Iranian Society of Gynecology Oncology

Document Type : Original Research Article


Women's Reproductive Health Research Center, Tabriz University of Medical Sciences, Tehran, Iran


Background & Objective: Diabetes mellitus and gestational diabetes are complications that may be associated with preterm premature rupture of the membrane (i.e. PPROM) during pregnancy. We have investigate the impact of gestational and overt diabetes on PPROM through a statistical campaign. 
Materials & Methods: This study was conducted in two parts: In the first part, the PPROM patients (211 cases) were classified into three groups, without diabetes (W/ODM=126 cases), gestational diabetes (GDM=69 cases consist of 44 cases under insulin therapy and 25 cases of diet controlled), and diabetes mellitus (ODM=16 cases). PPROM complications were studied and compared between these three groups. In the second part, GDM patients under insulin therapy or diet control were compared to W/ODM patients in terms of PPROM complications. 
Results: There were no significant statistical differences between the groups regarding pregnancy outcomes, except, for mean gestational age at rupture of membrane and delivery. For maternal outcomes, there were significant changes between groups in terms of labor duration, hospital stay after childbirth, and severe preeclampsia. Fetus and neonatal outcomes suggested that the newborn weight, neonatal hyperglycemia, Apgar score, revive need, infant death, and umbilical cord blood gas test results (except BE) were significantly different between the three groups. Results of the second part of the study, in terms of statistically significant differences between insulin therapy, diet control, and W/ODM are consistent with the first part, for all discussed factors. 
Conclusion: Results revealed that PPROM protocol management on PPROM cases who have gestational or overt diabetes is applicable and does not have any further risk. 


 Results revealed that PPROM protocol management on PPROM cases who have gestational or overt diabetes is applicable and does not have any further risk.


