Öz
Objectives: Diabetes is a disease that effects fetal development during pregnancy and leads metabolic disorders in newborns. In this study, we aimed to evaluate the problems of infants of diabetic mothers and to determine risk factors of mothers during pregnancy. Material and Methods: The morbidity rates of 31 infants of diabetic mothers who were born and followed in neonatal intensive unit between January 2013 and December 2013 at Gaziosmanpasa University and demographic properties of mothers were retrospectively evaluated. Results: A total of 31 infants were included. The incidence of insulin dependent diabetes mellitus was %22,6 and the incidence of gestational diabetes was 77,4%. Mothers’ mean age was 32,6±7,9 years and HbA1c level was 5,4±1 (4,2-10,2). The mean gestational age of infants was 37,5±1,5 weeks and the mean birth weight of infants was 3322,5± 695,8 g. Macrosomia was present in 32.2% of infants. Hypoglycemia was present in 9,7% of infants, hypocalcemia was seen 3.2%, polycytemia was seen 6.5%, anemia was seen 6.5%, thrombocytopenia was seen 9.2%, hyperbilirubinemia was seen 41.9%, respiratory distress syndrome was seen 12.9%, congenital anomaly was seen 3.7% of all infants. There was no correlation between HbA1c levels of mothers and hypoglycemia, hypocalcemia, anemia and respiratory distress syndrome. Conclusion: Many complications may be prevented with appropriate management, obstetric care and neonatal management in infants of diabetic mother. It is possible to reduce morbidities with the identification of gestational diabetes and metabolic control of hyperglycemia, the determination of risk factors, the close contact between the diabetic mother and her infant in the first hours of delivery and the close follow-up of infants of diabetic mothers with rooming-in who do not need neonatal intensive care unit care.
Anahtar Kelimeler
Kaynakça
- KAYNAKLAR
- Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am 2004;51:619-37.
- Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA 2001;286:2516-8.
- Topaloğlu N, Yıldırım S, Tekin M, et al. Mean Platelet Volume and Ischemia Modified Albumin Levels in Cord Blood of Infants of Diabetic Mothers. Pediatr Neonatol 2014; 20. S1875-9572(14)00061-8.
- Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006;108:644-50.
- Jordan DN, Jordan JL. Carpenter- Coustan criteria compa¬red with the national diabetes data group thresholds for gesta¬tional diabetes mellitus. Obstet Gynecol 2009;114:1376-7.
- Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab 2013;26:861-5.
- Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr 2010;77:1123-8.
- Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med 1998;152:249-54.
- Landon MB, Gabbe SG, Piana R, Mennuti MT, Main EK. Neonatal morbidity in pregnancy complicated by diabetes mellitus: predictive value of maternal glycemic profiles. Am J Obstet Gynecol 1987;156:1089-95.
- Wender-Ozegowska E, Wroblewska K, Zawiejska A, Pietryga M, Szczapa J, Biczysko R. Threshold values of maternal blood glucose in early diabetic pregnancy-prediction of fetal malformations. Acta Obstet Gynecol Scand 2005; 84: 17-25.
- Michael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med 2009;14:111-8.
- Neiger R. Fetal macrosomia in the diabetic patient. Clin Obstet Gynecol 1992;35:138-50.
- Brooks C. Neonatal hypoglycemia. Neonatal Netw 1997;16:15-21.
- Sundercombe SL, Raynes-Greenow CH, Carberry AE, Turner RM, Jeffery HE. Audit of a clinical guideline for neonatal hypoglycaemia screening. J Paediatr Child Health 2013;49:833-8.
- Sann L. Neonatal hypoglycemia. Biol Neonate 1990;58:16-21.
- Suhonen L, Hiilesmaa V, Teramo K. Glycaemic control during early pregnancy and fetal malformations in women with type 1 diabetes mellitus. Diabetologia 2000;43:79–82.
- Catalano PM. Obesity, insulin resistance and pregnancy outcome. Reproduction 2010;140:365–371.
- Klemetti M, Nuutila M, Tikkanen M, Kari MA, Hiilesmaa V, Teramo K. Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989-2008. Diabetologia 2012;55:2327-34.
- Akarsu S, Kurt ANC, Kurt A, Yılmaz E, Aygun AD. Diyabetik anne bebeğinde klinik ve laboratuar bulguları. Fırat Tıp Dergisi 2008;13:199-204.
