Farklı Maternal Diyabet Tiplerinde Yenidoğan Sonuçları: Üçüncü Basamak Yoğun Bakım Ünitesi Deneyimi

Year 2024, Volume: 18 Issue: 4, 240 - 246, 22.07.2024

Aylin Avdan , Gülçin Seyhun Türkoğlu , İrem Altınışık , Fatma Nur Sarı , İbrahim İlker Çetin , Evrim Alyamac Dizdar

https://doi.org/10.12956/tchd.1445074

Abstract

Amaç: Diyabetik anne bebekleri (DAB) farklı nedenlerle yenidoğan yoğun bakım ünitelerine (YYBÜ) yatırılarak izlenebilir. Çalışmamızda DAB’lerinde perinatal ve postnatal dönemde ortaya çıkan malformasyonların, izlemde eşlik eden morbiditelerin, klinik ve laboratuvar bulguların maternal diyabet tiplerine göre karşılaştırılması amaçlandı.

Gereç ve Yöntemler: Ankara Bilkent Şehir Hastanesi’nde 3. Düzey YYBÜ’de 01.01.2020 ile 01.01.2022 tarihleri arasında yatırılarak izlenen 4713 yenidoğanın annelerinin diyabet durumu incelendi. Annelerinde bozulmuş glukoz toleransı (BGT), gestasyonel diyabetes mellitus (GDM) veya Pre-GDM olan 616 yenidoğan retrospektif olarak incelendi.

Bulgular: Altıyüzonaltı vakanın 167’si (%27.1) BGT’li, 394’ü (%64) GDM’li, 55’i (%8.9) Pre-GDM’li anne bebeğiydi. Makrozomi sıklığı Pre-GDM’de (%30.9), BGT (%15) ve GDM (%19.3) gruplarına göre anlamlı derecede yüksekti (p=0.033). Vakalarda en sık görülen malformasyonlar kardiyovasküler sistem (KVS) (%77.4) ile ilgiliydi. Septal hipertrofi sıklığı Pre-GDM’de BGT, GDM gruplarından, GDM grubunda da BGT grubundan anlamlı (p<0.001) olarak daha yüksekti. İnsülin ihtiyacı olan ve HbA1c düzeyi yüksek olan özellikle Pre- GDM’li anne bebeklerinde septal hipertrofi, KVS malformasyonu, LGA/makrozomi, hipokalsemi görülme oranları anlamlı olarak yüksek saptandı (p<;0.001). Septal hipertrofiyi öngören optimum maternal HbA1c değeri için yapılan ROC analizi sonucuna göre %62 duyarlık ve %66 özgüllük ile eşik değer %6 (AUC: 0.693) olarak bulundu. Lojistik

Sonuç: Maternal diyabet tipindeki farklılığa rağmen YYBÜ’ye yatırılarak izlenen diyabetik anne bebeklerinde ciddi klinik sorunlar yaşanmaktadır. BGT’li annelerin bebekleri de maternal hiperglisemiye maruz kalabilir. Glisemik kontrolü bozuk olan özellikle de HbA1c değeri yüksek gebelerden doğan bebeklerde potansiyel olarak bazı sorunların görülme sıklığı artmaktadır. Maternal glisemik kontrol sağlanarak ve bu bebekler yakın takip edilerek mortalite ve morbidite azaltılabilir.

Keywords

Gestasyonel Diyabetes Mellitus, Tip 1 Diyabetes Mellitus, Tip 2 Diyabetes Mellitus, konjenital malformasyon, septal hipertrofi

Neonatal Outcomes in Different Maternal Diabetes Types: Experience from a Tertiary Care Unit

Abstract

Objective: Infants of mothers with diabetes (IMD) may require hospitalization in neonatal intensive care units (NICU) for various reasons. In our study, our objective was to compare clinical and laboratory findings, as well as malformations and morbidities among IMD based on the types of maternal diabetes.

Material and Methods: The diabetic status of mothers of 4713 infants admitted to tertiary neonatal intensive care unit (NICU) at Ankara Bilkent City Hospital between January 1, 2020, and January 1, 2022, was examined. We retrospectively analyzed demographic data, clinical and laboratory characteristics, and morbidities for 616 infants born to mothers with impaired glucose tolerance (IGT), gestational diabetes mellitus (GDM), or pre-existing gestational diabetes mellitus (Pre- GDM).

