Browsing by Author "Motha, C."

Now showing 1 - 6 of 6

Diabetes mellitus in pregnancy – a Sri Lankan experience
(Wiley-Blackwell, 2015) Dias, T.; Palihawadana, T.; Motha, C.; Thulya, S.D.
INTRODUCTION Diabetes mellitus in pregnancy carries high perinatal morbidity/mortality and maternal morbidity. Only a proportion of women would have pre-existing diabetes mellitus with the majority developing gestational diabetes (GDM). The burden of diabetes in pregnancy is expected to increase in Sri Lanka as obesity is high among pregnant population. Aims of this study were to look at the prevalence, risk factors and complications of diabetes in pregnancy. METHODS The North Colombo Obstetric database (NORCOD), which records pregnancy data of all women delivering at the university obstetric unit of the North Colombo Teaching hospital, Ragama, Sri Lanka, was used for retrospectively analysis. 1830 deliveries between March and August 2014 were included. Those with incomplete data were excluded. Details regard to prevalence, associated risk factors and complications were identified. RESULTS: Diabetes mellitus complicated 130 (7.1%) pregnancies. This consisted of 26 with pre-existing disease and 104 with GDM. A positive family history in first degree relative (OR 7.87, 95% CI 5.08–12.1), and a BMI of >23 kg/m2 (OR 2.68 95% CI 1.75–4.11) were associated with development of GDM. The mean (SD) age was significantly higher among women who developed GDM compared to those did not (32.1 (4.76) versus 28.7 years (4.7), P = 0.03 respectively). The mean (SD) postprandial blood sugar (PPBS) estimate done in the first half of the pregnancy was significantly higher among women who developed GDM later in pregnancy compared to those who did not (120 (39.2) versus 95 mg/dL (14.6), P < 0.0001 respectively). Hypertensive disorders of pregnancy was significantly associated with diabetes in pregnancy (OR 2.39 95% CI 1.49–3.83) and a birthweight of >3 kg at term (OR 1.63 95% CI 1.11–2.40). CONCLUSION: Diabetes mellitus complicates a significant number of pregnancies. Pre-existing diabetes constitutes one fifth of thesepregnancies, highlighting the importance of provision of preconception care to women contemplating pregnancy. A positive family history increases the risk of GDM by nearly 8 fold. Abnormal PPBS results in early part of pregnancy, in women who later develop GDM suggest the presence of abnormal glucose homeostasis in this group even at early stages of pregnancy. This has the potential for developing in to a test of early detection of GDM in pregnancy.
Management of anaemia in pregnancy: experience from a Sri Lankan tertiary hospital unit
(Wiley-Blackwell, 2015) Palihawadana, T.; Dias, T.; Motha, C.; Thulya, S.D.; Herath, R.; Wijesinghe, P.S.
INTRODUCTION: Higher rates of pregnancy complications have been reported among anaemic pregnant women. Universal iron supplementation during pregnancy is recommended in countries where iron deficiency anaemia (IDA) prevalence rates are high. Sri Lanka also carries out a policy of such supplementation. The effectiveness of such programmes in different settings is variable. A retrospective analysis of the effectiveness of our current policy on prevention and treatment of anaemia was done for programme evaluation. METHODS: The North Colombo Obstetric Database (NORCOD) was used retrospectively to analyse the data between March and August 2014, at the university obstetric unit of the North Colombo Teaching Hospital, Sri Lanka. All singleton pregnancies without medical comorbidities were included in the analysis. Those who did not have haemoglobin (Hb) recording in the first trimester or in the third trimester were excluded at the data cleaning stage. An Hb level of <11 g/dL and a level of <10.5 g/dL were considered as anaemia in first and third trimesters respectively. The prevalence of anaemia at booking, and the Hb status in the third trimester were assessed. RESULTS: A total of 1340 singleton pregnancies were included in the analysis and 74 were excluded from the analysis due to incomplete data. 28.9% (n = 366) were found to be anaemic at booking while 63.9% (n = 809) were with a normal Hb and 7.1% (n = 91) were with an Hb of >13 g/dL. In the third trimester the prevalence of anaemia was 11.5% (n = 146) while 64.7% (n = 820) were with normal Hb and 23.6% (n = 300) were with an Hb of >13 g/dL. Among the anaemic women at booking, 22% (n = 81) persisted to be anaemic in the third trimester while 65% (n = 238) became normal and 12.8% (n = 47) developed a higher Hb level. Among those with a high Hb at booking only 1% became anaemic by third trimester while 40.6% persisted to have a high Hb level. CONCLUSION The prevalence of anaemia in this population was of moderate severity (>20% but <40%) as defined by the WHO. Major shortcoming in our practice is that we were unable to successfully treat nearly quarter of women who present with anaemia at booking, thus highlighting sub-optimal treatment. Furthermore, a policy of universal supplementation seems to over treat women with a high Hb at booking. Therefore, a more individualised supplementation and treatment policy should be encouraged in routine clinical practice.
Maternal medicine
(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Motha, C.
