Management of Blood Sugar Degrees in Hyperglycemia in Pregnancy (Hip) Reduces Perinatal, Infant Morbidity & Mortality as a Result of a Large Prospective Cohort Learn From Up, India

Abstract

Rajesh Jain, Susanne Olejas and Rachna Jain

Background: Gestational diabetes mellitus (GDM) is a glucose intolerance that occurs or is identified for the first time all through pregnancy. Perinatal & Neonatal morbidity mortality is significant in pregnant women in GDM with extra hazard of growing diabetes later in life. Uttar Pradesh is a largest state of India with one of the highest rate of the infant as well as maternal mortality which might be, at least partially due to GDM. Thus, Careful evaluation, administration & Training of HCPs for GDM can improve the outcomes in National health Mission supported Govt funded Program, supported by World Diabetes foundation, Denmark.

Aims & Objectives: Primary objective of this study to be determine the Maternal-Fetal outcomes of GDM and management of Hyperglycemia in Pregnancy HIP reduces Neonatal & Perinatal Mortality as per the NHM, GOI Guidelines for GDM, As this will go long way help us in reduction of Perinatal & infant mortality. Thus, this study was once undertaken to recognize the extent of the burden on the healthcare and formulating further policy for Implementation of Gestational Diabetes Program in the largest state of Uttar Pradesh.

Materials and Methods: A prospective cohort study was done for 2 year from October 1, 2016, to September 31, 2018, at 828 GDM screening units as a part of the Gestational Diabetes Prevention and Control Project, Uttar Pradesh approved by the Indian Government in the state of Uttar Pradesh, India, largest state with second Highest MMR & IMR, A total of 515,532 pregnant women were screened during their 16–32th weeks of pregnancy by impaired oral glucose test (OGTT) as per NHM Guidelines for GDM, 12784 GDM & 7287 Non GDM maternal and perinatal outcomes were followed up in both GDM and non�??GDM categories in the 2 year (2016-2018) after blood sugar management (September 2016-October 2018) was executed at 828 (DHs, CHCs & PHCs healthcare) facilities, 515532 Pregnant Women have been screened at 16-20 Weeks & 24th-28 weeks of pregnancy as per Guidelines of National health Mission, GOI Guideline.

Results: Perinatal mortality increased significantly from 2.6% to 9.1% when blood sugar levels increased from 120 mg/dl to 199 mg/dl and above. Perinatal mortality in GDM cases were significantly to the control of blood sugar levels (P < 0.0001). Relative Risk of Stillbirth, Perinatal & neonatal mortality have been respectively 2.5, 2.3 & 2.5 times greater in GDM compare Non GDM (Table 1). Most of the GDM used to be identified in primigravida (52%). It was also found in our study those GDM who were strictly controlled with Hyperglycemia in pregnancy (HIP) to <120 mg/dl, Post Prandial blood sugar, have lowest risk for perinatal and neonatal mortality compare to those GDM pregnant women Blood sugars were not controlled, Risk for Perinatal mortality increases steadily and reaches 9.1% beyond blood sugar> 200 mg/dl.

Conclusion: All the Pregnant women need screening in Public health facilities & Implementation of National health Mission, GOI Guidelines for GDM has to be followed to improve outcome for Mother and Newborn, As the lack of information about GDM amongst pregnant women is high, to decrease the risk, increase awareness & full Implementation of NHM GDM Guidelines is key to Perinatal and neonatal mortality reduction in Public health care facilities where large number of ANC visit for Maternal and fetal health care.

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