Original Article

Maternal and Perinatal Outcome in Gestational Diabetes

Mellitus Compared to Pregestational Diabetes Mellitus
Mustary Fa, Chowdhury TAb, Begum Fc, Mahjabeen Nd

Abstract
Background: Diabetes mellitus is the most frequently encountered endocrine disorder in pregnancy and is
associated with adverse outcomes if remain undiagnosed or untreated.
This study was done to compare the maternal and perinatal outcome of pregestational diabetes mellitus
(PGDM) with that of gestational diabetes (GDM).
Methods: This observational analytical study with group comparison was carried out in the Department of
Obstetrics and Gynaecology, BIRDEM General Hospital, Dhaka from July 2015 to June 2016. This study was
conducted on two groups of pregnant women: group A (PGDM) and group B (GDM). A total of 100 cases were
selected and in each group 50 pregnant women were enrolled. Singleton pregnancy and age 18 to 45 years
were included. Pregnancy with hypertension, heart disease, renal disease and other metabolic disorders were
excluded.
Results: In this study mean gestational age of the study subjects were 35.72 ± 2.61 weeks and 36.58 ± 2.34
weeks in PGDM and GDM groups. History of GDM [34.0% vs 16.0%], intrauterine death (IUD) [14.0% vs
2.0%] and abortion [22.0% vas 6.0%] were significantly higher among PGDM patients than GDM patients.
Regarding present pregnancy complications, polyhydramnios [32.0% vs 14.0%], preterm delivery [38.0% vs
20.0%], vulvovaginitis [28.0% vs 12.0%] and premature rupture of membrane (PROM) [24.0% vs 8.0%] were
significantly higher in PGDM than GDM patients. Wound infection was significantly high in PGDM groups
[35.7% vs 11.1%] among the patients delivered by lower uterine Cesarean section (LUCS). Regarding perinatal
complications, hypoglycemia [22.0% vs 8.0%], birth asphyxia [24.0% vs 8.0%], RDS [24.0% vs 8.0%] were
significantly higher among PGDM comparing GDM patients.
Conclusion: The maternal and perinatal outcomes of pregestational diabetes mellitus were less favorable
than those of gestational diabetes mellitus.
Key Words : Gestational diabetes mellitus, pregestational diabetes, maternal outcome, perinatal outcome.
(BIRDEM Med J 2019; 9(2): 127-132)

Author Information Introduction

a. Dr. Faryal Mustary, Associate Consultant, NHN, Rampura Diabetes mellitus is a chronic condition characterized
Centre, Diabetic Association of Bangladesh.
by increased glucose levels in the body. The long-term
b. Professor Dr. T.A. Chowdhury, Professor, Department of
Obstetrics and Gynaecology, BIRDEM General Hospital, increased levels of glucose, called hyperglycemia, result
Dhaka. in various health complications.1,2 When diabetes
c. Professor Dr. Ferdousi Begum, Professor and Head of the mellitus is diagnosed before pregnancy, it is designated
Department of Obstetrics and Gynaecology, BIRDEM General
Hospital, Dhaka.
as pre-gestational diabetes mellitus (PGDM).
d. Nusrat Mahjabeen, Lecturer, Department of Obstetrics and Gestational diabetes mellitus (GDM) is defined as a
Gynaecology, Z.H. Sikder Women’s Medical College and
Hospital, Dhaka.
glucose intolerance of variable severity with onset or
Address of correspondence: Dr. Faryal Mustary, Associate first recognized during the present pregnancy. The entity
Consultant, NHN, Rampura Centre, Diabetic Association of usually presents late in the second or during the third
Bangladesh. E-mail: dr.faryalsaroare@gmail.com trimester. 3 It is one of the most common medical
Received: June 9, 2018 Accepted: February 28, 2019
complications of pregnancy. 4 GDM can adversely
Maternal and Perinatal Outcome in Gestational Diabetes Mellitus Compared to Pregestational Diabetes Mellitus Mustary F et al

