Clinical presentation and management of diabetes mellitus in pregnancy

OBJECTIVE: To evaluate the clinical presentation, management, and the outcome of diabetes mellitus in pregnancy. METHODS: One hundred seventy-one patients with diabetes mellitus admitted between September 1, 2006, and June 30, 2008, to the labor room at Maternity Hospital in Kuwait for induction of labor made up the study population; while an equivalent number of patients without medical complications who also were admitted for induction of labor made up the control group. The patients were assessed at admission, and their medical data were extracted. The study and control patients were monitored through labor/puerperium, and the outcome was documented. RESULTS: Gestational diabetes mellitus was diagnosed in 71.9% of the study patients, a past history of diabetes mellitus was recorded in 81.34% of the study patients, and 49.2% of the patients were admitted at 8–12 weeks of gestation for diabetic control. The mean weight gained in pregnancy was significantly higher for control patients (11.52±5.643 versus [vs] 9.90±5.757 kg/m(2); P<0.009), and the body mass index of study patients was higher (32.00±6.160 vs 28.20±5.885 kg/m(2); P<0.0001). Of the study population, 64.3% of the patients were managed with diet and increased physical activity and 35.7% with insulin, diet, and increased physical activity. The incidences of maternal morbidity in both study and control groups were comparable, and the incidence of preeclampsia was low, at 2.3%. The gestational age at delivery was higher in the control group (39.02±1.834 weeks vs 38.62±1.773 weeks; P<0.0001), and the percentage of cesarean deliveries was higher in the study population (44.4% vs 33.3%; P=0.046). The Apgar scores of the both groups were comparable and in the normal range, and the incidences of fetal anomaly (1.17%), shoulder dystocia (1.8%), and Erb’s palsy (1.8%) were low. CONCLUSION: Gestational diabetes mellitus was diagnosed in 71.9% of the diabetic patients studied, and dietary control and increased physical activity were the main modalities of management. There was an increased rate of cesarean section in the study population, the incidences of maternal and perinatal morbidity were low, and the perinatal outcomes were satisfactory.