75 gr oral glukoz tolerans testi sağlıklı gebelerde maternal ve fetal Doppler parametrelerini etkiler mi? Kesitsel-gözlemsel bir çalışma

Year 2020, Volume: 51 Issue: 2, 113 - 116, 15.06.2020

Gürcan Türkyılmaz , Emircan Ertürk , Şebnem Türkyılmaz , Gokcenaz Kucukbas Onur Karaaslan

https://doi.org/10.16948/zktipb.683420

Abstract

Amaç: Oral glukoz tolerans testi (OGTT) gestasyonel diyabet (GDM) taramasında tüm dünyada yaygın olarak kullanılmaktadır. Bu çalışmada Van Bölge Eğitim ve Araştırma hastanesine başvuran ve 75 gr OGTT yapılan ve GDM saptanmayan gebelerde testin maternal ve fetal Doppler parametrelerine etkisini inceledik.
Materyel-metod: Kliniğimizde takip edilen, 24-28 gebelik haftaları arasında 75 gr OGTT uygulanan ve GDM saptanmayan 46 sağlıklı gebede OGTT’den 1 saat önce ve testin tamamlanmasından 1 saat sonra umblikal arter PI, RI, ve S/D, MCA PSV, PI, RI ve her iki uterin arterin ortalama PI, RI,S/D değerleri kaydedildi. Veriler SPSS-16 programı ve Mann Whitney-U testi kullanılarak analiz edildi ve p değeri<0.05 anlamlı kabul edildi.
Bulgular: Olguların ortalama yaşı 24.6±5.4 yıl, ortalama gebelik sayısı 2.3±0.8, ortalama vücut kitle indeksi (VKİ) 25.5±5.1 kg/m2 ve ortalama gebelik haftası 26.5±1.5 bulundu. Testten 1 saat önce ortalama umblikal arter PI: 1.14±0.26, RI: 0.71±0.14 ve S/D oranı 2.24±0.73 saptandı. Testin tamamlanmasından 1 saat sonra ise ortalama umblikal arter PI: 1.04±0.43, RI: 0.58±0.21 ve S/D oranı 2.01±0.44 saptandı ve bu fark istatistiksel anlamlı değildi (p:0.64, 0,56, 0.71). Testten 1 saat önce ortalama MCA PSV 30.4±11.3 cm/sn, ortalama PI: 1.89±0.36 ve RI: 0.81±0.19 saptandı. Testin tamamlanmasından 1 saat sonra ise ortalama MCA PSV 38.4±13.2 cm/sn, ortalama PI: 2.11±0.24 ve RI: 0.68± 0.21 saptandı ve bu fark istatistiksel anlamlı değildi (p:0.83, 0.66, 0.82). Test öncesi her iki uterin arter ortalama PI:1.13±0.21, RI: 0.69±0.11 ve S/D oranı 2.03±0.34 bulundu. Test sonrası ise her iki uterin arter ortalama PI:1.24±0.11, RI: 0.74±0.16 ve S/D oranı 1.87±0.22 saptandı ve bu fark anlamlı bulunmadı (p:0.72, 0.79, 0.56).
Sonuç: 75 gr OGTT normal saptanan sağlıklı kadınlarda OGTT maternal ve fetal kan akımı üzerine anlamlı etkisi bulunmamaktadır.

Keywords

Doppler, diyabet

Does 75-g oral glucose tolerance test (OGTT) influence maternal and fetal Doppler parameters in healthy pregnancies? A cross-sectional observational study

Abstract

Aim: Oral glucose challenge test (OGTT) is widely used around the world screening for gestational diabetes mellitus (GDM). In our study, we aimed to evaluate the effect of 75 g OGTT on maternal and fetal Doppler parameters.
Material and Methods: Measurements of umbilical artery PI, RI, S/D, middle cerebral artery (MCA) PSV, PI, RI and mean PI, RI S/D of uterine arteries assessed 1 hour before OGTT and 1 hour following the test in 46 pregnancies between 24-28 weeks of gestation. Mann Whitney-U test was employed to compare variables. Statistical significance was established at p<0.05.
Results: The mean age of pregnant women was 24.6±5.4, the mean gravity status was 2.3±0.8, the mean BMI was 25.5±5.5 kg/m, and the mean gestational age was 26.5±1.6 Mean umbilical artery PI: 1.14±0.26, RI: 0.71±0.14, S/D ratio 2.24±0.73 calculated 1 hour before test and mean PI: 1.04±0.43, RI: 0.58±0.21, S/D ratio 2.01±0.44 and there was no significance (p: 0.64, 0,56, 0.71). Mean MCA PSV: 30.4±11.3 cm/sn, PI:1.89±0.36, RI: 0.81±0.19 measured 1 hour before test and 1 hour following test Mean MCA were PSV: 38.4±13.2 cm/sn, PI: 2.11±0.24, RI: 0.68± 0.21 and there was no difference (p: 0.83, 0.66, 0.82). Mean uterine arteries PI:1.13±0.21, RI: 0.69±0.11, S/D ratio 2.03±0.34 measured before the test and mean PI:1.24±0.11, RI: 0.74±0.16, S/D ratio 1.87±0.22 calculated after the test and these results were similar (p: 0.72, 0.79, 0.56).
Conclusion: There was no significant effect on maternal and fetal Doppler parameters of 75 g OGTT among healthy pregnancies.

