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P349 Perinatal mortality due to diabetes mellitus recorded with the Perinatal Problem Identification Program (PPIP) in South Africa
S514
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Method: Pregnant women attending the ante natal clinic at Kalafong Hospital were asked after informed consent to take part in the study. Kalafong hospital is a level 2 hospital in South Africa. They were divided into women with risk factors for GDM and women without risk factors for GDM. The risk factors were age > 35 years, acanthosis nigrican, maternal weight > 85 kg, repeated glycosuria, previous infant > 4 kg, history of previous GDM, first degree family member wit diabetes mellitus and a previous unexplained stillbirth. The women were then asked to come back after an overnight fasting. A 75 g oral glucose tolerance test (OGTT) was done and blood was collected at fasting, 1 hour and 2 hours. The WHO, CDA, ADA and EASD diagnostic criteria for GDM was applied to each patient. Patients diagnosed with GDM were transferred to the special diabetes in pregnancy unit for treatment. All patients were between 20 and 28 weeks. The ante natal cards from patient who attended ante natal clinic in the Southwest Tshwane were evaluated for documented risk factors. Results: A total of a 104 women were recruited. In total 22 women were excluded from analysis due to incomplete data. There were 39 women without risk factors and 43 with risk factors. In the group without risk factors 2 (5%) women had GDM and in the group with risk factors 6 (13.9%) had GDM. The mean age for women without risk factors were 26 years compared to 34 years in the group with risk factors. The parity was 0.89 versus 2.1; the mean fasting glucose were 4.2 mmol/l versus 4.4 mmol/l. The mean 1 hour value was 5.9 mmol/l versus 6.5 mmol/l and the 2 hour value was 5.6 mmol/l versus 6.1 mmol/l respectively. Table 1 summarizes the kappa coefficient between the different diagnostic criteria. The incidence of risk factors among women attending the ante natal clinics in the Southwest Tshwane area was 22.2%.
40% of deliveries in South Africa. This is institutional data from voluntary sites taking part in the PPIP audit. The perinatal mortality rate was calculated for all deaths that were found to be due to Diabetes Mellitus. Diabetes Mellitus is inclusive of Type 1 DM, Type 2 DM and Gestational Diabetes Mellitus (GDM). The study also evaluated the perinatal mortality from unexplained still births weighing more than 4 kg. The perinatal mortality rate is expressed per 1000 deliveries. Results: From the 1st of January 2000 until the 31st of December 2007 there were a total of 1 809 347 deliveries recorded in the PPIP sites. In total there were 373 deaths recorded due to DM. From this group of deaths that were related to DM, 96 of the deaths had a birth weight of more than 4 kg. Over this period there were 192 unexplained still births with a birth weight of more than 4 kg. The perinatal mortality rate (PMNR) is presented in table.
Table 1. Comparing the different diagnostic criteria applied to the same patient.
P350 Comparison of fasting and 15 min post glucose bolus insulin release between women at high and low risk for gestational diabetes mellitus H. Lombaard1 , C. Pillay2 , D. Van Zyl3 , N. Crowther4 . 1 Department Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, 2 Maternal and Fetal Medicine Unit, Department Obstetrics and Gynecology, University of Pretoria, 3 University of Pretoria, Kalafong Hospital, 4 Department of Chemical Pathology, University of Witwatersrand, National Health Laboratory Service
Diagnostic criteria
WHO
CDA
EASD
ADA WHO CDA
0.688
0.903 0.584
0.575 0.643
0.413
ú = 0–0.19 poor; 0.2–0.39 fair; 0.4–0.59 moderate; 0.6–0.79 good; 0.8–1.0 very good.
Conclusion: The prevalence of GDM was 10% in the women tested. In the group of women with out risk factors 5% had GDM compared to the 13.9% of women with GDM. This was not statistically significant. The WHO criteria picked up most of the women from Africa with GDM. There is good correlation between the WHO and ADA criteria in the patients from Africa. Almost half of the patients who will develop GDM do not have any risk factors. P349 Perinatal mortality due to diabetes mellitus recorded with the Perinatal Problem Identification Program (PPIP) in South Africa H. Lombaard1 , R. Pattinson. 1 University of Pretoria, Steve Biko Academic Hospital, 2 Aim: The aim was to study the perinatal mortality rate due to Diabetes Mellitus (DM) in the sites that uses the Perinatal Problem Identification Program (PPIP) throughout South Africa. Methods: South Africa is a developing country. The PPIP data from the 1st of January 2000 until the 31st of December 2007 was analyzed. PIPP was started in 2000 and at that stage included 27 sites which were regional and level 3 hospitals throughout South Africa. PPIP is constantly expanding in South Africa. In 2007 180 health care centers took part in the PPIP audit. All the centra are from the public health sector. The sites are distributed trough the metropolitan, urban and rural areas in South Africa. As the program expanded it included also Midwife Obstetric Units (MOU) in South Africa. During the period 2006 and 2007 the program covered
Perinatal mortality due to DM in PPIP sites in South Africa Years
2000*
2001*
2002
2003
2004
2005
2006
2007
Total deliveries PNMR (DM) PNMR (IUD>4) Sum
62931 0.485 0.039 0.524
88306 0.336 0.129 0.465
164144 0.196 0.084 0.280
254294 0.290 0.124 0.414
265991 0.202 0.109 0.311
315344 0.259 0.121 0.380
362041 0.272 0.195 0.467
297768 0.277 0.182 0.458
* Only regional and Level 3 hospitals (MOU’s excluded)
Since 2002 there is a steady increase in the perinatal mortality rate due to DM in South Africa. We were unable to calculate a perinatal mortality rate specific for women with DM. Conclusion: Since 2002 there is a steady incline in the perinatal mortality due to DM. The decline from 2000 until 2002 is probably due to the inclusion of MOU’s and not a true decline in the perinatal mortality rate. In South Africa we are not meeting the St Vincent declaration.
