Gestasyonel diabetes mellitus ile komplike gebelerde doğum sonrası metabolik sendrom ve polikistik over sendromu taraması
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Date
2009
Authors
Arslan, Emel
Journal Title
Journal ISSN
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Publisher
Uludağ Üniversitesi
Abstract
Geçirilmiş gebelikleri gestasyonel diabetes mellitus (GDM) ile komplike olmuş kadınlarla sağlıklı gebelik geçirmiş kadınları polikistik over sendromu (PCOS) ve metabolik sendrom prevalansı açısından karşılaştırmaktır.Mart 2007 ile Eylül 2008 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum polikliniğine başvuran, geçirilmiş gebelikleri GDM ile komplike olmuş 27 kadın çalışma grubunu (Grup I), gebeliklerinde obstetrik sorun yaşamayan 30 kadın ise kontrol grubunu oluşturdu. Gruplar demografik değişkenler, vücut yapısı özellikleri, kan basıncı, lipid ve hormon profili, PCO morfolojisi, doğum şekli, sezeryan doğum endikasyonları, fetal doğum ağırlığı, apgar skoru, insülin direnci (IR) açısından karşılaştırıldı. İstatistiksel değerlendirmelerde oranların karşılaştırılmasında ki-kare, grup ortalamalarının karşılaştırılmasında t-testi ve Mann-Whitney U testi kullanıldı.Kontrol grubu ile karşılaştırıldığında, ortalama yaş (p=0.01), gravida (p=0.03) ve abortus (p=0.03) GDM grubunda anlamlı olarak daha yüksekti. Aynı grupta gebelik öncesi kilo (p=0,01) ve vücut kütle indeksi (VKİ) (p<0,001) de anlamlı olarak yüksekken, gebelikte alınan kilo açısından gruplar arasında anlamlı fark yoktu (p=0.16). Doğum şekli (p=0.72) ve sezeryan endikasyonları (p=0.6) gruplar arasında farklılık göstermiyordu. Postpartum kontrol GDM grubunda ortalama 107±18.1, kontrol grubunda ise ortalama 126±18,9 haftada yapıldı (p=0.42). Doğum sonrası boy (p=0.01), kilo (p=0.01), VKİ (p=0.001), bel (p<0.001) ve kalça çevresi (p=0.02) ortalamaları GDM grubunda anlamlı olarak yüksekti. Aynı grubun ortalama arteriyel sistolik (p=0.01) ve diastolik (p=0.01) kan basıncı değerleri de daha yüksek bulundu. Hiperinsülinemi sıklığı (p=0.21) ve insülin/glukoz oranları (p=0.60) açısından gruplar arasında istatistiksel olarak anlamlı fark saptanmadı. HOMA için eşik değer 2,24 olarak alındığında, GDM grubunda %48.1, kontrol grubunda ise %20.6 sıklıkla insülin rezistansı belirlendi (p=0,02). IDF 2005 kriterlerine göre, GDM grubunda bel çevresi (p=0.006), kan basıncı (p=0.01), AKŞ (p=0.02) ve trigliserid düzeyleri (p=0.002) kontrol grubuna göre daha sıklıkla eşik değerlerin üzerindeydi. GDM grubunda metabolik sendrom sıklığı %33 iken kontrol grubunda %3,3 saptandı (p=0.01). Polikistik over görünümü ve PCOS açısından gruplar arasında istatistiksel olarak anlamlı farklılık saptanmamasına rağmen (p=0.89), hiperandrojenizm laboratuvar bulguları (p=0.003) GDM grubunda daha sıklıkla belirlendi.GDM metabolik sendromun erken bir klinik yansıması olabilir. Bu açıdan, GDM ile komplike gebelik geçiren kadınlar ileriki yaşamlarında metabolik sendrom riski açısından bilgilendirilmeli ve düzenli aralıklarla değerlendirilmelidir.
