Diyabetik gebelerde HbA1c ve glukoz düzeyleriyle doğum ağırlığının tahmin edilmesi

Yıl 2022, Cilt: 19 Sayı: 1, 1164 - 1168, 25.03.2022

Özgür Kara , Deniz Oluklu , Dilek Sahin

https://doi.org/10.38136/jgon.1059937

Öz

Amaç Pregestasyonel diabetes mellitus (PGDM) ve gestasyonel diabetes mellitus (GDM) tanılı gebelerde 28 ve 32. gebelik haftalarında açlık glukozu, tokluk 1. saat glukozu ve Hemoglobin A1c düzeyleri ile doğum ağırlığını tahmin etmek.
Gereç ve Yöntemler Çalışmamıza 66 GDM, 39 PGDM (7 tip 1 DM ve 32 tip 2 DM) tanılı toplam 105 gebe dahil edildi. Tüm katılımcıların yaşı, obstetrik öyküleri, gebelik öncesi vücut kitle indeksi (VKİ), gebelikte kilo alımı (GKA), gebelik haftaları, açlık ve 1. saat tokluk glukozu, HbA1c, doğumda gebelik haftası, doğum ağırlığı ve persentili ve 1. ve 5. dakika Apgar skorları kaydedildi
Bulgular 28. ve 32. gebelik haftalarında ölçülen açlık glukozu, tokluk 1. saat glukozu ve HbA1c değerleri PGDM grubunda GDM grubuna göre anlamlı derecede yüksekti, GKA ve gebelik öncesi VKİ değerleri benzerdi. GDM grubunda gebelik yaşına göre büyük doğum ağırlığı (LGA)'yı öngören açlık glukozu, 1. saat tokluk glukozu ve GKA' ya göre ROC analizi yapıldı (sırasıyla, EAA: 0,663, %95 CI [0,526, 0,800], EAA: 0,678, %95 CI [0,540, 0,816], AUC: 0,677, %95 CI[0,548, 0,805]). Ayrıca, PGDM grubunda LGA'yı öngören açlık glukozu, 1. saat tokluk glukozu ve HbA1c'ye göre ROC analizi yapıldı (sırasıyla, EAA: 0.889, %95 CI [0.782, 0.996], EAA: 0.893, %95 CI [0.737, 1.000], EAA: 0,931, %95 CI [0,807, 1,000]).
Sonuç PGDM ve GDM'li gebelerde glisemik kontrol kritik öneme sahiptir. LGA riski, PGDM'de HbA1c ve tokluk glukozu ve GDM'de ve tokluk glukozu ve GKA'yı yakından izleyerek azaltılabilir. Fetal aşırı büyümeyi en aza indirerek çocukluk çağı obezitesi ve uzun vadede gelişebilecek metabolik sendrom riski azaltılabilir.

Anahtar Kelimeler

HbA1c, Açlık glukoz düzeyi, Tokluk glukoz düzeyi, Doğum ağırlığı, Gebelik yaşına göre büyük doğum ağırlığı, Diyabetik gebeler

Prediction of birth weight by HbA1c and glucose levels in diabetic pregnant women

Öz

Objective: To estimate the birth weight by examining the fasting glucose, 1st -hour postprandial glucose, and Hemoglobin A1c levels in pregnant women diagnosed with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) at 28th and 32nd gestational weeks.
Methods: A total of 105 pregnant women diagnosed with 66 GDM, 39 PGDM (7 of type 1 DM and 32 of type 2 DM) were included in our study. All participants' age, obstetric histories, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), gestational weeks, fasting and 1st-hour postprandial glucose, HbA1c, gestational week at delivery, newborn weight and percentile, and 1st and 5th minute Apgar score were noted.
Results: Fasting glucose, 1st-hour postprandial glucose, and HbA1c values measured at 28th and 32nd gestational weeks were significantly higher in the PGDM group compared to the GDM group, and the GWG and pre-pregnancy BMI values were similar. ROC curve analysis was used to assess for fasting glucose, 1st-hour postprandial glucose, and GWG predicting large for gestational age (LGA) in the GDM group (AUC: 0.663, %95 CI [0,526, 0,800], AUC: 0.678, %95 CI [0,540, 0,816], AUC: 0.677, %95 CI [0,548, 0,805], respectively). Also, determined to fasting glucose, 1st-hour postprandial glucose, and HbA1c predicting LGA in the PGDM group (AUC: 0.889, %95 CI [0,782, 0,996], AUC: 0.893, %95 CI [0,737, 1,000], AUC: 0.931, %95 CI [0,807, 1,000], respectively).
Conclusion: Glycemic control is critical in pregnant women with PGDM and GDM. The risk of LGA may be reduced by closely monitoring HbA1c and postprandial glucose in PGDM and postprandial glucose and GWG in GDM. By minimizing fetal overgrowth, the risk of childhood obesity and metabolic syndrome that may develop in the long term may be reduced.

Anahtar Kelimeler

HbA1c, Fasting glucose level, Postprandial glucose level, Birth weight, Large for gestational age, Diabetic pregnant women

Kaynakça

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