Nilgün KUTAY GÜDÜCÜ, Gökçenur GÖNENÇ, Herman İŞÇİ, Alin Başgül YİĞİTER, İlkkan DÜNDER

Gestasyonel diabetes mellitus riskinin maternal yaş ve gebeliğin başlangıcındaki vücut kitle indeksi ile ilişkisi

Amaç: Anne yaşı ve vücut kitle indeksine (VKİ) göre Gestasyonel Diabetes Mellitus (GDM) riskini belirlemek Yöntemler: 2007-2011 yılları arasında hastanemizde takip edilmiş gebelerin kartları retrospektif olarak taranıp, 50 gram ve 100 gram tarama testlerinin sonuçları, bebeklerin doğum kiloları ve demografik verileri kaydedildi. Bulgular: 544 hasta çalışmaya dâhil edildi. Hastaların ortalama yaşı 30,2±4,2 yıl, ortalama VKİ değeri 23,3±4,1 kg/m2 (15,6-66), ortalama doğum haftası 38,9±1,2 hafta (34,9-42), ortalama doğum ağırlığı 3409±415 gram olarak bulundu. 40 yaş üzeri olgularda GDM için odds oranı 7.84, VKİ≥25 olanlar için odds oranı 1,74 olarak hesaplandı. Sonuç: Gestasyonel DM sıklığı ileri anne yaşı ve artan VKİ ile artmaktadır. Gebelik öncesi takiplerinde VKİ≥25 olan hastalara beslenme ve egzersiz önerilmeli, mümkünse VKİ

The relationship between the risk of the gestational diabetes mellitus with respect to maternal age and initial body mass index

Objective: To establish the risk of the gestational diabetes mellitus (GDM) with respect to maternal age and body mass index (BMI). Methods: The data of the patients, admitted to our clinic for pregnancy follow up between 2007 and 2011were collected retrospectively. 50 gram and 100 gram screening test results, birth weight of the newborns and demographic features of the patients were recorded. Results: 544 patients were included. Mean age of the patients was 30.2±4.2 years, mean BMI value was 23.3±4.1 kg/m2 (15.6-66), mean gestational age at delivery was 38.9±1.2 weeks (34.9-42), and mean birth weight was 3409±415 grams. The odds ratio for GDM at the patients above 40 years old was 7.84 and the odds ratio for patients with a body mass index ≥25 was 1.74. Conclusion: Gestational diabetes mellitus increases with advanced maternal age and body mass index. The patients with a body mass index ≥25 at the antenatal visits may be offered regular nutrition and exercise program and get pregnant after having a body mass index below 25 if possible.

