Prognosis of Pregnancies with Different Degrees of Glucose Intolerance

AMAÇ: Bu çalışmada gebelerde farklı düzeylerdeki glukoz intoleransının maternal ve perinatal sonuçlara olan etkisinin araştırılması amaçlanmıştır. GEREÇ VE YÖNTEM: Gestasyonel diyabet için tarama programına alınan 500 tekil gebeliğin retrospektif verileri değerlendirilmiştir. Test sonuçlarına göre hastalar 4 gruba ayrılmış ve maternal ve perinatal sonuçlar karşılaştırılmıştır. Birinci grupta normal 50 g tarama testi olan gebeler, ikinci grupta 50 g tarama testi yüksek olup, 100 g glukoz yükleme testi normal olan gebeler, üçüncü grupta 50 g tarama testi yüksek olup, 100 g glukoz yükleme testinde tek değer yüksekliği olan gebeler, dördüncü grupta gestasyonel diyabet tanısı almış gebeler mevcuttu. BULGULAR: Makrozomi, neonatal yoğun bakım ünitesi gereksinimi ve preterm erken membran rüptürü 100 g testinde tek değer yüksekliği olan gebelerde diğer gruplara göre yüksek oranda tespit edildi. Preterm eylem gestasyonel diyabet grubunda en yüksek oranda bulundu. Preeklampsi, polihidramnioz, neonatal hipoglisemi oranları arasında gruplar arasında fark yoktu (p>0,05). SONUÇ: 100 g glukoz tolerans testi sonuçlarına göre tek de- ğer yüksekliği olan hastalar gestasyonel diyabet tanısı almamalarına rağmen kötü maternal sonuçlar için risk grubundadırlar. Bu grup hastalar glukoz intoleransına bağlı olduğu düşü- nülen obstetrik komplikasyonlara meyilli gibi görünmektedir. Dolayısıyla antenatal ve intrapartum dönemde çok dikkatli izlenmeleri gereklidir.

Farklı Düzeylerde Glukoz Entoleransının Gebelik Prognozuna Etkileri

OBJECTIVE: The purpose of the present study was to evaluate the effect of different degrees of glucose intolerance on maternal and perinatal outcomes. STUDY DESIGN: Retrospective data of 500 singleton pregnancies screened for gestational diabetes mellitus were reviewed. Maternal and perinatal outcomes for four different groups were compared. First group consisted of patients with normal 50-g test, second group was formed by patients with abnormal 50-g test but a normal 100-g test. Third group included patients with one abnormal value after 100-g test. Patients in the fourth group were diagnosed to have gestational diabetes mellitus with two or more abnormal values after 100-g test. RESULTS: Macrosomia, neonatal intensive care unit admission and preterm premature rupture of membranes were the highest in the group with one elevated value after glucose tolerance test. Preterm labor was the highest in the gestational diabetes group. The difference in the rate of preeclampsia, polyhydramnios, neonatal hypoglycemia and hypocalcemia was not statistically significant (p>0.05). CONCLUSION: Although women with one elevated value after glucose tolerance test are not diagnosed with gestational diabetes mellitus, they are still at risk for adverse maternal and perinatal outcomes. They seem to be prone to develop obstetric complications related to glucose intolerance and should be followed up carefully during the antepartum and intrapartum period.

Kaynakça

1. ACOG Practice Bulletin. Clinical management guidelines for obstetrician-gynecologists. Number 30. Gestational diabetes. Obstet Gynecol 2001;98:525-38.

2. Biri A, Korucuoglu U, Ozcan P, Aksakal N, Turan O, Himmetoglu O. Effect of different degrees of glucose intolerance on maternal and perinatal outcomes. J Matern Fetal Neonatal Med 2009;22:473-8.

3. Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005;16:2477-86.

4. Stamilio DM, Olsen T, Ratcliffe S, Sehdev HM, Macones GA. False-positive 1-hour glucose challenge test and adverse perinatal outcomes. Obstet Gynecol 2004;103:148- 56.

5. Gumus II, Turhan NO. Are patients with positive screening but negative diagnostic test for gestational diabetes under risk for adverse pregnancy outcome? J Obstet Gynaecol Res 2008;34:359-63.

6. McLaughlin GB, Cheng YW, Caughey AB. Women with one elevated 3-hour glucose tolerance test value: are they at risk for adverse perinatal outcomes? Am J Obstet Gynecol 2006;194:e16-9.

7. Kim HS, Chang KH, Yang JI, Yang SC, Lee HJ, Ryu HS. Clinical outcomes of pregnancy with one elevated glucose tolerance test value. Int J Gynaecol Obstet 2002;78:131-8.

8. Gruendhammer M, Brezinka C, Lechleitner M. The number of abnormal plasma glucose values in the oral glucose tolerance test and the feto-maternal outcome of pregnancy. Eur J Obstet Gynecol Reprod Biol 2003;10:131-6.

9. Gezer A, Esen F, Mutlu H, Oztürk E, Ocak V. Prognosis of patients with positive screening but negative diagnostic test for gestational diabetes. Arch Gynecol Obstet 2002;266:201-4.

10. Dudhbhai M, Lim L, Bombard A, Juliard K, Meenakshi B, Trachelenberg Y, Weiner Z. Characteristics of patients with abnormal glucose challenge test and normal oral glucose tolerance test results: comparison with normal and gestational diabetic patients. Am J Obstet Gynecol 2006;194:e42-5.

11. Grotegut CA, Tatineni H, Dandolu V, Whiteman VE, Katari S, Geifman-Holtzman O. Obstetric outcomes with a false-positive one-hour glucose challenge test by the Carpenter-Coustan criteria. J Matern Fetal Neonatal Med 2008;21:315-20.

12.Nordin NM, Wei JW, Naing NN, Symonds EM. Compari - son of maternal-fetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. J Obstet Gynaecol Res 2006;32:107-14.

13. Corrado F, Benedetto AD, Cannata ML, Cannizzaro D, Giordano D, Indorato G, Rizzo P, Stella NC, D'Anna R. A single abnormal value of the glucose tolerance test is related to increased adverse perinatal outcome. J Matern Fetal Neonatal Med 2009;22:597-601.

14. Di Cianni G, Seghieri G, Lencioni C, Cuccuru I, Anichini R, De Bellis A, Ghio A, Tesi F, Volpe L, Del Prato S. Normal glucose tolerance and gestational diabetes mellitus: what is in between? Diabetes Care 2007 ;30:1783-8.

15. Fassett MJ, Dhillon SH, Williams TR. Effects on perinatal outcome of treating women with 1 elevated glucose tolerance test value. Am J Obstet Gynecol 2007;196:597.e1-4.

Kaynak Göster

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