Gestational diabetes complicated by hydramnios was not associated with increased risk of perinatal morbidity and mortality

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Abstract

Objective: To determine whether gestational diabetes (GDM) complicated with hydramnios is associated with higher rates of perinatal morbidity and mortality than those with normal amniotic fluid (AFI). Study Design: A case control study of 368 pregnant women with GDM was conducted between January 1995 and December 1996. The study group consisted of 184 women with hydramnios (AFI>25 cm) that were matched for maternal age, parity, and gestational age to 184 women with gestational diabetes and normal AFI. A Student’s t-test, McNemar test and logistic regression test were used to compare the two groups. Results: Both groups were under strict metabolic control; mean glucose levels of 5.2±2.4 mmol/l in the study group and 5.5±2.4 mmol/l in the controls (P>0.05). There were no significant differences between groups in the rates of severe preeclampsia, premature rupture of membranes (PROM), cesarean section rate, intrauterine growth restriction (IUGR), antepartum fetal death, fetal distress, prolapse of umbilical cord and placenta abruption. Even though the prevalence of large for gestational age (LGA) and birth weight were significantly higher in the study group (31 versus 19% and 3441±477 versus 3232±554 g, respectively), the prevalence of neonatal trauma was the same in both groups (2.6%). There was no significant difference in the Apgar scores (1 and 5 min), newborn hypoglycemia, metabolic acidosis and hyperbilirubinemia. Conclusions: Hydramnios in women with GDM was not associated with increased risk of perinatal morbidity and mortality.

Introduction

Polyhydramnios is a common finding in pregnancy (0.5–2%) [1], and is associated with increased maternal and fetal complications [2], [3]. Polyhydramnios is defined as amniotic fluid index (AFI) value of more then 25 cm, or more than 8 cm in one pocket. Diabetic pregnancies are commonly complicated by polyhydramnios (1.5–66%) [1], [2], [3]. The cause is still unclear. There are several hypotheses [4], [5], [6]: fetal hyperglycemia with polyuria, increased glucose concentration in the amniotic fluid that may cause an osmotic gradient leading to a shift of water into the amniotic space and increased fetal urine production in the fasting state.

The clinical significance of polyhydramnios in diabetic pregnancy has not been addressed enough in the literature [7], [8], [9], [10].

The aim of the present study was to assess influence of polyhydramnios in diabetic pregnancy on maternal and prenatal outcome.

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Materials and methods

A case control study of pregnant women with GDM (n=368) were enrolled in this study. The study population consisted of patients with singleton gestation and gestational diabetes who delivered at Soroka University Medical Center, between 1 January 1995, and 31 December 1996. The study group consist of pregnant women with gestational diabetes and polyhydramnios (n=184). They were compared with pregnant women with gestational diabetes and a normal amount of amniotic fluid (n=184). The two groups

Results

During the study period, 890 women with pregnancy complicated with GDM delivered at Soroka University Medical Center. The prevalence of polyhydramnios was 20.6% (184/890). The women in both groups were under strict metabolic control, with those in the study group having mean blood glucose of 5.2±2.4 mmol/l and HbA1c of 5.2±0.8% and hose in the control group having 5.5±2.4 mmol/l, HbA1c of 5.3±0.9% (NS). Maternal age and gestational age at delivery were matched between the two groups. (Maternal

Comments

The prevalence of polyhydramnios in the GDM population during the study period was 20.6% (184/890). This rate is similar to that previously reported by other investigators [1], [2], [3].

It has been long recognized that polyhydramnios is associated with increases in maternal morbidity as well as perinatal morbidity and mortality. The presence of hydramnios associated with GDM seems to raise the risk of adverse perinatal outcome. However, this is usually the result of poor glycemic control or

Condensation

Hydramnios in pregnancy complicated by GDM was not associated with increase risk of perinatal morbidity and mortality.

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