Kamuran SUMAN, Ebru GÖK, Zafer BÜTÜN, Pınar BÜTÜN, Musa BÜYÜK, Murat SUMAN

Diyabetik Gebelerde HbA1c ve Glukoz Düzeylerinin Doğum Ağırlığı Tahmininde Kullanılması

Amaç: Bu çalışmanın amacı, pregestasyonel diyabet mellitus (PGDM) ve gestasyonel diyabet mellitus (GDM) tanısı konan hamilelerin HbA1c düzeyleri ile ilişkili olarak bebek doğum ağırlığı tahmininin duyarlılığını araştırmaktır. Gereç ve Yöntemler: Kriterleri karşılayan 105 hasta çalışmamya dahil edildi. Hastaların 7'si tip 1 DM ve 32'si tip 2 DM idi. Katılmayı kabul eden hastaların gebelik öyküleri, demografik bilgilerinin yanı sıra gebelik süresince kilo alımları, HbA1c ve açlık kan şekeri düzeyleri de dahil olmak üzere kayıt edildi. Bulgular: Açlık glukoz değerleri, gebeliğin 28 ve 32. haftalarında ölçüldü. Tokluk sonrası bir saatte ölçtüğümüz kan glukoz değerleri ve HbA1c, PDGM grubunda GDM grubuna göre daha yüksekti. Kilo alımı ve BMI değerleri arasında anlamlı bir fark yoktu. GDM'li hastalarımızda açlık ve tokluk sonrası kan glukoz seviyeleri veya gebelik sırasında kilo alımının LGA bebekleri (LGA) öngörmedeki tahmin gücünü test etmek için ROC eğrisi analizi kullandık (sırasıyla 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]). Ayrıca, LGA'yı öngörmek için açlık kan glukoz ölçümleri, 1 saatlik tokluk sonrası kan glukoz ölçümleri ve HbA1c düzeylerini değerlendirmede ROC analizi kullanıldı (sırasıyla 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]). Sonuç: Sağlıklı insanlarda ve gebelerde kan glukoz seviyelerinin normal sınırlar içinde tutulması önemlidir. PDGM veya GDM tanısı konan gebelerde ise bebek sağlığı göz önünde bulundurularak bu daha da önemlidir. PDGM'li gebelerde tokluk sonrası kan glukoz ve HbA1c seviyelerinin yakın takibiyle LGA doğumları önlenebilir. GDM tanısı konan gebelerin takibinde de GWG'nin yakın takibi faydalıdır.

Anahtar Kelimeler:

HbA1c, Açlık glukoz düzeyi, Doğum ağırlığı

Estimation of Birth Weight from HbA1c and Glucose Levels in Diabetic Pregnancies

Aim: The aim of this study was to investigate the sensitivity of baby birth weight estimation in relation to HbA1c levels of pregnant women diagnosed with pre-gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM). Material and Methods: 105 patients who met the criteria agreed to participate in our study, of whom 7 were type 1 DM and 32 were type 2 DM. The pregnancy history of the patients who agreed to participate was obtained with a lot of demographic information as well as weight gains during pregnancy, HbA1c and fasting blood glucose levels. Results: Fasting glucose values were measured at 28 and 32 weeks of gestation. The blood glucose values that we measured one hour after satiation and HbA1c were higher in the PDGM group than in the GDM group. There was no significant difference between weight gain and BMI values. We used ROC curve analysis to test the predictive power of fasting and postprandial blood glucose levels or weight gain during pregnancy in our patients with GDM for LGA babies(LGA) (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).In addition, ROC analysis was used in evaluating fasting blood glucose measurements, 1-hour postprandial blood glucose measurements, and HbA1c levels to predict LGA.(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: In both healthy people and pregnant women, it is important to keep blood glucose levels within normal limits. In pregnant women diagnosed with PDGM or GDM, this is even more important as the welfare of the baby is considered. LGA deliveries can be avoided in pregnant women with PDGM by close monitoring of postprandial blood glucose and HbA1c levels. Close monitoring of GWG is also beneficial in the follow-up of pregnant women diagnosed with GDM.