impact perinatal outcome, increase the risk of obesity the maternal and perinatal outcome of pregnancy among
in offspring and the subsequent development of diabetes patients with pregestational diabetes and gestational
in mothers.5,6 Prevalence of GDM is 9.7% according diabetes mellitus.
to the WHO criteria and 12.9% according to the ADA
Methods
criteria in Bangladesh.7 South Asians are more prone
This observational analysitcal study was carried out in
to have diabetes at an earlier age and thus more
the Department of Obstetrics and Gynaecology in
vulnerable to GDM.8
BIRDEM hospital, Dhaka, from July 2015 to June 2016
Pregnancy is a great stressful physiological condition over a period of one year. Study was carried out between
in women during their reproductive period. two groups of pregnant women. Fifty cases of PGDM
Hyperglycemia at the time of conception and in early pregnant women (Group-A) and 50 cases of GDM
pregnancy specially during organogenesis results in six pregnant women of all trimester were enrolled from the
fold increase in risk of midline defects in the developing Inpatient Department, Department of Obstetrics and
embryo.3 Even a mild increase in glucose levels during Gynaecology, BIRDEM Hospital, Dhaka in this study.
pregnancy can adversely affect both the mother and Singleton pregnancy and age 18 to 45 years (mean age
fetus. Increased incidences of pre-eclampsia, preterm 26±) were included. Pregnancy with hypertension, heart
delivery, miscarriage, fetal malformation and perinatal disease, renal disease and other metabolic disorders
mortality and morbidity have been reported in diabetic were excluded.
pregnancies in comparison to the general population.9
PGDM patients were diagnosed case of diabetes and
Hyperglycaemia during pregnancy is associated with
GDM patients were selected after doing OGTT
macrosomia, which may subsequently lead to shoulder
dystocia and birth trauma in addition to an increase in (diagnosed by diagnostic criteria of NICE Clinical
the rate of Caesarean sections.10 Guideline, February, 2015). Then follow up was done
for several times, during antenatal, intrapartum, post
Globally, researchers are concerned about an increase partum and perinatal period. The perinatal and
in the prevalence of gestational diabetes mellitus (GDM) postpartum complications were recorded during the
and pregestational diabetes (PGDM).11 Middle Eastern period of hospital stay.
countries are reported to have a high prevalence of GDM
and PGDM, ranging from 4.7% in Iran12 to 24.9% in The purpose of the study was discussed with the patients
the United Arab Emirates13 in comparison to the United who fulfilled the enrollment criteria. Information about
States, where the prevalence ranges from 3.47% to the patients was recorded in the prescribed data
7.15%.14 PGDM and GDM are associated with adverse collection form, after taking informed consent. Data
fetal and maternal outcomes.15 Adverse fetal outcomes were collected by interview and from records. Statistical
include congenital anomalies, trauma during birth, analysis was performed by using window based
macrosomia and perinatal mortality.16 Adverse maternal computer software devised with Statistical Packages for
outcomes include increased rates of caesarean section Social Sciences (SPSS-21) (SPSS Inc, Chicago, IL,
and increased lifetime risk of developing type 2 USA). Quantitative data were expressed as mean and
diabetes.17 Cesarean deliveries may be associated with standard deviation and qualitative data were expressed
a range of morbidities, with complications ranging from
as frequency and percentage. Association between
mild to serious.18 Pregnant diabetic women have an
categorical variables was analyzed by Chi-square test
increased risk of developing obstetric complications
and continuous variable by independent sample t-test.
such as preeclampsia and preterm delivery and perinatal
For all statistical tests, p value <0.05 was considered
complications such as miscarriages and fetal
statistically significant.
malformations. These complications are observed more
frequently in women with PGDM compared to women Results
with GDM; this may be due to the prolonged and severe Total patients were 100, 50 in each group. There was
fetal exposure to hyperglycaemia.19 no significant difference between group A (PGDM) and
Number of studies on this subject done in our country group B (GDM) redarding age and gestational age
is limited. So the present study is planned to find out (Table I). Table II shows distribution of study subjects

