Incidence of Helicobacter pylori Seropositivity in Turkish Pregnant Women with Gestational Diabetus Mellitus

Yıl 2019, Cilt: 3 Sayı: 3, 149 - 153, 31.12.2019

Adile Yeşim Akdemir , İrem Darka , Ülkü Özmen , Müge Harma , Mehmet Harma

Öz

Aim: The aim of this study to determine the Helicobacter pylori (HP) seropositivity in pregnant Turkish women and investigate the relationship with Gestational Diabetus Mellitus (GDM) with HP. 

Material and Methods: A prospective case control study was conducted between September and November 2019 at Zonguldak Bulent Ecevit University, School of Medicine, Obstetrics and Gynecology Department. Pregnant women who were 18-40 years old, at 26-37 weeks of gestational age and had singleton pregnancies included. Exclusion criteria were: Multiple pregnancy, pre-gestational diabetes mellitus, hypertension, hyperlipidemia, anemia and other systemic diseases. Study group was consisted of 46 women with diagnosed as GDM due to 75 gr oral glucose test and control group was consisted of 28 women. HP IgA ve IgG antibodies were measured using ELISA. Women were considered as HP (+) when IgA and/or IgG antibodies were positive, and considered as HP (-)  when both antibodies were negative.

Results: No difference were seen in maternal age, gravidity, parity, abortus, gestational age, ultrasonographic age, and estimated fetal weight between two groups. Body mass index, fasting blood glucose and fasting insulin levels, and HOMA-IR were significantly higher in GDM group than control group (p=0.018; p=<0.001; p=0.004; p=0.001 respectively).  HP seropositivity were 77.3% in GDM group and 66.7% in control group but this difference was not statistically significant. HP IgG seropositivity was significantly higher in GDM group than control group (65.9% vs 31.8%, p=0,010). On the other hand HP IgA incidence was not different between two groups. Presence of both HP IgG and IgA seropositivity was higher in GDM group (28.2% vs 10.71%, GDM and control groups respectively, p= 0.008).   

Conclusion: Incidence of HP seropositivity and HP IgG seropositivity in Turkish pregnant women with GDM were higher than pregnant women without GDM, but statistical significance could not be established in aspect of HP seropositivity. This data will be helpful for future studies that will investigate relation between HP seropositivity and pregnancy complications. 

Anahtar Kelimeler

Pregnancy, Helicobacter pylori, Gestational diabetes mellitus

Türk Toplumundaki Gestasyonel Diabetes Mellitus’lu Gebelerde Helicobacter pylori Seropozitivitesi Insidansı

Öz

Amaç: Bu çalışmanın amacı Türk toplumundaki gebe kadınlarında Helicobacter pylori (HP) seropozitivitesinin GDM ile ilişkisini araştırmaktır. 

Gereç ve Yöntemler: Eylül 2019- Kasım 2019 tarihleri arasında, Zonguldak Bülent Ecevit Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum AD’na başvuran 18-40 yaş arası, 26-37 haftalar arasında tekil gebeliği bulunan gebeler çalışmaya dahil edildi. Çoğul gebelikler, gebelik öncesi diyabet, hipertansiyon, hiperlipidemi, anemi ve ek sistemik hastalığı bulunan gebeler dışlandı. GDM tanısı almış 46 gebe GDM Grubu, diğer 28 gebe kontrol grubu olarak ayrıldı. Gebelerde HP IgA ve IgG antikorları ELISA yöntemi ile çalışıldı. IgA ve IgG antikorlarından herhangi biri pozitif olan hastalar HP(+), IgA ve IgG antikorlarından her ikisi de negatif olan hastalar HP(-) kabul edildi. 

Bulgular: Yaş, gravida, parite, abortus, gestasyonel yaş, ultrasonografik yaş, ve tahmini fetal ağırlık her iki grupta da benzerdi. VKİ, AKŞ, açlık insülin ve HOMA-IR değerleri GDM grubunda kontrol grubuna göre anlamlı olarak yüksekti (sırasıyla p=0,018; p=<0,001; p=0,004; p=0,001). GDM grubunda gebelerin %77,3’ü, kontrol grubundaki gebelerin ise %66,7’si HP (+)  olarak saptandı fakat istatistiksel olarak fark bulunamadı. GDM grubunda HP IgG %65,9 oranında pozitif iken, kontrol grubunda ise %31,8 olarak saptandı (p=0,010). Diğer taraftan HP IgA insidansı açısından iki grup arasında fark gözlenmedi (p=0,563). Her iki HP antikorunun da pozitif saptandığı gebelerin oranın ise GDM grubunda kontrol grubuna göre daha yüksek olduğu görüldü (%28,2 vs %10,71, p= 0,008).  

