Management and Outcomes in Patients with Gestational Diabetes Mellitus in Multi-ethnic Population in Western Hospital Sunshine — ASN Events
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Management and Outcomes in Patients with Gestational Diabetes Mellitus in Multi-ethnic Population in Western Hospital Sunshine (#300)

Indriana Pangestu 1 , Edward Janus 1 , Deepak Dutta 1 , Emily Karahalios 1
  1. Western Health, Melbourne, VIC, Australia

Background:

Given increasing number of births and culturally diverse obstetric population being cared for at Western Health, it is important to evaluate the characteristics and management of gestational diabetes (GDM) in this cohort to improve future obstetric care.

Aim:

To define characteristics and outcomes of women diagnosed with GDM at Sunshine Hospital. To compare maternal and fetal outcomes in GDM patients treated with and without insulin.

Methods:

Retrospective data was collected on women receiving antenatal care in Sunshine hospital who were diagnosed with GDM by ADIPS 1998 criteria in 2013. We collected data from medical records on ethnicity, BMI, family and past medical history, management of GDM as well as maternal and fetal outcomes. These variables were then compared in patients treated with and without insulin.

Results:

684 women were diagnosed with gestational diabetes in 2013. Of these patients, 61.5% were Asian, 25.3% Caucasian, and 7% Africans. 30.3% were obese (BMI ≥30) and 7% were morbidly obese (BMI≥ 40). 51.3% has family history of diabetes and 19.7% had past history of GDM. In term of their management, 56.9% required insulin.

Patients treated with insulin are more likely to be older (mean age 32.1 vs 30.7), have higher BMI (median BMI 27 vs 24. p 0.006), family history of diabetes (59.1% vs 41%. p <0.001), past history of GDM (23.7% vs 14.6%. p 0.151) and higher fasting glucose level (mean 5.11 mmol/L vs. 4.58 mmol/L. p<0.0001) compared to patients not needing insulin. They also attended more endocrinology appointments (mean 7 vs. 5 p<0.0001).

In term of neonatal outcomes, there is no difference statistically in the two groups. Patients who were on insulin have less normal vaginal delivery (14.9% vs 31.9%. OR 0.37. p<0.001) but more likely to have induction of labour (33.2% vs 21%. OR 1.86. p 0.005) and elective cesarean delivery (21.6% vs 15.9%. OR 1.45. p0.06).

Conclusion

In this culturally-diverse population, high proportion of patients needed insulin for their GDM management, resulting in high resource utilization. Further research are needed to determine which patients are more likely to need insulin to improve management of GDM in the future.