Main Subjects

1. Gomez R, Romero R, Edwin SS, David C. Pathogenesis of preterm labor and preterm premature rupture of membranes associated with intraamniotic infection. Infect Dis Clin. 1997;11(1):135-76. [DOI:10.1016/S0891-5520(05)70347-0] [PMID]
2. Mercer BM. Preterm premature rupture of the membranes. Obstet Gynecol. 2003;101(1):178-93. [DOI:10.1097/00006250-200301000-00033] [PMID]
3. Menon R, Fortunato SJ. The role of matrix degrading enzymes and apoptosis in repture of membranes. J Soc Gynecol Investig JSGI. 2004;11(7):427-37. [DOI:10.1016/j.jsgi.2004.04.001] [PMID]
4. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768-73. [DOI:10.1016/0002-9378(82)90349-0] [PMID]
5. Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and changes in preexisting diabetes and gestational diabetes among women who had a live birth-United States, 2012-2016. Morb Mortal Wkly Rep. 2018;67(43):1201-1207. [DOI:10.15585/mmwr.mm6743a2] [PMID] [PMCID]
6. Ebrahimi FS, Rad AH, Mosen M, Abbasalizadeh F, Tabrizi A, Khalili L. Effect of L. acidophilus and B. lactis on blood glucose in women with gestational diabetes mellitus: a randomized placebo-controlled trial. Diabetol Metab Syndr. 2019;11(1):1-7. [DOI:10.1186/s13098-019-0471-5] [PMID] [PMCID]
7. Almasi SZ, Salehiniya H. The prevalence of gestational diabetes mellitus in Iran (1993-2013): a systematic review. J Isfahan Med Sch. 2014;32(299):1396-412.
8. Harlev A, Wiznitzer A. New insights on glucose pathophysiology in gestational diabetes and insulin resistance. Curr Diab Rep. 2010;10(3):242-7. [DOI:10.1007/s11892-010-0113-7] [PMID]
9. Aghdam NK, Mousavi S, Hantoushzadeh S, Sahaf F. Comparing Early and Late Postpartum Glucose Tolerance Test in Patients With Gestational Diabetes Mellitus. Crescent J Med Biol Sci. 2019;6(1):123-8.
10. Jahanjoo F, Farshbaf-Khalili A, Shakouri SK, Dolatkhah N. Maternal and neonatal metabolic outcomes of Vitamin D supplementation in gestational diabetes mellitus: A systematic review and meta-analysis. Ann Nutr Metab. 2018;73(2):145-59. [DOI:10.1159/000491643] [PMID]
11. Eidem I, Vangen S, Hanssen KF, Vollset SE, Henriksen T, Joner G, et al. Perinatal and infant mortality in term and preterm births among women with type 1 diabetes. Diabetologia. 2011;54(11):2771-8. [DOI:10.1007/s00125-011-2281-7] [PMID]
12. Durnwald C, Huston-Presley L, Amini S, Catalano P. Evaluation of body composition of large-for-gestational-age infants of women with gestational diabetes mellitus compared with women with normal glucose tolerance levels. Am J Obstet Gynecol. 2004;191(3):804-8. [DOI:10.1016/j.ajog.2003.11.033] [PMID]
13. Mc Farland MB, Langer O, Fazioni E, Trylovich CG, Kobes CG. Antropometric and body composition differences in large for gestational age, but not appropriate for gestational age infants of mothers with and without diabetes mellitus. J Soc Gynecol Invest. 2000;7:231-7.
14. Miao M, Dai M, Zhang Y, Sun F, Guo X, Sun G. Influence of maternal overweight, obesity and gestational weight gain on the perinatal outcomes in women with gestational diabetes mellitus. Sci Rep. 2017;7(1):1-8. [DOI:10.1038/s41598-017-00441-z] [PMID] [PMCID]
15. Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: a large, population-based study. Diabetes Care. 2009;32(11):2005-9. [DOI:10.2337/dc09-0656] [PMID] [PMCID]
16. Rolo LC, Nardozza LMM, Araujo Júnior E, Simioni C, Zamith MM, Moron AF. Reference curve of the fetal ventricular septum area by the STIC method: preliminary study. Arq Bras Cardiol. 2011;96(5):386-92. [DOI:10.1590/S0066-782X2011005000036] [PMID]
17. Stamler EF, Cruz ML, Mimouni F, Rosenn B, Siddiqi T, Khoury J, et al. High infectious morbidity in pregnant women with insulin-dependent diabetes: an understated complication. Am J Obstet Gynecol. 1990;163(4):1217-21. [DOI:10.1016/0002-9378(90)90694-3] [PMID]
18. Yanit KE, Snowden JM, Cheng YW, Caughey AB. The impact of chronic hypertension and pregestational diabetes on pregnancy outcomes. Am J Obstet Gynecol. 2012;207(4):333-e1. [DOI:10.1016/j.ajog.2012.06.066] [PMID] [PMCID]
19. Conway DL, Langer O. Elective delivery of infants with macrosomia in diabetic women: reduced shoulder dystocia versus increased cesarean deliveries. Am J Obstet Gynecol. 1998;178(5):922-5. [DOI:10.1016/S0002-9378(98)70524-1] [PMID]
20. Dittakarn Boriboonhirunsarn M, Talungjit P, Sunsaneevithayakul P. Adverse pregnancy outcomes in gestational diabetes mellitus. J Med Assoc Thai. 2006;89(4):S23-8.
21. Kuppusamy N, Vidhyadevi A. Prevalence of preterm admissions and the risk factors of preterm labor in rural Medical College Hospital. Int J Sci Study. 2016;4(9):123-6.
22. Niromanesh S, Alavi A, Sharbaf FR, Amjadi N, Moosavi S, Akbari S. Metformin compared with insulin in the management of gestational diabetes mellitus: a randomized clinical trial. Diabetes Res Clin Pract. 2012;98(3):422-9. [DOI:10.1016/j.diabres.2012.09.031] [PMID]
