Diyabetik anne bebeklerinde kord kanı ferritin düzeyleri ve erken demir eksikliği anemisi gelişmesi arasındaki ilişkinin araştırılması
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Date
2021
Authors
Muştucu, Zeynep
Journal Title
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Diyabet gebelikte %16 gibi sık bir oranda görülen önemli bir sorundur. Maternal diyabet ister gestasyonel ister bilinen diyabet olsun, başta solunum, metabolik ve hematolojik problemler olmak üzere yenidoğan sağlığını etkileyen pek çok sorunu beraberinde getirmektedir. Bu sorunlardan biri de bu bebeklerde polisitemiye bağlı artan demir ihtiyacı ve uteroplasental yetmezlik gibi çeşitli sebeplerle demir depolarının yetersiz olmasıdır. Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi Yenidoğan ünitemize başvuran maternal diyabeti olan bebeklerde doğumda ve 4. aya kadar takip eden aylarda seri olarak demir depolarını değerlendirmek ve bu bebeklerde demir eksikliği gelişme zamanını belirlemek amaçlanmıştır. Bu prospektif çalışmaya 25/12/2018-01/07/2021 tarihleri arasında yenidoğan ünitemize başvuran, 37 hafta ve üzerinde doğan, maternal diyabeti olan bebekler alındı. Doğumdan dördüncü aya kadar aylık takiplerle bebeklerde hemoglobin (Hb), hematokrit (Hct), demir, demir bağlama kapasitesi (DBK), ferritin düzeylerine bakılarak literatürdeki referans değerlerle karşılaştırıldı. Çalışmaya toplam 86 bebek dahil edildi. Kan uyuşmazlığı olan, 37 haftanın altında doğan, hipoksik doğum öyküsü olan, başka bir nedenle polisitemisi olan ve solunum sıkıntısı veya sepsis ön tanısıyla hastaneye yatışı olan bebekler çalışmaya dahil edilmedi. Dahil edilen 86 olgunun annelerinden %9’unda Tip 1 DM (diabetes mellitus), %15’inde tip 2 DM, %76’sında Gestasyonel DM (GDM) olduğu saptandı. Çalışmada gruplar arasında cinsiyet, gestasyonel hafta, doğum ağırlığı, doğum şekli, beslenme şekli, anne yaşı, mulitparite, gebelikte demir kullanımı açısından anlamlı fark olmadığı görüldü. Hastaların %17’sinde makrozomi, %9,3’ünde hipoglisemi saptandı, diyabet tiplerine göre dağılımına bakıldığında makrozomi Tip 2 DM’li olgularda, hipoglisemi Tip 1 DM’li olgularda anlamlı derecede yüksek oranda tespit edildi. Dört aylık izlemde demir eksikliği açısından laboratuvar bulguları median değerlerinin seyrine bakıldığında, Hb, Hct, demir, ferritin düzeylerinde azalma, DBK’da artış olduğu görüldü. Diyabet tiplerine göre değerlendirildiğinde, özellikle Tip 1 DM’li olgularda doğumda en düşük demir ve ferritin; en yüksek Hb ve Hct, takip eden birinci ayda da en düşük Hb ve Hct seviyesinin olduğu tespit edildi. Sonuç olarak bu çalışmada maternal diyabeti olan bebeklerde doğumdaki yetersiz demir depoları ve takip eden aylarda da Hb, demir ve ferritin düzeylerinde azalma olduğu ve bu bebeklerin demir eksikliği açısından takibinin önemi gösterildi.
