Komplikacijos, pasireiškiančios vaisiui ir naujagimiui gestacinio diabeto atvejais = : Perinatal outcome in women with gestational diabetes mellitus

Abstract

Darbo tikslas – nustatyti, kokios komplikacijos būdingos vaisiui ir naujagimiui gestacinio diabeto (GD) atvejais, ir įvertinti, ar galima jas sumažinti tinkamai prižiūrint nėščiąsias. Tyrimo metodika. Retrospektyviai ištirtos 150-ies naujagimių (iš jų 3 poros dvynių), kurių motinos 1996-1998 m. gimdė KMUK, naujagimystės laikotarpio komplikacijos. GD moterims diagnozuotas atlikus gliukozės toleravimo mėginį (GTM) pagal PSO metodiką su 75 g gliukozės, kai glikemija po 2 val. buvo 7,8 mmol/l ir didesnė. Nėščiosios buvo prižiūrimos pagal sudarytą planą, kontroliuojant glikemiją ir vaisiaus būklę. Tyrimų rezultatai palyginti su 300 naujagimių, kuriuos pagimdė nėščiosios, parinktos atsitiktinai. Be to, tiriamosios grupės naujagimiai buvo lyginami su 85 naujagimiais, kurių motinoms GD buvo diagnozuotas ir jos gimdė KMUK 1988-1994 m., kai į šią patologiją nebuvo kreipiama pakankamai dėmesio: diagnozė neretai buvo nustatoma vėlai, nėštumo metu šios moterys buvo nepakankamai ir neplaningai prižiūrimos. Rezultatai. [...]. Objective. To evaluate the main neonatal complications and perinatal outcome in women with gestational diabetes mellitus (GDM). Methods. A retrospective study was performed of 147 pregnancies complicated by GDM. GDM was diagnosed by oral 75 g - glucose tolerance testing according to the WHO criteria. Glycaemia and fetal well-being during pregnancy were regularly checked up. The neonatal complications in the newborns born to women with GDM were compared with the complications in 300 randomly selected newborns of the control group. The data of the investigated group were also compared with the data of 85 newborns born to women with GDM in 1988-1994, when this condition did not receive proper attention, and the women were not suitably cared for. Results. The mean birth weight and length of the newborns in the GDM group and the incidence of such complications as macrosomia, hypoxia neonatal hypoglycaemia, hyperbilirubinemia, respiratory distress syndrome and congenital malformations were significantly higher than in the control group. Except for the malformations all there complications occurred significantly more frequently in the group in which GDM was not sufficiently controlled. There also occured 3 stillbirths and 2 neonatal deaths. Conclusions. The regular control of glycaemia and fetal well-being in GDM complicated pregnancies are important in decreasing neonatal complications. Therefore all pregnant women should be screened for GDM, in which meticulous management is recommended.