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according to past obstetric history. Bad past obstetric preterm delivery, vulvovaginitis and premature rupture
history was significantly high in PGDM. History of of membrane significantly higher in group A than group
GDM, intrauterine death (IUD) and abortion was B. Mode of delivery was comparable between two
significantly high in group A (PGDM) than group B groups (Table V). Table VI shows no significant
(GDM). There was no significant difference between difference in intra-partum maternal complication
group A and group B in blood glucose at fasting and at between two groups as was true for pregnancy outcome
2-hr ABF (Table III). Table IV shows polyhydramnios, (Table VII).

Table I Age and gestational age of the study population at enrollment (N=100)

Group p value
Group A (Mean ±SD) Group B (Mean ±SD)
Age (years) 26.62 ± 4.57 26.04 ± 4.62 0.529
Gestational age (weeks) 35.72 ± 2.61 36.58 ± 2.34 0.087

Table II Distribution of study population according to their past obstetric history (N=100)
Past obstetric history Group p value
Group A (n, %) Group B (n, %)
History of GDM 17 (34.0) 8 (16.0) 0.038
Congenital anomaly 6 (12.0) 2 (4.0) 0.140
IUD 7 (14.0) 1 (2.0) 0.027
Over weight baby 2 (4.0) 0 (0.0) 0.495
Stillbirth 1 (2.0) 0 (0.0) 1.000
Abortion 11 (22.0) 3 (6.0) 0.021

*Multiple responses

Table III Distribution of study population according to their mean blood glucose level at enrolment in the
study (N=100)
Blood glucose Group P value
Group A (Mean ±SD) Group B (Mean ±SD)
Fasting 6.68 ± 1.19 6.47 ± 1.10 0.347
2-hr ABF 11.92 ± 1.23 12.25 ± 1.38 0.219

Table IV Distribution of study population according to the complications in current pregnancy (N=100)
Present pregnancy complications Group P value
Group A (n, %) Group B (n, %)
Abortion 3 (6.0) 2 (4.0) 1.000
UTI 13 (26.0) 15 (30.0) 0.656
Polyhydramnios 16 (32.0) 7 (14.0) 0.032
Preterm delivery 19 (38.0) 10 (20.0) 0.047
PIH/Pre-eclampsia 7 (14.0) 10 (20.0) 0.424
Vulvovaginitis 14 (28.0) 6 (12.0) 0.046
PROM 12 (24.0) 4 (8.0) 0.029
Oligohydramnios 1 (2.0) 0 (0.0) 1.000
* Multiple responses

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Maternal and Perinatal Outcome in Gestational Diabetes Mellitus Compared to Pregestational Diabetes Mellitus Mustary F et al

Table V Distribution of study population according to mode of delivery (N=100)

Mode of delivery Group P value
Group A (n, %) Group B (n, %)
Vaginal delivery 22 (44.0) 23 (46.0) 0.841
Caesarean section 28 (56.0) 27 (54.0)

Table VI Distribution of study population according to intra-partum maternal complications who delivered
vaginally (N=100)

Intra-partum maternal Group P value

complications Group A (n=22) Group B (n=23)
(n, %) (n, %)
Cervical tear 2 (9.1) 3 (13.0) 0.673
Perineal tear 2 (9.1) 3 (13.0) 0.673
Shoulder dystocia 1 (4.5) 2 (8.7) 0.577

Table VII Distribution of study population according to their pregnancy outcome (100)
Pregnancy outcome Group P value
Group A Group B
Live birth 39 (78.0) 41 (82.0) 0.617
Abortion 3 (6.0) 2 (4.0) 1.000
IUFD 6 (12.0) 5 (10.0) 0.749
Fresh stillbirth 2 (4.0) 2 (4.0) 1.000

There was no significant difference in post-partum maternal complications between group A (PGDM) and group B
(GDM) who delivered by LUCS except wound infection (Table VIII). Wound infection was significantly high in
PGDM group. No significant difference in post-partum maternal complications between group A (PGDM) and
group B (GDM) who delivered by vaginally. There was no significant difference in hypoglycemia, birth asphyxia
and RDS between two groups (Table IX). No significant difference regarding congenital malformation between
group A and group B was found (Table X).

