Gestasyonel Diyabet Taramasında Karşılaşılan Önemli Bir Problem: Gebeler Neden Oral Glukoz Tolerans Testi Yaptırmak İstemiyor?
Abstract
Amaç: Gebelerin,
gestasyonel diabetes mellitus (GDM) taraması için
kullanılan 75g oral glukoz tolerans testini (OGTT) yaptırmasında etkili olan
faktörleri incelemeyi amaçladık.
Gereç
ve Yöntem: Çalışmaya
Düzce Üniversitesi Tıp Fakültesi Hastanesi antenatal takip polikliniğine baş
vuran ve GDM taraması için 75 g OGTT yaptırmayı kabul
eden 129 ve GDM taraması için 75 g OGTT yaptırmayan 133 olmak üzere toplam 262
gebe dahil edildi. Gebelerin demografik özellikleri, eğitim düzeyleri ve gelir
seviyeleri araştırıldı.
Bulgular: OGTT
yapılan grupta GDM sıklığı %7.9’du (n=10). OGTT
yaptıran grupta VKİ daha yüksekti ve gruplar arasındaki fark istatistiksel
olarak anlamlıydı (29.17 ± 5.67 vs. 26.93 ± 4.02; p= 0.003). Gruplar eğitim seviyeleri
açısından karşılaştırıldığında, OGTT yaptıran grupta yalnızca
okur-yazar olan gebelerin oranı daha yüksekti (8.5% vs. 0; p=0.004). OGTT
yaptırmayan grupta bunun en sık nedeni 57.8%
oranında testin bebeğe zarar vereceği endişesiydi (n=77), ikinci
sıklıkta bu testin özellikle görsel medyada yer alan bazı sağlık personelleri tarafından önerilmemesi geliyordu (30.8%,
n=41).
Sonuç: Son
yıllarda gebelerin GDM taraması için OGTT yaptırma oranları düşmektedir. Bunun
başlıca nedenleri arasında özellikle görsel medyada var olan bilgi kirliliği ve
gebelerin sağlık personeli tarafından yeterinde
bilgilendirilmemesi gösterilebilir. Bu nedenle sağlık bakımını sağlayan tüm
paydaşlar tarafından prekonsepsiyonel dönemden başlayarak gebelik esnasında
halkın yanlış bilgi edinmesinin önüne geçecek programlar ortaya koymalı ve bu konudaki bilgi kirliliğinin ortadan kaldırılmalıdır.
References
- 1. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on gestational diabetes mellitus. Diabetes Care 2007;30 (Suppl.2):S251-60. 2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.3. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglyacemia in pregnancy. Diabetes Res Clin Pract 2014;103:176-85.4. Öztürk FY, Altuntaş Y. Gestasyonel diabetes mellitus. Şişli Etfal Hastanesi Tıp Bülteni 2015;49:1-10.5. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-82.6. M.E. Griffin, M. Coffey, H. Johnson, P. Scanlon, M. Fole, J. Stronge, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome Diabet Med. 2000; 17: 26-32.7. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.8. American Diabetes Association. Executive summary: standards of medical care in diabetes 2011. Diabetes Care. 2011;34(Suppl 1):S4–10.9. World Health Organization . Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus.2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).10. ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–173.11. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. ACOG committee opinion no. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. 2006; 108: 469-477.12. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006; 29: 43–4813. Metzger BE, Lowe P, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. New Engl J Med. 2008; 38: 1991–2002.14. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358: 1991–2001.15. Mertoğlu C, Gunay M, Siranli G, Kulhan M, Gok G, Erel Ö. The Effect of the 50 g Glucose Challenge Test on The Thiol/Disulfide Homeostasis in Pregnancy. Fetal Pediatr Pathol. 2018 Apr 25:1-10.16. Nakanishi S, Yoneda M, Maeda S. Impact of glucose excursion and mean glucose concentration in oral glucose-tolerance test on oxidative stress among Japanese Americans. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2013;6:427-433. doi:10.2147/DMSO.S53760.17. Rueangdetnarong H, Sekararithi R, Jaiwongkam T, Kumfu S, Chattipakorn N, Tongsong T. et al. Comparisons of the oxidative stress biomarkers levels in gestational diabetes mellitus (GDM) and non-GDM among Thai population: cohort study. Endocr Connect. 2018; 7: 681-87.18. Schwartz N, Green M.S, Yefet E, Nachum Z. Modifiable risk factors for gestational diabetes recurrence. Endocrine. 2016; 54: 714-22.19. Ozgu-Erdinc A.S, Yilmaz S, Yeral M.I, Seckin K.D, Erkaya S, Danisman A.N. Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015; 28: 1957-62.20. Goodarzi-Khoigani M, Mazloomy Mahmoodabad SS, Baghiani Moghadam MH, et al. Prevention of Insulin Resistance by Dietary Intervention among Pregnant Mothers: A Randomized Controlled Trial. International Journal of Preventive Medicine. 2017; 8:85. 21. Zhang C, Solomon C.G, Manson J.E, Hu F.B.A. Prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med. 2006; 166: 543-48.22. Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med. 2012;46:656–61.23. Pate RR, Pratt M, Blair SN, et al. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA1995;273:402–7.24. Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37:6–12.
An Important Problem in Gestational Diabetes Scan: Why Do Pregnant Women Refuse to Have Oral Glucose Tolerance Test?
Abstract
Objective: We
have seen a decline in the rates of having 75g oral glucose tolerance test
(OGTT) used for gestational diabetes mellitus (GDM) scan by pregnant women who
applied to our clinic in recent years. Therefore, we aimed to examine the
factors that are effective on why pregnant women do not have this test.
