Comparative study of neonatal and maternal adverse outcomes in women with gestational diabetes mellitus followed or treated with insulin versus dietary regimen

Öz

Aim: Primary aim of this study is to compare the neonatal and maternal complications of women with Gestational Diabetes Mellitus (GDM) treated with insulin or followed by diet. Secondary aim is to evaluate the rate of cesarean section and indications of that. Methods: Women with GDM were divided into two groups as insulin (n=110) and diet (n=200). Demographic data, antenatal follow-up measurements, gestational week at birth and type of delivery were recorded. Neonatal complications (neonatal intensive care admission, shoulder dystocia, hypoglycemia, low apgar score) and maternal complications (thrombosis, hypoglycemia and cellulitis) were recorded. Total and primary cesarean section rates were calculated by dividing them according to indications. Statistical analysis between groups was performed. Results: Age and body mass index were not statistically significant in both groups. Low apgar score, admission to neonatal intensive care, postpartum maternal complications and primary cesarean section rate were statistically significantly higher in the insulin group compared to the diet group (p <0.05 for all). Vaginal delivery rate was statistically significantly higher in the diet group (OR: 1.8, CI: 95%). Macrosomia and related cesarean section were found to be statistically significantly higher in the insulin group (p<0.05). There was no significant difference in terms of induction of labor and preterm delivery rates. Conclusion It is important to achieve normoglycemia in women with GDM. However, dietary follow-up, which is the primary approach for this purpose, seems to be advantageous in terms of neonatal and maternal complications compared to insulin which is known as an effective medical treatment.

Anahtar Kelimeler

• Gstational diabetes mellitus
• insulin
• dietary regimen
• outcome

Diyet ile takip edilen veya insülin ile tedavi edilen gestasyonel diyabetli kadınlarda neonatal ve maternal komplikasyonların karşılaştırılması

Öz

Amaç: Bu çalışmanın birincil amacı, insülin ile tedavi edilen veya diyetle takip edilen Gestasyonel Diabetes Mellitus (GDM) hastalarının neonatal ve maternal komplikasyonlarını karşılaştırmaktır. İkincil amaç ise sezaryen oranını ve endikasyonlarını değerlendirmektir. Gereç ve Yöntemler: GDM'li kadınlar insülin (n = 110) ve diyet (n = 200) olarak iki gruba ayrıldı. Demografik veriler, antenatal takip ölçümleri, doğumda gebelik haftası ve doğum şekli kaydedildi. Yenidoğan komplikasyonları (yenidoğan yoğun bakım yatışı, omuz distosisi, hipoglisemi, düşük apgar skoru) ve maternal komplikasyonlar (tromboz, hipoglisemi ve selülit) kaydedildi. Toplam ve primer sezaryen oranları hesaplandı ve endikasyonlara göre gruplandı. Gruplar arasında istatistiksel analiz yapıldı. Bulgular: Yaş ve vücut kitle indeksi açısındaniki grup arasından istatistiksel olarak anlamlı fark yok idi. Diyet grubuna göre insülin grubunda düşük apgar skoru, yenidoğan yoğun bakıma yatış, postpartum maternal komplikasyonlar ve primer sezaryen oranı istatistiksel olarak anlamlı yüksekti (tümü için p <0.05). Vajinal doğum oranı diyet grubunda istatistiksel olarak anlamlı derecede yüksekti (OR: 1.8, CI:% 95). Makrozomi ve buna bağlı sezaryen, insülin grubunda istatistiksel olarak anlamlı yüksek bulundu (p <0.05). Doğum indüksiyonu ve erken doğum oranları açısından anlamlı fark yoktu. Sonuç: GDM'li kadınlarda normoglisemiye ulaşmak önemlidir. Ancak bu amaçla birincil yaklaşım olan diyet takibi, etkili bir medikal tedavi olarak bilinen insüline göre neonatal ve maternal komplikasyonlar açısından avantajlı görünmektedir.

Anahtar Kelimeler

• Gestasyonel diabetes mellitus
• insülin
• diyet rejimi
• komplikasyon

Kaynakça

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