Predictor of HbA1C in abnormal OGCT in 1st and 2nd trimester and its correlation with abnormal fetal outcome in comparison with ultra sonogram

INTRODUCTION: Pregnancy is an unique metabolic state in which, the mother has to provide fuel not only for herself but also for the metabolic needs of the conceptus. To accomplish this certain physiological changes. (especially is glucose metabolism) and women with preexisting aberration in insulin economics or preexisting decline in B cell function develop GDM (CURET et al). Normal pregnancy is an insulin resistant state mediated by placental anti-insulin hormones. If the maternal pancreas cannot increase production of insulin to sustain normoglycemia despite these anti insulin hormones gestational diabetes occurs. Gestational diabetes is a commonest metabolic disorder in pregnancy. Incidence varies between 3 to 12% depending on the sample population and diagnostic criteria used. The name gestational diabetes mellitus was recommended by American college of obstetricians and gyenaecologists in the second international workshop conference on gestational Diabetes Mellitus in Chicago on October 25th 1984, replacing the names impaired glucose tolerance in pregnancy (RUST, JAMES et al). Gestational diabetes mellitus and other categories of glucose intolerance during pregnancy are one of the causes for increased perinatal mortality and maternal mortality. As pregnancy proceeds the prevention of maternal complication and perinatal mortality and morbidity required continued normalization of metabolism and close surveillance of the fetal condition. Hence it is mandatory that universal screening of all pregnant subjects must be undertaken to detect abnormal glucose tolerance during 1st and 2nd trimester for early detection and effective management. Decreased infant, perinatal mortality and morbidity rates have followed higher detection rates and more aggressive treatment of mild carbohydrate intolerance in pregnancy. AIM OF THE STUDY: To study the HbA1c in abnormal OGCT in 1st and 2nd trimester and its correlation with abnormal fetal outcome. MATERIAL AND METHODS: TYPE OF STUDY: Descriptive study. STUDY PLACE: Department of Obstetrics and Gynaecology, ISO-KGH, Madras Medical College, Chennai. At the time of first antenatal visit all pregnant women are clinically evaluated by a detailed history and a proper general, system, obstetric examination and Oral Glucose Challenge Test (OGCT). Among them 500 patients with abnormal OGCT will be enrolled for the study. These patients are analysed further by HbA1C and ultrasonogram examination during 1st and 2nd trimester. After study is completed, the various levels of HbA1C are interpreted in terms of maternal and fetal outcome. HbA1C is measured by an on-chip electrochemical flow immunoassay method. HbA1C 9% is advised termination. Those with HbA1C between 6-9% is correlated with USG findings and further management decided. If no abnormality detected the mother is advised for further management regarding Gestational Diabetes Mellitus (GDM). All the patients will be provided with routine antenatal care till delivery. Statistical Tools (To be included at the end of Materials and Methods). The information collected regarding all the selected cases were recorded in a Master Chart. Data analysis was done with the help of computer using Epidemiological Information Package (EPI 2010) developed by Centre for Disease Control, Atlanta. Using this software range, frequencies, percentages, means, standard deviations, chi square and 'p' values were calculated. Kruskul Wallis chisquare test was used to test the significance of difference between quantitative variables and Yate’s chi square test for qualitative variables. A 'p' value less than 0.05 is taken to denote significant relationship. SUMMARY: In our present study 500 antenatal women with abnormal glucose challenge test in first and second trimester had been selected and subjected to HbA1C estimation. Among the 500 women studied only 7 mothers had an abnormal HbA1C value 6 had good fetal outcome which accounts for 85.7% and 1 had abnormal fetal outcome which accounts for 14.3%. The mean HbA1C values were 5.64 for those with good fetal outcome and 5.91 for those with abnormal outcome these differences were not statically significant. CONCLUSION: In our present study 500 antenatal women with abnormal glucose challenge test in first and second trimester had been selected and subjected to HBA1C estimation. The study revealed HbA1C is not a good predictor for GDM with adverse fetal outcomes. Hence the study HbA1C is not a marker for GDM with congential anomalies