Incidence and risk factors of gestational diabetes mellitus in antenatal mothers in Goa, India

Background: Gestational Diabetes Mellitus (GDM) accounts for almost 90% of all pregnancies complicated by diabetes. Its prevalence in the Indian population ranges from 5.5% to 11.5 %.Methods: The present study was undertaken to assess the incidence of GDM among antenatal mothers admitted in Goa Medical College for a period of 18 months and also to study the risk factors associated with GDM amongst such cases.Results: Present study revealed that among 7717 antenatal mothers who were admitted and delivered in our Hospital, 424 women were diagnosed with GDM. Of these women diagnosed with GDM, almost one third were in the age group of 31- 35 years (35.8%); 56.2 % of these women were multigravidas. Advancing maternal age, rising parity, obesity, family history of Diabetes Mellitus (DM) and past history of GDM were among the risk factors found to be significantly associated with GDM.Conclusions: The incidence of GDM in present study population was 5.49%. Advancing maternal age, maternal obesity, family history of DM and past history of GDM were found to be important determinants of GDM

Impact of maternal pre-pregnancy body mass index on neonatal outcomes: a hospital based study in a tertiary care hospital in Goa

Background: Maternal under-nutrition as well as obesity, both are known to have adverse effects on the perinatal outcomes. In developing countries like India wherein the burden of both under-nutrition and obesity is rising, there is a need to spread awareness regarding the need to achieve adequate weight prior to pregnancy. Thus, this study was undertaken to observe effect of maternal pre-pregnancy BMI on neonatal outcomes in Goa Medical College (GMC) during the time period from December 2018- December 2019.Methods: A hospital based retrospective observational study was conducted wherein the neonatal outcomes of 3940 women delivering in Goa Medical College during the time period of 1 year were studied. All the study participants were divided into five groups depending upon their BMI calculated at the first antenatal visit in the first trimester.Results: Most of the women in our study were in the normal BMI category (49.8%), however a large number were overweight (37.3%), 3.2% were obese and 0.1% were morbidly obese and 9.6%were underweight. The neonates born to underweight mothers were mostly low birth weight (66.6%) while macrosomia was more common in those born to obese (3.1%) and morbidly obese (25%) women. Neonatal complications like birth asphyxia, respiratory distress syndrome and hypoglycaemia were found in significantly higher proportion in both underweight as well as obese groups. These complications were responsible for a higher NICU admission rate and a higher neonatal mortality observed in both underweight as well obese group of mothers.Conclusions: Thus in view of the poor neonatal outcomes observed in both extremes of maternal BMI, it is the need of the hour to establish better nutrition programs and educate our women regarding the necessity to achieve adequate pre-pregnancy BMI to improve the pregnancy outcomes

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally