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Pregestasyonel diabetes mellitus ve gestasyonel diabetes mellitus tanılı hastalarda gebelikte kilo alımı ile ikinci ve üçüncü trimester gebelik komplikasyonları arasındaki ilişki–Retrospektif vaka kontrol çalışması

Year 2022, Volume: 5 Issue: 2-3, 61 - 71, 13.03.2023

Abstract

Amaç: Pregestasyonel diabetes mellitus (DM) tanılı gebeler ile gestasyonel diabetes mellitus (GDM) tanılı gebelerde gebelikte kilo alımı ile meydana gelebilecek obstetrik ve fetal komplikasyonlar arasında ilişki olup olmadığını saptamak.
Yöntem: Bu araştırma retrospektif vaka kontrol çalışmasıdır. ………………………. Uygulama ve Araştırma Hastanesinde Ocak 2013 ve Aralık 2017 tarihleri arasında yapılmıştır. Bu araştırmanın evrenini hastanemizde DM tanısı almış, takiplerine gelen ve hastanemizde doğum yapmış 321 hasta oluşturmaktadır. Hastalar gebelikte aldığı kilolara göre 7 kilogram (kg) altı, 7-12.9 kg arası ve 13 kg ve üzerinde kilo alımı şeklinde gruplandırılmış obstetrik ve fetal komplikasyon oranlarına bakılmıştır. Çalışmamızın istatistik analizi için SPSS (IBM SPSS for Windows, Ver.24) istatistik paket programı kullanılmıştır.
Bulgular: 7-12.9 kg arası kilo alımı olan grupta gestasyonel hipertansiyon (GHT) 1.53 kat, preeklampsi 1.34 kat, polihidroamnios 1.26 kat, Large for Gestational Age (LGA) 2 kat, preterm doğum 1.3 kat ve yenidoğan hipoglisemisi 1.82 kat daha sık saptanmıştır. 13 kg ve üzerinde kilo alımı olan grupta GHT 2.2 kat, preeklampsi 2.12 kat, polihidroamnios 2.58 kat, LGA 2.9 kat, preterm doğum 2.17 kat ve yenidoğan hipoglisemisi 2.1 kat daha sık saptanmıştır. (%95 güven aralığında, p<0.05)
Sonuç: Çalışmamızda gebelik boyunca 13 kg ve üzeri kilo alımı olan gebelerde obstetrik komplikasyon oranlarında anlamlı bir artma saptanmıştır. Gebelikte kilo alımının kontrol altında tutulmasının obstetrik komplikasyon oranlarında azalma sağlayacağı kanısındayız.

References

  • 1. Strehlow SL, Greenspoon JS, Janzen C, Palmer SM. (Çev: Koç A, Güldoğan EC). Diabetes Mellitus ve Gebelik In: Decherney AH, Nathan L, Goodwın TM, Laufer N, (Çev. Edit: Tıraş B). Güncel Obstetrik ve Jinekoloji Tanı ve Tedavi. Ankara: Güneş Tıp Kitabevleri; 2010: 311-7.
  • 2. Thangaratinam S, Rogozińska E, Jolly K, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16(31):iii-191. doi:10.3310/hta16310
  • 3. Davies, G., Maxwell, C., McLeod, L., MATERNAL FETAL MEDICINE COMMITTEE, & CLINICAL PRACTICE OBSTETRICS (2010). Obesity in pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC,32(2), 165–173. https://doi.org/10.1016/S1701-2163(16)34432-2
  • 4. Jevitt C. Pregnancy complicated by obesity: midwifery management. J Midwifery Womens Health. 2009;54(6):445-451. doi:10.1016/j.jmwh.2009.02.002
  • 5. American College of Obstetricians and Gynecologists (2013). ACOG Committee opinion no. 549: obesity in pregnancy. Obstetrics and gynecology, 121(1), 213–217. https://doi.org/10.1097/01.aog.0000425667.10377.60
  • 6. Hajagos-Tóth J, Ducza E, Samavati R, Vari SG, Gaspar R. Obesity in pregnancy: a novel concept on the roles of adipokines in uterine contractility. Croat Med J. 2017;58(2):96-104. doi:10.3325/cmj.2017.58.96
  • 7. Olson, C. M., & Strawderman, M. S. (2003). Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association, 103(1), 48–54. https://doi.org/10.1053/jada.2003.50001
  • 8. Larsen, T. B., Sørensen, H. T., Gislum, M., & Johnsen, S. P. (2007). Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thrombosis research, 120(4), 505–509. https://doi.org/10.1016/j.thromres.2006.12.003
  • 9. Baeten, J. M., Bukusi, E. A., & Lambe, M. (2001). Pregnancy complications and outcomes among overweight and obese nulliparous women. American journal of public health, 91(3), 436–440. https://doi.org/10.2105/ajph.91.3.436
  • 10. Rode, L., Nilas, L., Wøjdemann, K., & Tabor, A. (2005). Obesity-related complications in Danish single cephalic term pregnancies. Obstetrics and gynecology, 105(3), 537–542. https://doi.org/10.1097/01.AOG.0000152304.39492.1c
  • 11. Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091-1097. doi:10.1016/j.ajog.2003.09.058
  • 12. Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-1182. doi:10.1038/sj.ijo.0801670
  • 13. Idris N, Wong SF, Thomae M, Gardener G, McIntyre DH. Influence of polyhydramnios on perinatal outcome in pregestational diabetic pregnancies. Ultrasound Obstet Gynecol. 2010;36(3):338-343. doi:10.1002/uog.7676
  • 14. Sewell MF, Huston-Presley L, Super DM, Catalano P. Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. Am J Obstet Gynecol. 2006;195(4):1100-1103. doi:10.1016/j.ajog.2006.06.014
  • 15. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109(2 Pt 1):419-433. doi:10.1097/01.AOG.0000253311.44696.85
  • 16. Lucas MJ, Lowe TW, Bowe L, McIntire DD. Class A1 gestational diabetes: a meaningful diagnosis?. Obstet Gynecol. 1993;82(2):260-265.
  • 17. Karcaaltincaba D, Yalvac S, Kandemir O, Altun S. Glycosylated hemoglobin level in the second trimester predicts birth weight and amniotic fluid volume in non-diabetic pregnancies with abnormal screening test. J Matern Fetal Neonatal Med. 2010;23(10):1193-1199. doi:10.3109/14767050903511586
  • 18. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110(4):759-764. doi:10.1097/01.AOG.0000279450.85198.b2