- Karagöl BS, Karadağ N, Zenciroğlu A, Kundak AA, Okumuş N. Yenidoğan yoğun bakımında yedi yıllık diyabetik anne bebeği deneyimi. Çocuk Dergisi 2012;12:169-176.
- Ullmo S, Vial Y, Di Bernardo S et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 2007: 28:1319–1325.
- Potter CF, Kicklighter SD. Infant of diabetic mother. Diabetes Care 2006;100:619–637.
- Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology 2001;64:98-106.
- Van Howe RS, Storms MR. Hypoglycemia in infants of diabetic mothers: experience in a rural hospital. Am J Perinatol 2006;23:105-10.
- Digiacomo JE, William W, Hary JR. Abnormal glucose homeostasis. In: Sinclair JC, Bracken MB (eds). Effective Care of Newborn Infant. First ed. New York: Oxford University Press, 1992: 591-600.
- Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Jensen DM, Mathiesen ER. Elevated third-trimester haemoglobin A 1c predicts preterm delivery in type 1 diabetes. J Diabetes Complications. 2008 Sep-Oct;22(5):297-302.
- Kjos SL, Walther FJ, Montoro M, Paul RH, Diaz F, Stabler M. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gynecol 1990;163:898-903.
Öz
Amaç: Diyabet gebelikte fetal gelişimi etkileyen ve yenidoğanlarda metabolik bozukluklara yol açan bir hastalıktır. Çalışmamızda diyabetik anne bebeklerinin yenidoğan sorunlarının annelerinin gebelik takipleri ile birlikte değerlendirilmesi amaçlanmıştır.
Gereç ve yöntem: Çalışmada Gaziosmanpaşa Üniversitesi Tıp Fakültesi Hastanesinde Ocak 2013- Aralık 2013 tarihleri arasında doğan ve yenidoğan yoğun bakım ünitesinde izlenen 31 diyabetik anne bebeğinin morbidite oranları ve annelere ait demografik özellikleri retrospektif olarak değerlendirildi.
Bulgular
Çalışmaya 31 diyabetik anne bebeği alındı. Annelerden 7’si (%22,6) insuline bağımlı diyabet ve 24’ü (%77,4) gestasyonel diyabet tanısı ile takip edilmekte idi. Annelerin ortalama yaşı 32,6±7,9 yıl, ortalama glikolize hemoglobin (HbA1c) değerleri % 5,4±1 (4,2-10,2) saptandı. Bebeklerin ortalama gebelik haftaları 37,5±1,5 hafta, ortalama doğum ağırlığı 3322,5± 695,8 gr. idi, makrozomi sıklığı %32,2 idi. Bebeklerde hipoglisemi %9,7, hipokalsemi %3,2, polistemi %6,5, anemi %19,4, trombositopeni %9,7, hiperbilirubinemi % 41,9, respiratuar distres sendromu %12,9, doğuştan anomali %3,7 oranında bulundu. Annenin HbA1c düzeyi ile hipoglisemi, hipokalsemi, polistemi, anemi, respiratuar distres sendromu arasında ilişki bulunmadı (p>0,05).
Sonuç
Diyabetik anne bebeklerinde uygun medikal yaklaşım, obstetrik bakım ve neonatal yaklaşım ile görülebilecek çoğu komplikasyonun önlenmesi mümkündür. Gestasyonel diyabetin tanımlanması, hipergliseminin kontrol altına alınması ile konjenital
anomaliler ve perinatal ölümler azaltılabilir.
Anahtar kelimeler: diyabetik anne bebeği, komplikasyon
anomaliler ve perinatal ölümler azaltılabilir.
Anahtar Kelimeler
Kaynakça
- KAYNAKLAR
- Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am 2004;51:619-37.
- Jovanovic L, Pettitt DJ. Gestational diabetes mellitus. JAMA 2001;286:2516-8.
- Topaloğlu N, Yıldırım S, Tekin M, et al. Mean Platelet Volume and Ischemia Modified Albumin Levels in Cord Blood of Infants of Diabetic Mothers. Pediatr Neonatol 2014; 20. S1875-9572(14)00061-8.
- Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol 2006;108:644-50.