Materials and Methods: A total of 262 pregnant women who
attended antenatal follow-up polyclinic of Düzce University Medical Faculty
were included in the study; 129 who admitted 75g OGTT for GDM scan and 133 who
refused 75g OGTT for GDM scan. Demographic characteristics, educational levels
and income levels of the pregnant women were investigated.
Results: The frequency of GDM in the OGTT group
was 7.9% (n=10). BMI was higher in the OGTT group and the difference between
the groups was statistically significant (29.17 ± 5.67 vs. 26.93 ± 4.02; p=
0.003). When the groups were compared in terms of educational levels, the rate
of only literate women was higher in the OGTT group (8.5% vs. 0; p=0.004). The
most common reason in the group without OGTT was the concern that the test
would be harmful to the baby with 57.8%
rate (n=77), the second reason was that the test was not recommended by some
health professionals especially on visual media (30.8%, n=41).
Conclusion: There
has been a decrease in the rates of having OGTT for GDM scan by pregnant women
in recent years. Information pollution, especially in the visual media and
insufficient information provided by health professionals are considered as the
main reasons for this situation.
Therefore, all healthcare providers should start programs that would
prevent misinformation during pregnancy starting from the preconceptional
period and the information pollution on this issue should be removed.
References
- 1. Metzger BE, Buchanan TA, Coustan DR, de Leiva A, Dunger DB, Hadden DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on gestational diabetes mellitus. Diabetes Care 2007;30 (Suppl.2):S251-60. 2. International Association of Diabetes and Pregnancy Study Groups Consensus Panel, Metzger BE, Gabbe SG, Persson B, Buchanan TA, Catalano PA, et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010;33:676-82.3. Guariguata L, Linnenkamp U, Beagley J, Whiting DR, Cho NH. Global estimates of the prevalence of hyperglyacemia in pregnancy. Diabetes Res Clin Pract 2014;103:176-85.4. Öztürk FY, Altuntaş Y. Gestasyonel diabetes mellitus. Şişli Etfal Hastanesi Tıp Bülteni 2015;49:1-10.5. International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care. 2010; 33: 676-82.6. M.E. Griffin, M. Coffey, H. Johnson, P. Scanlon, M. Fole, J. Stronge, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome Diabet Med. 2000; 17: 26-32.7. Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, Coustan DR, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008;358:1991–2002.8. American Diabetes Association. Executive summary: standards of medical care in diabetes 2011. Diabetes Care. 2011;34(Suppl 1):S4–10.9. World Health Organization . Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications: Report of a WHO Consultation Part 1: Diagnosis and Classification of Diabetes Mellitus.2nd ed. Geneva, Switzerland: World Health Organization; 1999. (WHO/NCD/NCS/99).10. ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–173.11. American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. ACOG committee opinion no. 343: psychosocial risk factors: perinatal screening and intervention. Obstet Gynecol. 2006; 108: 469-477.12. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2006; 29: 43–4813. Metzger BE, Lowe P, Dyer AR et al. Hyperglycemia and adverse pregnancy outcomes. New Engl J Med. 2008; 38: 1991–2002.14. HAPO Study Cooperative Research Group, Metzger BE, Lowe LP et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med. 2008; 358: 1991–2001.15. Mertoğlu C, Gunay M, Siranli G, Kulhan M, Gok G, Erel Ö. The Effect of the 50 g Glucose Challenge Test on The Thiol/Disulfide Homeostasis in Pregnancy. Fetal Pediatr Pathol. 2018 Apr 25:1-10.16. Nakanishi S, Yoneda M, Maeda S. Impact of glucose excursion and mean glucose concentration in oral glucose-tolerance test on oxidative stress among Japanese Americans. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2013;6:427-433. doi:10.2147/DMSO.S53760.17. Rueangdetnarong H, Sekararithi R, Jaiwongkam T, Kumfu S, Chattipakorn N, Tongsong T. et al. Comparisons of the oxidative stress biomarkers levels in gestational diabetes mellitus (GDM) and non-GDM among Thai population: cohort study. Endocr Connect. 2018; 7: 681-87.18. Schwartz N, Green M.S, Yefet E, Nachum Z. Modifiable risk factors for gestational diabetes recurrence. Endocrine. 2016; 54: 714-22.19. Ozgu-Erdinc A.S, Yilmaz S, Yeral M.I, Seckin K.D, Erkaya S, Danisman A.N. Prediction of gestational diabetes mellitus in the first trimester: comparison of C-reactive protein, fasting plasma glucose, insulin and insulin sensitivity indices. J Matern Fetal Neonatal Med. 2015; 28: 1957-62.20. Goodarzi-Khoigani M, Mazloomy Mahmoodabad SS, Baghiani Moghadam MH, et al. Prevention of Insulin Resistance by Dietary Intervention among Pregnant Mothers: A Randomized Controlled Trial. International Journal of Preventive Medicine. 2017; 8:85. 21. Zhang C, Solomon C.G, Manson J.E, Hu F.B.A. Prospective study of pregravid physical activity and sedentary behaviors in relation to the risk for gestational diabetes mellitus. Arch Intern Med. 2006; 166: 543-48.22. Barakat R, Cordero Y, Coteron J, Luaces M, Montejo R. Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial. Br J Sports Med. 2012;46:656–61.23. Pate RR, Pratt M, Blair SN, et al. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA1995;273:402–7.24. Artal R, O’Toole M. Guidelines of the American College of Obstetricians and Gynecologists for exercise during pregnancy and the postpartum period. Br J Sports Med. 2003;37:6–12.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | August 15, 2018 |
| Acceptance Date | June 21, 2018 |
| Published in Issue | Year 2018 |