The relationship between pregnancy weight gain and second and third-trimester pregnancy complications in patients with pregestational diabetes mellitus and gestational diabetes mellitus-Retrospective case-control study

Year 2022, Volume: 5 Issue: 2-3, 61 - 71, 13.03.2023

Abstract

Aim: To determine whether there is a relationship between weight gain during pregnancy and obstetric and fetal complications in pregnant women with pregestational diabetes mellitus (DM) and gestational diabetes mellitus (GDM).
Material-Methods: This research is a retrospective case-control study. It was carried out at ……………….. Practice and Research Hospital between January 2013 and December 2017. The population of this study consists of 321 patients who were diagnosed with DM in our hospital, followed up, and gave birth in our hospital. Obstetric and fetal complication rates were evaluated according to the weight gain of the patients during pregnancy, grouped as less than 7 kilograms (kg), between 7-12.9 kg, and weight gain of 13 kg or more. SPSS (IBM SPSS for Windows, Ver.24) statistical package program was used for the statistical analysis of our study.
Results: Gestational hypertension (GHT) 1.53 times, preeclampsia 1.34 times, polyhydramnios 1.26 times, Large for Gestational Age (LGA) 2 times, preterm birth 1.3 times, and neonatal hypoglycemia 1.82 times were found in the group with weight gain between 7-12.9 kg. In the group with a weight gain of 13 kg or more, GHT was 2.2 times, preeclampsia 2.12 times, polyhydramnios 2.58 times, LGA 2.9 times, preterm birth 2.17 times, and neonatal hypoglycemia 2.1 times more frequent. (95% CI, p<0.05)
Conclusion: In our study, a significant increase was found in the rates of obstetric complications in pregnant women who gained 13 kg or more during pregnancy. We believe that keeping weight gain under control during pregnancy will reduce the rate of obstetric complications.

