Farklı Düzeylerde Glukoz İntoleransı Bulunan Gebelerin Kan Şekeri Profilleri ve Perinatal Sonuçlarının Değerlendirilmesi

Year 2016, Volume: 16 Issue: 1, 0 - 0, 04.03.2016

Engin Burak Selçuk , Ayşe Kafkaslı Ayşe Sertkaya

https://doi.org/10.17098/amj.33824

Abstract

Amaç: Bu çalışmanın amacı farklı düzeylerde glukoz intoleransı gösteren gebelerde kan şekeri profilleri ve perinatal sonuçlarını karşılaştırarak gebelerin takip ve tedavilerine katkıda bulunmaktır.

Materyal ve Metot: Gebe Polikliniği’ne müracaat eden 24-28. gebelik haftaları arasında ki gebelere 50 gram Glukoz Tolerans Testi (GTT) yapıldı ve sonucu pozitif olanlara 100 gram Oral Glukoz Tolerans Testi (OGTT) yapıldı. Test sonucuna göre gebeler Normal, Anormal Glukoz Tolerans Testi (AGTT) olanlar ve gestasyonel diyabeti (GDM) olanlar olarak 3 gruba ayrıldı. Her üç grupta demografik veriler, GTT ve OGTT sonuçları, doğum öncesi ve doğum sonrası kan şekeri profilleri, perinatal sonuçlar ve maternal komplikasyonlar yönünden kendi aralarında değerlendirildi.

Bulgular: AGTT görülme sıklığı % 17,42 olarak bulunurken, GDM görülme sıklığı % 14,57 olarak bulundu. Gebelik öncesi ve 50 gram GTT sırasındaki vücut kitle indeksi (VKİ) yönünden karşılaştırıldığında, AGTT grubunda, normal gruba göre yüksek bulundu (p<0,05). AGTT grubunun 24 saatlik ve postpartum ilk 24 saatlik kan şekeri profilleri normal grupla karşılaştırıldığında yüksek bulundu (p<0.05). Bu değerler GDM grubunda da AGTT grubuna göre yüksek bulundu (p<0.05).

Sonuç: AGTT grubunun GDM grubuna göre daha hafif şiddette, ancak normal grup ile karşılaştırıldığında anlamlı kabul edilecek kadar daha şiddetli glukoz intoleransına sahip olduğu görülmüştür. Bu nedenle AGTT saptanan gebelerin de GDM saptanan gebeler gibi yakın takibinin ve gerektiğinde tedavi edilmesinin gerek fetal komplikasyonlar, gerekse maternal komplikasyonların önlenmesi yönünden yararlı olacağı düşünülmektedir.

Keywords

Anormal glukoz tarama testi, gestasyonel diyabet, gebelik

Evaluation of Blood Glucose Profile and Perinatal Outcomes in Pregnant with Different Levels of Glucose Intolerance

Abstract

Objectives: The aim of this study is to contribute to the monitoring and treatment in pregnant women with different levels of glucose intolerance by comparing blood glucose profiles and perinatal outcomes.

Materials and Methods: A 50-gram Glucose Tolerance Test (GTT) was performed on pregnant women between 24th and 28th weeks of pregnancy who admitted to the outpatient clinic followed by a 100-gram OGTT on those who tested positive with 50 g GTT. The patients were allocated into three groups according to the test results as Normal, Abnormal Glucose Challenge Test (AGCT) and Gestational Diabetes Mellitus (GDM). All groups were evaluated in terms of demographic data, GTT and OGTT results, prenatal and postnatal blood glucose profiles, maternal complications, and perinatal outcomes.

Results: The prevalence of AGCT was found to be 17.42% while GDM was 14.57%. When compared as to prepregnancy and during 50 g OGTT values, the body mass index (BMI) was found significantly higher in AGTT group than the normal group (p<0.05). Twenty-four hour and postpartum first 24-hour blood glucose profiles of the AGCT group were found to be higher than the normal group (p<0.05), whereas these values were found to be significantly higher in the GDM group when compared to the AGCT group (p<0.05).

Conclusion: We found that glucose intolerance in the AGCT group was slightly higher when compared to GDM group and appears to be significantly increased when compared to the normal group. Therefore, we suggest that the pregnant women with AGCT should be followed up closely and treated if needed, similar to the patients diagnosed with GDM in order to prevent both fetal and maternal complications.