With the advancement of medical science, more women with medical disorders are reaching adulthood and rearing children. However, these women are at increased risk of morbidity and mortality due to exacerbation of these conditions during pregnancy. When reviewing the leading causes of maternal mortality in Sri Lanka, medical disorders are at the forefront with no sign of decline. The lack of a robust referral system to manage women identified with medical problems in the preconception stage, a dearth of studies on medical disorders in pregnancy in Sri Lanka and inadequate knowledge of these conditions among clinicians were identified as reasons for this non reassuring trend. As a first step in addressing these deficiencies we undertook research in the area of maternal medical disorders. Common medical conditions during pregnancy were studied and relevant recommendations made. We studied pre-existing medical problems in pregnant women in order to gauge the magnitude and pattern of medical disorders so as to make suitable recommendations to the preconception care service through the Ministry of Health with the ultimate aim of promoting ‘life giving’ rather than ‘life saving’.
Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, post-menopausal, urban Sri Lankan females: a community cohort follow-up study
(Sri Lanka Medical Association, 2017) Dias, T.D.; Niriella, M.A.; de Silva, S.T.; Ediriweera, D.; Motha, C.; Palihawadana, T.; de Silva, H.J.
INTRODUCTION & OBJECTIVES: Metabolic syndrome (MetS) has been recognized as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old females from the Ragama MOH area by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: Of the original female cohort, 813/1636 (49.7%) attended follow-up; ET was measured in 567 (69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57 (10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95% CI 1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95% CI 1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95% CI 0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95% CI 0.10–0.89, p<0.05] were protective. CONCLUSION: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.
Metabolic syndrome and risk of endometrial carcinoma among asymptomatic, postmenopausal, urban Sri Lankan females: a community cohort follow-up study
(Wiley Publishing, 2017) Dias, T.; Niriella, M.; de Silva, S.; Motha, C.; Palihawadana, T.S.; Ediriweera, D.; de Silva, J.
OBJECTIVES: Metabolic syndrome (MetS) has been recognised as a risk factor for malignancies. The aim of this study was to evaluate the association of MetS and risk of endometrial carcinoma (EC), by measuring endometrial thickness (ET). METHODS: The Ragama Health Study (RHS) recruited 35-64-year-old female cohort by age-stratified random sampling in 2007 and re-evaluated them in 2014, using a structured interview, anthropometric measurements and biochemical tests. Liver ultrasound to detect fatty liver was performed in 2007. Pelvic ultrasound to detect ET was performed in 2014 among consenting participants. MetS was diagnosed on established International Diabetes Federation (IDF 2012) criteria. Increased ET was defined as >5mm. Simple logistic regression was used to screen variables and multiple logistic regression was used to obtain adjusted effects of risk factors for increased ET. RESULTS: 813/1636(49.7%) of the original female cohort attended follow-up; ET was measured in 567(69.7%). Median (IQR) age of females was 61 (56-66) years. 323 fulfilled criteria for MetS (prevalence 57.1%) in 2007. 57(10.1%) had increased ET in 2014. Increasing plasma triglycerides [OR=1.004 per mg/dl, 95%CI:1.001-1.007, p<0.05] and being hypertensive [OR=2.16, 95%CI:1.11–4.08, p<0.05] were associated with increased ET, while advancing age [OR=0.93 per year, 95%CI:0.89–0.98, p<0.01] and being diabetic [OR= 0.34, 95%CI:0.10–0.89, p<0.05] were protective. CONCLUSIONS: Hypertension and increased plasma triglyceride levels, in the pre-menopausal period, were risk factors for future asymptomatic increased ET.
A retrospective analysis of the prevalence of heart disease in pregnancy – a Sri Lankan experience
(Wiley-Blackwell, 2015) Motha, C.; Palihawadana, T.; Dias, T.; Thulya, S.D.; Godage, T.
INTRODUCTION: With improvement in obstetric care, the burden due to direct causes of maternal mortality has declined bringing medical conditions to the forefront. Heart disease in pregnancy remains a major cause of maternal morbidity and mortality in Sri Lanka. In the absence of a robust pre-conception care programme, many women with pre-existing heart disease embark on pregnancy unaware of the underlying abnormalities. This study was aimed at describing the proportion of women with heart disease, the type of heart disease and the time of detection in this population. METHODS: The North Colombo Obstetric database (NORCOD) records data for all women who deliver at the university obstetric unit of the North Colombo Teaching hospital, Ragama, Sri Lanka. Details of women delivered between March and August 2014 were used in a retrospective analysis. Data on booking screening, and pregnancy care with regard to heart disease were analysed. RESULTS: A total of 1830 pregnancies were included. Fifty (2.7%) were complicated with heart disease. 15 (0.8%) patients were known to have pre-existing heart disease at the time of booking. They included 10 with congenital heart disease (treated ASD in 3, untreated ASD in 1, untreated VSD in 1, ligated PDA in 1 and mitral valve disease in 4) and 5 acquired heart disease due to rheumatic heart disease. A cardiac murmur on auscultation was detected in 61 women (3.3%) at their booking screening. 26 (42.6%) of them were found to have an underlying cardiac lesion. The commonest lesion was isolated mitral valve prolapse (n = 11), followed by mitral regurgitation associated with mitral valve prolapse (MVP) in 10, tricuspid regurgitation (TR) in 3, and one each of ASD and VSD. Nine others were found to have underlying cardiac lesion at assessment during pregnancy, in the absence of any abnormality at booking. These included 6 with MVP, 2 with mitral regurgitation (MR) with MVP, and one with MR. CONCLUSION A significant proportion of women with cardiac abnormalities (70%) were detected during pregnancy. This highlights the importance of pre-conception care with screening in this population. While booking screen was able to identify a majority of patients, some were detected only during subsequent assessment. Clinical vigilance throughout pregnancy facilitates such detection.