The association between an oral glucose tolerance test performed at term pregnancy and obstetric outcomes

Aims Assessing the value of oral glucose tolerance test performed at term pregnancy in identifying obstetric complications. Methods Retrospective cohort study of women with a normal 50 g glucose challenge test who also had an oral glucose tolerance test at term (defined as at or after 37 weeks of gestation). Comparison between the pathological and normal oral glucose tolerance test groups was performed. Results The mean glucose in the glucose challenge test of women in the normal oral glucose tolerance test ( n = 256) group was lower than that in the pathological oral glucose tolerance test ( N = 16) group (105 ± 17 mg/dl (5.8 ± 0.9 mmol/l) vs 117 ± 13 mg/dl (6.5 ± 0.7 mmol/l), p = 0.007). Relevant obstetrical complications did not differ significantly between the groups. Of note, in the pathological oral glucose tolerance test group only one woman delivered a macrosomic infant. Conclusions A pathological oral glucose tolerance test performed at term was unable to identify women at risk for impaired glucose metabolism-related obstetric complications and is therefore of limited clinical value and seems to be unjustified.

Pregnancy and perinatal outcomes in women with polycystic ovarian syndrome

Background: To study the pregnancy and perinatal outcomes in women with PCOS with normal women and to study the incidence of complications like menstrual irregularities, mode of conception, gestational diabetes mellitus, pre eclampsia, preterm labour and NICU admissions in women with PCOS.Methods: It was prospective comparatives study done in 100 women to compare outcome in pregnancy with PCOS and normal women. A detailed history, general and obstetric examination, antenatal investigations, routine dating scan, glucose challenge test at 24 to 28 weeks in study and control groups, blood pressure recording and urine for proteinuria after 20 weeks to evaluate preeclampsia. After delivery, birth weight and APGAR score at 1 and 5 minutes were recorded. Body mass index was calculated and pregnancy outcome studied and compared.Results: Out of 50 women with PCOS 13 developed GDM, 10 developed pre eclampsia, 6 had abortion, 4 went into preterm labour. 15 babies required NICU admission.Conclusions: Pregnancy complications like GDM, pre eclampsia, preterm labour, abortions and neonatal complications like NICU admissions are higher in women with PCOS when compared with normal women. Hence PCOS needs to be diagnosed early and treated accordingly to prevent pregnancy complications.

The Auto-Brewery Syndrome: A Perfect Metabolic “Storm” with Clinical and Forensic Implications

Auto-brewery syndrome (ABS) is a rare, unstudied, unknown, and underreported phenomenon in modern medicine. Patients with this syndrome become inebriated and may suffer the medical and social implications of alcoholism, including arrest for inebriated driving. The pathophysiology of ABS is reportedly due to a fungal type dysbiosis of the gut that ferments some carbohydrates into ethanol and may mimic a food allergy or intolerance. This syndrome should be considered in patients with chronic obstruction or hypomotility presenting with elevated breath and blood alcohol concentrations, especially after a high carbohydrate intake. A glucose challenge test should be performed as the confirmatory test. Treatment typically includes antifungal drugs combined with changes in lifestyle and nutrition. Additional studies are particularly needed on the human microbiome to shed light on how imbalances of commensal bacteria in the gut allow yeast to colonize on a pathological level.

Validation the sensitivity and specificity of diabetes in pregnancy study group of India recommended 75 g oral glucose challenge test by comparing with carpenter and couston 100 g oral glucose tolerence test

Background: Diabetes is one of the most common non communicable diseases globally. India is considered as the world diabetes capital. Women detected with gestational diabetes mellitus (GDM) have an increased incidence of developing diabetes; especially type 2 diabetes mellitus in the later life, and future development of obesity and diabetes in the offspring. So the aim of this study is to validate the sensitivity and specificity of diabetes in pregnancy study group of India (DIPSI) recommended 75 g oral glucose challenge test (OGCT) by comparing with carpenter and couston 100 g oral glucose tolerance test (OGTT) and to note the prevalence of gestational diabetes in antenatal population attending Kempegowda Institute of Medical Sciences (KIMS).Methods: All antenatal patients reporting to our hospital at or before 24 to 28 weeks period of gestation will be recruited for the study. Patients at random will be subjected to 75g glucose load according to DIPSI criteria and one week later to carpenter and couston 100 g OGTT. Blood glucose is estimated from venous blood using glucose oxidase and peroxidase (GOD-POD) method and patients diagnosed according to respective criteria.Results: Most of the patients were in age distribution of 20–25 years. Among 100 patients in study group 28 were diagnosed as GDM by DIPSI criteria. Among 100 patients, 12 patients were detected as GDM by carpenter and couston GTT, 19 patients had impaired glucose tolerance. The incidence of GDM in the antenatal population attending KIMS hospital between gestational ages of 24–28 weeks is 12%.Conclusions: DIPSI can be used as a diagnostic test for GDM as one step simple and easy procedure especially I low resource settings like India for improved pregnancy outcome.

Screening of Diabetes in Pregnancy at Nepalgunj Medical College Teaching Hospital Kohalpur

Introduction: Gestational Diabetes Mellitus (GDM) is defined as glucose intolerance of variable severity or hyperglycemia occuring for the first time during pregnancy but the glucose intolerance reverting back to normal after the puerperium. According to American Diabetic Association, approximately 7% of all pregnancy are complicated by Gestational Diabetes Mellitus, resulting in more than two lakhs cases annually and the prevalence may range from 1-14% of all pregnancies. Gestational Diabetes Mellitus usually develop in the second trimester and carries grave prognosis both for mother and fetus. So screening of diabetes is necessary for early detection of diabetes and prevention of further progression. Aims: Screening of impaired glucose tolerance and gestational diabetes mellitus by glucose challenge test (GCT) and oral glucose tolerance test (OGTT) at 24-28 weeks of pregnancy. Methods: This study was conducted in Nepalgunj Medical College Teaching Hospital over one year period taking 98 pregnant women who came to ANC (Antenatal Check up) out patient department. Screening for diabetes was done giving 50 gm of oral glucose (glucose challenge test) to the pregnant women at 24-28 weeks of gestational age. Results: The incidence of Impaired glucose tolerance and gestational diabetes in this study population was 4.1% and 1% respectively. Conclusion: Screening of Diabetes mellitus in Second trimester of pregnancy is important investigation to be done to prevent the mother and the fetus from many upcoming complications of diabetes.