Gestational Diabetes Mellitus in Primi Gravida of Bangladesh in Different Trimesters

Background: Gestational Diabetes Mellitus is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. It is an important dimension of the syndrome of Diabetes Mellitus. Similar to other members of the Asian race, Bangladeshi women are also considered to be at a high risk for developing gestational diabetes.

Materials and Methods: In order to better understand whether this heightened risk attributed to race really exists even in primi gravida of Bangladesh, what is the percentage of the disease among them and whether there is any association of classical risk factors of the disease, a hospital based observational study was performed and the glycemic status of the primi gravida women presenting to Chittagong Medical College Hospital were assessed.

Results: A total of 117 primi gravida women, 39 in each of the three trimesters of pregnancy were selected as study subjects during the study period on the basis of set criteria and a 2 h, 75 g OGTT was performed over them. The mean age of the subjects enrolled was 21.1 ± 2.29 years, mean BMI was 21.6 ± 2.72 kg/m2, the mean fasting serum glucose values in mmol/l were 4.5 ± 0.63, 4.6 ± 0.62 and 4.7 ± 0.56 in 1st, 2nd and 3rd trimesters and the 2 h post 75 g glucose load serum glucose values in mmol/l were found 6.1 ± 1.08, 6.6 ± 1.76 and 7.0 ± 1.42 respectively. Using the cut-off value mentioned in the operational definition of GDM, 13.7% of the subjects were found to have the disease. Among them, 12.5% were in first trimester, 31.2% were in second trimester and 56.3

% were in third trimester of pregnancy. Maternal obesity/over-weight and a family history of diabetes, not the maternal older age, have shown statistically significant association with GDM. Prevalence of GDM has been noted in clinically non-risk group of subjects also.

Conclusion: From the above study, the inference could be drawn that, screening for GDM should be done as early as possible during pregnancy, even at first trimester, irrespective of presence or absence of established risk factors. But larger trials are needed to truly assess the disease burden of gestational diabetes among primi gravida women.