Abstract

Aim: To study the incidence of metabolic syndrome in postnatal women with history of gestational diabetes mellitus in the index pregnancy when compared to a women without the history of gestational diabetes mellitus

To study the socio-demographic factors affecting the development of metabolic syndrome in postnatal women with history of gestational diabetes mellitus in the index pregnancy

Materials and Methods: The recruitment of the postnatal women to the study was started after obtaining clearance from the Ethical committee conducted in Sree Avittom Thirunal Hospital, Government Medical College, Thiruvananthapuram and study period was for one year. This was a Prospective cohort study

Results: In our  study we included only women >19 years and <35 years and majority of the women in the GDM group belonged to the age group 26-30 and women in the non GDM group who belonged to 25. In the present study 49.7% of the women in the GDM group belonged to Class IV when compared to 64.6% in the non GDM group also belonged to the same socioeconomic status. Majority of the women belonged to the Hindu religion both in the GDM and the non GDM group.60% of the multipara belonged to the GDM group when compared to 40% of the primipara belonged to the GDM group.24.6% of the patients in the GDM group had a history of gestational hypertension, when compared to 8% of the non GDM group.20% of the women in the GDM group had a past history of GDM in their previous pregnancies.23.4% of the women in the GDM group had a family history of diabetes in father when compared to 5.1% of the non GDM group. Majority of the women in the study did not have any family history of diabetes in the siblings.45.1% of the women belonging to the GDM group had a birth weight between 2.6 to 3.5kg.28% of the women belonging to the GDM group had a pre pregnancy BMI > = 25 when compared to 13.1% of the women in the non GDM group.69% of the women belonging to the GDM group had BMI >= 25 when compared to 48% of the women belonging to the non GDM group. In our study, we included only women >19 yrs and <35 yrs and the percentage of metabolic syndrome was higher in either ends of the range that is 55.6% and 44% respectively. Majority of the subjects were booked at our hospital but the percentage of metabolic syndrome was found to be slightly higher in the referral subjects, p value was 0.4 and it was not statistically significant. In our study, the socioeconomic status is classified according to Kuppuswamy classification. The percentage of metabolic syndrome was slightly higher in the class III that is 47.4%.The percentage of metabolic syndrome in Muslim population was slightly higher that is 44.1% when compared to the other religions. In this study, 71.2% of the women with higher order pregnancies that is multiparous women had metabolic syndrome when compared to 28% of the primiparous women and the p value was 0.01 with the relative risk of 1.65 and this association was found to be statistically significant. In the present study, the women with MNT had a metabolic syndrome rate of 39.8% when compared to the women who were not on MNT that is 43.7%. But the other group who were not on MNT was on insulin therapy This association was not statistically significant as the p value was 0.6.Women receiving insulin therapy had a higher incidence of metabolic syndrome that is 63.01% when compared to the women who were not on insulin therapy. The p value was 0.02 with the relative risk being 1.5 and this association was statistically significant. In the present study, the women with the gestational hypertension in this index pregnancy were found to have a higher rate of metabolic syndrome that is 46.5% when compared to the women without history of gestational hypertension. This association is statistically significant with a p value of 0.03 and relative risk of 1.504.Women with history of GDM in their previous pregnancy had a metabolic syndrome rate of 65.7%, when compared to the women without this history and the p value was found to be 0.001 with a relative risk of 1.84 and found to be statistically significant. Majority of the women in the study group did not have any significant past history of illness. Among the study group there were 8 women who had a history of epilepsy and in them the metabolic syndrome rate was found to be 62.5%. But this was not statistically significant as the number of women belonging to this group were very small.53.4% of the women with the family history of diabetes in mother had metabolic syndrome, p value was 0.02 with a relative risk of 1.49 and was statistically significant. In the present study, the women who delivered > 4 kg babies had a higher rate of metabolic syndrome of 83.3%, when compared to the other women with lesser birth weight. In the present study, 71.4% of the women with the pre-pregnancy BMI >25 had metabolic syndrome whereas only 30.2% of the women with BMI25 had metabolic syndrome. The p value was 0.001 and relative risk of 2.368 and this was statistically significant. In this study 54.5% of the women with postnatal BMI > 25 had metabolic syndrome whereas only 13% women with postnatal BMI < 25 had metabolic syndrome. The p value was 0.001 and relative risk was 4.28 which were statistically significant.

Conclusions: The present study was conducted to explore the incidence of metabolic syndrome in the postnatal women with GDM, when compared to a non GDM group and also to study the socio-demographic factors affecting the development of metabolic syndrome in GDM group.

In 2001 metabolic syndrome was noted as a legitimate cardiac risk factor and designated ICD-9 code of 277.7. Women with GDM tend to meet many criteria of metabolic syndrome. A link has been established between metabolic syndrome and GDM. Many view GDM as a pre metabolic syndrome condition. The incidence of metabolic syndrome in postnatal women with GDM attending our hospital is found to be 46.1%.

The study was conducted at Sree Avittom Thirunal Hospital, Thiruvananthapuram over a period of one year and involved 175 postnatal women in each in the study and the control groups. The findings of our study were. The women with history of GDM in the index pregnancy had a higher incidence rate of metabolic syndrome, when compared to the non GDM group. Though the study was conducted in an immediate postpartum that is after 6 weeks period, but the study group was compared with a control group which did not show any increased incidence of Metabolic Syndrome. Also a sensitivity analysis was conducted and waist circumference was excluded as criteria as there was significant weight retention 6wks postpartum but the incidence of Metabolic Syndrome was more in the GDM group when compared to non GDM group. This suggests that GDM is an important predictor of metabolic syndrome.