GESTASYONEL DİABETES MELLİTUS YAŞAM TARZI MÜDAHALELERİ İLE ÖNLENEBİLİR Mİ?

Year 2020, Volume: 51 Issue: 4, 231 - 239, 15.12.2020

Pınar Kumru Nimet Emel Lüleci Ahmet Topuzoglu

https://doi.org/10.16948/zktipb.743692

Abstract

Gestasyonel diyabetes mellitus(GDM) gebelik sırasında ortaya çıkan, kısa ve uzun vadede anne/yenidoğanda ciddi mortalite ve morbidite artışına neden olan önemli bir komplikasyondur. GDM prevalansı dünyada artan tip 2 Diabetes Mellitus ile paralel olarak artış göstermektedir. GDM nüksü de oldukça yaygın olarak (%40-73) bildirilmiş olup bu durum anne/fetüs/çocuk sağlığı risklerini daha da artırmaktadır. GDM için bilinen en önemli değiştirilebilir ve bağımsız risk faktörleri; gebelik öncesi fazla kilolu / obez olmak ve gebelik sırasında aşırı kilo almaktır.
Literatürde prospektif kohort çalışmalarda, gebelik sırasında diyet, aktivite artışı ve çeşitli sağlıklı davranış stratejilerini içeren yaşam tarzı müdahaleler ile GDM riskinin azaltılabileceği bildirilmesine rağmen, bu konudaki randomize kontrollü çalışmalarda tutarsızlıklar vardır. Bazı araştırmalar bu tür müdahalelerin GDM'nin önlenmesinde etkili olduğunu, bazıları ise etkisi olmadığını bildirmiştir.
GDM öyküsü olan kadınlarda doğum sonrası yaşam tarzı müdahalelerinin etkilerini inceleyen araştırmalar, uzun dönemde diyabet insidansının azaldığını ve kardiyovasküler hastalık risk faktörlerinde iyileşme olduğunu göstermiştir. Bununla birlikte, gebelik sırasında ve gebelik öncesi yaşam tarzı müdahalelerinin sonraki GDM üzerine etkileri henüz bilinmemektedir.
Bundan sonraki süreçte, GDM'yi önlemek amacı tüm toplum için özellikle de adolesan kız çocukları ve üreme çağındaki kadınlar için optimal sağlıklı yaşam tarzı stratejisinin belirlenmesi ve toplumda benimsenerek yaygınlaşmasının sağlanmalıdır. Geliştirilecek halk sağlığı stratejisinin belirlenmesi için ise güçlü, iyi tasarlanmış randomize klinik çalışmalara ihtiyaç vardır.
Anahtar Kelimeler: Gestasyonel diabetes mellitus, sağlıklı yaşam biçimi davranışlar, anne ve yenidoğan sağlığı.

CAN GESTATIONAL DIABETES MELLITUS BE PREVENTED BY LIFE STYLE INTERVENTIONS?

ABSTRACT
Gestational diabetes mellitus (GDM) is a significant complication that occurs during pregnancy and causes severe mortality and morbidity with short and long term health problems in both mother and newborn. The prevalence of GDM is increasing in parallel with the increasing type 2 Diabetes Mellitus worldwide. Recurrence of GDM is also widely reported in women (40-73%), which increases the risk of maternal/fetal / child health. Modifiable and independent risk factors for GDM include excess weight gain during maternal pregnancy, weight before pregnancy, and obesity.
Although it has been reported in the literature in prospective cohort studies, the risk of GDM can be reduced by lifestyle interventions involving diet, increased activity, and various healthy behavior strategies during pregnancy, there are inconsistencies in randomized controlled studies on this issue. Some studies have reported that such interventions effectively prevent GDM, while others have reported that they have no effect.
In women with a long-term history of GDM, studies investigating the effects of postpartum lifestyle interventions have shown that the incidence of diabetes is reduced, and cardiovascular disease risk factors improve. However, the effects of lifestyle interventions during pregnancy and before pregnancy on subsequent GDM are not yet known.
In the next process, in order to prevent GDM, an optimal healthy lifestyle strategy should be determined for the whole society, especially for adolescent girls and women of reproductive age. It should be ensured that it is adopted and expanded in society.
Keywords: Gestational diabetes mellitus, healthy lifestyle behaviors, maternal and newborn health.

