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

Yıl 2021, Cilt: 18 Sayı: 3, 938 - 944, 25.09.2021

Mehmet Ufuk Ceran

https://doi.org/10.38136/jgon.895195

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

Proje Numarası

KA 20/13

Teşekkür

Yazar istatistik desteği için Hüseyin Candan 'a teşekkürlerini sunar.

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

Proje Numarası

KA 20/13

Kaynakça

• Correa A, Bardenheier B, Elixhauser A, Geiss LS, Gregg E. Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993–2009. Maternal and child health journal. 2015;19(3):635-42.
• Diabetes IAo, Panel PSGC. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. J Diabetes care. 2010;33(3):676-82.
• Group HSCR. Hyperglycemia and adverse pregnancy outcomes. New England Journal of Medicine. 2008;358(19):1991-2002.
• López Stewart G. Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy: a World Health Organization Guideline. 2014.
• Association AD. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2018. Diabetes care. 2018;41(Supplement 1):S13-S27.
• Akgol S, Obut M, Baglı İ, Kahveci B, Budak MS. An evaluation of the effect of a one or two-step gestational diabetes mellitus screening program on obstetric and neonatal outcomes in pregnancies. Gynecology obstetrics & reproductive medicine. 2019;25(2):62-6.
• ACOG. Practice Bulletin No. 190 Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64.
• Scholtens DM, Kuang A, Lowe LP, Hamilton J, Lawrence JM, Lebenthal Y, et al. Hyperglycemia and Adverse Pregnancy Outcome Follow-up Study (HAPO FUS): Maternal Glycemia and Childhood Glucose Metabolism. Diabetes Care. 2019;42(3):381-92.
• Mpondo BC, Ernest A, Dee HE. Gestational diabetes mellitus: challenges in diagnosis and management. Journal of Diabetes & Metabolic Disorders. 2015;14(1):42.
• Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews. 2018(8).
• Arshad R, Karim N, Hasan JA. Effects of insulin on placental, fetal and maternal outcomes in gestational diabetes mellitus. Pakistan journal of medical sciences. 2014;30(2):240.
• Chowdhury AM, Anwar S, Begum M, Eva KN, Shahnaz F. Effects of insulin treated established diabetes mellitus (EDM) on the volume of placental parenchyma and weight of the neonate. Bangladesh Journal of Anatomy. 2009;7(1):45-8.
• Wong VW, Jalaludin B. Gestational diabetes mellitus: who requires insulin therapy? Australian and New Zealand Journal of Obstetrics and Gynaecology. 2011;51(5):432-6.
• FAROUGH M, AHMAD I, AYAZ A, ALI BL. Maternal and neonatal outcomes in gestational diabetes mellitus. 2007.
• Bane A, Gillan J. Massive perivillous fibrinoid causing recurrent placental failure. BJOG: an international journal of obstetrics and gynaecology. 2003;110(3):292-5.
• Fazel-Sarjoui Z, Namin AK, Kamali M, Namin NK, Tajik A. Complications in neonates of mothers with gestational diabetes mellitus receiving insulin therapy versus dietary regimen. International Journal of Reproductive BioMedicine. 2016;14(4):275.
• Giuffrida FdMA, Castro AA, Atallah A, Dib SA. Diet plus insulin compared to diet alone in the treatment of gestational diabetes mellitus: a systematic review. Brazilian journal of medical and biological research. 2003;36(10):1297-300.
• Brown J, Grzeskowiak L, Williamson K, Downie MR, Crowther CA. Insulin for the treatment of women with gestational diabetes. Cochrane Database of Systematic Reviews. 2017(11).
• Brown J, Alwan NA, West J, Brown S, McKinlay CJ, Farrar D, et al. Lifestyle interventions for the treatment of women with gestational diabetes. Cochrane Database of Systematic Reviews. 2017(5).
• Gascho CLL, Leandro DMK, Silva JC. Predictors of cesarean delivery in pregnant women with gestational diabetes mellitus. Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(2):60-5.
• Inocêncio G, Braga A, Lima T, Vieira B, Zulmira R, Carinhas M, et al. Which factors influence the type of delivery and cesarean section rate in women with gestational diabetes? The Journal of reproductive medicine. 2015;60(11-12):529.
• Grabowska K, Stapińska-Syniec A, Saletra A, Jarmużek P, Bomba-Opoń D. Labour in women with gestational diabetes mellitus. Ginekologia polska. 2017;88(2):81-6.