Sonuç: Türk toplumundaki GDM’li gebelerde HP seropozitivitesi insidansı GDM bulunmayan gebelerden yüksek olsa da istatistiksel olarak benzerdir. HP IgG seropozitivitesi ise GDM grubunda daha yüksek bulunmuştur. Bu bulgular Türk toplumundaki gebe kadınlarda HP enfeksiyonu ve gebelik komplikasyonlarının araştırılması açısından da faydalı olacaktır. 

Anahtar Kelimeler

Gestasyonel diabetes mellitus, Gebelik, Helicobacter pylori

Kaynakça

• 1. Zamani M, Ebrahimtabar F, Zamani V, et al. Systematic review with meta‐analysis: the worldwide prevalence of Helicobacter pylori infection. Aliment Pharmacol Ther. 2018;47(7):868‐876.
• 2. Weyermann M, Rothenbacher D, Gayer L, Bode G, Adler G, Grab D, Flock F, Brenner H. Role of Helicobacter pylori infection in iron defciency during pregnancy. Am J Obstet Gynecol 2005; 192: 548-553
• 3. Kitagawa M, Natori M, Katoh M, Sugimoto K, Omi H, Akiyama Y, Sago H. Maternal transmission of Helicobacter pylori in the perinatal period. J Obstet Gynaecol Res 2001; 27: 225-230
• 4. Karaer A, Ozkan O, Ozer S, Bayir B, Kilic S, Babur C, Danişman N. Gastrointestinal symptoms and Helicobacter pylori infection in early pregnancy. A seroepidemiologic study. Gynecol Obstet Invest 2008; 66: 44-46
• 5. Berker B, Soylemez F, Cengiz SD, Kose SK. Serologic assay of Helicobacter pylori infection. Is it useful in hyperemesis gravidarum? J Reprod Med 2003; 48: 809-812
• 6. Bassily S, Frenck RW, Mohareb EW, Wierzba T, Savarino S, Hall E, Kotkat A, Nafcy A, Hyams KC, Clemens J. Seroprevalence of Helicobacter pylori among Egyptian newborns and their mothers: a preliminary report. Am J Trop Med Hyg 1999; 61: 37-40
• 7. Sugano K, Tack J, Kuipers EJ, Graham DY, El-Omar EM, Miura S, et al. Kyoto global consensus report on Helicobacter pylori gastritis. Gut. 2015.
• 8. Cardarapoli S, Rolfo A, Todros T. Helicobacter pylori and pregnancy related disorders. World J Gastroenterol 2014; 20(3):654-664.
• 9. Zhan Y, Si M, Li M, Jiang Y. The risk of Helicobacter pylori infection for adverse pregnancy outcomes: A systemic review and meta-analysis. Helicobacter. 2019; 24:e12562.
• 10. Göymen A, Özdurak İ, Özkaplan ŞE, Şimsek Y, Avcı F, Akpak YK. The relationship between the helicobacter pylori seropositivity with systemic and local oxidative status and hyperemesis gravidarum: a pilot study. J Matern Fetal Neonatal Med. 2018 May;31(9):1204-1208.
• 11. Bonfigli AR, Boemi M, Festa R, et al. Randomized, double‐blind, placebo‐controlled trial to evaluate the effect of Helicobacter pylori eradication on glucose homeostasis in type 2 diabetic patients. Nutr Metab Cardiovasc Dis. 2016;26(10):893‐898.
• 12. Georges JL, Rupprecht HJ, Blankenberg S, Poirier O, Bickel C, Hafner G, et al. Impact of pathogen burden in patients with coronary artery disease in relation to systemic infammation and variation in genes encoding cytokines. Am J Cardiol. 2003;92(5):515–21.
• 13. Manco M, Putignani L, Bottazzo GF. Gut microbiota, lipopolysaccharides,and innate immunity in the pathogenesis of obesity and cardiovascular risk. Endocr Rev. 2010;31:817–44.
• 14. Cardaropoli S, Giuffrida D, Piazzese A, Todros T. Helicobacter pylori seropositivity and pregnancy-related diseases: a prospective cohort study. J Reprod Immunol. 2015 Jun;109:41-7.
• 15. Alshareef SA, Rayis DA, Adam I, Gasim GI. Helicobacter pylori infection, gestational diabetes mellitus and insulin resistance among pregnant Sudanese women. BMC Res Notes. 2018 Jul 28;11(1):517.
• 16. Salomaa-Räsänen A, Kosunen TU, Karjalainen J, Aromaa A, Knekt P, Sarna S, Rautelin H. IgA antibodies in persisting Helicobacter pylori infection in Finnish adults. Clin Microbiol Infect. 2006 Mar;12(3):236-40.
• 17. Han JW, Kamber M. Data mining: concepts and techniques. Morgan Kaufmann Publishers, USA 2001: 16.
