32.2.36 Gestational Diabetes and the Preterm Births in Obese Women in Low Socioeconomic Group

Original Article

 

Gestational Diabetes and Preterm Births

Gestational Diabetes and the Preterm Births in Obese Women in Low Socioeconomic Group

Aisha Khatoon1, Shabnam Nadeem2, Muhammad Saad Usmani3 and Alvia Saad2

ABSTRACT

Objective: To determine Gestational Diabetes and the Preterm births in obese women in low socioeconomic group.

Study Design: Prospective case control study.

Place and Duration of Study: This study was conducted in Obstetrics and Gynecology Department Unit III at Abbasi Shaheed hospital from January 2018 to December 2018.

Materials and Methods: Total 182 patients were included in study. The inclusion criteria involved women of reproductive age group i-e; 16- 45years, pregnant obese and non-obese females visiting outpatient department and also admitting in inpatient department due to complications, belonging to lower socioeconomic class. Pregnant females with comorbid like previously diagnosed diabetes mellitus, hypertension, end stage renal disease, bleeding disorders were not included in study.

Results: Out of 182 patients enrolled in the study the mean age of the patients was 32.7± 3.76 yrs. Most of the patients belong to age group 31-35yrs, n=84(46.2%). There were 91 women in both obese and non-obese groups. The average BMI of patients was 33.04mg/kg body weight. Out of 91 obese women, mostly women were in the range of mild obesity i.e.; n=64(35.2%) while 27(14.8%) were with moderate obesity. There was total n= 138 preterm births seen among women enrolled. The mean preterm births took place at 34weeks ±3.1 weeks. The preterm births when compared between obese and non-obese, increased number of preterm births were found with statistical correlation found. (p value-0.000).  The mean of random blood sugars of patients was 279.4mg/dl± 37.02 mg/dl.

Conclusion: The obese women with gestational diabetes are at increased risk of preterm births. The increased incidence was seen among women of low socioeconomic class with non-adherence towards treatment due to unawareness, financial issues and casual attitude towards gestational diabetes.

Key Words: Preterm births, gestational diabetes

Citation of article: Khatoon A, Nadeem S, Usmani MS, Saad A. Gestational Diabetes and the Preterm Births in Obese Women in Low Socioeconomic Group. Med Forum 2021;32(2):152-155.

 

 

INTRODUCTION

Worldwide, incidence of overweight and Obesity incidence is increasing among women of reproductive age1-5. Around 38.4% women in reproductive age are overweight and 63.39% obese in Pakistan. In US, the incidence among obese 11-40% and in overweight 12-38% among pregnant women1.  According to American Medical association, obesity and overweight are preventable causes of mortality.

 

 

1. Department of Obstet and Gynae, Sobraj Maternity Hospital Karachi.

2. Department of Obstet and Gynae, Abbasi Shaheed Hospital, Karachi.

3. Department of Anatomy, Liaquat College of Medicine &Dentistry, Karachi.

 

 

Correspondence: Dr. Alvia Saad, Registrar, Abbasi Shaheed Hospital, Karachi.

Contact No: 0331-2471903

Email: alviasaad @gmail.com

 

 

Received:  August, 2020

Accepted:  October, 2020

Printed:      February, 2021

 

 

Preterm births itself is one the most common cause of neonatal morbidity and mortality and also later in life childhood morbidity 1.

In Pakistan, studies have shown 20.4% incidence of gestational diabetes in women had pre-pregnancy obesity6. Various studies had also shown that there is increased risk of preterm births, cesarean sections, macrosomic babies also large for gestational age babies in overweight as well as obese women4-8. A large population based study by Su et al in 2019 has shown increased risk of preterm births and other pregnancy related complications in women with pre-pregnancy weight 4. Another study by Anwar et al has shown incidence of 22.7%-31.8% preterm births in women with gestational diabetes11.

Lower socioeconomic population in Pakistan constitutes around 17.2% 9. The social norms, dietary habits, unawareness towards outcomes of gestational diabetes and preterm births, no adherence to treatments, lack of knowledge, fear of antidiabetic medications affecting births are the common observations among pregnant women 10.

