Introduction:
GDM affects 8–10% of pregnancies in Australia. Historically diagnosis of GDM in Australia has been derived from an ad hoc consensus. In 2013, RANZCOG working party recommended OGTT at 24-28 weeks and the adoption of 2013 WHO diagnostic criteria.
Aim:
To evaluate the effect of the implementation of new GDM fasting level guidelines on maternal and neonatal outcomes.
Design:
Retrospective Audit
Materials and Methods:
Perinatal database was utilised to collect the data from mothers diagnosed with GDM in 2015 with fasting BSL of 5.1, 5.2, 5.3, 5.4 to 5.5 mmol/l. Demographics included BMI and age of patients. Primary outcomes were management of GDM, mode of delivery, post-partum haemorrhage, perineal tear, shoulder dystocia. Secondary outcomes were neonatal birth weight, APGAR < 7 at 5 minutes and neonatal unit admission. Data was analysed with SPSS program.
Results:
151 patients were identified (35% of the total GDM patients diagnosed in 2015). The mean age calculated were 28.82 yrs and mean BMI was 32.6.
The proportion of participants on Metformin and insulin was higher in the BSL=5.5 group (p=0.03). There were no significant difference with mode of delivery (p=0.8), PPH >500mls (p=0.9), perineal tears (p=0.2) and shoulder dystocia (p=0.4) across the groups.
As for neonatal outcomes, mean birth weight was 3529grams (SD=545) with no significant difference between the groups (p=0.831). There were no calculated difference in APGAR p=0.2) and admission to neonatal unit (p=0.5) between the groups.
Conclusion:
Reduction in fasting blood sugar cut off significantly increased the number of women diagnosed with GDM. In our study, there is no trend within the group with regard to our maternal and neonatal outcome. However, patient with higher BSL were more likely to be treated with a combination of medications.