ANTENATAL FACTORS AFFECTING THE DECISION TO HAVE AN ORAL GLUCOSE TOLERANCE TEST

Öz

Aim We aimed to investigate the factors that may affect the pregnant’s decision to have an oral glucose tolerance test (OGTT) between 24-28 gestational weeks. Material and Methods This descriptive and cross-sectional study was conducted prospectively with 307 pregnant women. Demographic characteristics of the pregnant women, pregnancy follow-up findings, antenatal tests, and their decision for having an OGTT were questioned and recorded. All the factors were analyzed that may have a possible effect on the OGTT decision. Results Fifty-three percent of the participants had OGTT during pregnancy. The rate of positive OGTT was found to be 8.5%. Body mass index, gravida, history of abortion, miscarriage risk, weight gain during pregnancy, the rate of using antenatal folic acid and iron supplementation were similar between the groups that had and did not have OGTT (p >0.05). In the univariate model, age, parity, planned pregnancy, regular follow-up, educational status and physical activity were found to have a significant effect on predicting patients who will have OGTT (p <0.05). Also, antenatal screening tests and level 2 obstetrics ultrasonography were shown to have a significant independent effect in predicting patients who will have OGTT (p <0.05). Conclusion By evaluating the factors that may affect the decision of pregnant about OGTT during pregnancy follow-up, we can predict the patients who tend not to have GDM screening and we can increase the screening rate by giving these pregnant women more detailed information. Thus, we have a chance to diagnose and treat more GDM and reduce related mortality and morbidity.

Anahtar Kelimeler

• Gestational Diabetes
• Oral Glucose Tolerance Test
• Pregnancy
• Maternal Serum Screening Tests

ORAL GLUKOZ TOLERANS TESTİ YAPTIRMA KARARINI ETKİLEYEN ANTENATAL FAKTÖRLER

Öz

Amaç Gebelerin 24 - 28. gebelik haftaları arasında oral glukoz tolerans testi (OGTT) yaptırma kararını etkileyebilecek faktörleri araştırmayı amaçladık. Gereç ve Yöntem Tanımlayıcı ve kesitsel olan bu çalışma prospektif olarak 307 gebe ile yapılmıştır. Gebelerin demografik özellikleri, gebelik takip bulguları, antenatal testleri ve OGTT yaptırma kararları sorgulanarak kaydedildi. OGTT kararını etkileyebilecek tüm faktörler analiz edildi. Bulgular Katılımcıların %53’ü hamilelik sırasında OGTT testi yaptırmayı kabul etti. OGTT sonucunun pozitiflik oranı %8.5 olarak saptandı. OGTT olan ve olmayan gruplar arasında vücut kitle indeksi, gravida, düşük öyküsü, düşük riski, gebelikte kilo alımı, antenatal folik asit kullanımı ve demir kullanımı oranları benzerdi (p>0.05). Tek değişkenli modelde; yaş, parite, planlı gebelik olması, düzenli gebelik takibi yapılması, eğitim durumu ve fiziksel aktivitenin OGTT yaptıracak hastaları öngörmede anlamlı etkisi olduğu bulundu (p<0.05). Ayrıca antenatal tarama testleri ve 2. düzey obstetrik ultrasonografinin OGTT olacak hastaları öngörmede anlamlı bağımsız etkiye sahip olduğu gösterilmiştir (p<0.05). Sonuç Gebelerin takipleri sırasında OGTT ile ilgili kararını etkileyebilecek faktörleri değerlendirerek GDM taraması yaptırmama eğiliminde olan hastaları öngörebilir ve bu gebelere daha detaylı bilgi vererek tarama oranını artırabiliriz. Böylece daha fazla GDM tanısı koyarak tedavi etme ve buna bağlı oluşabilecek mortalite ve morbiditeyi azaltma fırsatı bulabiliriz.

Anahtar Kelimeler

• Gestasyonel Diyabet
• Oral Glukoz Tolerans Testi
• Gebelik
• Anne Serumu Tarama Testleri

Kaynakça

1. Referans1. 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(3):526-528. doi:10.2337/dc11-1641
2. Referans2. Alfadhli EM. Gestational diabetes mellitus. Saudi Med J. 2015;36(4):399-406. doi:10.15537/smj.2015.4.10307
3. Referans3. Moyer VA; U.S. Preventive Services Task Force. Screening for gestational diabetes mellitus: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(6):414-420. doi:10.7326/M13-2905
4. Referans4. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64. doi:10.1097/AOG.0000000000002501
5. Referans5. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nat Rev Dis Primers. 2019;5(1):47. Published 2019 Jul 11. doi:10.1038/s41572-019-0098-8
6. Referans6. Johns EC, Denison FC, Norman JE, Reynolds RM. Gestational Diabetes Mellitus: Mechanisms, Treatment, and Complications. Trends Endocrinol Metab. 2018;29(11):743-754. doi:10.1016/j.tem.2018.09.004
7. Referans7. Tieu J, McPhee AJ, Crowther CA, Middleton P, Shepherd E. Screening for gestational diabetes mellitus based on different risk profiles and settings for improving maternal and infant health. Cochrane Database Syst Rev. 2017;8(8):CD007222. Published 2017 Aug 3. doi:10.1002/14651858.CD007222.pub4
8. Referans8. Moore TR. A comparison of amniotic fluid fetal pulmonary phospholipids in normal and diabetic pregnancy. Am J Obstet Gynecol. 2002;186(4):641-650. doi:10.1067/mob.[phone]

