Features of medical care for gestational diabetes mellitus (in case of a specialized obstetric hospital)

Radzinsky V.E., Papysheva O.V., Esipova L.N., Startseva N.M., Kotaish G.A.

1 Department of Obstetrics and Gynecology with Course of Perinatology, Medical Institute, Peoples’ Friendship University of Russia, Ministry of Education and Science of Russia, Moscow 117198, Miklukho-Maklaya str. 6, Russia; 2 N.E. Bauman City Clinical Hospital Twenty-Nine, Moscow Healthcare Department, Moscow 111020, Gospitalnaya pl. 2, Russia
Objective. To evaluate the efficiency of methodological approaches to optimizing the care of pregnant women with gestational diabetes mellitus (GDM) under the present-day conditions of a progressive increase in the incidence of this disease in case of a specialized obstetric hospital.
Materials and methods. The statistical data on the 2015–2016 activities of the Outpatient Department and the Maternity Department, Moscow City Clinical Hospital Twenty-Nine, were retrospectively analyzed.
Results. GDM was diagnosed in two thirds of the pregnant women at more than 30 weeks’ gestation in primary outpatient care services.
In the management of pregnant women with untimely detected GDM, the sensitivity of ultrasound fetometry using the specific markers of diabetic fetopathy (DF) was 65.5%. Programmed labor (PL) was one of the leading methods during childbirth.
Conclusion. Ultrasound fetometry using specific markers for DF and the strict continuity of outpatient and inpatient care permitted the frequency of DF to be reduced about 1.5-fold. The use of PL methods in GDM contributed to a two-fold decrease in the cesarean delivery rate without deteriorating the perinatal outcomes of labor.

Keywords

gestational diabetes mellitus
diabetic fetopathy
programmed labor
perinatal outcomes of labor

Supplementary Materials

  1. Figure. Annual populational frequency of GDM among women in the Municipal Maternity Hospital №29, % on the total number of births for the year

References

1. Бурумкулова Ф.Ф., Петрухин В.А. Гестационный сахарный диабет: вчера, сегодня, завтра. Терапевтический архив. 2014; 86(10): 109-15. [Burumkulova F.F., Petrukhin V.A. Gestational diabetes: yesterday, today, tomorrow. Terapevticheskiy arhiv. 2014; 86 (10): 109-15. (in Russian)]

2. Billionnet C., Mitanchez D., Weill A, Nizard J., Alla F., Hartemann A. et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia. 2017; 60(4): 636-44. doi: 10.1007/s00125-017-4206-6.

3. Regnault N., Salanave B., Castetbon K., Cosson E., Vambergue A., Barry Y. et al. Diabète gestationnel en France en 2012: dépistage, prévalence et modalités de prise en charge pendant la grossese. Bull. Epidémiol. Hebd. 2016; 9: 164-72.

4. Башмакова Н.В., Дерябина Е.Г., ред. Гестационный сахарный диабет. Что мы знаем о нем сегодня? Екатеринбург; 2015. 124c. [Bashmakova N.V., Deryabina E.G., ed. Gestational diabetes mellitus. What do we know about it today? Ekaterinburg; 2015. 124p. (in Russian)]

5. Гестационный сахарный диабет: диагностика, лечение, послеродовое наблюдение. Клинические рекомендации (протокол). М.; 2014: 18. [Gestational diabetes mellitus: diagnosis, treatment, postnatal observation. Clinical recommendations (protocol). Moscow; 2014: 18. (in Russian)]

6. Дедов И.И., Краснопольский В.И., Сухих Г.Т. от имени рабочей группы. Российский национальный консенсус «Гестационный сахарный диабет: диагностика, лечение, послеродовое наблюдение». Сахарный диабет. 2012; 4: 4-10. [Dedov I.I., Krasnopolsky V.I., Sukhikh G.T. on behalf of the working group. Russian national consensus “Gestational diabetes mellitus: diagnosis, treatment, postnatal observation”. Saharnyiy diabet. 2012; 4: 4-10. (in Russian)]

7. Kautzky-Willer A., Harreiter J., Bancher-Todesca D., Berger A., Repa A., Lechleitner M. et al. Gestational diabetes mellitus. Wien. Klin. Wochenschr. 2016; 128(Suppl. 2): 103-12. doi: 10.1007/s00508-015-0941-1.

