GESTASYONEL DİYABETES MELLİTUS RİSKİ DÜŞÜK GEBELERDE, FETAL VE PLASENTAL ANTROPOMETRİ VE KAN GLUKOZ DÜZEYLERİ

Year 2006, Volume: 7 Issue: 3, 13 - 18, 01.12.2006

Ali Rıza Odabaşı Hasan Yüksel Samet Kafkas Selda Demircan Sezer Zekeriya Güner Minegül Eben Ergün Onur

Abstract

Amaç:Gestasyonel diyabetes mellitus (GDM) taraması pozitif ancak tüm oral glukoz tolerans test (OGTT)değerleri normal ve sadece bir OGTT değeri anormal olan gebelerin, fetal ve plasental antropometrik değerlerininkıyaslanmasıGereç ve Yöntem:GDM riski olmayan, 38.-40.gebelik haftaları arasında doğum yapmış ve 24.-28.gebelikhaftaları arasında 50 gram 1 saatlik glukoz tarama testi (GTT) uygulanan 317 olgunun dosyaları, retrospektifolarak incelendi. Tarama sonucu negatif olanlar ve taramasının pozitif olması nedeniyle (GTT-1.saat kan glukozdüzeyi 140 mg/dl) OGTT uygulanan olgular araştırmaya alındı. OGTT sonuçlarına göre, iki çalışma ve ikikontrol grubu oluşturuldu: Group 1, tarama pozitif ancak OGTT’de tüm değerleri normal (OGTT - TDN, =24)olguları kapsadı. Grup 2, tarama pozitif ve OGTT'de sadece bir değeri yüksek (OGTT-BDY, =16) olgulardanoluşturuldu. Kontrol grupları ise, tarama negatif (GTT-Normal, =263) ve GDM ( =14) olgularındanoluşturuldu. Sadece GDM olguları diyet tedavisine alındı. Tüm olguların doğuma kadar normoglisemikkalmaları sağlandı. Gebelik öncesi ağırlık ve vücut kitle indeksi (VKİ), gebe son ağırlığı, gebelikte kilo alımı,fetal ağırlık, ponderal indeks, plasental ağırlık ve fötoplasental oranları kıyaslandı. Fetal ve plasental ağırlığın vefötoplasental oranın, maternal antropometrik ölçümler ve kan glukoz değerleriyle ilişkisi araştırıldı.Bulgular:Tüm değişkenler açısından, gruplar arasında istatistiksel bir fark yoktu. Fetal ağırlıkla hiçbir değişkenarasında ilişki bulunmadı. Plasental ağırlıkla, OGTT-2.saat dışında, tüm OGTT değerleriyle pozitif birkorelasyon saptandı. Plasental ağırlıkla, gebelik öncesi VKİ arasında pozitif, gebelikte kilo alımı arasında zayıfnegatif bir ilişki görüldü. Fötoplasental oranla, gebelikte kilo alımı arasında zayıf pozitif, GTT-0.saat değeriarasında zayıf negatif bir ilişki saptandı.Sonuç:Sadece tarama pozitif olduğu için GDM riski görece düşük özel bir populasyonda, “tanı testi negatif veyaglukoz intoleransı” olan gebelerin fetal ve plasental antropometrik değerleri olumsuz etkilenmemektedir. Aynısonucun, sadece diyet tedavisi alan GDM olgularında da gözlenmesi, riski görece düşük gebelerde çalışılmışolmasından ve diyet tedavisinin yeterli olmasından kaynaklandığını düşündürmektedir.Ancak GDM riski göreceyüksek gebelerde dikkatli olunmalıdır

Keywords

gebelikte glukoz taraması, gestasyonel diyabetes mellitus, fetal ağırlık, plasental ağırlık, fötoplasental oran

Fetal and Placental Anthropometry and Blood Glucose Levels in Women at Low Risk of Gestational Diabetes Mellitus

Abstract

Aim: To compare fetoplacental anthropometric outcomes of gestational diabetes mellitus (GDM) in screening negative and positive women Material and Methods: By retrospective surveillance of 317 women who delivered in their 38th-40thweek ofgestation and who had undergone glucose challenge test (GCT) in their 24th-28th of gestation, the screen negative and positive women (GCT-1st hour ≥140 mg/dl) were assigned into four groups: The screen positive women all of whose OGTT values were normal (n=24), screen positive women who had only one abnormal value (n=16),women negative for GDM (n=263) and women with GDM (n=14). Only GDM group was given a diet therapy. We compared fetal and placental weight (FW, PW), ponderal index and fetoplacental ratio (FPR). We also investigated the correlations between all variables. Results: There was no significant difference in all variables between the groups. There was no correlation between FW and all other variables. There was a positive correlation between PW and BMI and all OGTT values except OGTT 2 hour value. The correlation between PW and weight gain and FPR and GTT-0.hour value was negative, whereas a positive correlation between FPR and weight gain was determined. Conclusion: In a special population with a low risk of GDM, “having a negative diagnostic test or impaired glucose tolerance” do not adversely affect fetoplacental anthropometric outcomes. The same results also exist for the GDM cases. It might be due to the fact that the study was conducted in a low risk group and the diet therapy was appropriate. However, care should be taken in pregnant women at high risk.

Keywords

glucose screening in pregnancy, gestational diabetes mellitus, fetal weight, placental weight, fetoplacental ratio

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