Keywords:

HbA1c Fasting glucose level, Postprandial glucose level, Birth weight,

PDF

___

Kansu-Celik H, Ozgu-Erdinc AS, Kisa B, Eldem S, Hancerliogullari N, Engin-Ustun Y. Maternal serum glycosylated hemoglobin and fasting plasma glucose predicts gestational diabetes at the first trimester in Turkish women with a low-risk pregnancy and its relationship with fetal birth weight; a retrospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; 34(12): 1970-7.
Immanuel J, Simmons D, Desoye G, Corcoy R, Adelantado JM, Devlieger R, et al. Performance of early pregnancy HbA1c for predicting gestational diabetes mellitus and adverse pregnancy outcomes in obese European women. Diabetes research and clinical practice. 2020; 168: 108378.
Abdelsttar MM, Omarah MA, Abdelgaied AM, El-Sharkawy MA. Role of glycosylated hemoglobin in prediction of birth weight and amniotic volume in gestational diabetes. Menoufia Medical Journal. 2018; 31(4): 1258.
Fayez Mohamed Fathi M, Mohammed Moustafa T, Ramadan Alsawy Rady I. The role of umbilical cord thickness and glycated hemoglobin (hba1c) levels for prediction of fetal macrosomia in patients with gestational diabetes mellitus. Al-Azhar Medical Journal. 2020; 49(4): 1741-52.
Kumar N, Kumar P, Harris N, Monga R, Sampath V. Impact of maternal HbA1c Levels≤ 6% and race in nondiabetic pregnancies on birthweight and early neonatal hypoglycemia. The Journal of pediatrics. 2020; 227: 121-7. e3.
Belay DM, Bayih WA, Alemu AY, Sinshaw AE, Mekonen DK, Ayele AS, et al. Macrosomia and its predictors in pregnant women with diabetes in Ethiopia. Tropical Medicine & International Health. 2021;26(12):1539-52.
Wojtyla C, Stanirowski P, Gutaj P, Ciebiera M, Wojtyla A. Perinatal outcomes in a population of diabetic and obese pregnant women-the results of the polish national survey. International Journal of Environmental Research and Public Health. 2021; 18(2): 560.
Abolfathi M, Ashtarian H, Eskandari S, Irandoost SF, NeJhaddadgar N, Mirzaei N. Evaluation of quality of life in diabetic pregnant women. Primary Care Diabetes. 2022; 16(1): 84-8.
Lorusso L, Kato DMP, Dalla Costa NRA, Araujo Junior E, Bruns RF. Performance of local reference curve on the diagnosis of large for gestational age fetuses in diabetic pregnant women. The Journal of Maternal-Fetal & Neonatal Medicine. 2022; 35(10): 1899-906.
Hong JGS, Fadzleeyanna MYN, Omar SZ, Tan PC. HbA1c at term delivery and adverse pregnancy outcome. BMC pregnancy and childbirth. 2022; 22(1): 1-9.
Mañé L, Flores-Le Roux JA, Pedro-Botet J, Gortazar L, Chillarón JJ, Llaurado G, et al. Is fasting plasma glucose in early pregnancy a better predictor of adverse obstetric outcomes than glycated haemoglobin? European Journal of Obstetrics & Gynecology and Reproductive Biology. 2019; 234: 79-84.
Zhang X, Xiao Y, Fan Y. Investigating the reliability of HbA1c monitoring for blood glucose control during late pregnancy in patients with gestational diabetes mellitus (GDM) with and without β-thalassemia minor. Diabetes Therapy. 2018; 9(6): 2305-13.
Kaur N, Goel P, Mehra R, Kaur J. Correlation of HbA1c levels in late pregnancy with maternal and perinatal outcome in patients with gestational diabetes mellitus. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2019; 8(9): 3664-71.
Mendes N, Alves M, Andrade R, Ribeiro RT, Papoila AL, Serrano F. Association between glycated haemoglobin, glycated albumin and fructosamine with neonatal birthweight and large-for-date status infants in gestational diabetes mellitus: a prospective cohort study. Journal of Obstetrics and Gynaecology. 2019; 39(6): 768-73.
Bozkurt L, Göbl CS, Leitner K, Pacini G, Kautzky-Willer A. HbA1c during early pregnancy reflects beta-cell dysfunction in women developing GDM. BMJ Open Diabetes Research and Care. 2020; 8(2): e001751.