- Jordan DN, Jordan JL. Carpenter- Coustan criteria compa¬red with the national diabetes data group thresholds for gesta¬tional diabetes mellitus. Obstet Gynecol 2009;114:1376-7.
- Vanhaltren K, Malhotra A. Characteristics of infants at risk of hypoglycaemia secondary to being 'infant of a diabetic mother'. J Pediatr Endocrinol Metab 2013;26:861-5.
- Jain A, Agarwal R, Sankar MJ, Deorari A, Paul VK. Hypocalcemia in the newborn. Indian J Pediatr 2010;77:1123-8.
- Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med 1998;152:249-54.
- Landon MB, Gabbe SG, Piana R, Mennuti MT, Main EK. Neonatal morbidity in pregnancy complicated by diabetes mellitus: predictive value of maternal glycemic profiles. Am J Obstet Gynecol 1987;156:1089-95.
- Wender-Ozegowska E, Wroblewska K, Zawiejska A, Pietryga M, Szczapa J, Biczysko R. Threshold values of maternal blood glucose in early diabetic pregnancy-prediction of fetal malformations. Acta Obstet Gynecol Scand 2005; 84: 17-25.
- Michael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med 2009;14:111-8.
- Neiger R. Fetal macrosomia in the diabetic patient. Clin Obstet Gynecol 1992;35:138-50.
- Brooks C. Neonatal hypoglycemia. Neonatal Netw 1997;16:15-21.
- Sundercombe SL, Raynes-Greenow CH, Carberry AE, Turner RM, Jeffery HE. Audit of a clinical guideline for neonatal hypoglycaemia screening. J Paediatr Child Health 2013;49:833-8.
- Sann L. Neonatal hypoglycemia. Biol Neonate 1990;58:16-21.
- Suhonen L, Hiilesmaa V, Teramo K. Glycaemic control during early pregnancy and fetal malformations in women with type 1 diabetes mellitus. Diabetologia 2000;43:79–82.
- Catalano PM. Obesity, insulin resistance and pregnancy outcome. Reproduction 2010;140:365–371.
- Klemetti M, Nuutila M, Tikkanen M, Kari MA, Hiilesmaa V, Teramo K. Trends in maternal BMI, glycaemic control and perinatal outcome among type 1 diabetic pregnant women in 1989-2008. Diabetologia 2012;55:2327-34.
- Akarsu S, Kurt ANC, Kurt A, Yılmaz E, Aygun AD. Diyabetik anne bebeğinde klinik ve laboratuar bulguları. Fırat Tıp Dergisi 2008;13:199-204.
- Karagöl BS, Karadağ N, Zenciroğlu A, Kundak AA, Okumuş N. Yenidoğan yoğun bakımında yedi yıllık diyabetik anne bebeği deneyimi. Çocuk Dergisi 2012;12:169-176.
- Ullmo S, Vial Y, Di Bernardo S et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 2007: 28:1319–1325.
- Potter CF, Kicklighter SD. Infant of diabetic mother. Diabetes Care 2006;100:619–637.
- Loffredo CA, Wilson PD, Ferencz C. Maternal diabetes: an independent risk factor for major cardiovascular malformations with increased mortality of affected infants. Teratology 2001;64:98-106.
- Van Howe RS, Storms MR. Hypoglycemia in infants of diabetic mothers: experience in a rural hospital. Am J Perinatol 2006;23:105-10.
- Digiacomo JE, William W, Hary JR. Abnormal glucose homeostasis. In: Sinclair JC, Bracken MB (eds). Effective Care of Newborn Infant. First ed. New York: Oxford University Press, 1992: 591-600.
- Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Jensen DM, Mathiesen ER. Elevated third-trimester haemoglobin A 1c predicts preterm delivery in type 1 diabetes. J Diabetes Complications. 2008 Sep-Oct;22(5):297-302.
- Kjos SL, Walther FJ, Montoro M, Paul RH, Diaz F, Stabler M. Prevalence and etiology of respiratory distress in infants of diabetic mothers: predictive value of fetal lung maturation tests. Am J Obstet Gynecol 1990;163:898-903.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Orjinal Çalışma |
| Yazarlar | |
| Yayımlanma Tarihi | 19 Ocak 2015 |
| Yayımlandığı Sayı | Yıl 2014 Cilt: 4 Sayı: 3 |