Keywords

Doppler, diabetes, fetus

References

• 1. Lao TT, Tam KF. Gestational diabetes diagnosed in third-trimester pregnancy and pregnancy outcomes. Acta Obstet Gynecol Scand. 2001; 80:1003-8 2. Society of Maternal-Fetal Medicine (SMFM) Publications Committee. SMFM Statement: Pharmacological treatment of gestational diabetes. Am J Obstet Gynecol 2018; 218:B2. 3. Catalano PM, Tyzbir ED, Wolfe RR. Longitudinal changes in basal hepatic glucose production and suppression during insülin infusion in normal pregnant women. Am J Obstet Gynecol. 1992; 167:913-9 4. William SB, Goldfine AB, Timimi FK. Acute hyperglycemia attenuates endothelium-dependent vasodilatation in humans in vivo. Circulation. 1998; 97:1695-9 5. Marfalle R, Nappo F, De Angelis L. Hemodynamic effects of acute hyperglycemia ibün type 2 diabetic patients. Diabetes Care 2000; 23:658-63 6. Sacks DA, Hadden DR, Maresh M, et al. Frequency of gestational diabetes mellitus at collaborating centers based on IADPSG consensus panel-recommended criteria: the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Diabetes Care 2012; 35:526. 7. Bhide A, Acharya G, Bilardo CM, Brezinka C, Cafici D, Kalache K, Le B, et al. ISUOG Practice Guidelines: use of Doppler ultrasonography in obstetrics. Ultrasound Obstet Gynecol 2013; 41: 233–239. 8. Patrick J, Natale R, Richardson B. Patterns of human fetal breath activity at 34 to 35 weeks gestational age. Am J Obstet Gynecol 1978; 132:507-11 9. Senoh D, Hata T, Kitao M. Effect of maternal hyperglycemia on fetal regional circulation in appropriate for gestational age and small for gestational age fetuses. Am J Perinatal 1995; 12:223-6 10. Pardo J, Orvieto R, Rabinerson D, Bar J, Hod M, Kaplan B. Fetal middle-cerebral and umbilical artery flow assessments after glucose challenge test. Int J Gynecol Obstet 1999; 65:255-9 11. Gillis S, Connors G, Poots P, Hunse C, Richordson B. The effect of glucose on Doppler flow velocity waveforms and heart rate pattern in the human fetus. Early Hum Dev 1192; 30:1-10 12. Haugen G, Bollerslev J, Henriksen T. Human fetoplacental and fetal liver blood flow after maternal glucose loading: a cross-sectional observational study. Acta Obstet Gynecol Scand 2014; 93:778-85 13. Human umbilical and fetal cerebral blood flow velocity waveforms following maternal glucose loading: a cross-sectional observational study. Haugen G, Bollerslev J, Henriksen T. Acta Obstet Gynecol Scand 2016; 95:683-9 14. Zanjani MS, Nasirzadeh R, Fereshtehnejad S, Asi LY, Pooya SA, Askari S. Fetal cerebral hemodynamic in gestational diabetic versus normal pregnancies: a Doppler velocimetry of middle cerebral and umbilical arteries. Acta Neurol Belg 2014; 114:15-23 15. To WW, Mok CK. Fetal umbilical arterial and venous Doppler measurements in gestational diabetic and nondiabetic pregnancies near term. J Matern Fetal Neonatal Med. 2009; 22:1176-82 16. Leung WC, Lam H, Lee CP, Lao TT. Doppler study of the umbilical and fetal middle cerebral arteries in women with gestational diabetes mellitus. Ultrasound Obstet Gynecol. 2004; 24:534-7 17. Wong SF, Petersen SG, Idrıs N, Thomae M, McIntyre HD. Ductus venosus velocimetry in monitoring pregnancy in women with pregestational diabetes mellitus. Ultrasound Obstet Gynecol 2010; 36:350-4 18. Rakoczi I, Tihanyi K, Gero G, Csech I, Rozsa I. Release of prostacyclin (PGI2) from trophoblast in tissue culture: the effect of glucose concentration. Acta Physiol Hung 1998; 71:545-9