Table VIII Distribution of study population according to post-partum maternal complications (N=100)
Post-partum maternal Group P value
complications Group A (n=28) Group B (n=27)
(n, %) (n, %)
Delivered by LUCS
PPH 4 (14.3) 3 (11.1) 1.000
UTI 6 (21.4) 8 (29.6) 0.485
Mastitis 3 (10.7) 2 (7.4) 0.670
Wound infection 10 (35.7) 3 (11.1) 0.032
Others 1 (3.6) 1 (3.7) 1.000
Delivered vaginally
PPH 3 (13.6) 1 (4.3) 0.346
UTI 2 (9.1) 3 (13.0) 1.000
Multiple responses

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Table IX Distribution of study population according to perinatal complications (N=100)

Perinatal complications Group P value

Group A Group B
Hypoglycemia 11 (22.0) 4 (8.0) 0.049
Birth asphyxia 12 (24.0) 4 (8.0) 0.029
Hyperbilirubinemia 8 (16.0) 6 (12.0) 0.564
Macrosomia 1 (2.0) 4 (8.0) 0.169
RDS 12 (24.0) 4 (8.0) 0.029
Congenital malformation 4 (8.0) 1 (2.0) 0.362
* Multiple responses

Table X Distribution of study population according to congenital malformation (N=100)

Type of congenital malformation Group P value

Group A Group B
Present 4 (8.0) 1 (2.0) 0.362

Discussion Pregnancy outcome was less favourable in PGDM than

In this study, there was no significant difference between GDM. The patients of PGDM lost 11 pregnancy and
PGDM and GMD regarding mean age of the study the patients of GDM lost 9 pregnancy; as stillbirth, IUFD
subjects. Maternal age was higher in PGDM than that and abortion. The still birth rate was higher in PGDM
of GDM in the study of Wahabi et al.20 which is similar than GDM.20
to this study. In a study of Clausen et al.21 shows that
Regarding perinatal complications hypoglycemia, birth
increasing age of the patients of GDM had been
asphyxia and RDS were significantly higher in PGDM
described as a risk factor for pregnancy complication.
than GDM group, which is similar to the study of Abu-
There was statistical significant difference between Heija et al.22, they found neonatal hypoglycemia were
PGDM and GDM in past bad obstetric history. History significantly high in PGDM. Macrosomia has been
of GDM, IUD and abortion were significantly higher demonstrated to be the predominant adverse outcome
among PGDM patients than GDM patients. History of
in cases of GDM.23
previous miscarriage was higher in PGDM than GDM.20
In this study, less significant difference were found
Regarding present pregnancy complications,
bewteen PGDM and GDM outcome. It may be
polyhydramnios, preterm delivery, vulvovaginitis and
mentionable that the study was done in a referral
PROM were significantly higher in PGDM than GDM
hospital, where the diabetic patients were well managed.
patients. In PGDM group 1 patient had
oligohydramnios. Women with PGDM had a So it is believed that, if the field of study was any where
significantly higher incidence preterm deliveries rather than referral hospital, the result of the same study
comparing GDM.20,22 Incidence of Oligohydramnios would become remarkably different and significant.
was also higher in PGDM comparing GDM.22
Conclusion
Caesarean section was more frequently needed in pre-
The maternal and perinatal outcomes of pregestational
gestational than gestation pregnant women. There was
diabetes mellitus were less favorable than those of
no statistical significant difference between PGDM and
GMD. Wahabi et al.20 revealed C/S was higher in gestational diabetes mellitus.
PGDM than GDM. Conflict of interest: Nothing to declare.

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