Diyabetik Gebelerde HbA1c ve Glukoz Düzeylerinin Doğum Ağırlığı Tahmininde Kullanılması

Abstract

Amaç: Bu çalışmanın amacı, pregestasyonel diyabet mellitus (PGDM) ve gestasyonel diyabet mellitus (GDM) tanısı konan hamilelerin HbA1c düzeyleri ile ilişkili olarak bebek doğum ağırlığı tahmininin duyarlılığını araştırmaktır. Gereç ve Yöntemler: Kriterleri karşılayan 105 hasta çalışmamya dahil edildi. Hastaların 7'si tip 1 DM ve 32'si tip 2 DM idi. Katılmayı kabul eden hastaların gebelik öyküleri, demografik bilgilerinin yanı sıra gebelik süresince kilo alımları, HbA1c ve açlık kan şekeri düzeyleri de dahil olmak üzere kayıt edildi. Bulgular: Açlık glukoz değerleri, gebeliğin 28 ve 32. haftalarında ölçüldü. Tokluk sonrası bir saatte ölçtüğümüz kan glukoz değerleri ve HbA1c, PDGM grubunda GDM grubuna göre daha yüksekti. Kilo alımı ve BMI değerleri arasında anlamlı bir fark yoktu. GDM'li hastalarımızda açlık ve tokluk sonrası kan glukoz seviyeleri veya gebelik sırasında kilo alımının LGA bebekleri (LGA) öngörmedeki tahmin gücünü test etmek için ROC eğrisi analizi kullandık (sırasıyla AUC: 0.663, %95 CI [0.526, 0.800], AUC: 0.678, %95 CI [0.540, 0.816], AUC: 0.677, %95 CI [0.548, 0.805]). Ayrıca, LGA'yı öngörmek için açlık kan glukoz ölçümleri, 1 saatlik tokluk sonrası kan glukoz ölçümleri ve HbA1c düzeylerini değerlendirmede ROC analizi kullanıldı (sırasıyla AUC: 0.889, %95 CI [0.782, 0.996], AUC: 0.893, %95 CI [0.737, 1.000], AUC: 0.931, %95 CI [0.807, 1.000]). Sonuç: Sağlıklı insanlarda ve gebelerde kan glukoz seviyelerinin normal sınırlar içinde tutulması önemlidir. PDGM veya GDM tanısı konan gebelerde ise bebek sağlığı göz önünde bulundurularak bu daha da önemlidir. PDGM'li gebelerde tokluk sonrası kan glukoz ve HbA1c seviyelerinin yakın takibiyle LGA doğumları önlenebilir. GDM tanısı konan gebelerin takibinde de GWG'nin yakın takibi faydalıdır.

Keywords

• HbA1c
• Açlık glukoz düzeyi
• Doğum ağırlığı

Estimation of Birth Weight from HbA1c and Glucose Levels in Diabetic Pregnancies

Abstract

Aim: The aim of this study was to investigate the sensitivity of baby birth weight estimation in relation to HbA1c levels of pregnant women diagnosed with pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). Material and Methods: 105 patients who met the criteria agreed to participate in our study, of whom 7 were type 1 DM and 32 were type 2 DM. The pregnancy history of the patients who agreed to participate was obtained with a lot of demographic information as well as weight gains during pregnancy, HbA1c and fasting blood glucose levels. Results: Fasting glucose values were measured at 28 and 32 weeks of gestation. The blood glucose values that we measured one hour after satiation and HbA1c were higher in the PDGM group than in the GDM group. There was no significant difference between weight gain and BMI values. We used ROC curve analysis to test the predictive power of fasting and postprandial blood glucose levels or weight gain during pregnancy in our patients with GDM for LGA babies(LGA) (AUC: 0.663, %95 CI [0.526, 0.800], AUC: 0.678, %95 CI [0.540, 0.816], AUC: 0.677, %95 CI [0.548, 0.805], respectively).In addition, ROC analysis was used in evaluating fasting blood glucose measurements, 1-hour postprandial blood glucose measurements, and HbA1c levels to predict LGA.(AUC: 0.889, %95 CI [0.782, 0.996], AUC: 0.893, %95 CI [0.737, 1.000], AUC:0.931, %95 CI [0.807, 1.000], respectively). Conclusion: In both healthy people and pregnant women, it is important to keep blood glucose levels within normal limits. In pregnant women diagnosed with PDGM or GDM, this is even more important as the welfare of the baby is considered. LGA deliveries can be avoided in pregnant women with PDGM by close monitoring of postprandial blood glucose and HbA1c levels. Close monitoring of GWG is also beneficial in the follow-up of pregnant women diagnosed with GDM.

Keywords

• HbA1c
• Fasting glucose level
• Postprandial glucose level
• Birth weight

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