GEBELİKTE BESLENME DURUMU İLE GLUKOZ TOLERANSI ARASINDAKİ İLİŞKİLER

Yıl 2021, Cilt: 84 Sayı: 3, 376 - 385, 31.07.2021

Merve Yabacı İlhan Satman Cemile İdiz Fulya Çalıkoğlu Atıl Yüksel Beyhan Ömer Birsen Demirel Emel Özer

https://doi.org/10.26650/IUITFD.2021.803339

Öz

Amaç: Gestasyonel diabetes mellitus (GDM), gebelik esnasında ortaya çıkan ve tedavi edilmediğinde hem maternal hem de fetal açıdan olumsuz sonuçlara neden olabilen bir diyabet formudur. Çalışmamızda; gebelikte beslenme özellikleri ile GDM ve gestasyonel glukoz intoleransı (GGİT) gelişimi arasındaki ilişkilerin incelenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya oral glukoz tolerans testi (OGTT- 50 g ve 100 g) sonuçlarına göre; normal glukoz toleransı (NGT, n=60), GGİT (n=60) ve GDM (n=60) olmak üzere üç grup gebe dahil edilmiştir. Katılımcıların demografik özellikleri, sağlık durumları ve beslenme alışkanlıkları sorgulanmış, ayrıca hastalardan üç günlük besin tüketim kayıtları istenmiştir. Bulgular: Gestasyonel diabetes mellitus ve GGİT gruplarında ortalama yaş, vücut ağırlığı, günlük karbonhidrat ve protein alım miktarları ve ailede diyabet öyküsü sıklığı NGT grubundan daha yüksek bulunmuş; GDM grubunda ayrıca yağ alım miktarının da, NGT ve GGİT gruplarından daha yüksek olduğu saptanmıştır (p<0,05). Lojistik regresyon modellerine göre yaş; günlük protein, karbonhidrat ve yağ tüketimleri; daha önce gebe kalmamış olmak ve gebelik öncesi vücut kitle indeksinin (VKİ)>25 kg/m2 olması GDM riski ile; benzer şekilde yaş, günlük protein tüketimi, daha önce iri bebek doğurmuş olmak ve sigara kullanmak GGİT riski ile pozitif yönde ilişkili bulunmuştur. Sonuç: Gebelerde beslenme alışkanlıkları ile birlikte fenotipik özellikler, ailede diyabet öyküsü ve daha önceki obstetrik sorunların; GDM veya GGİT riski ile yakından ilişkili olduğu saptanmıştır. Özellikle yüksek riskli gebelerde genel sağlığa ve dengeli beslenmeye özel bir önem atfedilmelidir.

Anahtar Kelimeler

Gestasyonel diabetes mellitus, gestasyonel glukoz intoleransı, beslenme tarzı, oral glukoz tolerans testi

THE RELATIONSHIP BETWEEN NUTRITIONAL STATUS AND GLUCOSE TOLERANCE IN PREGNANCY

Öz

Objective: Gestational diabetes mellitus (GDM) is a form of diabetes that appears during pregnancy and can cause both maternal and fetal consequences if left untreated. The aim of this study was to investigate the relationship between the nutritional characteristics of pregnancy and the development of GDM and gestational glucose intolerance (GGIT). Material and Method: Three groups of pregnant women were included in the study. They were grouped according to the results of the oral glucose tolerance test (OGTT-50 g and 100 g) as follows: normal glucose tolerance (NGT, n=60), GGIT (n=60), and GDM (n=60). The demographic characteristics, health conditions, and nutritional habits of the participants were questioned, and a 3-day food consumption record was requested from the patients. Results: Average age, body weight, daily carbohydrate and protein intakes, and the frequency of diabetes history in the family were found to be higher in the GDM and GGIT groups than in the NGT group. It was also found that the amount of fat intake was higher in the GDM group than in the NGT and GGIT groups (p<0.05). According to logistic regression models, age, daily protein, carbohydrate, and fat consumption, not being pregnant before, and having a body mass index (BMI)>25 kg/m2 before pregnancy were the factors associated with the risk of GDM. Similarly, age, daily protein consumption, having a macrosomic baby, and current smoking were positively associated with the risk of GGIT. Conclusion: The phenotypic characteristics, family history of diabetes, and previous obstetric problems in pregnant women were found to be closely related to GDM or GGIT risk. Special attention should be paid to general health and balanced nutrition, especially in high-risk pregnant women.

