الفهرس 
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Abstract
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. it is important to screen, diagnose and treat hyperglycemia in pregnancy to prevent these adverse outcome. Screening for GDM is usually done at 24-28 weeks of gestation. It is estimated by IDF Atlas 2017 that 21.3 million or 16.2% of pregnant women in 2017 had some form of hyperglycaemia in pregnancy. An estimated 86. 4% of those cases were due to gestational diabetes mellitus (GDM). After delivery, females with GDM are at increased risk of developing diabetes, with a cumulative occurrence of between 15% and 50% over subsequent decades. Early postpartum screening measures and detection of predictive factors for subsequent developing type 2 diabetes, provided an opportunity to decrease the risk of diabetes progression in women with a history of GDM. This work aimed to: 1. To estimate the prevalence of developing type 2 DM in women with previous GDM. 2. To evaluate risk factors associated with increased susceptibilityto developing type 2 DM after GDM. 3. To increase awareness about GDM and importance of postpartumfollow up. This study included: A cross sectional study included 1150 pregnant women not known to have DM before gestation, presented to gestation diabetes mellitus outpatient clinic of Assiut University Hospital. between the period of May 2016 and May 2017 Inclusion criteria: All women diagnosed with GDM in their pregnancy between 24-28 weeks of gestation in gestation diabetes mellitus outpatient clinic of Assiut UniversityHospital. Exclusion criteria:
Pregestational diabetes mellitus. Diabetes in the first trimester.
All pregnant women were subjected to the following: 1- Detailed history & clinical examination : name, age, residence , marriage age , age of the patient at diagnosis of GDM , hypertension history, history of preeclampsi , gestational age at the beginningofGDMcare,OGTTglucosevaluesduringpregnancy, method used for managing GDM (life style modification or the need for insulin treatment or metformin during pregnancy) , family history of diabetes history of other diseases ,life style ,diet . 2- Study their anthropometric characteristics by measuring their weight, height and calculatingBMI 3- Study their maternal outcomes: vaginal candidiasis, polyhydromnios , preterm labour , abortion , premature ruptureof membranes and cesarean section. 4- Study their fetal outcomes: normal babies , macrosomia , stillbirth shoulder dystocia , hypoglycaemia , trauma/injury , congenital abnormality , respiratory distress syndrome and ICU admission . 5- - Laboratory investigations :
(A(Oral glucose tolerance test at 24-28 weeks gestation using 75g glucose anhydrous:
Pregnant women were given 75g anhydrous glucose in 250-300ml of water and plasma glucose was estimated after 2 hour. A 2-hours plasma glucose ≥ 140 mg/dl is taken as GDM according to DIPSI (Diabetes in Pregnancy Study GroupIndia) (B) Oral glucose tolerance test at 6-24 weeks postpartum for GDM women using 75g glucoseanhydrous: Type 2diabetes mellitus when fasting plasma glucose(≥126mg/dl) and/or 2-hours after 75-g glucose (≥200mg/dl) Impaired fasting glucose whenfasting plasmaglucose (>100 mg/dl and < 126 mg/dl) and 2-hours after 75 g normal glucose (< 140mg/dl) Impaired glucose tolerance , when glucose values 2-hour after 75-g glucose were (140mg/dl and 200 mg/ dl ) and fasting plasma glucose was( < 100mg/dl) Normal glucose tolerance when fasting plasma glucose (<100 mg/dl) and 2-hours after 75 g glucose (< 140 mg/dl). Lipid profile include (cholesterol ,triglyceride ,LDL,HDL) . (D)Kidney function tests. (E)Liver function tests The results of this study showed that: In Our study, It was found that 150 (13%) among 1150 pregnant women had GDM. Family history of DM was the most frequent risk factor forGDM (56.7%) in our study with p value=0.01 In addition to, our study found that obesity was a significant risk factor for GDM with BMI >30 with p value =0.03 as obesity is one of major risk factor for DM in our population.
Our study also found that increasing parity were significantly higher in those with GDM in comparison to those without GDM with Pvalue
=0.03.
Furthermore our study showed that previous history of GDM increased risk for GDM with P value =0.03 GDM was controlled with education and life style modification while insulin therapy in addition to life style modification was required in 45 (30%) of enrolled women and 22 (14.7%) women required metformin. Regarding the maternal outcome in the current study. The majority (86%) of women needed caesarean section. Preterm labour occurred in (12%) women while (2.7%) women suffered from premature rupture of membranes.
Polyhydromnios, vaginal candidiasis and abortion occurred in (6%), (2%) and (6%) women respectively.
Furthermore there were no significant differences between different types of management with exception of preterm labor that was frequently higher in those women with GDM and managed with life style modification. Regarding the fetal complications in the current study. There was only one neonate was stillbirth and only one neonate had shoulder dystocia. Neonatal jaundice occurred in the majority (78.7%) of neonates while macrosomia presented in (44%) neonates. (8%) neonates suffered from respiratory distress syndrome while (4%) neonates were hypoglycaemic. Trauma and injury occurred in (2%) neonates while (4%) neonates had different forms of congenital anomalies. In addition there were no significant differences between different types of management with exception of hypoglycemia that was frequently higher in those women with GDM and managed with life style modification plus insulin . Based on the result of 75 gm-OGTT 6-24 weeks after delivery our study found that (12.7%) women had T2DM, (21.3%) women had impaired fasting glucose, (13.3%) women had impaired glucose tolerance and (52.7%) women had normal glucose tolerance. The current study showed that predictors to development of type II DM in women with GDM were family history of DM (P= 0.001), insulin therapy during pregnancy (P= 0.001), high glucose level at time of diagnosis (P= 0.03), previous history of GDM (P= 0.002) and , high body mass index (P= 0.04). Women who became type II DM, prediabetic, or with normal glucose tolerance test based on based on 75 gm- OGTT 6-24weeks after delivery had no significant differences as regarding maternal and fetal outcome and fetal complications with exception of: High birth weight in those with type II DM and prediabetic groups in comparison to normal glucose tolerancegroup.
- High frequency of ICU admission in those with type II DM and prediabeticgroupsincomparisontonormalglucosetolerancegroup.