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Mahalakshmi MM, Bhavadharini B, Maheswari K, et al. Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3). Indian J Endocrinol Metab. 2016;20(4):491-6doi: 10.4103/2230-8210.183469.
Mahalakshmi, M. M., Bhavadharini, B., Maheswari, K., Kalaiyarasi, G., Anjana, R. M., Ranjit, U., Mohan, V., Joseph, K., Rekha, K., Nallaperumal, S., Malanda, B., Kayal, A., Belton, A., & Uma, R. (2016). Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3). Indian journal of endocrinology and metabolism, 20(4), 491-6. https://doi.org/10.4103/2230-8210.183469
Mahalakshmi, Manni Mohanraj, et al. "Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3)." Indian journal of endocrinology and metabolism vol. 20,4 (2016): 491-6. doi: https://doi.org/10.4103/2230-8210.183469
Mahalakshmi MM, Bhavadharini B, Maheswari K, Kalaiyarasi G, Anjana RM, Ranjit U, Mohan V, Joseph K, Rekha K, Nallaperumal S, Malanda B, Kayal A, Belton A, Uma R. Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3). Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):491-6. doi: 10.4103/2230-8210.183469. PMID: 27366715; PMCID: PMC4911838.
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Indian J Endocrinol Metab. 2016 Jul-Aug;20(4):491-6. doi: 10.4103/2230-8210.183469.

Comparison of maternal and fetal outcomes among Asian Indian pregnant women with or without gestational diabetes mellitus: A situational analysis study (WINGS-3).

Indian journal of endocrinology and metabolism

Manni Mohanraj Mahalakshmi, Balaji Bhavadharini, Kumar Maheswari, Gunasekaran Kalaiyarasi, Ranjit Mohan Anjana, Unnikrishnan Ranjit, Viswanathan Mohan, Kurian Joseph, Kurian Rekha, Sivagnanam Nallaperumal, Belma Malanda, Arivudainambi Kayal, Anne Belton, Ram Uma

Affiliations

  1. Department of Epidemiology and Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India.
  2. Department of Obstetrics and Gynecology, Joseph Nursing Home, Chennai, Tamil Nadu, India.
  3. Department of Diabetology, Prashanth Infertility Research Centre, Chennai, Tamil Nadu, India.
  4. Department of Policy and Programmes, International Diabetes Federation, Brussels, Belgium.
  5. Department of Obstetrics and Gynecology, Seethapathy Clinic and Hospital, Chennai, Tamil Nadu, India.

PMID: 27366715 PMCID: PMC4911838 DOI: 10.4103/2230-8210.183469

Abstract

AIM: To compare the existing maternal and fetal outcomes in Asian Indian women with or without gestational diabetes mellitus (GDM) before the development of the Women in India with GDM Strategy (WINGS) GDM model of care (MOC).

MATERIALS AND METHODS: Records of pregnant women were extracted retrospectively from three maternity centers in Chennai. GDM was diagnosed using the International Association for Pregnancy Study Groups criteria or the Carpenter and Coustan criteria. Demographic details, obstetric history, antenatal follow-up, treatment for GDM, and outcomes of delivery were collected from the electronic medical records.

RESULTS: Of the 3642 records analyzed, 799 (21.9%) had GDM, of whom 456 (57.1%) were treated with insulin and medical nutrition therapy (MNT), 339 (42.4%) with MNT alone, and 4 (0.5%) with metformin. Women with GDM were older than those without (28.5 ± 4.5 vs. 27.1 ± 4.5 years; P < 0.001) and had higher mean body mass index at first booking (26.4 ± 5.2 kg/m(2) vs. 25.2 ± 5.1 kg/m(2); P < 0.001). Rates of cesarean section (26.2% vs. 18.7%; P < 0.001), preeclampsia (1.8% vs. 0.8%; P = 0.04), and macrosomia (13.9% vs. 10.8%; P = 0.02) were significantly higher among women with GDM. In women with GDM treated with insulin and MNT, emergency cesarean section (16.2% vs. 36.6%; P < 0.0001), preeclampsia (0.7% vs. 3.2%; P = 0.015), and macrosomia (9.9% vs. 18.6%; P = 0.0006) were significantly lesser compared to those treated with MNT alone.

CONCLUSION: Pregnancy outcomes were in general worse in GDM women. Treatment with insulin was associated with a significantly lower risk of complications. However, in countries with limited access to insulin and other medicines may lead to poor follow-up and management of GDM. Data from this retrospective study will form the basis for the development of the WINGS GDM MOC, which will address these gaps in GDM care in low-resource settings.

Keywords: Asian Indians; South Asians; fetal outcomes; gestational diabetes mellitus; maternal outcomes

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