	*3,223.58±550.390	0.139
Mean Apgar score, 5 min	8.00±1.182	*8.04±1.095	0.745
Mean birth weight >4500.00 g	$\begin{array}{c}12(7.01)\\ 4(2.30)\end{array}\}16(9.36)$	$\begin{array}{c}0(0.00)\\ 12(7.01)\end{array}\}12(7.01)$
Mean birth weight >4000.00 g
Admission to SCBU	40 (23.30)	12 (7.01)
Fetal anomaly	2 (1.17)	0 (0.00)
Admission to NICU	8 (4.70)	0 (0.00)
Shoulder dystocia	3 (1.8)	0 (0.00)
Erb’s palsy	3 (1.8)	0 (0.00)

Notes: For gestational age at delivery, mean birth weight, and mean Apgar score, data are expressed as mean ± standard deviation. All other data are expressed as number (%).

* Indicates statistically significant.

Abbreviations: LSCS, lower segment cesarean section; min, minutes; NICU, neonatal intensive care unit; SCBU, special care baby unit; SVD, spontaneous vaginal delivery.

Table 7 Events at delivery and fetal outcome: diabetic subgroups and control

Event	Group A, GDM (n=123)	Group B, type 1 diabetes (n=21)	Group C, IGT (n=27)	Group D, control (n=171)	P-value
Gestational age at delivery, weeks	38.70±1.783	37.76±2.364	38.93±0.781	39.02±5.643	1. 0.094 2. 0.298 3. 0.136 4. 0.040* 5. 0.027* 6. 0.662
Fetal birth weight, g	3,290.61±634.961	3,307.86±720.969	3,452.50±440.101	3,223.58±550.590	1. 0.910 2. 0.119 3. 0.346 4. 0.424 5. 0.610 6. 0.040*
Apgar score	7.86±1.307	8.14±0.727	8.52±0.580	8.04±1.095	1. 0.163 2.<0.0001* 3. 0.214 4. 0.049* 5. 0.581 6. 0.001*
SVD	59 (48.0)	13 (61.9)	8 (29.6)	99 (57.9)	1. 0.345 2. 0.091 3. 0.117 4. 0.040* 5. 0.817 6. 0.007*
C/S	51 (41.4)	8 (38.1)	17 (63.0)	57 (33.3)	1. 0.815 2. 0.054* 3. 0.192 4. 0.144 5. 0.635 6. 0.004*
Ventouse	13 (10.6)	–	2 (7.4)	10 (5.9)	1. 0.215 2. 1.000 3. 0.205 4. 0.497 5. 0.604 6. 0.670

Notes: 1, A versus B; 2, A versus C; 3, A versus D; 4, B versus C; 5, B versus D; and 6, C versus D. Data are expressed as mean ± standard deviation and number (%). A Chi-square test was used for SVD, C/S, and ventouse.

* Indicates statistically significant.

Abbreviations: GDM, gestational diabetes mellitus; C/S, lower-segment cesarean section; IGT, impaired glucose tolerance; SVD, spontaneous vaginal delivery.