DİYABETİK GEBELERDE YÜKSEK GLİKOLİZE HEMOGLOBİN DÜZEYLERİNİN OBSTETRİK VE NEONATAL SONUÇLARA ETKİSİ

Abstract

Amaç: Diyabet metabolik bir hastalıktır ve gebeliğin en sık görülen komplikasyonudur. Retrospektif olarak yaptığımız bu çalışmada, gestasyonel diyabetes mellitus saptanan gebelerde, HbA1c düzeyleri ile perinatal sonuçlar arasındaki ilişkiyi değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Çalışmamız, Ocak 2010 ile Aralık 2015 tarihleri arasında, Doğu Anadolu’da referans merkez olan Atatürk Üniversitesi Tıp Fakültesi Hastanesi kadın hastalıkları ve doğum polikliniğine başvuran, 22 hafta ve üzerinde gestasyonel diyabetes mellitus tanısı alan, doğumu kliniğimizde gerçekleştirilmiş çalışma grubunun (93 vaka) verilerini, diyabetik olmayan kontrol grubunun (208 vaka) verilerini ve yenidoğan yoğun bakıma yatış verilerini kapsamaktadır.

Bulgular: Gestasyonel diyabetes mellitus olan grup; HbA1c düzeyi %6.5 ve üzerinde (37 hasta) ve %6.5’un altında (56 hasta) olan iki alt gruba ayrılarak kontrol grubuyla karşılaştırmalı olarak incelenmiştir. Gestasyonel diyabetes mellitus olan ve olmayan gruplar arasında sırasıyla; yaş, abortus sayısı, ölü doğum sayısı, doğum şekli ve 1. dakika APGAR skoru açısından istatistiksel olarak anlamlı fark görülmedi (p>0.05). Gravida, parite ve yaşayan sayısı yönünden anlamlı fark olup (p=0.005, p=0.003), bu farkın nedeni kontrol grubuna göre HbA1c <%6.5 olan gestasyonel diyabetes mellitus grubunun gravida ve paritesinin daha düşük olmasıydı (sırayla p=0.004, p=0.005 ve p=0.020, p=0.007 ve p=0.038). Gebelik haftalarına bakılarak olguların dağılımları incelendiğinde, kontrol grubuna göre HbA1c ≥%6.5 olan gestasyonel diyabetes mellitus grubunda term oranı istatistiksel olarak daha düşük, geç preterm oranı ise daha yüksekti (p<0.001 ve p=0.008). HbA1c <%6.5 olan gestasyonel diyabetes mellitus grubunda bebek doğum ağırlığı daha yüksek (p<0.001), her iki alt grupta makrozomi görülme sıklığı daha yüksek bulundu (p=0.023 ve p=0.005). HbA1c ≥%6.5 olan gestasyonel diyabetes mellitus grubunda yenidoğan yoğun bakım gereksinimi daha fazlaydı (p<0.001).

Sonuç: Diyabetik gebelerdeki HbA1c değerleri ile yenidoğan yoğun bakım yatış oranları arasında anlamlı bir ilişki saptanmıştır. Bu açıdan bakıldığında, maternal HbA1c seviyesinin yenidoğan yoğun bakıma yatış açısından bir risk faktörü olarak kullanılabileceğini düşünmekteyiz.

Keywords

• Diabetes mellitus
• pre-hemoglobin A
• glikolize hemoglobin
• yoğun bakım
• yenidoğan

The Influence of High Glycosylated Hemoglobin Levels on Obstetrical and Neonatal Results in Diabetic Pregnant Women

Abstract

Objective: Diabetes is the most common metabolic disorder during pregnancy. In this retrospective study, we aimed to evaluate the association between high HbA1c levels of pregnant women diagnosed gestational diabetes mellitus with perinatal outcomes.

Material and Methods: Our study includes 93 pregnant women who were diagnosed with gestational diabetes after the 22nd week of pregnancy between 2010 and 2015. The group with gestational diabetes mellitus was divided into 2 sub-groups whose HbA1c level was 6.5% and over (37 cases) and below 6.5% (56 cases) and examined comparatively with 208 non-diabetic pregnant women were used as controls, and the neonatal intensive care admission data was also analyzed.

Results: Statistically significant difference was not seen among groups in terms of age, the number of abortus and stillbirths, the mode of delivery, 1. min. APGAR score (p>0.05). There was a statistically difference in terms of gravida, parity and the number of living (p=0.005, p=0.003), the gravida and parity of the gestational diabetes mellitus group were lower compared to the control group (respectively p=0.004, p=0.005 and p=0.020, p=0.007 and p=0.038). When the distribution of the patients was examined in terms of pregnancy weeks, the ratio of those who are term in the gestational diabetes mellitus group, which is HbA1c ≥6.5%, compared to the control group and the ratio of those who are late preterm was statistically significantly higher (p<0.001 and p=0.008). It was found that the birth weight in the gestational diabetes mellitus group, which is HbA1c <6.5% was higher, and the frequency of macrosomia in both sub-groups was higher (p=0.023 and p=0.005). Neonatal intensive care needs in the gestational diabetes mellitus group, which is HbA1c ≥6.5%, was higher (p<0.001).

Conclusion: This study is the first one in the field. A positive correlation was found between high HbA1c levels and hospitalization in neonatal intensive care unit.

Keywords

• Diabetes mellitus
• pre-hemoglobin A
• glycosylated hemoglobin
• intensive care
• newborn

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