Preeklamptik Gebelerdeki İnsülin Direnci Ve Maternal-Fetal Sonuçlara Etkisi

Yıl 2025, Cilt: 35 Sayı: 6, 1205 - 1215, 31.12.2025

Gülin Okay , Cüneyt Eftal Taner

https://doi.org/10.54005/geneltip.1720259

Öz

Amaç
Preeklampsi olgularında saptanan hiperinsulinemi ve insülin direncinin gebelik süresince olan kilo artışıyla mı yoksa preeklampsi patofizyolojisi ile mi ilişkili olduğu henüz tam netlik kazanmamıştır. Çalışmamızda gestasyonel diyabeti olmayan hafif ve ağır preeklampsi tanısı almış gebelerde kilo alımı, obezite, biyokimyasal parametreler ile insülin direnci arasındaki bağlantı ve fetal sonuçlarına etkisi araştırıldı.

Gereç ve yöntem
Tepecik Eğitim ve Araştırma Hastanesi Perinatoloji polikliniğinde takipli 24-40. gebelik haftaları arasındaki gestasyonel diyabet tanısı almamış preeklamptik 18-44 yaş arasındaki 101 gebe dahil edildi. Gebelerin demografik verileri, biyokimyasal parametreleri, kilo ölçümleri ,glukoz metabolizmasına yönelik tetkikler ve fetüse ait veriler kaydedildi. HOMA (Homeostatic Model Assessment) değeri 2.5 ve üzerinde olması ve insülin sensitivite indeksinin 6’nın altında olması insülin direnci olarak değerlendirildi.

Bulgular
Hafif ve ağır preeklamptik olgulardan oluşan gruplar arasında açlık –tokluk kan şekeri, HOMA-IR (Homeostatic model assessment-insulin resistance), insülin sensitivite indeksi açısından anlamlı bir fark olmadığı fakat tokluk insülin değerlerinin ağır preeklampsi grubunda anlamlı olarak daha yüksek olduğu saptanmıştır. Doğum haftası,fetal doğum ağırlığı,1 ve 5. dk apgar skorlarına bakıldığında ise ağır preeklampsi grubunda daha kötü obstetrik sonuçlar elde edilmiştir.

Sonuç
Gestasyonel diyabeti olmayan preeklampsi olgularında klinik takipte tokluk insülin düzeylerini değerlendirmenin preeklampsinin prognozunu, maternal ve fetal sonuçlara etkisini ve ilerleyen yıllarda metabolik sendromu öngörebilmede yardımcı olacak bir parametre olup olamayacağı geniş çaplı prospektif randomize kontrollu çalışmalarla desteklenmelidir.

Anahtar Kelimeler

Preeklampsi , insülin sensivitesi , postprandiyal hiperglisemi

Insulin Resistance In Preeclampsia And Its Effect On Maternal-Fetal Outcomes

Öz

Aims
It is controversial whether insulin resistance and hyperinsulinemia in preeclamptic patients are due to weight gain during pregnancy or preeclampsia. This study aims investigation of the relation between insulin resistance and weight gain, obesity, biochemical parameters and fetal outcomes of insulin resistance in pregnant women with mild and severe preeclampsia without gestational diabetes.
Methods
This research was performed in Perinatology Department of Tepecik Training and Research Hospital. Non-diabetic preeclamptic 101 pregnant women between 18-44 years of age in 24-40 gestational weeks were involved in the research. Demographic data, biochemical parameters, weight measurements ,enquiries regarding glucose metabolism and data about fetuses were recorded.Homeostatic Model Assessment (HOMA) value of 2.5 and above and insulin sensitivity index below 6 were evaluated as insulin resistance.
Results
There is no remarkable variation in both groups concerning fasting and postprandial glucose level, HOMA-IR (homeostatic model assessment insulin resistance), insulin sensitivity index. Only, postprandial insulin was significantly higher in severe preeclampsia group (p <0,05). On the other hand, when the effects on fetal outcomes were examined; delivery time, birth weight, and 1 and 5 min apgar scores were significantly worse in the severe preeclampsia group.
Conclusion
Therefore, postprandial insulin levels should be taken into consideration in order to predict the effect of insulin resistance and sensitivity on the prognosis of the disease and maternal -fetal outcomes in preeclampsia cases. The relationship should be studied with large prospective randomised controlled studies to reveal whether it is a useful parameter estimating metabolic syndrome in subsequent years .

Anahtar Kelimeler

Preeclampsia , Insulin Sensitivity , Postprandial Hyperglycemia

Etik Beyan

Declaration of interest statement Author has no potential conflicts of interest to disclose. Funding Sources This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Teşekkür

Acknowledgements I would like to express my deepest appreciation to Assoc. Prof. Dr. Cüneyt Eftal Taner for his guidance and backing for my thesis.

Kaynakça

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