Aqueela AYAZ, Shazia SAEED, Mian Usman FAROOQ, Muhammad Luqman Ali BAHOO, Kashif HANİF

Gebelik diyabeti ve yenidogana etkisi

Amaç: Gebeligin farklı dönemlerinde gestasyonel diabet tanısı alan kadınlarda anne ve bebek sonuçlarını degerlendirmek Gereç ve Yöntem: Bu tanımlayıcı gözlemsel çalısma Pakistan\'daki 1300 yataklı âBahawal Victoria Hastanesiâ Kadın-Dogum Kliniginde 1 Ocak-31 Aralık 2007 tarihleri arasında gerçeklestirildi. Oral glukoz tolerans testi sonucuna göre Ulusal Diabet Veri Grubu kriterlerine uyan 76 gebe kadın diabet tanısı aldı. Çalısma grubundaki hastalar gestasyonel diabetin (GDM) ilk tanı anındaki gebelik dönemine göre Grup A (gebelik haftası 13-23 arası), Grup B (24-30 haftalık gebelik) ve Grup C (31-36 haftalıkgebelik) olarak alt gruplara ayrıldı. Bulgular: Toplam çalısma grubundan 19 (%25)\'u erken baslangıçlı GDM (13-23 hafta), 25 (%32.9)\'u 24-30 haftada, 32 (%42.1)\'i 31-36 haftada (geç baslangıçlı GDM idi. Erken baslangıçlı GDM\'li grupta gebelik ilintili hipertansiyon 5 (%26.3), polihidramniyos 5 (%26.3), insülin tedavisi 13 (%68.4)\'ünde görüldü ve bu oranlar diger dönemlerdeki hastalardan daha yüksekti (p

Anahtar Kelimeler:

Gebelik diyabeti, anne sonuçları, bebek sonuçları, tanı dönemi

Gestational diabetes mellitus diagnosed in different periods of gestation and neonatal outcome

Objective: To evaluate the maternal and neonatal outcomes in women diagnosed as gestational diabetes mellitus (GDM) in different periods of pregnancy. Materials and Methods: This descriptive observational study was carried out from 1st January 2007 to 31th December 2007 in the department of Obstetrics and Gynecology of a 1300 bedded tertiary care hospital "Bahawal Victoria Hospital" in Bahawalpur, Pakistan. Seventy six pregnant women met the inclusion criteria of diabetes diagnosed on the basis of the Oral glucose tolerance test (OGTT) according to the National Diabetic Data Group. The study subjects were divided on the basis of gestational age at the first time diagnosis of GDM in the current pregnancy into group A (gestational age 13-23 weeks), group B (24-30 weeks) and group C (31-36 weeks). Results: Out of total study subjects, 19 (25%) were diagnosed as GDM between 13-23 weeks of gestation (early-onset), 25 (32.9%) between 24-30 weeks while 32 (42.1%) diagnosed in the gestational age of 31-35 weeks (late-onset). Pregnancy-induced hypertension 5 (26.3%), polyhydramnios 5 (26.3%) and insulin treatment 13 (68.4%) were higher in women with earlier GDM diagnosis (p

Keywords:

Gestational diabetes mellitus; maternal outcome; neonatal outcome; period of diagnosis,