Results: Of the 616 cases, 167 (27.1%) were infants of mothers with IGT, 394 (64%) with GDM and 55 (8.9%) with Pre-GDM. The prevalence of macrosomia was significantly higher in Pre-GDM (30.9%) than in the IGT (15%) and GDM (19.3%) groups (p=0.033). The most common malformations in the cases were related to the cardiovascular system (CVS) (77.4%). The frequency of septal hypertrophy was significantly higher in the Pre-GDM group compared to the IGT and GDM groups, and in the GDM group compared to the IGT group (p<0.001). The rates of septal hypertrophy, CVS malformation, LGA/macrosomia, and hypocalcemia were found to be significantly higher in infants of mothers with insulin requirement and high HbA1c levels, particularly in Pre-GDM group (p<0.001). According to the ROC analysis for the optimum maternal HbA1c value predicting septal hypertrophy, the threshold value was found to be 6% (AUC=0.693) with 62% sensitivity and 66% specificity. In logistic regression analysis, macrosomia and maternal HbA1c ≥6% were determined as independent risk factors for the presence of septal hypertrophy.

Conclusion: Despite variations in the type of maternal diabetes, IMD experience significant clinical challenges when hospitalized and monitored in the NICU. Infants born to mothers with IGT may also be subjected to maternal hyperglycemia. The likelihood of certain complications rises in infants born to pregnant women with inadequate glycemic control, particularly those with elevated HbA1c levels. By ensuring maternal glycemic control and closely monitoring these infants, it is possible to reduce both mortality and morbidity.

Keywords

Gestational Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, congenital malformation, septal hypertrophy

References

• Harreiter J, Roden M. [Diabetes mellitus: definition, classification, diagnosis, screening and prevention (Update 2023)]. Wien Klin Wochenschr 2023;135(Suppl 1):7-17.
• Ringholm L, Damm P, Mathiesen ER. Improving pregnancy outcomes in women with diabetes mellitus: modern management. Nat Rev Endocrinol 2019;15:406-16.
• Zhang CH, Zhang PL. Adverse perinatal outcomes complicated with gestational diabetes mellitus in preterm mothers and preterm infants. Exp Ther Med 2023;26:425.
• Barnes-Powell LL. Infants of diabetic mothers: the effects of hyperglycemia on the fetus and neonate. Neonatal Netw 2007;26:283-90.
• Aberg A, Westbom L, Kallen B. Congenital malformations among infants whose mothers had gestational diabetes or preexisting diabetes. Early Hum Dev 2001;61:85-95.
• Nakshine VS, Jogdand SD. A Comprehensive Review of Gestational Diabetes Mellitus: Impacts on Maternal Health, Fetal Development, Childhood Outcomes, and Long-Term Treatment Strategies. Cureus. 2023;15:e47500.
• Liu S, Joseph KS, Lisonkova S, Rouleau J, Van den Hof M, Sauve R, et al. Association between maternal chronic conditions and congenital heart defects: a population-based cohort study. Circulation. 2013;128:583-9.
• Ullmo S, Vial Y, Di Bernardo S, Roth-Kleiner M, Mivelaz Y, Sekarski N, et al. Pathologic ventricular hypertrophy in the offspring of diabetic mothers: a retrospective study. Eur Heart J 2007;28:1319-25.
• Aman J, Hansson U, Ostlund I, Wall K, Persson B. Increased fat mass and cardiac septal hypertrophy in newborn infants of mothers with well-controlled diabetes during pregnancy. Neonatology 2011;100:147-54.
• Kautzky-Willer A, Winhofer Y, Kiss H, Falcone V, Berger A, Lechleitner M, et al. [Gestational diabetes mellitus (Update 2023)]. Wien Klin Wochenschr 2023;135:115-28.
• Karapınarlı A, Kibar Gül AS, Ünal S, Siyah Bilgin B, Azak E, Kavurt V, et al. Retrospective Evaluation of Congenital Heart Disease Cases Diagnosed in Neonatal Service and Intensive Care Unit. Türkiye J Pediatr Dis 2022;16:191-9.
• Diabetes Mellitus Ve Komplikasyonlarının Tanı, Tedavi Ve İzlem Kılavuzu. Türkiye Endokrinoloji Ve Metabolizma Derneği 2022;15.baskı.
• Bai W, Wang H, Fang R, Lin M, Qin Y, Han H, et al. Evaluating the effect of gestational diabetes mellitus on macrosomia based on the characteristics of oral glucose tolerance test. Clin Chim Acta 2023;544:117362.
• Persson M, Pasupathy D, Hanson U, Norman M. Birth size distribution in 3,705 infants born to mothers with type 1 diabetes: a population-based study. Diabetes Care 2011;34:1145-9.
• Kc K, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab 2015;66 Suppl 2:14-20.
• Group HSCR, Metzger BE, Lowe LP, Dyer AR, Trimble ER, Chaovarindr U, et al. Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 2008;358:1991-2002.
• Bi J, Ji C, Wu Y, Wu M, Liu Y, Song L, et al. Association Between Maternal Normal Range HbA1c Values and Adverse Birth Outcomes. J Clin Endocrinol Metab 2020;105: dgaa127.