To compare women with previous pregnancies complicated by gestational diabetes mellitus (GDM) and women with uncomplicated pregnancies with regard to the prevalence of polycystic ovary syndrome (PCOS) and metabolic syndrome (MS)Among women attending the outpatient clinic of the Department of Obstetrics and Gynecology of Uludag University Hospital during the time period between March 2007 and September 2007, 27 with previous pregnancies complicated by GDM (Group 1), and 30 with previous uncomplicated pregnancies (Group 2) were included in the study. The groups were compared for demographic variables, body constitution, blood pressure, lipid and hormone profiles, PCO morphology, route of delivery, indications for abdominal delivery, fetal birth weight, apgar scores and insulin resistance (IR). Chi-square tests were used for comparison of categorical variables between the groups, and the t-test and Mann-Whitney U-test for comparison of continuous variables.In comparison to the control group, the mean age of women (p=0,01), and the mean number of previous pregnancies (p=0,03) and miscarriages (p=0,03) were significantly higher in GDM group. Pre-pregnancy weight (p=0,01) and body mass index (BMI) (p<0,001) were also significantly higher in the same group, whereas there was no difference between the groups with regard to weight gain during pregnancy (p=0,16). The route of delivery (p=0.72) and indications for abdominal delivery (p=0.6) did not differ significantly between the groups. Visits to our outpatient clinic took place at 107±18.1 and 126±18,9 weeks postpartum for the GDM and control groups, respectively (p=0.42). At follow-up, mean height (p=0.01), weight (p=0.01), BMI (p=0.001), and waist (p<0.001) and hip circumference (p=0.02) were significantly higher in women previously diagnosed with GDM. The mean systolic (p=0,01) and diastolic arterial blood pressures (p=0,01) were also found to be higher in the same group. There was no statistically significant difference between groups with regard to frequency of hyperinsulinemia (p=0.21) or insulin/glucose ratio (p=0.60). Based on HOMA, with a cut-off of 2.24 defined as diagnostic, the frequencies of insulin resistance were 48,1% and 20,6% for the GDM and control groups, respectively (p=0,02). According to IDF 2005 criteria, waist circumference (p=0.006), blood pressure (p=0.01), fasting glucose level (FGL) (p=0.02) and triglyceride levels (p=0.002) were more frequently higher than threshold values in the GDM group than the control group. The frequency of metabolic syndrome was 33% and 3,3% in the GDM and control groups, respectively (p=0.01). While there was no statistically significant difference between the groups regarding polycystic ovary morphology or PCOS (p=0.89), hormonal findings of hyperandrogenism were more frequently observed in the GDM group (p=0.003).GDM may be an early clinical manifestation of the metabolic syndrome. Hence, women whose pregnancies are complicated by GDM should be informed about the future risk of metabolic syndrome and followed up accordingly.
To compare women with previous pregnancies complicated by gestational diabetes mellitus (GDM) and women with uncomplicated pregnancies with regard to the prevalence of polycystic ovary syndrome (PCOS) and metabolic syndrome (MS)Among women attending the outpatient clinic of the Department of Obstetrics and Gynecology of Uludag University Hospital during the time period between March 2007 and September 2007, 27 with previous pregnancies complicated by GDM (Group 1), and 30 with previous uncomplicated pregnancies (Group 2) were included in the study. The groups were compared for demographic variables, body constitution, blood pressure, lipid and hormone profiles, PCO morphology, route of delivery, indications for abdominal delivery, fetal birth weight, apgar scores and insulin resistance (IR). Chi-square tests were used for comparison of categorical variables between the groups, and the t-test and Mann-Whitney U-test for comparison of continuous variables.In comparison to the control group, the mean age of women (p=0,01), and the mean number of previous pregnancies (p=0,03) and miscarriages (p=0,03) were significantly higher in GDM group. Pre-pregnancy weight (p=0,01) and body mass index (BMI) (p<0,001) were also significantly higher in the same group, whereas there was no difference between the groups with regard to weight gain during pregnancy (p=0,16). The route of delivery (p=0.72) and indications for abdominal delivery (p=0.6) did not differ significantly between the groups. Visits to our outpatient clinic took place at 107±18.1 and 126±18,9 weeks postpartum for the GDM and control groups, respectively (p=0.42). At follow-up, mean height (p=0.01), weight (p=0.01), BMI (p=0.001), and waist (p<0.001) and hip circumference (p=0.02) were significantly higher in women previously diagnosed with GDM. The mean systolic (p=0,01) and diastolic arterial blood pressures (p=0,01) were also found to be higher in the same group. There was no statistically significant difference between groups with regard to frequency of hyperinsulinemia (p=0.21) or insulin/glucose ratio (p=0.60). Based on HOMA, with a cut-off of 2.24 defined as diagnostic, the frequencies of insulin resistance were 48,1% and 20,6% for the GDM and control groups, respectively (p=0,02). According to IDF 2005 criteria, waist circumference (p=0.006), blood pressure (p=0.01), fasting glucose level (FGL) (p=0.02) and triglyceride levels (p=0.002) were more frequently higher than threshold values in the GDM group than the control group. The frequency of metabolic syndrome was 33% and 3,3% in the GDM and control groups, respectively (p=0.01). While there was no statistically significant difference between the groups regarding polycystic ovary morphology or PCOS (p=0.89), hormonal findings of hyperandrogenism were more frequently observed in the GDM group (p=0.003).GDM may be an early clinical manifestation of the metabolic syndrome. Hence, women whose pregnancies are complicated by GDM should be informed about the future risk of metabolic syndrome and followed up accordingly.
Description
Keywords
Gestasyonel diabetes mellitus, Metabolik sendrom, Polikistik over sendromu, Gestational diabetes mellitus, Metabolic syndrome, Polycystic ovary syndrome
Citation
Arslan, E. (2009). Gestasyonel diabetes mellitus ile komplike gebelerde doğum sonrası metabolik sendrom ve polikistik over sendromu taraması. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.