Bahaa A. Abalkhail

Determinants of pregnancy outcome in patients with gestational diabetes

Objectives: To describe the experience of management of gestational diabetes ‘GDM’ among a high‐risk population and to determine the relative contribution of maternal risk factors and some indices of glucose intolerance on pregnancy outcome. Methods: A total of 173 antenatal patients with GDM, matched to 337 non‐diabetic controls were evaluated. Incidences of fetal macrosomia, large birth weight (>4000 g), and operative delivery were noted. Patients with GDM were subgrouped into group I and II, according to the fasting blood glucose (FBG) level on the glucose tolerance test ‘GTT’, whether ≥ or < 5.8 mmol/l, respectively. A logistic regression model was then developed with predictive variables, i.e. maternal weight, height, parity, gestational week at diagnosis of GDM, degree of glucose tolerance, treatment and means of fasting and post‐prandial blood glucose measurements as independent variables against each of the outcome measures as dependent variables. Results: Compared with non‐diabetics, patients with GDM were older in age, weight and parity. The mean fetal birth weight, incidences of macrosomia and babies >4 kg were significantly higher among GDM patients. In patients with GDM the degree of glucose intolerance (determined by FBG on the GTT) and maternal weight were the only variables that significantly increased the risk of macrosomia and operative delivery. Within group I patients (FBG ≥ 5.8 mg/dl) only ‘maternal weight’ significantly increased the risk of both having a baby > 4 kg, and operative delivery. Conclusion: Among patients with gestational diabetes, a GTT with a FBG level ≥ 5.8 mmol/l is a strong predictor for perinatal outcome. Maternal weight is an independent risk factor that increases the risk of both macrosomia and operative delivery.

Anthropometric measurements of newborns of gestational diabetic mothers: Does it indicate disproportionate fetal growth?

Anthropometric and skinfold measurements in 51 newborns of mothers with gestational diabetes were compared to reference ranges obtained from measurements of 501 newborns of nondiabetic mothers. In newborns of diabetic mothers, the means of fetal birth weight, biceps, subscapular, suprailiac skinfolds, and total fat index measurements (the sum of all measurements) were significantly greater than those of the nondiabetic group. While the means of fetal crown-heel length and head circumference did not significantly differ between the two groups, these findings suggest a disproportionate pattern of growth in fetuses of diabetic mothers, with increased tendency for deposition of subcutaneous fat. The studied population were then stratified into six categories according to birth weight percentiles. Within each category, the skinfold measurements in newborns of diabetic mothers were greater--though the difference was not statistically significant than that of nondiabetic mothers. It is possible, however, that in severe cases of maternal diabetes, the risks of complications, such as shoulder dystocia, increase with disproportionate deposition of subcutaneous fat. These risks appear greater than in fetuses of nondiabetic mothers at a comparable birthweight.

The Diagnosis of ‘Pathological Hyperglycaemia’ in Gestational Diabetes in a High Risk Obstetric Population

In order to define a level of ‘pathological hyperglycaemia’, i.e. glucose intolerance that predicts perinatal morbidity among the obstetric population, 100 g glucose tolerance tests (GTTs) were performed in 660 patients attending for antenatal care at the University Hospital in Jeddah. The results were analysed in two ways: (1) patients were stratified according to the number of abnormal glucose values on the GTTs and (2) patients were placed into one of three groups according to the 100 g GTT diagnostic criteria, i.e. normal (non‐GDM), abnormal with fasting blood glucose (FBG) ≥5.8 mmol l−1 (GDM), and abnormal with FBG <5.8 mmol l−1 (gestational induced hyperglycaemia, GIH). Although there was a stepwise association between fetal/maternal morbidity with increasing number of abnormal glucose values, no level of glucose intolerance could be defined as a threshold level for normal response. However, when stratified by FBG, GDM patients were significantly heavier (78.5 kg ± SD 14.9), had a higher incidence of both macrosomia (27.5 %) and operative delivery (25.3 %) than the other two groups (14.7 %, 14.3 %, and 15.4 %, 12.8 % in the non‐GDM and GIH, respectively). It is suggested that among patients with abnormal GTT results a FBG ≥ 5.8 mmol l−1 identifies a threshold for true ‘pathological hyperglycaemia’.

Prevalence and risk factors of obstructive sleep apnea syndrome in a Saudi Arabian population

Background: Obstructive sleep apnea (OSA) is a common disorder worldwide; however, epidemiological studies on its prevalence lack in Saudi Arabia. This study aimed to determine the prevalence and risk factors of OSA in Saudi Arabia. Methods: The study was performed from 2013 to 2015 in two stages. The screening stage was first; a random sample of Saudi employees (n = 2682) 30–60 years of age completed a survey that included the Wisconsin questionnaire. According to these data, the subjects were categorized as habitual, moderate, or nonsnorers (NSs). The confirmatory second stage was a case–control study conducted on 346 individuals selected from each group using polysomnography (PSG). Results: In the first stage, the prevalence of habitual snoring was 23.5%, moderate snoring was16.6%, while 59.9% of the sample was NSs. Among the 346 individuals who underwent PSG, a total of 235 (67.9%) subjects had OSA with an apnea-hypopnea index (AHI) of ≥5; 76 (22.0%) had OSA syndrome (OSAS), defined by an AHI of ≥5 plus daytime sleepiness; and 227 (65.6%) had clinically diagnosed OSA syndrome (COSAS), as defined by the American Academy of Sleep Medicine. A conservative estimate of at least 8.8% (12.8% in men and 5.1% in women) was calculated for the overall prevalence of OSA. Similarly, the overall estimated prevalence of OSAS and COSAS was 2.8% (4.0% in men and 1.8% in women) and 8.5% (12.4% in men and 4.8% in women), respectively. A multivariate analysis revealed age, gender, obesity, and hypertension as independent risk factors of OSA. Conclusions: Our study demonstrated that the rate and risk factors of OSA in the Saudi population are similar to those observed in Western studies.