PDF

___

American diabetes association. Preconception care of wom- en with diabetes mellitus. Diabetes Care 2003;26:S91-93.
Persson B, Hanson U. Neonatal morbidities in gestational diabetes mellitus. Diabetes Care 1998;21(suppl.2):B79– B84.
Kjos S, Buchanan T. Gestational diabetes mellitus. N Engl J Med 1999;341:1749-1756.
Langer O. Is normoglycemia the correct threshold to pre- vent complications in the pregnant diabetic patient? Dia- betes Reviews 1996;4:2-10.
Farrell T, Neale L, Cundy T. Congenital anomalies in the offspring of women with type 1, type 2 and gestational di- abetes. Diabet Med 2002;19:322-326.
Schaefer U, Songster G, Xiang A, Berkowitz K, Buchanan TA, Kjos SL. Congenital malformations in offspring of women with hyperglycemia first detected during preg- nancy. Am J Obstet Gynecol 1997;177:1165-1171.
Metzger BE, Coustan DR. Summary and Recommendations of the Fourth International Workshop-Conference on Ges- tational 1998;21(suppl.2):B161-167. Diabetes Care
Bartha J, Martinez P, Comino R. Gestational diabetes melli- tus diagnosed during early pregnancy. Am J Obstet Gyne- col 2000;182:346-350.
Meyer WJ, Carbone J, Gauthier DW, Gottmann DA. Early gestational glucose screening and gestational diabetes. J Reprod Med 1996;41:675-679.
Bartha JL, Martinez-Del-Fresno P, Comino-Delgado R. Early diagnosis of gestational diabetes mellitus and pre- vention of diabetes related complications. Eur J Obstet Gynecol Reprod Biol 2003;9:41-44.
National Diabetes Data Group. Classification: and diagno- sis of diabetes mellitus and other categories of glucose in- tolerance. Diabetes 1979;28):1039-1057.
Gillmer MDG, Hurley PA. Diabetes and endocrine disor- ders in pregnancy. In: Edmonds DK, editor. Dewhurst’s Textbook of obstetrics and gynaecology for postgraduates. 6th ed. Oxford: Blackwell Science 1999. p. 197-209.
Goldstein SR. Embryonic ultrasonographic measurements: crown-rump length revisited. Am J Obstet Gynecol 1991;165:497-501.
Nasrat AA, Augensen K, Abushal M, Shalhoub JT. The outcome of pregnancy following untreated impaired glu- cose tolerance. Int J Gynaecol Obstet 1994;47:1-6.
Tan YY, Yeo GS. Impaired glucose tolerance in preg- nancy – is it of consequence? Aust N Z J Obstet Gynaecol 1996 ;36:248-255.
Deerochanawong C, Putiyanum C, Wongsuryrat M, Serirat S, Jinayon P. Comparison of National Diabetes Data Group and World Health Organization criteria for detect- ing 1996;39:1070-1073. mellitus. Diabetologia
Jacobson JD, Cousins L. A population-based study of ma- ternal and perinatal outcome in patients with gestational diabetes. Am J Obstet Gynecol 1989;161:981-986.
Beischer NA, Oates JN, Henry OA, Sheedy MT, Walstab JE. Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia. Diabetes 1991;40 (Suppl 2): 35-38.
Sermer M, Naylor CD, Farine D, et al. The Toronto Tri- Hospital Gestational Diabetes Project . A preliminary re- view. Diabetes Care 1998;21(Supplement 2):B33-42.
El-Shafei A, Bashmi Y, Norman A. Incidence and severity of gestational diabetes in Bahrain and Australia. Aus NZ J Obstet Gyneacol 1989;29:204-209.
Moses RG, Colagiuri S. The extent of undiagnosed gesta- tional diabetes mellitus in New South Wales. Med J Aust 1997;167:14-16.
Berkowitz G, Roman S, Lapinski R. Maternal characteris- tics, neonatal outcome, and the time of diagnosis of gesta- tional diabetes. Am J Obstet Gynecol 1992;167(4 pt 1):976-982.
Svare J, Hansen B, Molsted-Pedersen L. Perinatal compli- cations in women with gestational diabetes mellitus. Acta Obstet Gynecol Scand 2001;80:899-904.
Super D, Edelberg S, Philipson E, Hertz R, Kalhan S. Di- agnosis of gestational diabetes in early pregnancy. Diabe- tes Care 1991;14:288-294.
Moses RG, Griffiths RD. Can a diagnosis of gestational diabetes be an advantage to the outcome of pregnancy? J Soc Gynecol Investig. 1995;2:523-525.
Leipold H, Worda C, Gruber CJ, Kautzky-Willer A, Hus- slein PW, Bancher-Todesca D. Large-for-gestational-age newborns in women with insulin-treated gestational diabe- tes under strict metabolic control. Review Group(s): Coch- rane Child Health Field, Cochrane Metabolic and Endo- crine Disorders Group. Source: Wiener Klinische Wochenschrift 2005;117:521-525.
Malinowska-Polubiec A, Czajkowski K, Sotowska A. Pregnancy and delivery course in patients with gestational diabetes mellitus. Ginekol Pol 2003;74:1200-1207.