Aim: To compare the fasting serum insulin and serum insulin levels 15 minutes after a 75 gram oral glucose bolus; between women with, and women without risk factors for gestational diabetes. The study also compared the indices of insulin resistance: quantitative insulin sensitivity check index (QUICKI) and homeostasis assessment model for insulin resistance (HOMA) between women with and women without risk factors for gestational diabetes mellitus (GDM). Method: The sample was selected from patients attending the antenatal clinic at a secondary hospital in South Africa. Women attending the antenatal clinic were assigned to a high risk or low risk group for GDM based on the presence or absence of risk factors. The risk factors were: age >35 years, weight >85 kg, previous infant with birth weight > 4 kg, previous history of GDM, a family history of diabetes, previous stillbirth of unknown cause, repeated glycosuria, and the presence of acanthosis nigrans. After informed consent was obtained fasting blood was drawn where after a 75 g oral glucose bolus was administered. Blood was collected again 15 minutes later for insulin. Results: One hundred and four patients were recruited to the study, 52 patients to each of the high and low risk arms. The median fasting insulin value differed significantly for women with risk factors and for women without risk factors (3.72 mIU/ml vs. 2.40 mIU/ml) (p = 0.015). The median values for the 15 min insulin levels were not significantly different with 16.25 mIU/ml in high risk patients, and 20.4 mIU/ml in the low risk group (p = 0.912).
Poster presentations / International Journal of Gynecology & Obstetrics 107S2 (2009) S413–S729
Method: Pregnant women attending the ante natal clinic at Kalafong Hospital were asked after informed consent to take part in the study. Kalafong hospital is a level 2 hospital in South Africa. They were divided into women with risk factors for GDM and women without risk factors for GDM. The risk factors were age > 35 years, acanthosis nigrican, maternal weight > 85 kg, repeated glycosuria, previous infant > 4 kg, history of previous GDM, first degree family member wit diabetes mellitus and a previous unexplained stillbirth. The women were then asked to come back after an overnight fasting. A 75 g oral glucose tolerance test (OGTT) was done and blood was collected at fasting, 1 hour and 2 hours. The WHO, CDA, ADA and EASD diagnostic criteria for GDM was applied to each patient. Patients diagnosed with GDM were transferred to the special diabetes in pregnancy unit for treatment. All patients were between 20 and 28 weeks. The ante natal cards from patient who attended ante natal clinic in the Southwest Tshwane were evaluated for documented risk factors. Results: A total of a 104 women were recruited. In total 22 women were excluded from analysis due to incomplete data. There were 39 women without risk factors and 43 with risk factors. In the group without risk factors 2 (5%) women had GDM and in the group with risk factors 6 (13.9%) had GDM. The mean age for women without risk factors were 26 years compared to 34 years in the group with risk factors. The parity was 0.89 versus 2.1; the mean fasting glucose were 4.2 mmol/l versus 4.4 mmol/l. The mean 1 hour value was 5.9 mmol/l versus 6.5 mmol/l and the 2 hour value was 5.6 mmol/l versus 6.1 mmol/l respectively. Table 1 summarizes the kappa coefficient between the different diagnostic criteria. The incidence of risk factors among women attending the ante natal clinics in the Southwest Tshwane area was 22.2%.
40% of deliveries in South Africa. This is institutional data from voluntary sites taking part in the PPIP audit. The perinatal mortality rate was calculated for all deaths that were found to be due to Diabetes Mellitus. Diabetes Mellitus is inclusive of Type 1 DM, Type 2 DM and Gestational Diabetes Mellitus (GDM). The study also evaluated the perinatal mortality from unexplained still births weighing more than 4 kg. The perinatal mortality rate is expressed per 1000 deliveries. Results: From the 1st of January 2000 until the 31st of December 2007 there were a total of 1 809 347 deliveries recorded in the PPIP sites. In total there were 373 deaths recorded due to DM. From this group of deaths that were related to DM, 96 of the deaths had a birth weight of more than 4 kg. Over this period there were 192 unexplained still births with a birth weight of more than 4 kg. The perinatal mortality rate (PMNR) is presented in table.