PDF

___

1. Toraman AR, Gürel A, Ulusal Z, et al. Evaluation of glucose challenge and oral glucose tolerance test results in pregnancy and estimination of prevalence of gestational diabetes mellitus at Sema Hospital in İstanbul. Turk J Med Sci 2012;42:1235-1240.
2. Classification and diagnosis of diabetes and other categories of glucose intolerance. National Diabetes Data Group. Diabetes 1979;28:1039-1057.
3. American Diabetes Association, Diagnosis and classification of diabetes mellitus. Diabetes Care 2011;34:62-69.
4. Yogev Y, Visser GH. Obesity, gestational diabetes and pregnancy outcome. Semin Fetal Neonatal Med 2009;14:77-84.
5. Hillier TA, Pedula KL, Schmidt MM, et al. Childhood obesity and metabolic imprinting: the ongoing effects of maternal hyperglycemia. Diabetes Care 2007;30:2287-2292.
6. Crowther CA, Hiller JE, Moss JR, et al. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Eng J Med 2005;352:2477- 2486.
7. ACOG Practice Bulletin: Clinical management guidelines for obstetrician-gynecologists. Gestational Diabetes. Obstet Gynecol 2001;98:525-538.
8. Teede HJ, Harrison CL, Teh WT, et al. Gestational Diabetes: development of an early risk prediction tool to facilitate oppurtunities for prevention, Aust NZ J Obstet Gynecol 2011;51:499-504.
9. Morisset AS, St-Yves A, Veillette J, et al. Prevention of gestational diabetes mellitus: a review of studies on weight management. Diabetes Metab Res Rev 2010;26:17-25.
10. Engelgau MM, Herman WH, Smith PJ, et al. The epidemiology of diabetes and pregnancy in the U.S., 1988. Diabetes Care 1995;18:1029-1033.
11. Kitzmiller JL. Cost analysis of diagnosis and treatment of gestational diabetes mellitus. Clin Obstet Gynecol 2000;43:140-153.
12. Sweeney AT, Brown FM. Gestational diabetes mellitus. Clin Lab Med 2001;21:173-192.
13. Makgoba M, Savvidou MD, Steer PJ. An analysis of the relationship between maternal age, body mass index and racial origin in the development of gestational diabetes mellitus. BJOG 2012;119:276-282.
14. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol 1982;144:768-773.
15. Turgut A, Boran SÜ, Dolgun ZN, et al. Bir doğumevi gebe izlem polikliniğinde gestasyonel diyabetes mellitus sıklığı. Dicle Med J 2011;38:325-328.
16. Erem C, Cihanyurdu N, Deger O, et al. Screening for gestational diabetes mellitus in northeastern Turkey (Trabzon City). Eur J Epidemiol 2003;18.39-43.
17. Caliskan E, Kayikcioglu F, Oztürk N, et al. A populationbased risk factor scoring will decrease unnecessary testing for the diagnosis of gestational diabetes mellitus. Acta Obstet Gynecol Scand 2004;83:524-530.
18. Tanir HM, Sener T, Gürer H, Kaya M. A ten-year gestational diabetes mellitus cohort at a university clinic of the mid-Anatolian region of Turkey. Clin Exp Obstet Gynecol 2005;32:241-244.
19. Karcaaltincaba D, Kandemir O, Yalvac S, et al. Prevalence of gestational diabetes mellitus and gestational impaired glucose tolerance in pregnant women by National Diabetes Data Group and Carpenter and Coustan criteria. Int J Gynaecol
Obstet 2009;106:246-249. 20. Karcaaltincaba D, Buyukkaragoz B, Kandemir O, et al. Gestational diabetes and gestational impaired glucose tolerance in 1653 teenage pregnancies: prevalence, risk factors and pregnancy outcomes. J Pediatr Adolesc Gynecol 2011;24:62-65.
21. Stuebe AM, Landon MB, Lai Y, et al. Maternal BMI, glucose tolerance, and adverse pregnancy outcomes. Am J Obstet Gynecol 2012;20:62-67.
22. Ricart W, Lopez J, Mozas J, et al. Spanish group for the Study of the Impact of Carpenter and Coustan GDM Thresholds. Body mass index has a greater impact on pregnancy outcomes than gestational hyperglycaemia. Diabetologia 2005; 48:1736-1742.
23. Ryan EA. Diagnosing gestational diabetes. Diabetologia 2011;54:480-486.
24. Wollf S, Legarth J, Vangsgaard K, et al. A randomized trial of the effects of dietary counseling on gestational weight gain and glucose metabolism in obese pregnant women. Int J Obes 2008;32:495-501.
25. Landon MB; Spong CY, Thom E, et al. A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 2009;361:1339-1348.
26. Kanagalingam MG, Forouhi NG, Greer IA, Sattar N. Changes in booking body mass index over a decade: retrospective analysis from a Glasgow Maternity Hospital. BJOG 2005;112:1431-1433.
27. Tobias DK, Zhang C, van Dam RM, et al. Physical activity before and during pregnancy and risk of gestational diabetes mellitus : a metaanalysis. Diabetes Care 2011;34:223-229.
28. Corrado F, DAnna R, Cannata ML, et al. Positive association between a single abnormal glucose tolerance test value and subsequent abnormal glucose tolerance. Am J Obstet Gynecol 2007;196:1-5.
29. Malinowska-Polubiec A, Sienko J, Lewandowski Z, et al. Risk factors of abnormal carbohydrate metabolism after pregnancy complicated by gestational diabetes mellitus. Gynecol Endocrinol 2012;28:360-364.
30. TNSA-2008-Nüfus Etütleri-Hacettepe Üniversitesi www. hips.hacettepe.edu.tr/tnsa2008/analiz.shtml.