Subarna Mitra

Feto-maternal outcomes in women with and without gestational diabetes mellitus according to the International Association of Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.

BACKGROUND Gestational diabetes mellitus (GDM) is responsible for majority of pregnancies complicated with diabetes mellitus. Both the screening (universal vs. selective) and the diagnostic criteria of GDM has been the subject of considerable controversy. METHODS This prospective cohort study was undertaken at Pondicherry Institute of Medical Sciences, Puducherry from August 2011 to July 2012. All the patients attending antenatal clinic underwent oral glucose tolerance test (OGTT) with 75g of anhydrous glucose between 24 and 32 weeks of gestation. Those patients diagnosed as GDM according to IADPSG diagnostic criteria were treated with diet and physical activity with or without insulin. All the antenatal and perinatal outcomes were noted. RESULTS The prevalence of GDM in our study was 27% (83/304). Out of all the GDM patients, 87% (72/83) cases were diagnosed by raised FBS alone or with other two values. A significant family history of diabetes mellitus was found among GDM mothers compared to non-GDM group (10.8% vs. 3.6%, p=0.01). Insulin was required only in 8 patients for glycemic control. The GDM patients delivered at significantly lower gestational age (p=0.02) with more antenatal complications (25% vs. 12%, p=0.02). Among neonatal outcomes, there was a significant difference only in the need for NICU admission>24h between GDM and non-GDM groups (p=0.02). CONCLUSION The prevalence of GDM increases with universal screening using IADPSG diagnostic criteria in India. The antenatal complications are present in up to one fourth of these patients.

Effect of maternal anthropometry and metabolic parameters on fetal growth.

Objective: The aim of this study was to determine the effect of maternal anthropometry and metabolic parameters on neonatal anthropometry. Materials and Methods: This observational cross-sectional study was conducted from January 2008 to June 2009 at a single tertiary care center. Maternal anthropometry and metabolic parameters like fasting serum insulin, lipid profile, and random blood glucose were estimated in 50 pregnant women at term. Detailed anthropometry of the neonates was performed. Results: Large for gestational age (LGA) babies had higher maternal body mass index (BMI), fasting serum insulin, and cord blood insulin levels, and lower maternal high density lipoprotein (HDL) compared to appropriate for gestational age (AGA) group (P < 0.001). Among the maternal parameters, BMI, gestational age, fasting serum insulin, and random blood sugar (RBS) had significant positive correlation, while HDL had negative correlation with birth weight (P < 0.05). However, only maternal BMI was the significant predictor of neonatal birth weight on multiple regression analysis (ß = 0.340, P = 0.01). Conclusion: The BMI of glucose-tolerant mother is more important than metabolic parameters in determining the birth weight of term babies.

Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients.

OBJECTIVE: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. MATERIALS AND METHODS: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. RESULTS: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. CONCLUSIONS: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.

Late Presentation of Unsafe Abortion after 5 Years of Procedure

A majority of the unsafe abortions are performed by untrained birth attendants or quacks leading to complications in a large proportion of these cases. Complications like bowel injury, bladder injury, uterine perforation, and septic abortion are mostly caused by unskilled hands and are detected immediately or within few days of the procedure, owing to the need for tertiary level care. Here we present a very interesting case of unsafe abortion induced by a Ryles tube in a 32-year-old lady, which was diagnosed five years after the procedure. Considering its atypical presentation, it is the first case of its kind in the literature. The details of the case and its management are described along with appropriate pictures.

Successful Pregnancy in Autoimmune Hepatitis/Primary Biliary Cirrhosis Overlap Syndrome: A Case Report.

Medical literature on pregnancy outcomes in hepatic overlap syndromes is limited. Autoimmune liver diseases are associated with sub-fertility and pregnancy is usually dissuaded in presence of portal hypertension and cirrhosis due to guarded prognosis for the pregnancy as well as the liver disease. We report a 24-year-old primigravida with autoimmune hepatitis/primary biliary cirrhosis overlap syndrome who had a successful pregnancy owing to intensive monitoring and meticulous treatment with drugs like immunosuppressants and ursodeoxycholic acid. She developed preterm prelabour rupture of membranes and delivered at 35 weeks without any major obstetric or hepatic complications.

