Abstract

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance occurringfor the first time during pregnancy. The prevalence of GDM varies in direct proportion to theprevalence of Type 2 diabetes for a given ethnic group or population. It is crucial to detectwomen with GDM as the condition is associated with diverse range of adverse maternal andneonatal outcomes. This study aims at determining the incidence of insulin resistance and gestational diabetes mellitus in the antenatal population and for their maternal and foetal outcomes.
Materials& Methods: A hospital based observational prospective study done on all pregnant women attending the antenatal clinic in government district hospital, Sirohi, Rajasthan, India during one year period.Screening for Insulin Resistance was done at the time of booking or the first antenatalvisit if they met the criteria for the high risk group, by Fasting Serum Insulin and FastingPlasma Glucose levels.IR value calculated with HOMA-2IR software and value > 1.8 wastaken as cut off for insulin resistance. Patients labelled GDM were started on specifictreatment with medical nutrition therapy, oral hypoglycaemic agent and insulin therapy. Theywere then followed up till term ensuring adequate glycaemic control with 3 weeklysupervised hospitalized blood sugar profile. Maternal and foetal outcomes were there afterdocumented and studied.
Results:Our study showed that total no. of antenatal patients was 500 during one year study period and 55 (11%) patients detected insulin resistance and gestational diabetes mellitus. So, the incidence of carbohydrate intolerance was 11%.The mean age of these pregnant women was 28.56±4.23 years.Our results shows that positive statistically significant correlationbetween insulin resistance and development of glucose intolerance (p <0.0001).  The present study shows that there is no statistical significant association between development of Gestational Hypertension and Insulin Resistance (P>0.05).
Conclusion: We concluded that early detection and institution of specific treatment of glucose intolerance with MNT/ OHA/ Insulin therapy certainly gives better maternal and neonatal outcomes.The costeffectiveness and simplicity of this model of care makes it suitable for countries with highprevalence of glucose intolerance.