Case management survey of diabetes in pregnancy
Keywords:
pregnancy, diabetes, pregnancy in diabetes, pregnancy complicationsAbstract
Objective
To survey the diabetes management care offered to pregnant women at Institute of Mother and Child Health of Pernambuco, Recife, Brazil.
Methods
This was a case note review involving 216 diabetic pregnant patients and their perinatals, who were assisted at the Institute. In order to assess the quality of care offered to the diabetic pregnant women, the survey considered all care procedures and events - such as screening, diagnosis, treatment, delivery type, pregnancy and perinatal complications -, in the light of each patient’s diabetes classification.
Results
Diagnosis using 100g Oral Glucose Tolerance Test was performed in 205 patients (94.9%). The screening for submission to the Oral Glucose Tolerance Test was done only through risk factors. The results of Oral Glucose Tolerance Test were: 150 patients (69.4%) had impaired glucose tolerance, 49 (22.7%) presented gestational diabetes, and 12 (5.6%) had non-insulin dependent diabetes mellitus, type II. The diabetes treatment started at 33 weeks of gestation in 75% of the patients. Fifty-four patients (25%) needed insulin. The incidence of pregnancy-induced hypertension (24%), preterm labour (14%) and polyhydramnios (13%) were not significantly different between the impaired glucose tolerance and gestational diabetes mothers. The high labor-induction rate (69%) contributed to an increase in the number of caesarean sections. The relative risk of cesarean section for induction of labor was 2.77 (95% CI 1.73 – 4.44). The perinatal mortality was 1.8% and there was no maternal death. The neonatal complications were macrosomia (10.1%), hypoglycemia (8.3%). Thirty-one neonates (14.4%) were admitted to the neonatal unit. The incidence of malformations was 5.5%. Two hundred five neonates (94.9%) were discharged in good health, being exclusively breastfed.
Conclusion
The maternal and perinatal outcomes were satisfactory, despite the late onset of diabetes treatment for some patients.
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