Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir?

Emel Arslan Yıldırım; Mehmet Bülbül; Kemal Özerkan; Osman Haldun Develioğlu

Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir?

Abstract

Amaç: Gestasyonel Diabetes Mellitus (GDM) gebeliklerin %1-14’ünü görülür. Polikistik over sendromu (PCOS) ve metabolik sendromda (MS) olduğu gibi patofizyolojisinde insülin direnci (IR) rol alır. Bundan dolayı bu üç klinik durumun birbiriyle ilişkili olduğu düşünülmektedir. Materyal ve Metot: Bu çalışmada GDM tanısı almış 27 kadın ve sağlıklı 30 kadın PCOS, MS ve IR açısından karşılaştırılmıştır. Bulgular: GDM grubunda kilo ve vücut kitle indeksi (BMI), bel ve kalça çevreleri kontrol grubundan daha yüksekti (sırasıyla 69.0±11,5 kg vs 62.0±10,3 kg, p:0,01; 27.0±4,7 kg/m2 vs 23.0±3,5 kg/m2, p:0,001; 82.0±8,5 cm vs 74.0±7,5 cm, p<0,001; 103.0±8,1 cm vs 98.0±8,7 cm, p:0,02). MS sıklığı GDM grubunda kontrol grubuna göre istatistiksel anlamlı olarak daha yüksekti. Bel çevresi, kan basıncı, açlık kan şekeri ve trigliserid düzeyleri yüksek olan hasta sayısı kontrol grubuna göre daha fazlaydı (sırasıyla %55,6 vs %20, p:0,006; %18,5 vs %0, p:0,01; %29,6 vs %6,7, p:0,02; %48,1 vs %10, p: 0,002). HDL kolesterol düzeyi açısından ise gruplar arasında istatistiksel olarak fark saptanmadı (p>0,05). HOMA için eşik değer 2.24 olarak alındığında GDM grubunda kontrol grubundan daha fazla insülin direnci saptandı sırasıyla (sırasıyla %48,1 vs %20,0, p: 0,02). Sonuç: GDM’de olduğu gibi MS ve PCOS’ta ortak problem IR’dır. Birçok çalışmada gösterildiği gibi bizim çalışmamızda da MS, GDM grubunda daha yüksek saptandı. Bundan dolayı GDM öyküsü olan hastalarda metabolik sendrom taranmalıdır

Keywords

gestasyonel diyabet; insulin direnci; metabolik sendrom; polikistik over sendromu

References

1. National Institute for Health and Welfare Ofcial Statistics of Finland; Health; 2014 [accessed 24 02 2018].
2. Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus. Am J Obstet Gynecol 1992;167:607–16.
3. Powe CE, Allard C, Battista MC Doyon M, Bouchard L, Ecker JL et al. Heterogeneous contribution of insulin sensitivity and secretion defects to gestational diabetes mellitus. Diabetes Care 2016;39(6):1052–55.
4. Ryan EA, Imes S, Liu D, McManus R, Finegood DT, Polonsky KS et al. Defects in insulin secretion and action in women with a history of gestational diabetes. Diabetes 1995;44:506–12.
5. Huvinen E, Eriksson JG, Koivusalo SB, Grotenfelt N, Tiitinen A, Stach-Lempinen B et al. Heterogeneity of gestational diabetes (GDM) and long-term risk of diabetes and metabolic syndrome: findings from the RADIEL study follow-up. Acta Diabetol 2018;55(5):493–501.
6. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012;33(6):981–1030.
7. Rosenfield RL, Ehrmann DA. The pathogenesis of polycystic ovary syndrome (PCOS): the hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocr Rev 2016;37(5):467–520.
8. Laven JS, Imani B, Eijkemans MJ, Fauser BC. New approach to polycystic ovary syndrome and other forms of anovulatory infertility. Obstet Gynecol Surv 2002;57:755–767.