Table 1. Comparing the different diagnostic criteria applied to the same patient.
P350 Comparison of fasting and 15 min post glucose bolus insulin release between women at high and low risk for gestational diabetes mellitus H. Lombaard1 , C. Pillay2 , D. Van Zyl3 , N. Crowther4 . 1 Department Obstetrics and Gynaecology, University of Pretoria, Steve Biko Academic Hospital, 2 Maternal and Fetal Medicine Unit, Department Obstetrics and Gynecology, University of Pretoria, 3 University of Pretoria, Kalafong Hospital, 4 Department of Chemical Pathology, University of Witwatersrand, National Health Laboratory Service
Diagnostic criteria
WHO
CDA
EASD
ADA WHO CDA
0.688
0.903 0.584
0.575 0.643
0.413
ú = 0–0.19 poor; 0.2–0.39 fair; 0.4–0.59 moderate; 0.6–0.79 good; 0.8–1.0 very good.
Conclusion: The prevalence of GDM was 10% in the women tested. In the group of women with out risk factors 5% had GDM compared to the 13.9% of women with GDM. This was not statistically significant. The WHO criteria picked up most of the women from Africa with GDM. There is good correlation between the WHO and ADA criteria in the patients from Africa. Almost half of the patients who will develop GDM do not have any risk factors. P349 Perinatal mortality due to diabetes mellitus recorded with the Perinatal Problem Identification Program (PPIP) in South Africa H. Lombaard1 , R. Pattinson. 1 University of Pretoria, Steve Biko Academic Hospital, 2 Aim: The aim was to study the perinatal mortality rate due to Diabetes Mellitus (DM) in the sites that uses the Perinatal Problem Identification Program (PPIP) throughout South Africa. Methods: South Africa is a developing country. The PPIP data from the 1st of January 2000 until the 31st of December 2007 was analyzed. PIPP was started in 2000 and at that stage included 27 sites which were regional and level 3 hospitals throughout South Africa. PPIP is constantly expanding in South Africa. In 2007 180 health care centers took part in the PPIP audit. All the centra are from the public health sector. The sites are distributed trough the metropolitan, urban and rural areas in South Africa. As the program expanded it included also Midwife Obstetric Units (MOU) in South Africa. During the period 2006 and 2007 the program covered
Perinatal mortality due to DM in PPIP sites in South Africa Years
2000*
2001*
2002
2003
2004
2005
2006
2007
Total deliveries PNMR (DM) PNMR (IUD>4) Sum
62931 0.485 0.039 0.524
88306 0.336 0.129 0.465
164144 0.196 0.084 0.280
254294 0.290 0.124 0.414
265991 0.202 0.109 0.311
315344 0.259 0.121 0.380
362041 0.272 0.195 0.467
297768 0.277 0.182 0.458
* Only regional and Level 3 hospitals (MOU’s excluded)
Since 2002 there is a steady increase in the perinatal mortality rate due to DM in South Africa. We were unable to calculate a perinatal mortality rate specific for women with DM. Conclusion: Since 2002 there is a steady incline in the perinatal mortality due to DM. The decline from 2000 until 2002 is probably due to the inclusion of MOU’s and not a true decline in the perinatal mortality rate. In South Africa we are not meeting the St Vincent declaration.
Aim: To compare the fasting serum insulin and serum insulin levels 15 minutes after a 75 gram oral glucose bolus; between women with, and women without risk factors for gestational diabetes. The study also compared the indices of insulin resistance: quantitative insulin sensitivity check index (QUICKI) and homeostasis assessment model for insulin resistance (HOMA) between women with and women without risk factors for gestational diabetes mellitus (GDM). Method: The sample was selected from patients attending the antenatal clinic at a secondary hospital in South Africa. Women attending the antenatal clinic were assigned to a high risk or low risk group for GDM based on the presence or absence of risk factors. The risk factors were: age >35 years, weight >85 kg, previous infant with birth weight > 4 kg, previous history of GDM, a family history of diabetes, previous stillbirth of unknown cause, repeated glycosuria, and the presence of acanthosis nigrans. After informed consent was obtained fasting blood was drawn where after a 75 g oral glucose bolus was administered. Blood was collected again 15 minutes later for insulin. Results: One hundred and four patients were recruited to the study, 52 patients to each of the high and low risk arms. The median fasting insulin value differed significantly for women with risk factors and for women without risk factors (3.72 mIU/ml vs. 2.40 mIU/ml) (p = 0.015). The median values for the 15 min insulin levels were not significantly different with 16.25 mIU/ml in high risk patients, and 20.4 mIU/ml in the low risk group (p = 0.912).