• 18. Domellof L. Reversal of gastric atrophy after Helicobacter pylori eradication: is it possible or not? Am J Gastroenterol 1998, 93: 1407-1408.
• 19. Gao H, Wang JY, Shen XZ, Liu JJ. Effect of Helicobacter pylori infection on gastric epithelial cell proliferation. World J Gastroenterol 2000; 6: 442-444.
• 20. Bener, A., Micallef, R., Afifi, M., Derbala, M., Al-Mulla, H.M., Usmani, M.A. association between type 2 diabetes mellitus and Helicobacter pylori infection. Turk. J. Gastroenterol. 2007; 18, 225–229.
• 21. e Luis, D.A., de la Calle, H., Roy, G., de Argila, C.M., Valdezate, S., Canton, R., Boixeda, D. Helicobacter pylori infection and insulin-dependent diabetes mellitus. Diabetes Res. Clin. Pract. 1998 39, 143–146.
• 22. Devrajani, B.R., Shah, S.Z., Soomro, A.A., Devrajani, T. Type 2 diabetes mellitus: a isk factor for Helicobacter pylori infection: a hospital based case–control study. Int. J. Diabetes Dev. Ctries. 2010; 30, 22–26
• 23. Anastasios, R., Goritsas, C., Papamihail, C., Trigidou, R., Garzonis, P., Ferti, A. Helicobacter pylori infection in diabetic patients: prevalence and endoscopic findings. Eur. J. Intern. Med. 2002; 13, 376.
• 24. Demir, M., Gokturk, H.S., Ozturk, N.A., Kulaksizoglu, M., Serin, E., Yilmaz, U. Helicobacter pylori prevalence in diabetes mellitus patients with dyspeptic symptoms and its relationship to glycemic control and late complications. Dig. Dis. Sci. 2008; 53, 2646–2649
• 25. Koh, G.C., Peacock, S.J., van der Poll, T., Wiersinga, W.J., 2012. The impact of diabetes on the pathogenesis of sepsis. Eur. J. Clin. Microbiol. Infect. Dis. 31, 379–388.
• 26. Perdichizzi, G., Bottari, M., Pallio, S., Fera, M.T., Carbone, M., Barresi, G. Gastric infection by Helicobacter pylori and antral gastritis in hyperglycemic obese and in diabetic subjects. New Microbiol. 1996; 19, 149–154.
• 27. Aslan, M., Horoz, M., Nazligul, Y., Bolukbas, C., Bolukbas, F.F., Selek, S., Celik, H., Erel, O. Insulin resistance in H. pylori infection and its association with oxidative stress. World J. Gastroenterol. 2006; 12, 6865–6868.
• 28. Francois, F., Roper, J., Joseph, N., Pei, Z., Chhada, A., Shak, J.R., de Perez, A.Z., Perez-Perez, G.I., Blaser, M.J. The effect of H. pylori eradication on meal-associated changes in plasma ghrelin and leptin. BMC Gastroenterol. 2011; 11, 37.
• 29. Aydemir S, Bayraktaroglu T, Sert M, Sokmen C, Atmaca H, Mungan G, Gun BD, Borazan A, Ustundag Y. The effect of Helicobacter pylori on insülin resistance. Dig Dis Sci 2005; 50: 2090– 3.
• 30. Eshraghian A, Hashemi SA, Jahromi AH, Eshraghian H, Masoompour SM, Davarpanah MA, et al. Helicobacter pylori infection as a risk factor for insulin resistance. Dig Dis Sci. 2009;54(9):1966–70.
• 31. Vafaeimanesh J, Parham M, Seyyedmajidi M, Bagherzadeh M. Helicobacter pylori infection and insulin resistance in diabetic and nondiabetic population. Sci World J. 2014;2014:391250
• 32. Tamura T, Morita E, Kawai S, Sasakabe T, Sugimoto Y, Fukuda N, et al. No association between Helicobacter pylori infection and diabetes mellitus among a general Japanese population: a cross-sectional study. Springerplus. 2015;4(1):602.
• 33. Polyzos SA, Kountouras J, Zavos C, Deretzi G. The association between Helicobacter pylori infection and insulin resistance: a systematic review. Helicobacter. 2011;16:79–88.
• 34. Gen, R., Demir, M., Ataseven, H., 2010. Effect of Helicobacter pylori eradication on insulin resistance, serum lipids and low-grade inflammation. South. Med. J. 103, 190–196.
• 35. Upala S, Sanguankeo A, Saleem SA, Jaruvongvanich V. Effects of Helicobacter pylori eradication on insülin resistance and metabolic parameters: a systemic review and meta-analysis. Eur J Gastroenterol Hepatol. 2017 Feb;29(2):153-159.