Maternal Characteristics and Complications in Pregnancies Complicated with Diabetes

Yıl 2023, , 114 - 120, 31.01.2023

Mehmet Çelik , Abdül Hamid Güler

https://doi.org/10.16899/jcm.1202083

Öz

Abstract
Aim: Pregnancies complicated with diabetes are risky pregnancies with different maternal characteristics and increased maternal complications compared to the normal pregnant group. In this study, it is aimed to determine maternal characteristics and maternal complications in pregnant women with different glucose intolerance or blood glucose levels, and to compare them with the information in the literature and to investigate the effectiveness of our follow-up and treatment protocols.
Material and Method: This study is carried out with 223 patients at Ümraniye Training and Research Hospital between May 2009 and March 2010. Group 1 in the study, normal glycemic group; Group 2, group with 1 value higher in 100 g oral glucose tolerance test (OGTT); Group 3, gestational diabetes mellitus (GDM), is the blood sugar regulated group; Group 4, the uncontrolled group diagnosed with GDM and whose blood sugar is not regulated; Group 5 consisted of patients with pregestational diabetes mellitus, with or without regulated blood sugar.
Results: Considering the maternal characteristics, it is seen that the age, gravida, parity, body mass index (BMI) of Group 3, Group 4 and Group 5 patients are significantly higher than the patients in Group 1 and Group 2. The rates of preeclampsia, macrosomic baby and preterm birth are significantly higher in groups 4 and 5. In terms of delivery types, normal birth rate is high in Group 1, while cesarean section rates are high in Groups 4 and 5. According to the groups, the cases with a 1st minute apgar score less than 7 are significantly higher in Group 4 and Group 5.
Conclusion: It is revealed that different glucose intolerances cause some problems in pregnancy, increase complications, and uncontrolled blood glucose levels increase these problems and complications. In pregestational and gestational periods; In such cases, it should be aimed and ensured that these problems and complications are reduced to the lowest possible level with appropriate diagnosis and treatment approaches.

Anahtar Kelimeler

gestational diabetes mellitus, high risk pregnancy, maternal outcomes

Diyabetle Komplike Olmuş Gebeliklerde Maternal Özellikler ve Komplikasyonlar

Öz

Öz
Amaç: Diyabetle komplike olmuş gebelikler normal gebe grubuna göre farklı maternal özellikler ve artmış maternal komplikasyonların olduğu riskli gebeliklerdir. Biz bu çalışmada farklı glukoz intoleransları veya kan glukoz düzeylerine sahip gebelerde maternal özellikleri ve maternal komplikasyonları saptamayı, bunları literatürdeki mevcut bilgilerle kıyaslıyarak takip ve tedavi protokollerimizin etkinliğini araştırmayı amaçladık.
Gereç ve Yöntem: Bu çalışma Mayıs 2009 ve Mart 2010 tarihleri arasında Ümraniye Eğitim ve Araştırma Hastanesi’nde 223 hasta ile gerçekleştirildi. Çalışmada Grup 1, normal glisemik grub; Grup 2, 100 gr oral glukoz tolerans testinde (OGTT) 1 değer yüksek grup; Grup 3, gestasyonel diyabetes mellitüs (GDM) olup kan şekeri regüle grup; Grup 4, GDM tanısı alıp kan şekeri regüle olmayan kontrolsüz grup; Grup 5, Pregestasyonel diyabetes mellitüslu, kan şekeri regüle veya regüle olmayan hastalardan oluşmaktaydı.
Bulgular: Maternal özelliklere bakıldığında Grup 3, Grup 4 ve Grup 5 hastaların Grup 1 ve Grup 2’de ki hastalara göre yaş, gravida, parite, vücut kitle indeksleri (VKİ)’leri, karşılaştırıldığında anlamlı yüksek olduğu görüldü. Grup 4 ve 5’te preeklampsi, makrozomik bebek, preterm doğum görülme oranları anlamlı derecede yüksekti. Doğum şekilleri açısından normal doğum oranı Grup 1’de yüksekken, sezaryan oranları Grup 4 ve 5’te yüksekti. Gruplara göre Grup 4 ve Grup 5’te 1. Dakika apgar skoru 7’den küçük olgular anlamlı yüksekti.
Sonuç: Farklı glukoz intoleranslarının gebelikte bir takım sorunlara yol açtığı, komplikasyonları artırdığı, kontrolsüz kan glukoz düzeylerinin bu sorun ve komplikasyonları daha da artırdığını ortaya koyduk. Pregestasyonel ve gestasyonel dönemlerde; bu tür olgularda, uygun tanı ve tedavi yaklaşımları ile bu sorun ve komplikasyonların mümkün olabilecek en düşük düzeye indirilmesi hedeflenmeli ve sağlanmalıdır.