23. Rice MM, Landon MB, Health EKSNI of C. What we have learned about treating mild gestational diabetes mellitus. In: Seminars in perinatology. Elsevier; 2016. p. 298-302. [DOI:10.1053/j.semperi.2016.03.006] [PMID] [PMCID]
24. Bhat M, Ramesha KN, Sarma SP, Menon S, Kumar SG. Outcome of gestational diabetes mellitus from a tertiary referral Center in South India: a case-control study. J Obstet Gynecol India. 2012;62(6):644-9. [DOI:10.1007/s13224-012-0226-9] [PMID] [PMCID]
25. Kari A, Sahhaf F, Abbasalizadeh F. Maternal, fetal and neonatal outcomes in mothers with diabetes mellitus or gestational diabetes that complicated with preterm premature rupture of the membrane (PPROM). Int J Womens Heal Reprod Sci. 2017;5(1):66-71. [DOI:10.15296/ijwhr.2017.12]
26. Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, Damm P, et al. International Association of Diabetes and Pregnancy Study Groups Consensus Panel International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010;33(3):676-82. [DOI:10.2337/dc09-1848] [PMID] [PMCID]
27. Leveno KJ, Bloom SL, Spong CY, Dashe JS, Hoffman BL, Casey BM, et al. Williams obstetrics. 2020.
28. Damm P, Kühl C, Bertelsen A, Mølsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol. 1992;167(3):607-16. [DOI:10.1016/S0002-9378(11)91559-2] [PMID]
29. Kim C, Newton KM, Knopp RH. Gestational diabetes and the incidence of type 2 diabetes: a systematic review. Diabetes Care. 2002;25(10):1862-8. [DOI:10.2337/diacare.25.10.1862] [PMID]
30. Köck K, Köck F, Klein K, Bancher-Todesca D, Helmer H. Diabetes mellitus and the risk of preterm birth with regard to the risk of spontaneous preterm birth. J Matern Neonatal Med. 2010;23(9):1004-8. [DOI:10.3109/14767050903551392] [PMID]
31. Bouvier D, Forest J-C, Blanchon L, Bujold E, Pereira B, Bernard N, et al. Risk factors and outcomes of preterm premature rupture of membranes in a cohort of 6968 pregnant women prospectively recruited. J Clin Med. 2019;8(11):1987. [DOI:10.3390/jcm8111987] [PMID] [PMCID]
32. Al Riyami N, Al-Ruheili I, Al-Shezaw F, Al-Khabori M. Extreme preterm premature rupture of membranes: risk factors and feto maternal outcomes. Oman Med J. 2013;28(2):108. [DOI:10.5001/omj.2013.28] [PMID] [PMCID]
33. Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth. 2020;20(1):73. [DOI:10.1186/s12884-020-2759-8] [PMID] [PMCID]
34. Nohr EA, Bech BH, Vaeth M, Rasmussen KM, Henriksen TB, Olsen J. Obesity, gestational weight gain and preterm birth: a study within the Danish National Birth Cohort. Paediatr Perinat Epidemiol. 2007;21(1):5-14. [DOI:10.1111/j.1365-3016.2007.00762.x] [PMID]
35. Yogev Y, Langer O. Spontaneous preterm delivery and gestational diabetes: the impact of glycemic control. Arch Gynecol Obstet. 2007;276(4):361-5. [DOI:10.1007/s00404-007-0359-8] [PMID]
36. Sheiner E, Mazor-Drey E, Levy A. Asymptomatic bacteriuria during pregnancy. J Matern neonatal Med. 2009;22(5):423-7. [DOI:10.1080/14767050802360783] [PMID]
37. Torres MAR. Gestational diabetes mellitus. Experience at a third level hospital. Ginecol Obstet Mex. 2005;73(09):484-91.
38. Kessous R, Weintraub AY, Sergienko R, Lazer T, Press F, Wiznitzer A, et al. Bacteruria with group-B streptococcus: is it a risk factor for adverse pregnancy outcomes? J Matern Neonatal Med. 2012;25(10):1983-6. [DOI:10.3109/14767058.2012.671872] [PMID]
39. Metzger BE, Contreras M, Sacks DA, Watson W, Dooley SL, Foderaro M, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002. [DOI:10.1056/NEJMoa0707943] [PMID]
40. Van Leeuwen M, Louwerse MD, Opmeer BC, Limpens J, Serlie MJ, Reitsma JB, et al. Glucose challenge test for detecting gestational diabetes mellitus: a systematic review. BJOG An Int J Obstet Gynaecol. 2012;119(4):393-401. [DOI:10.1111/j.1471-0528.2011.03254.x] [PMID]
41. Wen T, Yu VX, Wright JD, Goffman D, Attenello F, Mack WJ, et al. Postpartum length of stay and risk for readmission among women with preeclampsia. J Matern Neonatal Med. 2020;33(7):1086-94. [DOI:10.1080/14767058.2018.1514382] [PMID] [PMCID]
42. Hollingsworth DR, Vaucher Y, Yamamoto TR. Diabetes in pregnancy in Mexican Americans. Diabetes Care. 1991;14(7):695-705. [DOI:10.2337/diacare.14.7.695] [PMID]
43. Magee MS, Walden CE, Benedetti TJ, Knopp RH. Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity. Jama. 1993;269(5):609-15. [DOI:10.1001/jama.1993.03500050087031] [PMID]
44. Aalipour S, Hantoushzadeh S, Shariat M, Sahraian S, Sheikh M. Umbilical Cord Blood Acidosis in Term Pregnancies With Gestational Diabetes Mellitus and Its Relations to Maternal Factors and Neonatal Outcomes. Iran Red Crescent Med J. 2018;20(S1). [DOI:10.5812/ircmj.59267]
45. Subiabre M, Silva L, Toledo F, Paublo M, López MA, Boric MP, et al. Insulin therapy and its consequences for the mother, foetus, and newborn in gestational diabetes mellitus. Biochim Biophys Acta (BBA)-Molecular Basis Dis. 2018;1864(9):2949-56. [DOI:10.1016/j.bbadis.2018.06.005] [PMID]