Diyabetik gebelerde HbA1c ve glukoz düzeyleriyle doğum ağırlığının tahmin edilmesi

Amaç Pregestasyonel diabetes mellitus (PGDM) ve gestasyonel diabetes mellitus (GDM) tanılı gebelerde 28 ve 32. gebelik haftalarında açlık glukozu, tokluk 1. saat glukozu ve Hemoglobin A1c düzeyleri ile doğum ağırlığını tahmin etmek. Gereç ve Yöntemler Çalışmamıza 66 GDM, 39 PGDM (7 tip 1 DM ve 32 tip 2 DM) tanılı toplam 105 gebe dahil edildi. Tüm katılımcıların yaşı, obstetrik öyküleri, gebelik öncesi vücut kitle indeksi (VKİ), gebelikte kilo alımı (GKA), gebelik haftaları, açlık ve 1. saat tokluk glukozu, HbA1c, doğumda gebelik haftası, doğum ağırlığı ve persentili ve 1. ve 5. dakika Apgar skorları kaydedildi Bulgular 28. ve 32. gebelik haftalarında ölçülen açlık glukozu, tokluk 1. saat glukozu ve HbA1c değerleri PGDM grubunda GDM grubuna göre anlamlı derecede yüksekti, GKA ve gebelik öncesi VKİ değerleri benzerdi. GDM grubunda gebelik yaşına göre büyük doğum ağırlığı (LGA)'yı öngören açlık glukozu, 1. saat tokluk glukozu ve GKA' ya göre ROC analizi yapıldı (sırasıyla, EAA: 0,663, %95 CI [0,526, 0,800], EAA: 0,678, %95 CI [0,540, 0,816], AUC: 0,677, %95 CI[0,548, 0,805]). Ayrıca, PGDM grubunda LGA'yı öngören açlık glukozu, 1. saat tokluk glukozu ve HbA1c'ye göre ROC analizi yapıldı (sırasıyla, EAA: 0.889, %95 CI [0.782, 0.996], EAA: 0.893, %95 CI [0.737, 1.000], EAA: 0,931, %95 CI [0,807, 1,000]). Sonuç PGDM ve GDM'li gebelerde glisemik kontrol kritik öneme sahiptir. LGA riski, PGDM'de HbA1c ve tokluk glukozu ve GDM'de ve tokluk glukozu ve GKA'yı yakından izleyerek azaltılabilir. Fetal aşırı büyümeyi en aza indirerek çocukluk çağı obezitesi ve uzun vadede gelişebilecek metabolik sendrom riski azaltılabilir.

Anahtar Kelimeler:

HbA1c, Açlık glukoz düzeyi, Tokluk glukoz düzeyi, Doğum ağırlığı, Gebelik yaşına göre büyük doğum ağırlığı, Diyabetik gebeler

Prediction of birth weight by HbA1c and glucose levels in diabetic pregnant women

Objective: To estimate the birth weight by examining the fasting glucose, 1st -hour postprandial glucose, and Hemoglobin A1c levels in pregnant women diagnosed with pregestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM) at 28th and 32nd gestational weeks. Methods: A total of 105 pregnant women diagnosed with 66 GDM, 39 PGDM (7 of type 1 DM and 32 of type 2 DM) were included in our study. All participants' age, obstetric histories, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), gestational weeks, fasting and 1st-hour postprandial glucose, HbA1c, gestational week at delivery, newborn weight and percentile, and 1st and 5th minute Apgar score were noted. Results: Fasting glucose, 1st-hour postprandial glucose, and HbA1c values measured at 28th and 32nd gestational weeks were significantly higher in the PGDM group compared to the GDM group, and the GWG and pre-pregnancy BMI values were similar. ROC curve analysis was used to assess for fasting glucose, 1st-hour postprandial glucose, and GWG predicting large for gestational age (LGA) in the GDM group (AUC: 0.663, %95 CI [0,526, 0,800], AUC: 0.678, %95 CI [0,540, 0,816], AUC: 0.677, %95 CI [0,548, 0,805], respectively). Also, determined to fasting glucose, 1st-hour postprandial glucose, and HbA1c predicting LGA in the PGDM group (AUC: 0.889, %95 CI [0,782, 0,996], AUC: 0.893, %95 CI [0,737, 1,000], AUC: 0.931, %95 CI [0,807, 1,000], respectively). Conclusion: Glycemic control is critical in pregnant women with PGDM and GDM. The risk of LGA may be reduced by closely monitoring HbA1c and postprandial glucose in PGDM and postprandial glucose and GWG in GDM. By minimizing fetal overgrowth, the risk of childhood obesity and metabolic syndrome that may develop in the long term may be reduced.

