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Foetal outcomes in pregnancies complicated by Diabetes Mellitus Vaidya A 1, Gupta M 1 , El Kady A 1 , Koujan F 1 , Sethi P 1 , Sekhar R 1 1= Farwaniya Hospital Kuwait. Introduction Women with diabetes account for 2–5% of pregnancies. 1

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  1. Foetaloutcomes in pregnancies complicated by Diabetes Mellitus Vaidya A1, Gupta M1, El Kady A1, Koujan F1, Sethi P1,Sekhar R1 1= Farwaniya Hospital Kuwait Introduction Women with diabetes account for 2–5% of pregnancies.1 The prevalence of type 1 and type 2 diabetes is increasing. Particularly type 2 diabetes is increasing in certain groups like African, black Caribbean, South Asian, Middle Eastern and Chinese.2 Women with type 1 and type 2 diabetes have an increased risk of adverse pregnancy outcomes, including miscarriage, foetalcongenital anomaly and perinatal death3,4 Treatment of gestational diabetes reduces serious perinatal morbidity and may also improve the woman’s health-related quality of life.5 Results • Conclusions • In this series of retrospective study, control of diabetes in Type1 and type 2 was not ideal as the ideal 100% control was not achieved. • Pre-conceptional control is lacking in all the 3 types. • Uncontrolled diabetics in pregnancy in all three groups fared poorly in terms of fetal outcome. • A dedicated pre-conceptional diabetic clinic and joint management of pregnant Diabetics may improve control and thereby outcomes. A total of 248 cases were studied. There were 187 cases ofGDM (75.4%). 22 Cases of Type 1(8.87%) and 41 cases ofType2 (16.5%). Among the 3 types , GDM responded best to treatment in terms of glycaemic control followed by Type 2, while type1 fared the worst (p<0.005). Objective To compare foetaloutcomes in pregnancies complicated by Gestational Diabetes, Type1 and Type2 with good glycaemic control versus poor glycaemic control. Methods It was a retrospective cohort study in Farwania hospital-Kuwait. Hospital data- base was used to identify patients with any of the 3 types, Gestational, Type 1, Type 2 , who delivered in Farwania hospital in from 1st January to 31st December 2009. Data was analysed in MS excel and the T- test used for statistical significance. Fetal outcomes studied were birth weight, preterm delivery, Infant respiratory distress Syndrome (IRDS), hypoglycemia, hyperbilrubinemia, transient tachypnea of the newborn (TTN), birth asphyxia (BA), shoulder dystocia, birth injury, congenital anomalies and perinatal mortality in those with good versus those with poor control. Good blood glucose control defined as fasting blood sugar less than 5.9 MMol per liter; one hour post prandial less than 7.8 MMol per liter.6 Comparison of outcomes There were 27 cases of)IRDS; 18 (9.09%) were in the 199 Euglycemic patients and 9 (18%) in the 49 uncontrolled group. Uncontrolled diabetics had a significantly higher incidence of neonatal RDS -9 (18.36%) compared to controlled 18 (9%) (P=0.03). In all there were 57 ( 23%) cases of Hypoglycemia. Thirty seven cases (18.6%) were seen in the 199 controlled patients and 20 cases (40%) in the 49 uncontrolled patients. Uncontrolled diabetics had a significantly higher incidence of neonatal Hypoglycemia (P= 0.002). There was no statistically significant difference in the occurrence of hyperbilirubinemia , shoulder dystocia, congenital anomalies ,stillbirths and birth injuries. TTN and BA was very low in all groups. Discussion Diabetes mellitus in pregnancy is associated with peri-natal and maternal adverse outcomes and well controlled pregnant diabetics fair better than uncontrolled.5 Our study has also been able to substantiate this especially for the minor outcomes like RDS and admission to NICU. As severe morbidity and mortality have come down owing to more awareness of the condition, the focus would now shift to the minor outcomes, which are more important in terms of long term health consequences, and health care resource utilization. Comparison of combined neonatal complications showed significantly higher incidence of all problems (p= 0.014869) in uncontrolled patients. • References • CEMACH. Confidential Enquiry into Maternal and Child Health: Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–03, England, Wales and Northern Ireland . London: CEMACH; 2005. • CEMACH. Confidential Enquiry into Maternal and Child Health: Pregnancy in Women with Type 1 and Type 2 Diabetes in 2002–03, England, Wales and Northern Ireland . London: CEMACH; 2005. • Casson IF. Outcomes of pregnancy in insulin dependent diabetic women: results of a five year population cohort study. British Medical Journal 1997;315:275–8. • Hawthorne G. Prospective population based survey of outcome of pregnancy in diabetic women: results of the Northern Diabetic Pregnancy Audit, 1994. British Medical Journal 1997;315:279–81. • Affect of Treatment of Gestational Diabetes Mellitus on Pregnancy Outcomes-Caroline A. Crowther, F.R.A.N.Z.C.O.G., Janet E. Hiller, Ph.D., John R. Moss, F.C.H.S.E., Andrew J. McPhee, F.R.A.C.P., William S. Jeffries, F.R.A.C.P., and Jeffrey S. Robinson, F.R.A.N.Z.C.O.G.,for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group* • Diabetes in pregnancy-management of diabetes and its complications from preconception to the postnatal period clinical Guideline March 2008 (revised reprint July 2008)

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