8. Краснопольский В.И., Логутова Л.С., Петрухин В.А., Чечнева М.А., Бурумкулова Ф.Ф., Гурьева В.М., Лысенко С.Н., Коваленко Т.С., Аксенов А.Н., Троицкая М.В., Котов Ю.Б., Ермакова Л.Б. Антенатальная ультразвуковая диагностика диабетической фетопатии и макросомии. Российский вестник акушера-гинеколога. 2014; 14(2): 87-93. [Krasnopolsky V.I., Logutova L.S., Petrukhin V.A., Chechneva M.A., Burumkulova F.F., Gurieva V.M., Lysenko S.N., Kovalenko T.S., Aksenov A.N., Troitskaya M.V., Kotov Yu.B., Ermakova L.B. Antenatal ultrasound diagnosis of diabetic fetopathy and macrosomia. Rossiyskiy vestnik akushera-ginekologa. 2014; 14 (2): 87-93. (in Russian)]

9. Ордынский В.Ф. Значение ультразвукового обследования беременных с сахарным диабетом. Ультразвуковая и функциональная диагностика. 2014; 6: 56-70. [Ordynsky V.F. The value of ultrasound examination of pregnant women with diabetes mellitus. Ultrazvukovaya i funktsionalnaya diagnostika. 2014; 6: 56-70. (in Russian)]

10. Buhling K.J., Doll I., Siebert G., Catalano P.M. Relationship between sonographically estimated fetal subcutaneous adipose tissue measurements and neonatal skinfold measurements. Ultrasound Obstet. Gynecol. 2012; 39(5): 558-62.

11. Прозоров В.В., Есипова Л.Н., Старцева Н.М., Девятова Е.А., Дочкина А.И., Никифорова Я.Б. Программированные роды как метод родоразрешения пациенток с гестационным сахарным диабетом. В кн.: Тезисы IX Общероссийского семинара «Репродуктивный потенциал России: версии и контраверсии». 10-13 ноября 2016, Сочи. М.: Status Praesens; 2016: 89-91. [Prozorov V.V., Esipova L.N., Startseva N.M., Devyatova E.A., Dochkina A.I., Nikiforova Ya.B. Programmed delivery as a method of delivery of patients with gestational diabetes mellitus. In: Theses of the IX All-Russian Seminar “Reproductive Potential of Russia: Versions and Controversies”. November 10-13, 2016, Sochi. Moscow: Status Praesens; 2016: 89-91. (in Russian)]

12. Ehrenberg H.M., Durnwald C.P., Catalano P., Mercer B.M. The influence of obesity and diabetes on the risk of cesarean delivery. Am. J. Obstet. Gynecol. 2004; 191(3): 969-74.

13. Литвиненко И.А., Карпова Е.В., Оразмурадов А.А., Шешко П.Л. Особенности гестации и состояния плода у беременных с ГСД, выявленным в I триместре беременности. В кн.: Материалы IV Всероссийской конференции с международным участием «Медико-физиологические проблемы экологии человека». Ульяновск, 26-30 сентября 2011. Ульяновск: УлГУ; 2011: 138-9. [Litvinenko I.A., Karpova E.V., Orazmuradov A.A., Sheshko P.L. Features of gestation and fetal condition in pregnant women with GDM, detected in the first trimester of pregnancy. In: Materials of the IV All-Russian Conference with International Participation “Medico-Physiological Problems of Human Ecology”. Ulyanovsk, September 26-30, 2011. Ulyanovsk: USU; 2011: 138-9. (in Russian)]

14. Du M.K., Ge L. Y., Zhou M.L., Ying J., Qu F., Dong M. et al. Effects of pre-pregnancy body mass index and gestational weight gain on neonatal birth weight. J. Zhejiang. Univ. Sci. B. 2017; 18(3): 263-71. doi: 10.1631/jzus.B1600204.

15. Михалев Е.В., Шанина О.М., Саприна Т.В. Гормональные, электролитные нарушения и особенности гемостаза у доношенных новорожденных детей от матерей с гестационным сахарным диабетом. Сахарный диабет. 2015; 1: 78-86. [Mikhalev E.V., Shanina O.M., Saprina Т.V. Hormonal, electrolyte disorders and features of hemostasis in full-term newborn children from mothers with gestational diabetes mellitus. Saharnyiy diabet. 2015; 1: 78-86. (in Russian)]

16. Erjavec K., Poljičanin T., Matijević R. Impact of the Implementation of New WHO diagnostic criteria for gestational diabetes mellitus on prevalence and perinatal outcomes: a population-based study. J Pregnancy. 2016; 2016: 2670912. doi: 10.1155/2016/2670912.