Keywords

Gestasyonel diabetes mellitus, sağlıklı yaşam biçimi davranışları, anne ve yenidoğan sağlığı

References

• IDF 2017 https://www.idf.org/our-activities/world-diabetes-day/wdd-2017.html. Erişim: 17.10.2017.
• BH, Elixhauser A, Imperatore G, Devlin HM, Kuklina EV, Geiss LS, et al. Variation in prevalence of gestational diabetes mellitus among hospital discharges for obstetric delivery across 23 states in the United States. Diabetes Care 2013;36:1209-14.
• 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.
• ACOG Committee opinion no. 504: Screening and diagnosis of gestational diabetes mellitus. Obstet Gynecol. 2011; 118:751–3.
• Rayanagoudar G, Hashi AA, Zamora J, Khan KS, Hitman GA, Thangaratinam S. Quantification of the type 2 diabetes risk in women with gestational diabetes: a systematic review and meta-analysis of 95,750 women. Diabetologia. 2016;59:1403–1411.
• Ferrara A, Peng T, Kim C. Trends in postpartum diabetes screening and subsequent diabetes and impaired fasting glucose among women with histories of gestational diabetes mellitus: A report from the Translating Research Into Action for Diabetes (TRIAD) Study. Diabetes Care. 2009; 32:269–74.
• Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet. 2009; 373:1773–9.
• Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care. 2007; 30:1314–9.
• Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med. 2005; 352:2477–86.
• Philipps LH, Santhakumaran S, Gale C, et al. The diabetic pregnancy and offspring BMI in childhood: a systematic review and meta-analysis. Diabetologia. 2011; 54:1957–66.
• Dabelea D, Hanson RL, Bennett PH, Roumain J, Knowler WC, Pettitt DJ. Increasing prevalence of Type II diabetes in American Indian children. Diabetologia. 1998; 41:904–10.
• Barbour LA. Changing perspectives in pre-existing diabetes and obesity in pregnancy: maternal and infant short and long-term outcomes. Current opinion in endocrinology, diabetes, and obesity. 2014.
• Bain E, Crane M, Tieu J, Han S, Crowther CA, Middleton P. Diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2015; 4:CD010443.
• Song C, Li J, Leng J, Ma RC, Yang X. Lifestyle intervention can reduce the risk of gestational diabetes: a meta-analysis of randomized controlled trials. Obes Rev. 2016;17(10):960-9.
• Guo XY, Shu J, Fu XH, Chen XP, Zhang L, Ji MX, Liu XM, Yu TT, Sheng JZ, Huang HF. Improving the effectiveness of lifestyle interventions for gestational diabetes prevention: a meta-analysis and meta-regression. BJOG. 2019 Feb;126(3):311-320. doi: 10.1111/1471-0528.15467.
• Glueck CJ, Pranikoff J, Aregawi D, Wang P. Prevention of gestational diabetes by metformin plus diet in patients with polycystic ovary syndrome. Fertil Steril. 2008; 89:625–34.
• Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr. 2010; 103:1792–9.
• D'Anna R, Santamaria A, Alibrandi A, Corrado F, DI Benedetto A, Facchinetti F. Myo-Inositol for the Prevention of Gestational Diabetes Mellitus. A Brief Review. J Nutr Sci Vitaminol (Tokyo). 2019;65(Supplement):S59-S61. doi: 10.3177/jnsv.65.S59.
• Kwong W, Tomlinson G, Feig DS. Maternal and neonatal outcomes after bariatric surgery; a systematic review and meta-analysis: do the benefits outweigh the risks? Am J Obstet Gynecol. 2018 Jun;218(6):573-580. doi: 10.1016/j.ajog.2018.02.003.
• Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014; 311:806–14.
• Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, Flegal KM. Trends in Obesity Prevalence Among Children and Adolescents in the United States, 1988-1994 Through 2013-2014. JAMA. 2016 Jun 7;315(21):2292-9. doi: 10.1001/jama.2016.6361.
• Cavicchia PP, Liu J, Adams SA, Steck SE, Hussey JR, Daguisé VG, Hebert JR. Proportion of gestational diabetes mellitus attributable to overweight and obesity among non-Hispanic black, non-Hispanic white, and Hispanic women in South Carolina. Matern Child Health J. 2014 Oct;18(8):1919-26. doi: 10.1007/s10995-014-1437-8.
• Kim SY, England L, Wilson HG, Bish C, Satten GA, Dietz P. Percentage of gestational diabetes mellitus attributable to overweight and obesity. Am J Public Health. 2010; 100:1047–52.
• Torloni MR, Betran AP, Horta BL, et al. Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev. 2009; 10:194–203.