Anahtar Kelimeler

gestational diabetes mellitus, high risk pregnancy, maternal outcomes

Kaynakça

• 1. American Diabetes Association:Diagnosis and Classification of Diabetes Mellitus;Diabetes Care 2005;28:37-42.
• 2. American Diabetes Association:Gestational Diabetes Mellitus;Diabetes Care 2003;26(1):103-5.
• 3. İsmail D, Özlem O. Diabetes Mellitus ve Gebelik. Kadın Hastalıkları ve Doğum Bilgisi. 1. baskı. Güneş Kitabevi. Sayfa:435-450, 2006
• 4. Stephan C, Elizabeth S. Diabetes mellitus. İn:Michael T. Mc. Dermott eds. The Endocrine Secrets. 1th ed. Hanley and Belfus Medical Publishers:1-61, 2004
• 5. American College of Obstetricians and Gynecologists:Diabetes and pregnancy. ACOG Technical Bulletin. Washington, DC 1994
• 6. Gestational diabetes mellitus. ACOG Practice Bulletin No. 190. American College of Obstetricians and Gynecologists. Obstet Gynecol 2018;131:e49–64
• 7. Kirwan JP, Hauguel-de Mounzon S, et al. TNF –α is a predictor of insülin resistance in human pregnancy. Diabetes 2002;51:2207
• 8. Carla J, Jeffrey S. Diabetes Mellitus and Pregnancy. İn:Alan H. De Cherney, Lauren Nathan eds. Current Obstetric and Gynecologic Diagnosis and Treatment. 9th. Ed. Lange Medical Boks/McGraw Hill Companies:326-337,2003
• 9. Cunningham FG:Diabetes. İn:Cunningham FG, Mac Donald PC, Gant NF, et al. Eds. Williams Obstetrics 21th ed. Appleton & Lange:567-618, 2001
• 10. Abebe KZ, Scifres C, Simhan HN, Day N, Catalano P, Bodnar LM, et al. Comparison of two screening strategies for Gestational Diabetes (GDM2) Trial:Design and rationale. Contemp Clin Trials. 2017;62(1):43-9.
• 11. Sugiyama MS, Cash HL, Roseveare C, Reklai R, Basilius K, Madraisau S. Assessment of gestational diabetes and associated risk factors and outcomes in the Pacific Island Nation of Palau. Matern Child Health J. 2017;21(10):1961-6.
• 12. Metzger BE, Couston DR:Summary and recommendations of the fourth international workshop-conference on gestational diabetes mellitus. Diabetes Care 1998;21:B161.
• 13. Berkus MD, Langer O:Glucose tolerance test:Degree of glucose abnormality correlates with neonatal outcome. Obstet Gynecol 1993;81:344
• 14. Owen J, Phelan ST, Landon MB, Gabbe SG. Gestational diabetes survey. Am J Obstet Gynecol 1995;172:615-20.
• 15. Foster DW:Diabetes Mellitus. İn Fauci AS, Braunwald E, İsselbacher KJ, Wilson JD:Harrison’s Principles of İnternal Medicine, 14th ed. 1998
• 16. Gestational diabetes mellitus. ACOG Practice Bulletin No. 190. American College of Obstetricians and Gynecologists. Obstet Gyne- col 2018;131:e49–64.
• 17. George A. Bray:Medical Consequences of Obesity. The Journal of Clinical Endocrinology and Metabolism 2004;89(6):2583-89.
• 18. Colditz GA, Willett WC, Rotnitzky A, Manson JE:Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481–6.
• 19. Thomas R. Moore. Diabetes in pregnancy. In Creasy RK, Resnik R, eds. Maternal-Fetal Medicine. 5th ed. Philadelphia:WB Saunders Company, 2004;1023-61.
• 20. Sibai BM, Caritis S, Hauth J, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. Am J Obstet Gynecol 2000;182:364
• 21.Noraihan MN, Justen WHW, Nyi NN, et al. Comparison of maternalfetal outcomes in gestational diabetes and lesser degrees of glucose intolerance. J Obstet Gynecol Res 2006;32:1:107-14
• 22. Gunton JE, McElduff A, Sulway M, et al. Outcome of pregnancies complicated by pre-gestational diabetes mellitus. Aust N Z J Obstet Gynaecol 2000;40(1):38-43.
• 23. Monique M.H, Assiamira Ferrara, et al. Gestational Diabetes Mellitus and Lesser Degrees of Pregnancy Hyperglycemia:Association With Increased Risk of Spontaneous Preterm Birth. Obstetr Gynecol 2003;102:850-856,
• 24. American Diabetes Association:Standards of Medical Care in Diabetes. Diabetes Care 2005;28:4-36.
• 25. Caren G. Solomon, Steven W. Graves, et al. Glucose intolerance as a predictor of hypertension in pregnancy. Hypertension 1994;23:6:717-72.
• 26. Vambergue A, Nuttens MC, Goeusse P, et al. Pregnancy induced hypertension in women with gestational carbohydrate intolerance:the diagest study. European J of Obstetrics and Gynecology and Reproductive Biology 2002;102(1):31-5.
• 27. Caren G. Solomon, Steven W. Graves, et al. Glucose intolerance as a predictor of hypertension in pregnancy. Hypertension 1994;23:6:717-21.
• 28.Janice Falls, Lorraine Milio. Endocrine Disease in Pregnancy. İn:Brandon J.B, Amy E. H eds. The Johns Hopkins Manuel of Gynecology and Obstetrics. 2th ed. philadelphia:Lippincott Williams and Wilkins:162-182,2002
• 29. Kitzmiller JL, Gloherty JP:Diabetic pregnancy and perinatal morbidity. Am J Obstet Gynecol 1978;131:560.
• 30. Roversi GD, Gargiulo M:A new aproach to the treatment of diabetic pregnant women. Am Obstet Gynecol 1979;135:567.
• 31. Landon MB, Gabbe SG, Piana R, et al. neonatal morbidity in pregnancy complicated by diabetes mellitus predictive value of maternal glycemic profiles. Am J Obstet Gynecol 1987;156:1089.
• 32. Dashe JS, Nathan L, L cy complicated by diabetes. Am J Obstet Gynecol 2000;182:901.
• 33. Salvesen DR, Brudenel MJ, Nicholaides KH:Fetal polycythemia and trombocitepenia in pregnancies complicated by maternal diabetes. Am J Obstet Gynecol 1992;166:1987.
• 34. Salvasen DR, Brudenell MJ, Snijders JM, et al. Fetal plasma erythropoietin in pregnancies complicated by maternal diabetes mellitus. Am J Obstet Gynecol 1993;168:88.