9. Ehrmann DA. Polycystic ovary syndrome. N Engl J Med 2005;352(12):1223–1236.
10. Norman RJ, Dewailly D, Legro RS, Hickey TE. Polycystic ovary syndrome. Lancet 2007;370(9588):685–697.
11. Palomba S, Falbo A, Daolio J, Battaglia FA, LA Sala GB. Pregnancy complications in infertile patients with polycystic ovary syndrome: updated evidences. Minerva Ginecol 2018;Apr 11.
12. Homburg R. The management of infertility associated with polycystic ovary syndrome. Reprod Biol Endocrinol 2003;1:109.
13. Olah KS. The modern management of hirsutism. Rev in Gynecol Practice 2004;4:211–20.
14. Phipps WR. Polycystic ovary syndrome an ovulation induction. Obstet Gynecol Clin North Am 2001;28:165–82.
15. Speroff L, Fritz MA. Clinical Gynecologic Endocrinology and Infertility 7th ed. Lippincott Williams and Wilkins, Philadelphia 2005.
16. Homburg R. Management of infertility and prevention of ovarian hyperstimulation in women with polycystic ovary syndrome. Best Pract Res Clin Obstet Gynaecol 2004;18:773–88.
17. Carmina E, Koyama T, Chang L, Stanczyk FZ, Lobo RA. Do- es ethnicity influence the prevalence of adrenal hyperandrogenism and insulin resistance in polycystic ovary syndrome? Am J Obstet Gynecol 1992;167:1807–12.
18. Zeev S and Ariel Weissman Kempers RD. Fertility and Reproductive Medicine 1998:263–292.
19. Lamain-de Ruiter M, Kwee A, Naaktgeboren CA, de Groot I, Evers IM, Groenendaal F et al. External validation of prognostic models to predict risk of gestational diabetes mellitus in one Dutch cohort: prospective multicentre cohort study. BMJ 2016;354: i4338.
20. Williamson K, Gunn AJ, Johnson N, Milsom SR. The im- pact of ethnicity on the presentation of polycystic ovarian syndrome. Aust N Z J Obstet Gynaecol 2001;41:202–6.
21. Paradisi G, Steinberg HO, Hempfling A, Cronin J, Hook G, Shepard MK et al. Polycystic ovary syndrome is associated with endothelial dysfunction. Circulation 2001;103:1410–15.
22. Husueh V. A, Lyon C. J, Quinones M. J. Insulin resistance and endothelium Am JMed 2004;117:109–17.
23. Ek I, Arner P, Rydén M, Holm C, Thörne A, Hoffstedt J et al. A unique defect in the regulation of visceral fat cell lipolysis in the polycystic ovary syndrome as an early link to insulin resistance. Diabetes 2002;51(2):484–92.
24. Suzuki M, Takamisawa I, Suzuki K, Hiuge A, Horio T, Yoshimasa Y et al. Close assosiation of endothelial dysfunction with insulin resistance and carotid wall thickening in hypertension. Am J Hypertens 2004;17(3):228–32.
25. Hernandez-Pampaloni M, Quinones M, Chon Y. Endothelial dysfunction is associated with subclinical atherosclerosis in insulin resistant patients. J Nucl Med 2002;80:140–51.
26. Julie L. Sharples. Polycystic ovary syndrome and the metabolic syndrome. Clin Diabetes 2003;21:154–60.
27. Kiddy DS, Sharp PS, White DM, Scanlon MF, Mason HD, Bray CS et al. Differences in clinical and endocrine features between obese and nonobese subjects with polycystic ovary syndrome: An analysis of 263 consecutive cases. Clin Endocrinol 1990;32(2):213–20.
28. Beharier O, Shoham-Vardi I, Pariente G, Sergienko R, Kessous R, Baumfeld Y et al. Gestational diabetes mellitus is a signifcant risk factor for long-term maternal renal disease. J Clin Endocrinol Metab 2015;100(4):1412–16.
29. Hardiman P, Pillay OS, Atiomo W. Polycystic ovary syndrome and endometrial carsinoma. Lancet 2003;361:1810–12.
30. Onat A, Senocak M. Obesity in Turkish adults: prevalence, validity as a coronary risk factor and interrelation with other risk factors. Int J Ang 1995;4:94–8.
31. Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009;373(9677):1773–79.
32. Puhkala J, Kinnunen TI, Vasankari T, Kukkonen-Harjula K, Raitanen J, Luoto R. Prevalence of metabolic syndrome one year after delivery in Finnish women at increased risk for gestational diabetes mellitus during pregnancy. J Pregnancy 2013:139049.
33. Hakkarainen H, Huopio H, Cederberg H, Paakkonen M, Voutilainen R, Heinonen S. The risk of metabolic syndrome in women with previous GDM in a long-term follow-up. Gynecol Endocrinol 2016;32(11):920–925.
34. Lauenborg J, Mathiesen E, Hansen T, Glümer C, Jørgensen T, Borch-Johnsen K et al. The prevalence of the metabolic syndrome in a danish population of women with previous gestational diabetes mellitus is three-fold higher than in the general population. J Clin Endocrinol Metab 2005;90(7):4004– 10.
35. McKenzie-Sampson S, Paradis G, Healy-Proftos J, St-Pierre F, Auger N. Gestational diabetes and risk of cardiovascular disease up to 25 years after pregnancy: a retrospective cohort study. Acta Diabetol 2018;55(4):315–322.
36. Yildirim B and Kaleli B. Relation of intra-abdominal fat distribution to metabolic disorders in lean women with polycystic ovary syndrome. Fertil Steril 2003;79:1358–64.
37. Yılmaz Ö, Pala HG, Artunç Ülkümen B. Comparison of Insulin Sensitivity Levels in Women with PCOS and Women with Regular Menses. Kafkas J Med Sci 2017;7(2):102–106. doi:10.5505/kjms.2017.24582.
38. Lo JC, Feigenbaum SL, Escobar GJ, Yang J, Crites YM, Ferrara A. Increased prevalence of gestational diabetes mellitus among women with diagnosed polycystic ovary syndrome: a population-based study. Diabetes Care 2006;29(8):1915–17.
39. Joham AE, Ranasinha S, Zoungas S, Moran L, Teede HJ. Gestational diabetes and type 2 diabetes in reproductive-aged women with polycystic ovary syndrome. J Clin Endocrinol Metab 2014;99(3): E447–E452.
40. Sawada M, Masuyama H, Hayata K, Kamada Y, Nakamura K, Hiramatsu Y. Pregnancy complications and glucose intolerance in women with polycystic ovary syndrome. Endocr J 2015;62(11):1017–23.
41. Li G, Huang W, Zhang L, Tian Z, Zheng W, Wang T et al. A prospective cohort study of early-pregnancy risk factors for gestational diabetes in polycystic ovarian syndrome. Diabetes Metab Res Rev 2018:e3003.
42. Dunaif A, Segal KR, Futterweit W, Dobrjansky A. Profound peripheral insulin resistance, independent of obesity, in polycystic ovary syndrome. Diabetes 1989;38:1165–74.
43. Catalano PM, Bernstein IM, Wolfe R, Srikanta S, Tyzbir E, Sims EA. Subclinical abnormalities of glucose metabolism in subjects with previous gestational diabetes. Am J Obstet Gynecol 1986;155:1255–6.