• Honein MA, Devine O, Sharma AJ, et al. Modeling the potential public health impact of prepregnancy obesity on adverse fetal and infant outcomes. Obesity (Silver Spring). 2013; 21:1276–83.
• Li C, Liu Y, Zhang W. Joint and Independent Associations of Gestational Weight Gain and Pre-Pregnancy Body Mass Index with Outcomes of Pregnancy in Chinese Women: A Retrospective Cohort Study. PLoS One. 2015 Aug 27;10(8):e0136850. doi: 10.1371/journal.pone.0136850. eCollection 2015.
• Rasmussen, KM., Yaktine, AL. Institute of Medicine (U.S.). Committee to Reexamine IOM Pregnancy Weight Guidelines. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009
• Kumru P. Halk Sağlığı Yüksek Lisans Tezi. Gebelikteki Kilo Artışının Perinatal Ve Neonatal Sonuçlarla Olan İlişkisinin Değerlendirilmesi. http://katalog.marmara.edu.tr/veriler/yordambt/cokluortam/9F4C0066-92B3-CD42-B54C-41A4016C04A5/1D726E1B-9FA4-3B4C-A905-A4B85A52EF22.pdf http://hdl.handle.net/11424/37073
• Kimiko Enomoto, Shigeru Aoki, Rie Toma, Kana Fujiwara, Kentaro Sakamaki, Fumiki Hirahara. Pregnancy Outcomes Based on Pre-Pregnancy Body Mass Index in Japanese Women. PLoS One. 2016; 11(6): e0157081. Published online 2016 Jun 9. doi: 10.1371/journal.pone.0157081
• Brunner S, Stecher L, Ziebarth S, et al. Excessive gestational weight gain prior to glucose screening and the risk of gestational diabetes: a meta-analysis. Diabetologia. 2015; 58:2229–37.
• Rebecca F. Goldstein, Sally K. Abell, Sanjeeva Ranasinha, Marie Misso, Jacqueline A. Boyle, Mary Helen Black. Et all. Association of Gestational Weight Gain With Maternal and Infant Outcomes: A Systematic Review and Meta-analysis. JAMA. 2017 Jun 6; 317(21): 2207–2225. Published online 2017 Jun 6. doi: 10.1001/jama.2017.3635
• Phelan S. Windows of Opportunity for Lifestyle Interventions to Prevent Gestational Diabetes Mellitus. Am J Perinatol. 2016 Nov;33(13):1291-1299. Epub 2016 Aug 3.
• Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017 Nov 13;11:CD010443. doi: 10.1002/14651858.CD010443.pub3.
• Schoenaker DA, Mishra GD, Callaway LK, Soedamah-Muthu SS. The role of energy, nutrients, foods and dietary patterns in the development of gestational diabetes mellitus: a systematic review of observational studies. Diabetes Care 2015;58(12):2726–35. [DOI: doi:10.2337/DC150540
• American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice. ACOG committee opinion no 650: physical activity and exercise during pregnancy and the postpartum period. Obstetrics and Gynecology 2015;126(6):e135–42.
• National Institute for Health and Clinical Excellence (NICE). Antenatal care for uncomplicated pregnancies. London: NICE, Jan 2017.
• Pereira MA, Rifas-Shiman SL, Kleinman KP, Rich-Edwards JW, Peterson KE, Gillman MW. Predictors of change in physical activity during and after pregnancy: Project Viva. American Journal of Preventive Medicine 2007;32(4):312–9.
• Jeon C, Lokken P, Hu F, van Dam R. Physical activity of moderate intensity and risk of type 2 diabetes. Diabetes Care 2007;30(3):744–52.
• Russo LM, Nobles C, Ertel KA, Chasan-Taber L, Whitcomb BW. Physical activity interventions in pregnancy and risk of gestational diabetes mellitus: a systematic review and meta-analysis. Obstet Gynecol. 2015; 125:576–82.
• Tobias DK, Zhang C, van Dam RM, Bowers K, Hu FB. Physical activity before and during pregnancy and risk of gestational diabetes mellitus: a meta-analysis. Diabetes Care 2011; 34: 223–9 PubMed PMID: 20876206. PubMed Central PMCID: 3005457.
• Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, et al. The long term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 2008;371(9626):1783–9.
• Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine 2001;344:1343–50.
• Tuomilehto J, Schwarz P, Lindström J. Long-term benefits from lifestyle interventions for type 2 diabetes prevention. Diabetes Care 2011;34(Suppl 2):S210–4.
• Dutton GR, Laitner MH, Perri MG. Lifestyle interventions for cardiovascular disease risk reduction: a systematic review of the effects of diet composition, food provision, and treatment modality on weight loss. Curr Atheroscler Rep. 2014; 16:442.
• Meghan L. Butryn, Victoria Webb, Thomas A. Wadden. Behavioral Treatment of Obesity. Psychiatr Clin North Am. 2011 Dec; 34(4): 841–859. doi: 10.1016/j.psc.2011.08.006
