The study of anemia in gestational diabetes mellitus.
High Hb levels in pregnancy has been reported to be individual risk factor for GDM and low Hb levels and Anemia have shown to result in lowering the risk of GDM. Most such studies are from outside Indian country. Hence our study aims at investigating the possible association between Anemia and GDM in South Indian Women.
Aims and Objective:
* To investigate possible association between Anemia and Gestational Diabetes Mellitus (GDM).
MATERIALS AND METHODS:
* A total of 130 patients were screened for study out of which 100 were eligible for study. Demographic data, past obstetric history, detailed clinical examination including height, weight and BMI were taken. Blood sugars, HbA1c, complete blood counts including peripheral smear were estimated.
Place of study:
* The data for this study was collected from 100 GDM patients from out-patient and In-patient of Vani Vilas hospital and Bowring & Lady Curzon hospital, BMC & RI, Bangalore.
* November 2012 to July 2013
* Either newly detected GDM patients or on follow up
* Between age group of 18-35years.
* Renal impairment
* Thyroid dysfunction
* Overt diabetes either type 1 or 2.
* Statistical methods: Descriptive and inferential statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean [+ or -] SD (Min-Max) and results on categorical measurements are presented in number (%). Significance is assessed at 5 % level of significance.
* Students t test (two tailed, independent) has been used to find the significance of study parameters on continuous scale between two groups Inter group analysis) on metric parameters. Chi-square/ Fisher Exact test has been used to find the significance of study parameters on categorical scale between two or more groups.
* Statistical software: The Statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, Med Calc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc.
RESULTS: A total of 100 GDM patients were investigated. The mean age of the patient was 26.09 [+ or -] 3.4years.The overall prevalence of Anemia was 7.0%.The mean HbA1c was 7.80 [+ or -] 0.63. Mean haemoglobin was 12.01 [+ or -] 1.29 g/dl and it was positively associated (r=0.75) with impaired glucose metabolism. The mean blood glucose at 0hrs and 2hrs after was 158.73 [+ or -] 35.97 and 274.40 [+ or -] 67.04 mg/dl respectively. Haemoglobin level was highly correlating and statistically significant with prevalence of GDM (P<0.05).
Our study found that the incidence of anemia in GDM patients was considerably lower than the incidence in normal pregnancy. Those patients who had anemia, their peripheral smear examination showed majority to be Normocytic Normochromic Anemia. Other observations in our study revealed that younger age was associated with Anemia; BMI was not significantly associated with GDM.
Table 1: Age distribution of patients studied Age in years No. of patients % 19-24 37 37.0 25-29 46 46.0 30-34 17 17.0 Total 100 100.0
Mean [+ or -] SD: 26.09 [+ or -] 3.38
Table 2: Region distribution of patients studied Region No. of patients % Rural 1 1.0 Urban 99 99.0 Total 100 100.0 Table 3: BMI (kg/[m.sup.2]) distribution of patients studied BMI (kg/[m.sup.2]) No. of patients % <23 26 26.0 23-30 65 65.0 >30 9 9.0 Total 100 100.0 Mean [+ or -] SD: 26.23 [+ or -] 3.77 Table 4: Previous bleeding of patients studied Previous bleeding No. of patients % No 97 97.0 Yes 3 3.0 Total 100 100.0 Table 5: No. of deliveries No. of deliveries No. of patients % 0 2 2.0 1 76 76.0 2 14 14.0 3 4 4.0 4 & above 4 4.0 Total 100 100.0 Table 6: Incidence of anemia in patients studied Anemia No. of patients % Absent 94 94.0 Present 6 6.0 Total 100 100.0 Table 7: Age distribution according to incidence of Anemia in patients studied Age in years Anemia Total No anemia Anemia 19-24 34(36.2%) 3(50%) 37(37%) 25-29 44(46.8%) 2(33.3%) 46(46%) 30-34 16(17%) 1(16.7%) 17(17%) Total 94(100%) 6(100%) 100(100%) Lower age is positively associated with incidence of anemia with p=0.117 Table 8: BMI (kg/[m.sup.2]) with incidence of anemia BMI (kg/[m.sup.2]) Anemia Total No anemia Anemia <23 25(26.6%) 1(16.7%) 26(26%) 23-30 56(59.6%) 5(83.3%) 61(61%) >30 13(13.8%) 0(0%) 13(13%) Total 94(100%) 6(100%) 100(100%) BMI is not