26 nov. 2009 ASPECTE PRIVIND EVOLUTIA SARCINILOR LA PACIENTELE CU DZ TIP 1
Vladareanu R*, Mihailescu Doina*, Georgescu Olivia**, Burnei Anca*,Bot Mihaela*,Ciorascu M*, Fica Simona**
* Clinica de Obstetrica-Ginecologie, Spitalul Universitar de Urgenta Elias
** Clinica de Endocrinologie, Diabet si Boli de Nutritie, Spitalul Universitar de Urgenta Elias
Rezumat
Obiectivul: Studiul nostru observational a urmarit retrospectiv evolutia sarcinilor la pacientele cu Dz tip 1 aflate în evidenta Sectiei de Endocrinologie, Diabet si Boli de Nutritie a Spitalului Elias.
Material si metoda: Au fost cuprinse în studiu 134 paciente cu Dz tip 1, cu varste între 19-70 ani (varsta medie: 44,5 ani) la care s-au consemnat: varsta mamei la nastere, IMC pregestational, durata de evolutie a Dz la momentul nasterii, nr. sarcinilor/nasterilor, durata de evolutie a sarcinii tipul nasterii si greutatea copiilor la nastere.
Rezultate: 61 (45,5%) dintre paciente nu au avut sarcini, 10 (7,46%) au avut sarcini fara nasteri (pacientele au suferit avorturi spontane sau provocate) iar 63 (47,01%) au avut sarcini finalizate cu nasteri. Cele 63 paciente care au nascut au fost împartite în 2 loturi: A) 32 paciente cu Dz tip 1 diagnosticat înainte de gestatie (avand o durata medie a diabetului de 4,8 ani). B) 31 paciente cu Dz tip 1 diagnosticat dupa momentul nasterii. Nu s-au înregistat diferente semnificativ statistice între cele 2 loturi de paciente în ceea ce priveste: varsta mamei la nastere (26,21 vs. 26,7 ani) IMC pregestational (23,7 vs. 24,5 kg/m2) nr. nasterilor (1,12 vs. 1,83) pe parcursul per. fertile si durata de evolutie a sarcinii (38,34 vs. 38,64 saptamani). La pacientele din grupul A s-au înregistrat mai putine sarcini fata de grupul B, diferenta fiind semnificativ statistica (1,71 vs. 3,74 p=0,0001). Nasterea naturala s-a înregistrat într-un procent ridicat în ambele grupuri (86,3% vs. 68,7%) în timp ce nasterea prin cezariana a fost de doua ori mai frecventa în grupul A fata de grupul B (31,2% vs. 13,6%). Nu a fost înregistrata o diferenta semnificativa statistic între cele doua loturi în ceea ce priveste greutatea medie a fatului la nastere (3549g vs. 3480g) si incidenta macrosomiei (12,5% vs. 16,12%). Procentul complicatiilor aparute pe parcursul sarcinii a fost dublu în lotul A vs. B (28% vs. 13%).
Concluzii: Rata fertilitatii a fost mai redusa la pacientele cu DZ tip 1 pregestational. Prezenta DZ tip 1 la mama se asociaza cu un risc crescut pt. aparitia complicatiilor gestationale independent de varsta sau de IMC pregestational.
Abstract – ASPECTS REGARDING EVOLUTION OF PREGNANCY IN DIABETES MELLITUS TYPE 1 PATIENTS
Objective: Our observational study is a retrospective survey of pregnancy evolution in Diabetes Mellitus (DM) type I patients found in the register of the Endocrinology, Diabetes and Nutritional Diseases department of the Elias Hospital.
Material and method: 134 DM type I patients were entered in the study, aged 19-70years (average age 44.5years), from which we noted: mother’s age at birth, pregestational BMI, duration of DM evolution at the time of birth, number of prgnancies/births, duration of pregnancy, type of bith and newborn weight. Results: 61 (45,5%) patients did not have pregnancies, 10 (7,46%) had pregnancies but did not deliver(the patients suffered wither spontaneus or provoqued abortion), and 63 (47,01%) had pregnancies and delivered babies. The 63 patients who delivered were split in two groups: A) 32 patients with DM type I diagnosed before the pregnancy (having a median duration of diabetes of 4.8 years) B) 31 patients with type I diabetes diagnosed after the onset of pregnancy .
No statistically significant differences were noted between the two patient groups concerning: mother’s age at birth (26,21 vs. 26,7 ani), pregestational BMI (23,7 vs. 24,5 kg/m2), number of births (1,12 vs. 1,83) during the fertile period and duration of pregnancy (38,34 vs. 38,64 weeks). In group A patients less pregnancies were encountered compared to group B, the difference being statistically significant (1,71 vs. 3,74 p=0,0001). Natural birth was encountered in an increased percentage in each group (86,3% vs. 68,7%), whereas birth by cezarian section was twice more frequent in group a compared to group B (31,2% vs. 13,6%). No statistically significant difference was noted between the two groups concerning average newborn birthweight (3549g vs. 3480g) and macrosomy incidence (12,5% vs. 16,12%). The percentage of complications which occured during pregnancy was double in group A vs. B (28% vs. 13%).
Conclusions: Fertility rate was reduced in pregestational type I DM. The presence of type I DM in the mother is associated with an increased risc of gestational complications’ occcurence regardless mother’s age or pregestational BMI.