• Wadden TA, Butryn ML, Byrne KJ. Efficacy of lifestyle modification for long-term weight control. Obes Res. 2004; 12(Suppl):151S–62S.
• Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393–403.
• Han S, Middleton P, Crowther CA. Exercise for pregnant women for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2012 Jul 11;(7):CD009021. doi: 10.1002/14651858.CD009021.pub2.
• Tieu J, Shepherd E, Middleton P, Crowther CA. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. Cochrane Database Syst Rev. 2017 Jan 3;1:CD006674. doi: 10.1002/14651858.CD006674.pub3
• Gilmore LA, Klempel-Donchenko M, Redman LM. Pregnancy as a window to future health: Excessive gestational weight gain and obesity. Semin Perinatol. 2015 Jun;39(4):296-303. doi: 10.1053/j.semperi.2015.05.009. Epub 2015 Jun 19.
• International Weight Management in Pregnancy (i-WIP) Collaborative Group. Effect of diet and physical ctivity based interventions in pregnancy on gestational weight gain and pregnancy outcomes: metaanalysis of individual participant data from randomised trials. BMJ. 2017 Jul 19;358:j3119. doi: 10.1136/bmj.j3119
• Dodd JM, Turnbull D, McPhee AJ, et al. Antenatal lifestyle advice for women who are overweight or obese: LIMIT randomised trial. BMJ 2014; 348:g1285.
• Poston L, Bell R, Croker H, et al. Effect of a behavioural intervention in obese pregnant women (the UPBEAT study): a multicentre, randomised controlled trial. Lancet Diabetes Endocrinol 2015; 3:767.
• Koivusalo SB, Rönö K, Klemetti MM, Roine RP, Lindström J, Erkkola M, Kaaja RJ, Pöyhönen-Alho M, Tiitinen A, Huvinen E, Andersson S, Laivuori H, Valkama A, Meinilä J, Kautiainen H, Eriksson JG, Stach-Lempinen B. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A Randomized Controlled Trial. Diabetes Care. 2016; 39:24–30.
• Ferrara A, Hedderson MM, Albright CL, et al. A pragmatic cluster randomized clinical trial of diabetes prevention strategies for women with gestational diabetes: design and rationale of the Gestational Diabetes’ Effects on Moms (GEM) study. BMC Pregnancy Childbirth. 2014; 14:21.
• Liu H, Wang L, Zhang S, Leng J, Li N, Li W, Wang J, Tian H, Qi L, Yang X, Yu Z, Tuomilehto J, Hu G. One-year weight losses in the Tianjin Gestational Diabetes Mellitus Prevention Programme: A randomized clinical trial. Diabetes Obes Metab. 2018 May;20(5):1246-1255. doi: 10.1111/dom.13225. Epub 2018 Feb 15.
• Davis E, Olson C. Obesity in pregnancy. Primary Care; Clinics in Office Practice. 2009; 36(2): 341-56.
• Spencer L, Rollo M, Hauck Y, MacDonald-Wicks L, Wood L, Hutchesson M, Giglia R, Smith R, Collins C. The effect of weight management interventions that include a diet component on weight-related outcomes in pregnant and postpartum women: a systematic review protocol. JBI Database System Rev Implement Rep. 2015 Jan;13(1):88-98. doi: 10.11124/jbisrir-2015-1812.
• Sorbye LM, Skjaerven R, Klungsoyr K, Morken NH. Gestational diabetes mellitus and interpregnancy weight change: A population-based cohort study. PLoS Med. 2017 Aug 1;14(8):e1002367. doi: 10.1371/journal.pmed.1002367. eCollection 2017 Aug.
• Ehrlich SF, Hedderson MM, Feng J, Davenport ER, Gunderson EP, Ferrara A. Change in body mass index between pregnancies and the risk of gestational diabetes in a second pregnancy. Obstet Gynecol. 2011; 117:1323–30.
• Bogaerts A, Van den Bergh BR, Ameye L, Witters I, Martens E, Timmerman D, Devlieger R. Interpregnancy weight change and risk for adverse perinatal outcome. Obstet Gynecol. 2013 Nov;122(5):999-1009. doi: 10.1097/AOG.0b013e3182a7f63e.
• Johansson K, Cnattingius S, Näslund I, Roos N, Trolle Lagerros Y, Granath F, Stephansson O, Neovius M. Outcomes of pregnancy after bariatric surgery. N Engl J Med. 2015 Feb 26;372(9):814-24. doi: 10.1056/NEJMoa1405789.
• Phelan S. Pregnancy: a “teachable moment” for weight control and obesity prevention. Am J Obstet Gynecol. 2010; 202:135e1–8. [PubMed: 19683692]
• Kieffer EC, Willis SK, Arellano N, Guzman R. Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health. Health Educ Behav. 2002; 29:542–56.
• Tovar A, Chasan-Taber L, Eggleston E, Oken E. Postpartum screening for diabetes among women with a history of gestational diabetes mellitus. Prev Chronic Dis. 2011; 8:A124.