Diabetes is an important problem with a frequency of 16% in pregnancy. All of maternal diabetes types brings with it many problems that affect newborn health, especially respiratory, metabolic and hematological problems. One of these problems is the insufficient iron stores due to various reasons such as increased iron need due to polycythemia and uteroplacental insufficiency in these babies. In this study, we aimed to evaluate the iron stores serially at birth and in the following months up to the 4th month on mountly basis and to determine the time of development of iron deficiency in infants with maternal diabetes who applied to our Neonatal unit of Uludag University Faculty of Medicine. Infants with maternal diabetes (Type 1 DM, Type 2 DM, gestational diabetes) who were born at 37 weeks and above, admitted to our neonatal unit between 25/12/2018-01/07/2021 were included in this prospective study. Haemoglobin, hematocrit, iron, iron binding capacity, and ferritin levels were compared with reference values in the literature, with monthly follow-ups from birth to the fourth month. A total of 86 infants were included in the study. Babies with blood incompatibility, born below 37 weeks of age, with a history of hypoxic birth, polycythemia for another reason, and hospitalized with a prediagnosis of respiratory distress or sepsis were not included in the study. It was found that 9% of the mothers of the 86 cases included had Type 1 DM, 15% had type 2 DM, and 76% had gestational DM (GDM). In the study, there was no significant difference between the groups in terms of gender, gestational week, birth weight, delivery type, diet, maternal age, multiparity, and iron use during pregnancy. Macrosomia was found in 17% of the patients, and hypoglycemia was found in 9.3% of the patients. When the distribution according to diabetes types was examined, macrosomia was detected at a significantly higher rate in patients with Type 2 DM and hypoglycemia was found at a significantly higher rate in patients with Type 1 DM. When the course of the median values of laboratory findings in terms of iron deficiency was examined in the four-month follow-up, it was observed that there was a decrease in Hb, Hct, iron, ferritin levels, and an increase in iron binding capacity. When we evaluated according to diabetes types, especially in cases with Type 1 DM, the lowest iron and ferritin levels and highest Hb and Hct levels were observed at birth and the lowest Hb and Hct levels were observed at the first month evaluations. In conclusion, this study showed that infants with maternal diabetes had insufficient iron stores at birth and decreased Hb, iron and ferritin levels in the following months, and the importance of following these infants in terms of iron deficiency.
Diabetes is an important problem with a frequency of 16% in pregnancy. All of maternal diabetes types brings with it many problems that affect newborn health, especially respiratory, metabolic and hematological problems. One of these problems is the insufficient iron stores due to various reasons such as increased iron need due to polycythemia and uteroplacental insufficiency in these babies. In this study, we aimed to evaluate the iron stores serially at birth and in the following months up to the 4th month on mountly basis and to determine the time of development of iron deficiency in infants with maternal diabetes who applied to our Neonatal unit of Uludag University Faculty of Medicine. Infants with maternal diabetes (Type 1 DM, Type 2 DM, gestational diabetes) who were born at 37 weeks and above, admitted to our neonatal unit between 25/12/2018-01/07/2021 were included in this prospective study. Haemoglobin, hematocrit, iron, iron binding capacity, and ferritin levels were compared with reference values in the literature, with monthly follow-ups from birth to the fourth month. A total of 86 infants were included in the study. Babies with blood incompatibility, born below 37 weeks of age, with a history of hypoxic birth, polycythemia for another reason, and hospitalized with a prediagnosis of respiratory distress or sepsis were not included in the study. It was found that 9% of the mothers of the 86 cases included had Type 1 DM, 15% had type 2 DM, and 76% had gestational DM (GDM). In the study, there was no significant difference between the groups in terms of gender, gestational week, birth weight, delivery type, diet, maternal age, multiparity, and iron use during pregnancy. Macrosomia was found in 17% of the patients, and hypoglycemia was found in 9.3% of the patients. When the distribution according to diabetes types was examined, macrosomia was detected at a significantly higher rate in patients with Type 2 DM and hypoglycemia was found at a significantly higher rate in patients with Type 1 DM. When the course of the median values of laboratory findings in terms of iron deficiency was examined in the four-month follow-up, it was observed that there was a decrease in Hb, Hct, iron, ferritin levels, and an increase in iron binding capacity. When we evaluated according to diabetes types, especially in cases with Type 1 DM, the lowest iron and ferritin levels and highest Hb and Hct levels were observed at birth and the lowest Hb and Hct levels were observed at the first month evaluations. In conclusion, this study showed that infants with maternal diabetes had insufficient iron stores at birth and decreased Hb, iron and ferritin levels in the following months, and the importance of following these infants in terms of iron deficiency.
Description
Keywords
Diyabetik anne bebeği, Demir eksikliği, Demir deposu, Infants of diabetic mother, Iron deficiency, Iron storage
Citation
Muştucu, Z. (2021). Diyabetik anne bebeklerinde kord kanı ferritin düzeyleri ve erken demir eksikliği anemisi gelişmesi arasındaki ilişkinin araştırılması. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.