9. Referans9. Rosenstein MG, Cheng YW, Snowden JM, Nicholson JM, Doss AE, Caughey AB. The risk of stillbirth and infant death stratified by gestational age in women with gestational diabetes. Am J Obstet Gynecol. 2012;206(4):309.e1-309.e3097. doi:10.1016/j.ajog.2012.01.014
10. Referans10. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358(19):1991-2002. doi:10.1056/NEJMoa0707943
11. Referans11. Chiefari E, Arcidiacono B, Foti D, Brunetti A. Gestational diabetes mellitus: an updated overview. J Endocrinol Invest. 2017;40(9):899-909. doi:10.1007/s40618-016-0607-5
12. Referans12. Turan Z. , Toker E. Gebelerin oral glukoz tolerans testi yaptırmalarını etkileyen faktörlerin incelenmesi. ADYÜ Sağlık Bilimleri Derg. 2020; 6(2): 174-181.
13. Referans13. Başbuğ A. , Sönmez C. İ. , Ellibeş Kaya A. , Yıldırım E. Gestasyonel Diyabet Taramasında Karşılaşılan Önemli Bir Problem: Gebeler Neden Oral Glukoz Tolerans Testi Yaptırmak İstemiyor?. Konuralp Medical Journal. 2018; 10(2): 144-148.
14. Referans14. Yaprak M. , Gümüştakım R. Ş. , Tok A. , Doğaner A. Gebelerde Oral Glukoz Tolerans Testi Farkındalığının Tespiti. Ankara Med J. 2019; 19(3): 635-647.
15. Referans15. Turkyilmaz E. , Kelestemur E. , Karatas Eray İ. , Ocal F. D. , Yavuz A. F. Knowledge Level, Attitude and Behaviours About Glucose Challenge Test Among Turkish Pregnant Women. Ankara Med J. 2016; 16(2): 0-0.
16. Referans16. Hussain Z, Yusoff ZM, Sulaiman SA. Evaluation of knowledge regarding gestational diabetes mellitus and its association with glycaemic level: A Malaysian study. Prim Care Diabetes. 2015;9(3):184-190. doi:10.1016/j.pcd.2014.07.007
17. Referans17. Shriraam V, Rani MA, Sathiyasekaran BW, Mahadevan S. Awareness of gestational diabetes mellitus among antenatal women in a primary health center in South India. Indian J Endocrinol Metab. 2013;17(1):146-148. doi:10.4103/2230-8210.107861
18. Referans18. Champion ML, Harper LM. Gestational Weight Gain: Update on Outcomes and Interventions. Curr Diab Rep. 2020;20(3):11. Published 2020 Feb 27. doi:10.1007/s11892-020-1296-1
19. Referans19. Gregg VH, Ferguson JE 2nd. Exercise in Pregnancy [published correction appears in Clin Sports Med. 2018 Jan;37(1):xiii]. Clin Sports Med. 2017;36(4):741-752. doi:10.1016/j.csm.2017.05.005
20. Referans20. Wang C, Wei Y, Zhang X, et al. A randomized clinical trial of exercise during pregnancy to prevent gestational diabetes mellitus and improve pregnancy outcome in overweight and obese pregnant women. Am J Obstet Gynecol. 2017;216(4):340-351. doi:10.1016/j.ajog.2017.01.037
21. Referans21. WHO. Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva, World Health Organization, 2012.
22. Referans22. ACOG Committee on Practice Bulletins. ACOG Practice Bulletin No. 77: screening for fetal chromosomal abnormalities. Obstet Gynecol. 2007;109(1):217-227. doi:10.1097/00006250-200701000-00054
23. Referans23. Dilek Kusaslan Avci, Ercan Oner. Examination of the Knowledge, Attitude and Behaviours of Pregnant Women on Screening Tests made during Pregnancy. Eastern J Med. 2018; 23(2): 84-89
24. Referans24. Hocaoglu M, Turgut A, Guzin K, Yardimci OD, Gunay T, Demircivi Bor E, et al. Why some pregnant women refuse glucose challenge test? Turkish pregnant women’s perspectives for gestational diabetes mellitus screening. North Clin Istanb 2019;6(1):7-12.
25. Referans25. Destegül E, Gençdal, S. Oral glucose tolerance test in pregnant women and factors affecting their decisions . Cumhuriyet Medical Journal , 2020;42(2):224-229 . DOI: 10.7197/cmj.vi.659607
26. Referans26. Desdicioğlu R. , Yıldırım M. , Süleymanova İ. , Atalay İ. , Özcan M. , Yavuz A. F. Factors Affecting the Approach of Pregnant Women to Prenatal Tests. Ankara Med J. 2017; 17(1): 0-0.
27. Referans27. Koyucu RG. Gestasyonel Diyabet Risk Faktörleri Çerçevesinde Gebelerin Glukoz Tolerans Testine İlişkin Tutumları. Sağlık ve Toplum. 2018; 28(2): 65-76.