The aim of the study was to determine the frequency of preterm births in patients with gestational diabetes in obese and non-obese lower socioeconomic class visiting hospital in order to know the impact of morbidity due to it and its influence on society reduce the increasing maternal and neonatal health burden of society.

MATERIALS AND METHODS

This was a prospective case-control study conducted in Abbasi Shaheed hospital for a period of one year from January 2018 to December 2018 in Obstetrics and Gynecology Unit III from patients meeting inclusion criteria. The Ethical consent was taken from Ethical review committee of the hospital. The inclusion criteria involved women of reproductive age group i-e; 16- 45years, pregnant obese and non-obese females visiting outpatient department and also admitting in inpatient department due to complications. Patients belonging to lower socioeconomic class was included in study with salary income below 15k. Pregnant females with comorbid like previously diagnosed diabetes mellitus, hypertension, end stage renal disease, bleeding disorders, overweight pregnant women were not included in study. The sampling technique used was probability consecutive type with sample size of 182 patients keeping prevalence of 22.7% and margin of error of 9%11. Gestational diabetes was labelled by oral glucose tolerance test with fasting glucose 105 mg/dl, after1 hour 190 mg/dl, after 2 hours 165 mg/dl and after 3 hours 145 mg/dl. Preterm birth was defined as birth of child below 37weeks of gestation. According to WHO classification, preterm births were divided into extreme preterm births <28weeks, very preterm 28-32weeks, moderate to late preterm 32- 37weeks.Informed consent was taken from the patient and two groups were made by lottery method. Group 1 was patients who were obese labelled after checking body mass index greater than 30kg/m2. While group 2 included all normal weight patients. Detailed history regarding preconception weight and height, previous illnesses for exclusion or previous history of gestational diabetes was recorded in data. Patients were followed throughout pregnancy for pregnancy related complications i-e; preterm births.

The statistical analysis was performed by using SPSS.20. Mean +/- SD were calculated from age of patient, and duration of gestational diabetes mellitus and gestational hypertension. Stratification was done regarding to preterm births with obesity and normal weight patients. Chi square test was applied keeping p value <0.05 to be significant.

RESULTS

Out of 182 patients enrolled in the study the mean age of the patients was 32.7± 3.76yrs. Most of the patients belong to age group 31-35yrs, n=84(46.2%), while the rest 25-30yrs, n= 50(27.5%)and 36-40yrs, n=48(26.4%) (table 1). There were 91 women in both obese and non-obese groups. Most of the women were of age group 31-35yrs n=84, with frequency higher in both obese and non-obese women, but this was statistically not significant with no correlation was found. (p value-0.157). (table 2). The average BMI of patients was 33.04mg/kg body weight. Out of 91 obese women, mostly women werein the range ofmild obesity i.e.; n=64(35.2%)while 27(14.8%) were with moderate obesity (table 1).There was total n= 138 preterm births seen among women enrolled (figure 1). The mean preterm births took place at 34weeks ±3.1 weeks.The preterm births when compared between obese and non-obese, increased number of preterm births were found with statistical correlation found. (p value-0.000).  Mostly there were very preterm births then moderate to late preterm.  Extreme preterm births were more frequently observed among women with higher sugar levels and non-compliance to medications. Patents who were diagnosed with gestational diabetes were followed with advise for strict glycemic control but most of the women did not take medicines properly due to lack of availability due to financial constraints in almost all the patients n=120 while some took strict control of blood sugars. The mean of random blood sugars of patients was 279.4mg/dl± 37.02 mg/dl. The complications occurred in patients who were not vigilant in their glycemic control and therefore presented with preterm births. Around 95 patients underwent cesarean sections with n=55 patients from group 1 obese patients and remaining n=40 from group 2 i-e; non obese.

No maternal or neonatal mortality was noted with no patient presented with any emergency condition with very high blood sugars.