statistically associated with incidence of anemia with p=0.710 Table 9: P Smear findings of patients studied P Smear No. of patients % MCHC 3 3.0 NCNC 97 97.0 Total 100 100.0 Table 10: P. Smear findings with incidence of anemia P Smear Anemia Total No anemia Anemia MCHC 0(0%) 3(50%) 3(3%) NCNC 94(100%) 3(50%) 97(97%) Total 94(100%) 6(100%) 100(100%) Table 11: Baseline variables according to incidence of anemia in patients studied Anemia No anemia Anemia Age in years 26.09 [+ or -] 3.37 26.17 [+ or -] 3.87 BMI (kg/[m.sup.2]) 26.29 [+ or -] 3.86 25.31 [+ or -] 1.76 Pulse rate 80.28 [+ or -] 10.32 80.33 [+ or -] 13.35 Blood pressure 118.82 [+ or -] 8.28 120.10 [+ or -] 5.20 Hb 12.21 [+ or -] 0.99 8.93 [+ or -] 1.50 FBS 159.85 [+ or -] 35.95 141.17 [+ or -] 34.52 PPBS 283.81 [+ or -] 59.44 238.00 [+ or -] 49.65 HbA1c 7.42 [+ or -] 0.79 7.17 [+ or -] 0.82 Total P value Age in years 26.09 [+ or -] 3.38 0.955 BMI (kg/[m.sup.2]) 26.23 [+ or -] 3.77 0.540 Pulse rate 80.28 [+ or -] 10.45 0.990 Blood pressure 118.90 [+ or -] 8.11 0.710 Hb 12.01 [+ or -] 1.28 <0.001 ** FBS 158.73 [+ or -] 35.97 0.219 PPBS 281.06 [+ or -] 59.69 0.068+ HbA1c 7.41 [+ or -] 0.79 0.450 Table 12: Correlation of Gestational DM with incidence of anemia GDM Anemia Total No anemia Anemia No 94(94.00%) 0 94(94.0%) Yes 0 6(100.0%) 8(8.0%) Total 94(100.0%) 6(100.0%) 100(100.0%) GDM is significantly associated with incidence increased Hb with P<0.001 **
DISCUSSION: In this study we investigated the possible relation between Anemia and GDM. To our knowledge there are no studies from South India in this regard. We found that the incidence of anemia specifically Microcytic Hypochromic Anemia was considerably lower in GDM women compared to Non GDM pregnancy.
In a somewhat similar study Annika Helinet al (6) discovered that women with high dietary iron intake and high Hb had increased risk of GDM. But the study didn't include Indian women. Similarly Qiuet al (7) demonstrated an association between high Heme Iron intake during pregnancy and the risk of GDM.
Iron is a highly reactive component with a possibility to participate in harmful reactions. (8) Iron excreted from human body is with very limited mechanism and thus intake of iron is highly regulated according to body needs. (9)
Iron could interfere in Glucose metabolism by following possible mechanism.
* Iron decreases insulin secretion and metabolism in liver which leads to peripheral hyperinsulinemia. (10)
* Iron overload results in oxidative stress in pancreatic (3-cells that leads to destruction of Islet cells and thus decreases insulin secretion. (11)
CONCLUSION: Our study suggests that incidence of anemia especially Microcytic Hypochromic Anaemia is considerably lower in GDM. These finding suggests that routine supplementation of iron irrespective of Hemoglobin (Hb) levels should be reconsidered in risk group women and iron supplements to be given only to women who has anemia due to Iron deficiency anemia, though studies on a larger group is warranted.
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[1.] Srinivasa V.
[2.] Nagaraja B. S.
[3.] G. Chandra Mohan
[4.] Akila V.
[5.] Prakash Kikker Gowdaiah
PARTICULARS OF CONTRIBUTORS:
[1.] Associate Professor, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore.
[2.] Professor, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore.
[3.] Post Graduate, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore.
[4.] Post Graduate, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore.
[5.] Associate Professor, Department of General Medicine, Bangalore Medical College and Research Institute, Bangalore.
NAME ADDRESS EMAIL ID OF THE CORRESPONDING AUTHOR:
Dr. G. Chandra Mohan, Room No. 202, 2nd Floor, BMCRI Mens PG Hostel, Hospital Road, Shivajinagar, Bangalore-560001.
Date of Submission: 12/05/2014. Date of Peer Review: 13/05/2014. Date of Acceptance: 30/05/2014. Date of Publishing: 07/06/2014.
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|Title Annotation:||ORIGINAL ARTICLE|
|Author:||Srinivasa, V.; Nagaraja, B.S.; Mohan, G. Chandra; Akila, V.; Gowdaiah, Prakash Kikker|
|Publication:||Journal of Evolution of Medical and Dental Sciences|
|Date:||Jun 9, 2014|
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