Vitamin D Status and Cardio-Metabolic Risk in Indian Postmenopausal Women.

INTRODUCTION The prevalence of chronic and non-communicable health disorders like cardiovascular diseases and metabolic syndrome is increasing worldwide including in India. The various risk factors for these health issues need to be addressed. The role of vitamin D deficiency in the causation of all these abnormal health conditions among postmenopausal women is a matter of debate now-a-days. AIM To determine the correlation of serum vitamin D levels with various cardio-metabolic risk factors and metabolic syndrome (MetS) in postmenopausal women (PMW). MATERIALS AND METHODS Total of 64 PMW were included in this cross-sectional study. Clinical (waist circumference, body mass index, blood pressure) and biochemical (fasting plasma glucose, lipid profile and serum 25-hydroxyl vitamin D levels) parameters were measured. MetS was defined using modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) guidelines. Serum 25-hydroxyl vitamin D levels <50 nmol/l, between 52.5-72.5 nmol/l and >75 nmol/l were classified as deficient, insufficient and sufficient, respectively. RESULTS MetS was prevalent in 33 (52%) subjects. There were no differences in serum vitamin D levels or proportion of vitamin D deficient individuals in those with and without MetS. 33 women (52%) had vitamin D deficiency. Cardio-metabolic risk profile was similar in both vitamin D deficient and replete women. CONCLUSION Despite a high prevalence of vitamin D deficiency and MetS in Indian PMW, serum vitamin D concentrations do not correlate with the cardio-metabolic risk factors or MetS.

Comment on prediction of neonates' macrosomia with maternal lipid profile of healthy mothers by Mossayebi et al.

We read with interest the article by Mossayebi et al in which they analyzed the association between fasting lipid profile of healthy pregnant women in the third trimester of pregnancy and neonatal birth weight. The authors concluded that mothers’ triglyceride (TG) level was one of the independent predictors for both birth weight of newborns and presence of macrosomia/large for gestational age (LGA) babies. The participants included in this study were healthy pregnant women without illnesses such as, diabetes mellitus, prepregnancy obesity (body mass index 30 kg/m), hypertension/preeclampsia, thyroid disorders, and collagen vascular diseases. However, the authors have not mentioned whether mothers with pregnancy induced cholestasis (PIC) were included in their study. This is very much relevant to this paper as PIC is associated with dyslipidemia. PIC affects up to 2% of pregnant women and occurs usually in the third trimester of pregnancy. Mossayebi et al included participants in the first weeks of the third trimester of pregnancy in their study. Therefore, there is a possibility that some pregnant women, who were healthy at the time of recruitment into the study, might have developed PIC towards the latter part of pregnancy. These facts should be taken into account before interpretation of study results. Low-density lipoprotein (LDL) cholesterol, apolipoprotein B-100, and total cholesterol concentrations were significantly raised with low high-density lipoprotein (HDL) cholesterol during pregnancy in women with PIC compared with healthy controls in a study by Dann et al. However, serum TG was not measured in that study as participants were not in fasting states while giving blood samples for

The relevance of antral follicle count (AFC) as a marker of ovarian reserve in normal and infertile women in a tertiary care centre in Central India

Infertility is not merely a health problem, but it leads to distress, depression, discrimination and ostracism. Infertility is the failure of a couple to conceive after 1 year of regular, unprotected intercourse. Infertility affects approximately 8%-10% of couples worldwide. Ovulatory disorder is one of the most common cause of female factor infertility. Reproductive aging is considered to be the consequence of a decrease in the quantity and quality of the ovarian follicle pool. Many women these days defer childbearing to the later years, raising their risk of infertility associated with ovarian ageing. Demographic and clinical studies show that female fertility starts to decrease from the age of 30 years, and the ability to conceive becomes almost zero at a median age of 41 years.

Comment on Kulkarni et al. Maternal Lipids Are as Important as Glucose for Fetal Growth: Findings From the Pune Maternal Nutrition Study. Diabetes Care 2013;36:2706–2713

We read with great interest the article by Kulkarni et al. (1), which shows maternal fasting glucose, total cholesterol, and triglyceride but not HDL cholesterol to be associated with neonatal birth size. These findings, however, are not consistent with many other related studies, including one from India (2–4). Kulkarni et al. probably attribute the absence of the relationship …