Gestasyonel Diyabet Taramasında Karşılaşılan Önemli Bir Problem: Gebeler Neden Oral Glukoz Tolerans Testi Yaptırmak İstemiyor?

Abstract

Amaç: Gebelerin, gestasyonel diabetes mellitus (GDM) taraması için kullanılan 75g oral glukoz tolerans testini (OGTT) yaptırmasında etkili olan faktörleri incelemeyi amaçladık.

Gereç ve Yöntem: Çalışmaya Düzce Üniversitesi Tıp Fakültesi Hastanesi antenatal takip polikliniğine baş vuran ve GDM taraması için 75 g OGTT yaptırmayı kabul eden 129 ve GDM taraması için 75 g OGTT yaptırmayan 133 olmak üzere toplam 262 gebe dahil edildi. Gebelerin demografik özellikleri, eğitim düzeyleri ve gelir seviyeleri araştırıldı.

Bulgular: OGTT yapılan grupta GDM sıklığı %7.9’du (n=10). OGTT yaptıran grupta VKİ daha yüksekti ve gruplar arasındaki fark istatistiksel olarak anlamlıydı (29.17 ± 5.67 vs. 26.93 ± 4.02; p= 0.003). Gruplar eğitim seviyeleri açısından karşılaştırıldığında, OGTT yaptıran grupta yalnızca okur-yazar olan gebelerin oranı daha yüksekti (8.5% vs. 0; p=0.004). OGTT yaptırmayan grupta bunun en sık nedeni 57.8%  oranında testin bebeğe zarar vereceği endişesiydi (n=77), ikinci sıklıkta bu testin özellikle görsel medyada yer alan bazı sağlık personelleri tarafından önerilmemesi geliyordu (30.8%, n=41).

Sonuç: Son yıllarda gebelerin GDM taraması için OGTT yaptırma oranları düşmektedir. Bunun başlıca nedenleri arasında özellikle görsel medyada var olan bilgi kirliliği ve gebelerin sağlık personeli tarafından yeterinde bilgilendirilmemesi gösterilebilir. Bu nedenle sağlık bakımını sağlayan tüm paydaşlar tarafından prekonsepsiyonel dönemden başlayarak gebelik esnasında halkın yanlış bilgi edinmesinin önüne geçecek programlar ortaya koymalı ve bu konudaki bilgi kirliliğinin ortadan kaldırılmalıdır.

Keywords

• Gestasyonel Diabetes Mellitus,Oral Glukoz Tolerans Testi

An Important Problem in Gestational Diabetes Scan: Why Do Pregnant Women Refuse to Have Oral Glucose Tolerance Test?

Abstract

Objective: We have seen a decline in the rates of having 75g oral glucose tolerance test (OGTT) used for gestational diabetes mellitus (GDM) scan by pregnant women who applied to our clinic in recent years. Therefore, we aimed to examine the factors that are effective on why pregnant women do not have this test.

Materials and Methods:  A total of 262 pregnant women who attended antenatal follow-up polyclinic of Düzce University Medical Faculty were included in the study; 129 who admitted 75g OGTT for GDM scan and 133 who refused 75g OGTT for GDM scan. Demographic characteristics, educational levels and income levels of the pregnant women were investigated.

Results: The frequency of GDM in the OGTT group was 7.9% (n=10). BMI was higher in the OGTT group and the difference between the groups was statistically significant (29.17 ± 5.67 vs. 26.93 ± 4.02; p= 0.003). When the groups were compared in terms of educational levels, the rate of only literate women was higher in the OGTT group (8.5% vs. 0; p=0.004). The most common reason in the group without OGTT was the concern that the test would be harmful to the baby with  57.8% rate (n=77), the second reason was that the test was not recommended by some health professionals especially on visual media (30.8%, n=41).

Conclusion: There has been a decrease in the rates of having OGTT for GDM scan by pregnant women in recent years. Information pollution, especially in the visual media and insufficient information provided by health professionals are considered as the main reasons for this situation.  Therefore, all healthcare providers should start programs that would prevent misinformation during pregnancy starting from the preconceptional period and the information pollution on this issue should be removed.

Keywords

• Gestational diabetes mellitus,oral glucose tolerance test

References

1. 1. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on gestational diabetes mellitus. Diabetes Care 2007;30 (Suppl.2):S251-60. 2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.3. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglyacemia in pregnancy. Diabetes Res Clin Pract 2014;103:176-85.4. Öztürk FY, Altuntaş Y. Gestasyonel diabetes mellitus. Şişli Etfal Hastanesi Tıp Bülteni 2015;49:1-10.5. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-82.6. M.E. Griffin, M. Coffey, H. Johnson, P. Scanlon, M. Fole, J. Stronge, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome Diabet Med. 2000; 17: 26-32.7. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.8. American Diabetes Association. Executive summary: standards of medical care in diabetes 2011. Diabetes Care. 2011;34(Suppl 1):S4–10.9. World Health Organization . Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus.2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).10. ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–173.11. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. ACOG committee opinion no. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. 2006; 108: 469-477.12. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006; 29: 43–4813. Metzger BE, Lowe P, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. New Engl J Med. 2008; 38: 1991–2002.14. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358: 1991–2001.15. Mertoğlu C, Gunay M, Siranli G, Kulhan M, Gok G, Erel Ö. The Effect of the 50 g Glucose Challenge Test on The Thiol/Disulfide Homeostasis in Pregnancy. Fetal Pediatr Pathol. 2018 Apr 25:1-10.16. Nakanishi S, Yoneda M, Maeda S. Impact of glucose excursion and mean glucose concentration in oral glucose-tolerance test on oxidative stress among Japanese Americans. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2013;6:427-433. doi:10.2147/DMSO.S53760.17. Rueangdetnarong H, Sekararithi R, Jaiwongkam T, Kumfu S, Chattipakorn N, Tongsong T. et al. Comparisons of the oxidative stress biomarkers levels in gestational diabetes mellitus (GDM) and non-GDM among Thai population: cohort study. Endocr Connect. 2018; 7: 681-87.18. Schwartz N, Green M.S, Yefet E, Nachum Z. Modifiable risk factors for gestational diabetes recurrence. Endocrine. 2016; 54: 714-22.19. Ozgu-Erdinc A.S, Yilmaz S, Yeral M.I, Seckin K.D, Erkaya S, Danisman A.N. Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015; 28: 1957-62.20. Goodarzi-Khoigani M, Mazloomy Mahmoodabad SS, Baghiani Moghadam MH, et al. Prevention of Insulin Resistance by Dietary Intervention among Pregnant Mothers: A Randomized Controlled Trial. International Journal of Preventive Medicine. 2017; 8:85. 21. Zhang C, Solomon C.G, Manson J.E, Hu F.B.A. Prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med. 2006; 166: 543-48.22. Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med. 2012;46:656–61.23. Pate RR, Pratt M, Blair SN, et al. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA1995;273:402–7.24. Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37:6–12.