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The Obstetric Implications of Diabetes & Diabesity in Malaysia

The Obstetric Implications of Diabetes & Diabesity in Malaysia. G Muniswaran Obstetrician & Gynaecologist Hospital Raja Permaisuri Bainun , IPOH. INVESTIGATORS. Ganeshan Muniswaran 1 , Japaraj RP 1 , SA Soelar 2 , SD Karalasingam 2 , R Jeganathan 3

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The Obstetric Implications of Diabetes & Diabesity in Malaysia

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  1. The Obstetric Implications of Diabetes & Diabesityin Malaysia G Muniswaran Obstetrician & Gynaecologist Hospital Raja PermaisuriBainun, IPOH

  2. INVESTIGATORS Ganeshan Muniswaran1, JaparajRP1, SA Soelar2, SD Karalasingam2, R Jeganathan3 1- Hospital Raja PermaisuriBainun, Ipoh 2- Clinical Research Centre, Kuala Lumpur 3- Hospital SultanahAminah, Johor Bahru

  3. BACKGROUND REVIEW • Diabetes is highly prevalent in Malaysia • Obesity is a modern epidemic • The implications of diabetes and obesity in pregnancy are significant • Implications of diabesityin pregnancy?

  4. OBJECTIVE • To compare the obstetric implications of diabetes and diabesity

  5. METHODS • Cross sectional retrospective cohort study • Dataset is from the National Obstetric Registry of Malaysia (Fourteenmajor tertiary hospitals in nationwide) • Three year study period from 1st January 2010 till 31st December 2012

  6. DEFINITIONS Inclusioncriteria Exclusion criteria GDM were excluded Booking >18 weeks of pregnancy • Pre-gestationalDM • Hyperglycaemia in pregnancy (WHO) • Obesity – Booking BMI>30kg/m2 • Diabesity– Pre-gestational DM and Obesity

  7. METHODS Sample size 399,274pregnant mothers Diabetes 34,619pregnant mothers Diabesity 17,770pregnant mothers

  8. Outcome Variables Primary outcomes Secondary outcomes Shoulder dystocia Primary Post partum haemorrhage • Fetalmacrosomia • Caesarean section rates • Stillbirths Adjusted for maternal age, parity & ethnicity

  9. STATISTICAL ANALYSIS • Multivariate analysis using logistic regressions • Crude and adjusted odds ratio with respective 95% confidence interval • Paired sample t-test to compare the mean difference between odds ratio

  10. RESULTS

  11. DIABESITY IS COMMON • Incidence of diabesity in pregnancy – 4.5% • Most prevalent among Indians • Most common age group 35-39 years of age

  12. FETAL MACROSOMIA P value based on simple logistic regression , OR Odds Ratio

  13. CAESAREAN SECTION P value based on simple logistic regression , OR Odds Ratio

  14. STILLBIRTH P value based on simple logistic regression , OR Odds Ratio

  15. PRIMARY PPH P value based on simple logistic regression , OR Odds Ratio

  16. SHOULDER DYSTOCIA P value based on simple logistic regression , OR Odds Ratio

  17. CONCLUSION • Combination of diabetes & obesity has far greater obstetrics complications • More prevalent then what is perceived! • Risk of fetalmacrosomia & caesarean section is extremely significant

  18. STRENGTH OF STUDY • Large sample size • Adequately powered

  19. LIMITATIONS • Retrospective study • Based on a single registry

  20. RECOMMENDATIONS • Better awareness • Urgent need of a aggressive & holistic approach • Global Initiative & National Health Policy & Declaration

  21. REFERENCES • Diabesity : A worldwide Challenge : European Commission Report Feb 2012 • Hossain P, Kawar B, El Nahas M (2007) Obesity and diabetes in the developing world – a growing challenge. N Engl J Med 356: 213–215. doi: 10.1056/nejmp068177 • Jensen DM, Damm P, et al. Pregnancy outcome and prepregnancy body mass index in 2459 glucose tolerant Danish women. Am J Obstet Gynecol. 2003;188:239-44 • Mcmillen IC, Robinson J. Developmental origin of the metabolic syndrome. Physiol Rev. 2005;85:471-633

  22. THANK YOU

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