References

  • 1. Strehlow SL, Greenspoon JS, Janzen C, Palmer SM. (Çev: Koç A, Güldoğan EC). Diabetes Mellitus ve Gebelik In: Decherney AH, Nathan L, Goodwın TM, Laufer N, (Çev. Edit: Tıraş B). Güncel Obstetrik ve Jinekoloji Tanı ve Tedavi. Ankara: Güneş Tıp Kitabevleri; 2010: 311-7.
  • 2. Thangaratinam S, Rogozińska E, Jolly K, et al. Interventions to reduce or prevent obesity in pregnant women: a systematic review. Health Technol Assess. 2012;16(31):iii-191. doi:10.3310/hta16310
  • 3. Davies, G., Maxwell, C., McLeod, L., MATERNAL FETAL MEDICINE COMMITTEE, & CLINICAL PRACTICE OBSTETRICS (2010). Obesity in pregnancy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC,32(2), 165–173. https://doi.org/10.1016/S1701-2163(16)34432-2
  • 4. Jevitt C. Pregnancy complicated by obesity: midwifery management. J Midwifery Womens Health. 2009;54(6):445-451. doi:10.1016/j.jmwh.2009.02.002
  • 5. American College of Obstetricians and Gynecologists (2013). ACOG Committee opinion no. 549: obesity in pregnancy. Obstetrics and gynecology, 121(1), 213–217. https://doi.org/10.1097/01.aog.0000425667.10377.60
  • 6. Hajagos-Tóth J, Ducza E, Samavati R, Vari SG, Gaspar R. Obesity in pregnancy: a novel concept on the roles of adipokines in uterine contractility. Croat Med J. 2017;58(2):96-104. doi:10.3325/cmj.2017.58.96
  • 7. Olson, C. M., & Strawderman, M. S. (2003). Modifiable behavioral factors in a biopsychosocial model predict inadequate and excessive gestational weight gain. Journal of the American Dietetic Association, 103(1), 48–54. https://doi.org/10.1053/jada.2003.50001
  • 8. Larsen, T. B., Sørensen, H. T., Gislum, M., & Johnsen, S. P. (2007). Maternal smoking, obesity, and risk of venous thromboembolism during pregnancy and the puerperium: a population-based nested case-control study. Thrombosis research, 120(4), 505–509. https://doi.org/10.1016/j.thromres.2006.12.003
  • 9. Baeten, J. M., Bukusi, E. A., & Lambe, M. (2001). Pregnancy complications and outcomes among overweight and obese nulliparous women. American journal of public health, 91(3), 436–440. https://doi.org/10.2105/ajph.91.3.436
  • 10. Rode, L., Nilas, L., Wøjdemann, K., & Tabor, A. (2005). Obesity-related complications in Danish single cephalic term pregnancies. Obstetrics and gynecology, 105(3), 537–542. https://doi.org/10.1097/01.AOG.0000152304.39492.1c
  • 11. Weiss JL, Malone FD, Emig D, et al. Obesity, obstetric complications and cesarean delivery rate--a population-based screening study. Am J Obstet Gynecol. 2004;190(4):1091-1097. doi:10.1016/j.ajog.2003.09.058
  • 12. Sebire NJ, Jolly M, Harris JP, et al. Maternal obesity and pregnancy outcome: a study of 287,213 pregnancies in London. Int J Obes Relat Metab Disord. 2001;25(8):1175-1182. doi:10.1038/sj.ijo.0801670
  • 13. Idris N, Wong SF, Thomae M, Gardener G, McIntyre DH. Influence of polyhydramnios on perinatal outcome in pregestational diabetic pregnancies. Ultrasound Obstet Gynecol. 2010;36(3):338-343. doi:10.1002/uog.7676
  • 14. Sewell MF, Huston-Presley L, Super DM, Catalano P. Increased neonatal fat mass, not lean body mass, is associated with maternal obesity. Am J Obstet Gynecol. 2006;195(4):1100-1103. doi:10.1016/j.ajog.2006.06.014
  • 15. Catalano PM. Management of obesity in pregnancy. Obstet Gynecol. 2007;109(2 Pt 1):419-433. doi:10.1097/01.AOG.0000253311.44696.85
  • 16. Lucas MJ, Lowe TW, Bowe L, McIntire DD. Class A1 gestational diabetes: a meaningful diagnosis?. Obstet Gynecol. 1993;82(2):260-265.
  • 17. Karcaaltincaba D, Yalvac S, Kandemir O, Altun S. Glycosylated hemoglobin level in the second trimester predicts birth weight and amniotic fluid volume in non-diabetic pregnancies with abnormal screening test. J Matern Fetal Neonatal Med. 2010;23(10):1193-1199. doi:10.3109/14767050903511586
  • 18. Cedergren MI. Optimal gestational weight gain for body mass index categories. Obstet Gynecol. 2007;110(4):759-764. doi:10.1097/01.AOG.0000279450.85198.b2
There are 18 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Original Research
Authors

İsa Kaplan 0000-0002-0861-319X

Publication Date March 13, 2023
Acceptance Date October 5, 2022
Published in Issue Year 2022 Volume: 5 Issue: 2-3

Cite

APA Kaplan, İ. (2023). Pregestasyonel diabetes mellitus ve gestasyonel diabetes mellitus tanılı hastalarda gebelikte kilo alımı ile ikinci ve üçüncü trimester gebelik komplikasyonları arasındaki ilişki–Retrospektif vaka kontrol çalışması. Tıp Fakültesi Klinikleri Dergisi, 5(2-3), 61-71.


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