Keywords

Abnormal glucose challenge test, gestational diabetes, pregnancy

References

• Nelson-Piercy C. Handbook of Obstetric Medicine. In: Nelson-Piercy C (ed). Diabetes. Oxford: Isis Medical Media Ltd; 1997:66-79.
• Cruickshand K. The Epidemiology of Diabetes Mellitus. In: G Williams, J Pickup. (eds). Textbook of Diabetes. 2nd ed. Volume 1, Cambridge: Blackwell Sci; 1997:1-28.
• Henry OA, Beisher NA. Long-term implication of Gestational diabetes for the mother. Baillere’ s Clin Obstet Gynecol 1991;5:461-83.
• Moore TR. Diabetes in Pregnancy. In: Creacy RK, Resnik R (ed). Maternal-Fetal Medicine Principles and Practise. 5th ed. Philadelphia: WB Saunders; 2004:1023-61.
• Weiss PAM, Haeusler M, Kainer F, Pürstner P, Haas J. Toward universal criteria for gestational diabetes: Relationships between seventy-five and one hundred gram glucose loads and between capillary and venous glucose concentrations. Am J Obstet Gynecol 1998;178:830-5.
• Türk Endokrinoloji ve Metabolizma Derneği. Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. 7. Baskı, Ankara; Pelin Ofset: 2015:17-9. http://www.turkendokrin.org/files/15055_DIYABET_web(1).pdf (Erişim tarihi: Kasım 2015).
• Buchanan TA, Xiang AH. Gestational diabetes mellitus. J Clin Inves 2005;115:485-91.
• Landon MB, Gabbe SG, Sachs L. Management of diabetes mellitus and pregnancy. Obstet Gynecol 1990;75:635-40.
• Çorakçı A. Treatments of Diabetes Mellitus and Complications. Koloğlu S. (ed). Basic and Clinical Endocrinology. Medical Network, Ankara; 1996 (In Turkish).
• Vambergue A, Nuttens MC, Verier-Mine O, Dognin C, Cappoen JP, Fontaine P. Is mild gestational hyperglycaemia associated with maternal and neonatal complications? The Diagest Study. Diabet Med 2000;17:203-8.
• Weijers RNM, Bekedam DJ, Simulders YM. Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large Dutch multiethnic cohort. Diabetes Care 2002;25:72-7.
• American Diabetes Association. Gestational Diabetes Mellitus. Diabetes Care 2004;27 Suppl 1:88-90.
• Metzger BE, Coustan DR. Proceedings of the fourth international Workshop-Conference on gestational diabetes mellitus. Diabetes Care 1998;21 Suppl 2:B161-7.
• American Colloge of Obstetricians and Gynecologist. Clinical management guidelines for obstetricians-gynecologists. Gestational diabetes. ACOG Practise Bulletin 30. Obstet Gynecol 2001;98:525-38.
• Danilenko-Dixon DR, Winter T, Nelson RL, Ogburn PL. Universal versus selective gestational diabetes screening: Application of 1997 American Diabetes Association recommendations. Am J Obstet Gynecol 1999;181:798-802.
• Solomon CG, Willett WC, Carey VJ et al. A prospective study of pregravid determinants of gestational diabetes 1997; 278:1078-83.
• Weijers RNM, Bekedam DJ, Simulders YM. Determinants of mild gestational hyperglycemia and gestational diabetes mellitus in a large Dutch multiethnic cohort. Diabetes Care 2002;25:72-7.
• Buchanan TA, Metzger BE, Freinkel N, Bergman RN. Insulin sensitivity and beta cell responsiveness to glucose during late pregnancy in lean and moderately obese woman with normal glucose tolerance or mild gestational diabetes. Am J Obstet Gynecol 1990;162:1008-14.
• Morisset AS, St-Yves A, Veillette J, Weisnagel SJ, Tchernof A, Robitaille J. Prevention of gestational diabetes mellitus: a review of studies on weight management. Diabetes Metab Res Rev 2010;26:17-25.
• Riskin-Mashiah S, Damti A, Younes G, Auslander R. Pregestational body mass index, weight gain during pregnancy and maternal hyperglycemia. Gynecol Endocrinol 2010; 27:464-467.
• Alanbay I, Çoksüer H, Ercan CM et al. The comparison of maternal body mass index and weight gain with maternal biochemical parameters and fetal birth weight in patients with gestational diabetes mellitus. Gülhane Med J 2011;53:237-42 (In Turkish).
• Yalcin HR, Zorlu CG. Threshold value of glucose screening tests in pregnancy: Could it be standardized for every population ? Am J Perinatol 1996;13(5):317-20.
• Tanir HM, Sener T, Gurer H, Kaya M. A ten-year gestational diabetes mellitus cohort at a university clinic of the mid-Anatolian region of Turkey. Clin Exp Obstet Gynecol 2005;32(4):241-4.
• Bonomo M, Gandini ML, Mastropasqua A et al. Which cutoff level should be used in screening for glucose intolerance in pregnancy. Am J Obstet Gynecol 1998;179:179-85.
• Cousins L, Baxi L, Chez R et al. Screening recommendations for gestational diabetes mellitus. Am J Obstet Gynecol 1991;165:493-6.
• Buchanan TA. Pancreatic B-cell defects in gestational diabetes: Implications for the pathogenesis and prevention of type 2 diabetes. J Clin. Endocrinol. Metab 2001;86:989-93.