Keywords:

HbA1c, Fasting glucose level, Postprandial glucose level, Birth weight, Large for gestational age, Diabetic pregnant women,

PDF

___

1. Deputy NP, Kim SY, Conrey EJ, Bullard KM. Prevalence and Changes in Preexisting Diabetes and Gestational Diabetes Among Women Who Had a Live Birth - United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2018;67(43):1201-7.
2. Yuen L, Saeedi P, Riaz M, Karuranga S, Divakar H, Levitt N, et al. Projections of the prevalence of hyperglycaemia in pregnancy in 2019 and beyond: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107841.
3. Pedersen J. Weight and length at birth of infants of diabetic mothers. Acta Endocrinol (Copenh). 1954;16(4):330-42.
4. ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstet Gynecol. 2018;131(2):e49-e64.
5. Carpenter MW, Coustan DR. Criteria for screening tests for gestational diabetes. Am J Obstet Gynecol. 1982;144(7):768-73.
6. Combs CA, Gunderson E, Kitzmiller JL, Gavin LA, Main EK. Relationship of fetal macrosomia to maternal postprandial glucose control during pregnancy. Diabetes Care. 1992;15(10):1251-7.
7. Parfitt VJ, Clark JD, Turner GM, Hartog M. Maternal postprandial blood glucose levels influence infant birth weight in diabetic pregnancy. Diabetes Res. 1992;19(3):133-5.
8. Persson B, Hanson U. Fetal size at birth in relation to quality of blood glucose control in pregnancies complicated by pregestational diabetes mellitus. Br J Obstet Gynaecol. 1996;103(5):427-33.
9. Jovanovic L, Savas H, Mehta M, Trujillo A, Pettitt DJ. Frequent monitoring of A1C during pregnancy as a treatment tool to guide therapy. Diabetes Care. 2011;34(1):53-4.
10. Lapolla A, Dalfrà MG, Bonomo M, Castiglioni MT, Di Cianni G, Masin M, et al. Can plasma glucose and HbA1c predict fetal growth in mothers with different glucose tolerance levels? Diabetes Res Clin Pract. 2007;77(3):465-70.
11. Lowe LP, Metzger BE, Dyer AR, Lowe J, McCance DR, Lappin TR, et al. Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study: associations of maternal A1C and glucose with pregnancy outcomes. Diabetes Care. 2012;35(3):574-80.
12. Herranz L, Pallardo LF, Hillman N, Martin-Vaquero P, Villarroel A, Fernandez A. Maternal third trimester hyperglycaemic excursions predict large-for-gestational-age infants in type 1 diabetic pregnancy. Diabetes Res Clin Pract. 2007;75(1):42-6.
13. Damm P, Mersebach H, Råstam J, Kaaja R, Hod M, McCance DR, et al. Poor pregnancy outcome in women with type 1 diabetes is predicted by elevated HbA1c and spikes of high glucose values in the third trimester. J Matern Fetal Neonatal Med. 2014;27(2):149-54.
14. Evers IM, de Valk HW, Mol BW, ter Braak EW, Visser GH. Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands. Diabetologia. 2002;45(11):1484-9.
15. Yu H, Qi X, Wang X. Application of glycated hemoglobin in the perinatal period. Int J Clin Exp Med. 2014;7(12):4653-9.
16. Cahill AG, Tuuli MG, Colvin R, Cade WT, Macones GA. Markers of Glycemic Control and Neonatal Morbidity in High-Risk Insulin-Resistant Pregnancies. Am J Perinatol. 2016;33(2):151-6.
17. Karcaaltincaba D, Yalvac S, Kandemir O, Altun S. Glycosylated hemoglobin level in the second trimester predicts birth weight and amniotic fluid volume in non-diabetic pregnancies with abnormal screening test. J Matern Fetal Neonatal Med. 2010;23(10):1193-9.
18. Cheng YW, Chung JH, Kurbisch-Block I, Inturrisi M, Shafer S, Caughey AB. Gestational weight gain and gestational diabetes mellitus: perinatal outcomes. Obstet Gynecol. 2008;112(5):1015-22.
19. Siega-Riz AM, Viswanathan M, Moos MK, Deierlein A, Mumford S, Knaack J, et al. A systematic review of outcomes of maternal weight gain according to the Institute of Medicine recommendations: birthweight, fetal growth, and postpartum weight retention. Am J Obstet Gynecol. 2009;201(4):339.e1-14.