Anahtar Kelimeler

Gestational diabetes mellitus, gestational glucose intolerance, nutrition style, oral glucose tolerance test

Kaynakça

• 1. MOPS. Tuberculosis training manual for community health workers, 3 rd ed, 92; 2011.
• 2. Satman İ, Salman S, Deyneli O, Özdemir D, Yazıcı D, Mert M, et al. TEMD Diabetes Mellitus ve Komplikasyonlarının Tanı, Tedavi ve İzlem Kılavuzu. 10. Baskı, Türkiye Endokrinoloji ve Metabolizma Derneği (TEMD) Yayınları, Ankara; 2018. Retrieved from http://www.temd.org.tr.
• 3. Özdemir Ö, Sarı ME, Arpacı Ertuğrul F, Selimova Şakar V, Özcanlı G, Atalay C. Ankara Numune Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniğine Başvuran Gebelerde Gestasyonel Diyabet Sıklığı. Turkiye Klinikleri J Gynecol Obst 2014;24(1):24–29.
• 4. Özyurt R, Aşıcıoğlu O, Gültekin T, Güngördük K, Boran B. İstanbul Eğitim ve Araştırma Hastanesi Kadın Hastalıkları ve Doğum Kliniği’ ne Başvuran Gebelerde Gestasyonel Diyabet Sıklığı. JOPP Derg 2013;5(1):7–12. https://doi.org/10.5222/JOPP.2013.007.
• 5. IDF. IDF Diabetes Atlas Eighth edition 2017. https://doi.org/http://dx.doi. org/10.1016/S0140-6736(16)31679-8.
• 6. Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes : A systematic review and meta-analysis. Plos One 2017;12(10):1–15.
• 7. Yang H, Wei Y, Gao X, Xu X, Fan L, He J, et al. Pathophysiology Risk factors for gestational diabetes mellitus in Chinese women — a prospective study of 16 286 pregnant women in China. Diabetic Medicine 2009;26:1099–1104. https://doi.org/10.1111/j.1464-5491.2009.02845.x.
• 8. Schummers L, Hutcheon JA, Bodnar LM. Risk of Adverse Pregnancy Outcomes by Prepregnancy Body Mass Index: A Population-Based Study to Inform Prepregnancy Weight Loss Counseling. Obstet Gynecol 2016;125(1):133–143. https://doi.org/10.1097/AOG.0000000000000591.Risk.
• 9. Ehrlich SF, Hedderson MM, Feng J, Davenport ER. Change in Body Mass Index Between Pregnancies and the Risk of Gestational Diabetes in a Second Pregnancy. Obstet Gynecol 2012;117(6):1323–1330. https://doi.org/10.1097/AOG.0b013e31821aa358.Change.
• 10. Hedderson MM, Gunderson EP, Ferrara A. Gestational Weight Gain and Risk of Gestational Diabetes Mellitus. Obstet Gynecol 2011;115(3):597–604. https://doi.org/10.1097/AOG.0b013e3181cfce4f.Gestational.
• 11. Bogaerts A, Van den Bergh BRH, Ameye L, Witters I, Martens E, Timmerman D, et al. Interpregnancy Weight Change and Risk for Adverse Perinatal Outcome. Obstetrics&Gynecology 2013;122(5):999–1009. https://doi.org/10.1097/AOG.0b013e3182a7f63e.
• 12. Kim SY, Sharma AJ, Sappenfield W. Association of Maternal Body Mass Index, Excessive Weight Gain, and Gestational Diabetes Mellitus With Large-for- Gestational-Age Births. Obstet Gynecol 2015;123(4):737–744. https://doi.org/10.1097/AOG.0000000000000177.Association.
• 13. England LJ, Levine RJ, Qian C, Soule LM, Schisterman EF, Yu KF, et al. Glucose Tolerance and Risk of Gestational Diabetes Mellitus in Nulliparous Women Who Smoke during Pregnancy. Am J Epidemiol 2004;160(12):1205–1213. https://doi.org/10.1093/aje/kwh340.
• 14. Leng J, Wang P, Shao P, Zhang C, Li W, Li N, et al. Passive Smoking Increased Risk of Gestational Diabetes Mellitus Independently and Synergistically with Pre-pregnancy Obesity in Tianjin, China. Diabetes Metab Res Rev 2017;33(3). https://doi.org/10.1002/dmrr.2861.
• 15. Liang Y, Gong Y, Zhang X, Yang D, Zhao D, Quan L. Dietary Protein Intake , Meat Consumption , and Dairy Consumption in the Year Preceding Pregnancy and During Pregnancy and Their Associations With the Risk of Gestational Diabetes Mellitus : A Prospective Cohort Study in Southwest China. Frontiers in Endocrinology 2018;9(10):1-9. https://doi.org/10.3389/fendo.2018.00596.
• 16. Saldana TM, Siegariz AM, Adair LS. Effect of macronutrient intake on the development of glucose intolerance during pregnancy. Am J Clin Nutr 2004;79:479–486.
• 17. Zhang C, Liu S, Solomon C, Hu F. Dietary Fiber Intake , Dietary Glycemic Load , and the Risk for Gestational. Diabetes Care 2006;29(10):2223–2230. https://doi.org/10.2337/dc06-0266.
• 18. He J, Yuan M, Chen N, Lu J, Hu C, Mai W, et al. Maternal dietary patterns and gestational diabetes mellitus : a large prospective cohort study in China. British Journal of Nutrition 2015;113:1292–1300. https://doi.org/10.1017/S0007114515000707.
• 19. Georgoulis M, Kontogianni MD, Yiannakouris N. Mediterranean Diet and Diabetes: Prevention and Treatment. Nutrients 2014;6:1406–1423. https://doi.org/10.3390/nu6041406.