 

Table No.1: Demographic factors

Demographic factors

Mean ±SD

Age in years

32.7± 3.76

Gestational diabetes

(Blood sugars)

279.41±37.02

Preterm births in weeks

34.12±3.158

Obese women

Mild obesity

Moderate obesity

91(50%)

64 (35.2%)

27(14.8%)

Table No.2: Variables

Variables

Obese

N=91

Non obese

N=91

P value

Age in years

 

 

 

25-30yrs

25

25

 

0.770

31-35yrs

44

40

36-40yrs

22

26

Gestational random blood sugars range

200-250mg/dl

12

35

 

0.000

251-300mg/dl

48

36

301- 350mg/dl

31

20

 

P value 0.000

Figure No.1: Preterm birth with Obese vs non-obese

DISCUSSION

Preterm births are the common cause of morbidity and mortality especially among neonates. In Pakistan, preterm birth 4.9%-11.2% according to estimates of study in 2014 13- 16. While the gestational diabetes was reported to be 20.4% in obese antenatal women as concluded by study by Syed in 20146. Our study has shown the incidence of 31.8% preterm births with an observation increasingly found in lower socioeconomic group. The women belonging to socioeconomic group were either had financial constraints, noncompliance of medications, unawareness of complications associated with gestational diabetes and their outcomes.

Obesity is the problem encountered worldwide17-20. Around 28.4%-34% women belonging to reproductive age group are suffering from obesity in US, according to 2010 estimates14. In our study, the mean age of the patients in obese and non-obese group was nearly same. However, the women in obesity group has age mostly in the range of 31-35yrs. The Center of Disease Control has identified morbid obesity i.e. 7.8% in this reproductive age group of population 14. In our study the women, mild obesity 35.2%, moderate obesity 14.8%.The patients who were obese has higher incidence of preterm births compared to non-obese patients i-e; 20.8%:10.9%.

Mostly patients in reproductive age group also had raised random blood sugars diagnosed during pregnancy and on follow up too when treatment was advised, women did not show compliance to medicines and resulted in raised blood sugars and therefore leading to preterm births. These preterm births were higher in obese women compared to women who are not obese. This increased rate of preterm births seen in our study is most likely to two major risk factors i.e. obesity and gestational diabetes with non-adherence to treatment mostly due to financial constraints in lower socioeconomic class and other cause was non awareness regarding complications.

Among reproductive age group mostly women have problem of obesity and during pregnancy it leads to some health problems affecting both mother and child. There are different effects of obesity in pregnancy like during early gestation spontaneous abortions, congenital abnormalities, due to risk of insulin resistance, in late gestation fetal abnormalities, increased risk of cesarean sections, postoperative wound infections with delayed healing, thromboembolism, postpartum depression and other related illnesses6, 11, 12.  However, in our study as patients had mostly mild to moderate obesity and were not strikingly very high; therefore, no other complication besides lower segment cesarean sections were slightly more in obese compared to non-obese but this result was no statistically significant.

In our study patients with preterm births did not had any previous illness, nulliparous women, belonging to lower socioeconomic class. The preterm births in our study among obese compared to non-obese women were n= 86 vs 53, with increased ratio seen among obese gestational diabetic’s women compared to non-obese women. The results of our study therefore are consistent with Hanif et al has concluded in his study that preterm births early or late can be reduced by reduction in modifiable factors12. While Syed et al6 has found 15.2% obesity in antenatal women enrolled in study, with gestational diabetes found in 20.4% cases, increased lower segment cesarean sections in 30.4% cases, pre-eclampsia 4.8%, pregnancy induced hypertension in 17.2% of women.

CONCLUSION

The obese women with gestational diabetes are at increased risk of preterm births. The increased incidence was seen among women of low socioeconomic class with non-adherence towards treatment due to unawareness, financial issues and casual attitude towards gestational diabetes.

Author’s Contribution:

Concept & Design of Study:

Aisha Khatoon

Drafting:

Shabnam Nadeem

Data Analysis:

Muhammad Saad Usmani, Alvia Saad

Revisiting Critically:

Aisha Khatoon,
Shabnam Nadeem

Final Approval of version:

Aisha Khatoon

Conflict of Interest: The study has no conflict of interest to declare by any author.

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