Details

Primary Language

English

Subjects

Clinical Sciences

Journal Section

Research Article

Authors

Emel Arslan Yıldırım This is me
Türkiye

Mehmet Bülbül This is me
Türkiye

Kemal Özerkan This is me
Türkiye

Osman Haldun Develioğlu This is me
Türkiye

Publication Date

August 1, 2019

Submission Date

May 24, 2018

Acceptance Date

May 24, 2019

Published in Issue

Year 2019 Volume: 9 Number: 2

IZ

https://izlik.org/JA73DP37YR

Cite

RIS / Bibtex

APA

Yıldırım, E. A., Bülbül, M., Özerkan, K., & Develioğlu, O. H. (2019). Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir? Kafkas Journal of Medical Sciences, 9(2), 110-116. https://izlik.org/JA73DP37YR

AMA

1.Yıldırım EA, Bülbül M, Özerkan K, Develioğlu OH. Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir? Kafkas Journal of Medical Sciences. 2019;9(2):110-116. https://izlik.org/JA73DP37YR

Chicago

Yıldırım, Emel Arslan, Mehmet Bülbül, Kemal Özerkan, and Osman Haldun Develioğlu. 2019. “Gestasyonel Diyabet, Metabolik Sendrom Ile İlişkili Midir?”. Kafkas Journal of Medical Sciences 9 (2): 110-16. https://izlik.org/JA73DP37YR.

EndNote

Yıldırım EA, Bülbül M, Özerkan K, Develioğlu OH (August 1, 2019) Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir? Kafkas Journal of Medical Sciences 9 2 110–116.

IEEE

[1]E. A. Yıldırım, M. Bülbül, K. Özerkan, and O. H. Develioğlu, “Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir?”, Kafkas Journal of Medical Sciences, vol. 9, no. 2, pp. 110–116, Aug. 2019, [Online]. Available: https://izlik.org/JA73DP37YR

ISNAD

Yıldırım, Emel Arslan - Bülbül, Mehmet - Özerkan, Kemal - Develioğlu, Osman Haldun. “Gestasyonel Diyabet, Metabolik Sendrom Ile İlişkili Midir?”. Kafkas Journal of Medical Sciences 9/2 (August 1, 2019): 110-116. https://izlik.org/JA73DP37YR.

JAMA

1.Yıldırım EA, Bülbül M, Özerkan K, Develioğlu OH. Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir? Kafkas Journal of Medical Sciences. 2019;9:110–116.

MLA

Yıldırım, Emel Arslan, et al. “Gestasyonel Diyabet, Metabolik Sendrom Ile İlişkili Midir?”. Kafkas Journal of Medical Sciences, vol. 9, no. 2, Aug. 2019, pp. 110-6, https://izlik.org/JA73DP37YR.

Vancouver

1.Emel Arslan Yıldırım, Mehmet Bülbül, Kemal Özerkan, Osman Haldun Develioğlu. Gestasyonel Diyabet, Metabolik Sendrom ile İlişkili midir? Kafkas Journal of Medical Sciences [Internet]. 2019 Aug. 1;9(2):110-6. Available from: https://izlik.org/JA73DP37YR