Title Čimbenici rizika i perinatalni ishod kod blizanačkih trudnoća kompliciranih gestacijskim dijabetesom Title (english) Risk factors and perinatal outcomes in twin pregnancies complicated by gestational diabetes Author Irena Džanija Mentor Vesna Sokol Karadjole (mentor) Committee member Lana Škrgatić (predsjednik povjerenstva)Committee member Dinka Pavičić Baldani (član povjerenstva)Committee member Vesna Sokol Karadjole (član povjerenstva) Granter University of Zagreb Defense date and country 2022-07-15, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Cilj: Cilj ovog retrospektivnog istraživanja je ustanoviti povezanost gestacijskog dijabetesa melitusa (GDM) s patološkim ishodima blizanačkih trudnoća te ustanoviti faktore rizika za razvoj GDM kod trudnica s blizanačkom trudnoćom.
----- Metode: Ovom studijom u analizu je uključeno 297 blizanačkih trudnoća porođenih u Klinici za ženske bolesti i porode Kliničkog bolničkog centra Zagreb u periodu od 01. siječnja 2019. do 31. prosinca 2021. godine. Isključnim kriterijima iz istraživanja su isključene sve blizanačke trudnoće pobačene / porođene prije 28tjedna gestacije, ispitanice kojima nije učinjen oGTT test te majke blizanaca s preegzistentnim dijabetesom melitusom. Dijagnoza gestacijskog dijabetesa (GDM) postavljala se na temelju jedne ili više patoloških vrijednosti oGTT testa. Ispitanice su se u ovisnosti o tipu blizanačke trudnoće i o prisustvu GDM-a dijelile u četiri skupine: BC GDM+, BC GDM-, MC GDM+, MC GDM-. Perinatalni i rani neonatalni ishod analizirao se kroz sve četiri skupine. ----- Rezultati: Naši rezultati pokazuju povezanost ITM-e prije trudnoće i obiteljske anamneze na DM kao čimbenike rizika za razvoj GDM-a kod trudnica s MC i BC blizanačkim trudnoćama (β=0.0403, R=0.20, p=0.0481). Najveći udio žena koje su zanijele IVF postupkom bio je u skupini BC trudnoća (p<0.001), ali IVF nije predstavljen kao čimbenik rizika za razvoj GDM-a. Promatrajući pojavnost perinatalnih i neonatalnih komplikacija, vidljivo je kako se MC i BC blizanci trudnica s GDM-om rađaju ranije (p=0.039), što je u skladu s učestalijom pojavom neonatalnih komplikacija (p=0.010) kod istih. Na temelju rezultata ove studije MC i BC blizanačke trudnoće i GDM u pozitivnoj su korelaciji s pojavom perinatalnih i neonatalnih komplikacija. Primjerice, pokazana je korelacija potonjih s intrauterinom smrti jednog blizanca te diskordantnog rasta (R=0.36, p=0.0039) po pitanju perinatalnih, kao i komplikacija nezrelosti oba blizanca, neonatalne smrti te infekcije oba blizanca u vidu neonatalnih komplikacija (R=0.33, p=0.0433). -----
Zaključak: Rezultati ovog istraživanja ukazuju na statističkI veću učestalost perinatalnih i ranih neonatalnih komplikacija kod monokorijalnih i bikorijalnih trudnoća s GDM-om u odnosu na blizanačke trudnoće bez GDM-a. Kvalitetna antenatalna skrb usmjerena na blizanačku trudnoću i pravilno reguliranje glikemije trudnice tijekom trudnoće važni su za smanjenje perinatalnih komplikacija i rađanja zdrave novorođenčadi.
Abstract (english) Objective: The aim of this retrospective study was to establish the association between gestational diabetes mellitus (GDM) with the adverse outcomes of twin pregnancies, as well as indentifying the risk factors which contribute to developing GDM in twin pregnancies. -----
Methods: This study included 297 twin pregnancies born at the Clinic for Women's Diseases and Obstetrics of the Clinical Hospital Center Zagreb in the period from January 1, 2019 to December 31, 2021. The study excluded all twin pregnancies aborted / born before 28th week of gestation, women who did not undergo an oGTT test and mothers of twins with pre-existing diabetes mellitus. The diagnosis of gestational diabetes (GDM) was made on the basis of one or more pathological values of the oGTT test. Depending on the type of twin pregnancy and the presence of GDM, the subjects were divided into four groups: BC GDM +, BC GDM-, MC GDM +, MC GDM-. Perinatal and early neonatal outcome were analyzed across all four groups. -----
Results: Our results show the association of BMI before pregnancy and family history of DM as risk factors for the development of GDM in pregnant women with MC and DC twin pregnancies (β=0.0403, R=0.20, p=0.0481). The largest proportion of women who conceived through IVF was in the DC pregnancy group (p<0.001), but IVF was not presented as a risk factor for the development of GDM. By looking at the incidence of perinatal and neonatal complications, we concluded that women pregnant with DC or MC twins complicated by GDM underwent labour earlier (p=0.039), which is consistent with the more frequent occurrence of neonatal complications (p=0.010) in those groups. Based on the results of this study, MC and DC twin pregnancies and GDM are positively correlated with the occurrence of perinatal and neonatal complications. For example, the correlation of the latter with intrauterine death of one twin and discordant growth (R=0.36, p=0.0039) was shown in terms of perinatal complications, as well as complications of prematurity of both twins, neonatal death and infection of both twins in the form of neonatal complications (R=0.33, p =0.0433). -----
Conclusion:. The results of this study indicate a statistically higher frequency of perinatal and early neonatal complications in monochorionic and dichorionic pregnancies with GDM compared to twin pregnancies without GDM. Quality antenatal care aimed at twin pregnancies and proper glycemic control during pregnancy are important for reducing perinatal complications and giving birth to healthy newborns.
Keywords
blizanačka trudnoća
jednojajčani blizanci
dvojajčani blizanci
gestacijski dijabetes
perinatalni ishod
Keywords (english)
twin pregnancy
monochorionic twin pregnancy
dichronionic twin pregnancy
gestational diabetes
perinatal outcome
Language croatian URN:NBN urn:nbn:hr:105:097277 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-01-09 07:50:21