17. Boriboonhirunsarn D., Waiyanikorn R. Emergency cesarean section rate between women with gestational diabetes and normal pregnant women. Taiwan. J. Obstet. Gynecol. 2016; 55(1): 64-7. doi: 10.1016/j.tjog.2015.08.024.

18. Grabowska K., Stapińska-Syniec A., Saletra A., Jarmużek P., Bomba-Opoń D. Labour in women with gestational diabetes mellitus. Ginekol. Pol. 2017; 88(2): 81-6. doi: 10.5603/GP.a2017.0016.

19. Derulle P. Quoi de neuf dans la prise en charge de la macrosomia? Ginecol. Obstet. Fertil. 2015; 43(9): 616-8.

20. Gaudet L., Wen S.W., Walker M. The combined effect of maternal obesity and fetal macrisomia on pregnancy outcomes. J. Obstet. Gynaecol. Can. 2014; 36(9): 776-84.

21. Inocêncio G., Braga A., Lima T., Vieira B., Zulmira R., Carinhas M. et al. Which factors influence the type of delivery and cesarean section rate in women with gestational diabetes? J. Reprod. Med. 2015; 60(11-12): 529-34.

22. Alberico S., Erenbourg A., Hod M., Yogev Y., Hadar E., Neri F. et al. Immediate delivery or expectant management in gestational diabetes at term: the GINEXMAL randomised controlled trial. BJOG. 2017; 124(4): 669-77. doi: 10.1111/1471-0528.14389.

23. Marchiano D., Elkousy M., Stevens E., Peipert J., Macones G. Diet-controlled gestational diabetes mellitus does not influence the success rates for vaginal birth after cesarean delivery. Am. J. Obstet. Gynecol. 2004; 190(3):790-6.

Received 19.05.2017

Accepted 23.06.2017

About the Authors

Radzinskiy Viktor Evseevich, Doctor of Medicine, professor, Honored Researcher of the Russian Federation, corresponding member of the Russian Academy of Sciences,
vice-president of the Russian Society of Obstetricians and Gynecologists; Head of the Department of Obstetrics and Gynecology with a Perinatology Course
of the Medical Institute of the Peoples’ Friendship University of Russia, subdivision of the Ministry of Education and Science of Russia; Head of the Department of Obstetrics, Gynecology and Reproductive Medicine of the Advanced Medical Training Faculty of the Peoples’ Friendship University of Russia.
117198, Russia, Moscow, Miklukho-Maklaya str. 6. Tel.: +79037232212. E-mail: radzinsky@mail.ru
Papysheva Olga Viuhlenovna, Ph.D., Head Physician of N.E. Bauman City Clinical Hospital Twenty-Nine, Moscow Healthcare Department.
111020, Russia, Moscow, Gospitalnaya pl. 2. Tel.: +79039694501. E-mail: viulen@mail.ru
Esipova Larisa Nikolaevna, Deputy Head Physician for Obstetrics and Gynecology of N.E. Bauman City Clinical Hospital Twenty-Nine, Moscow Healthcare Department. 111020, Russia, Moscow, Gospitalnaya pl. 2. Tel.: +79166829746. E-mail: larisaesipova1@mail.ru
Startseva Nadezhda Mikhailovna, Doctor of Medicine, Head of Pathologic Pregnancy Department of N.E. Bauman City Clinical Hospital Twenty-Nine,
Moscow Healthcare Department. 111020, Russia, Moscow, Gospitalnaya pl. 2. Tel.: +79037280820. E-mail: n.startseva@yahoo.com
Kotaish Galina Aleksandrovna, Ph.D., obstetrician-gynecologist of N.E. Bauman City Clinical Hospital Twenty-Nine, Moscow Healthcare Department.
111020, Russia, Moscow, Gospitalnaya pl. 2. Tel.: +79057500251. E-mail: suslatin1@mail.ru

For citations: Radzinsky V.E., Papysheva O.V., Esipova L.N., Startseva N.M., Kotaish G.A. Features of medical care for gestational diabetes mellitus (in case of a specialized obstetric hospital). Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2018; (2): 108-14. (in Russian)
https://dx.doi.org/10.18565/aig.2018.2.108-114

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