26 nov. 2009 TULBURARI DE GLICOREGLARE LA GRAVIDELE AFLATE iN TRIMESTRUL AL TREILEA DE SARCINA
Claudia Lazar, Corina Matis, Gabriela Caracostea, D. Muresan, F. Stamatian *, Mihaela Iancu**
* Clinica Ginecologie I, UMF „I. Hatieganu”, Cluj- Napoca
** Catedra de Informatica, UMF „I. Hatieganu”, Cluj- Napoca
Rezumat
Introducere: Diabetul zaharat gestational complica 4-5% dintre sarcini. Ultimul trimestru de sarcina este caracterizat prin cresterea accelerata a unitatii feto-placentare, dar si cresterea concentratiei plasmatice a hormonilor diabetogeni- hormonul lactogen placentar , estrogenii respectiv cresterea rezistentei la insulina.
Obiectiv: urmarirea efectelor tulburarilor metabolismului glucidic asupra rezultatelor perinatale la paciente cu patologie asociata, aflate in ultimul trimestru de sarcina.
Metoda: s-a efectuat un studiu prospectiv, descriptiv, care a inclus 17 gravide cu sarcini între 34 si 36 SS. Dupa efectuarea testului de toleranta la glucoza (TTGO), s-au urmarit tulburarile metabolismului glucidic si complicatiile perinatale. Parametrii de evaluare neonatala au fost scorul Apgar la 5 minute si monitorizarea în Terapia Intensiva Neonatala (NICU).
Rezultate: Tulburarile de glicoreglare la gravidele de ultim trimestru s-au asociat în special cu hipertensiunea arteriala indusa de sarcina (47,05 %, p=0,002), hipertensiunea arteriala preexistenta sarcinii (11,76 %), obezitatea (64,7 %), cu ultimele doua variabile nu s-au gasit si corelatii statistice. Valorile glicemiei la TTGO au fost în medie 82,27 mg/dl(68-102) (± 8,81 DS) a jeun, 142,58mg/dl(107-203)(±25,70 DS) la o ora si 131,35 mg/dl (99-210) (±30,152 DS) la 2 ore. Scorurile Apgar la 5 minute n-au fost afectate de tulburarile de glicoreglare. Au existat doar 3 scoruri Apgar sub 7(16,66% din cazuri). Macrosomia fetala s-a corelat statistic semnificativ cu modificarile de glicoreglare (p=0,03).
Concluzii: in studiul nostru tulburarile de glicoreglare prezente în ultimul trimestru de sarcina au fost corelate cu prezenta factorilor de risc cardiovasculari materni (hipertensiune arteriala indusa de sarcina) si macrosomia fetala. Alterarea TTGO nu a avut valoare predictiva pentru afectarea prognosticului neonatal evaluat prin scorul Apgar < 7 la 5 minute.
Abstract – GLYCOREGUALTION DISORDERS IN 3RD TRIMESTER PREGNANCY WOMEN
Introduction: Gestational diabetes complicates 4-5% of pregnancies. Last trimester of pregnancy is characterized by accelerated growth of the feto-placental unit, by the increase of the serum concentration of diabetic hormones – placental lactogen hormone, estrogen – and, respectively, by the increased insulin resistance.
Objective: Monitoring the effects of carbohydrate metabolism disorders on perinatal outcomes in patients with associated pathology, during the last trimester of pregnancy.
Method: A prospective, descriptive study was conducted, which included 17 women with pregnancies between 34 and 36 weeks. After the oral glucose tolerance test (OGTT) was made, the carbohydrate metabolism disorders and perinatal complications were monitored. The neonatal assessment parameters were Apgar score at 5 minutes and monitoring in Neonatal Intensive Care (NICU).
Results: Glycoregulation disorders in pregnant women in the third trimester were particularly associated with hypertension induced by pregnancy (47.05 %, p=0.002), pregnancy pre-existing hypertension (11.76 %), obesity (64.7 %); for the last two variables statistical correlations were not found. Blood glucose values at OGTT were on average 82.27 mg/dl (68-102) (±-8.81 SD) a jeun, 142.58 mg/dl (107-203) (±25.70 SD) at one hour and 131.35 mg/dl (99-210)(±-30.152 SD) at two hours. The Apgar scores at 5 minutes were not affected by glycoregulation disorders. There were only 3 scores below 7 (16,66% of cases). Fetal macrosomia was statistically significantly correlated with glycoregulation modifications (p = 0.03).
Conclusion: In our study, glycoregulation disorders in the last trimester of pregnancy were correlated with the presence of maternal cardiovascular risk factors (hypertension induced by pregnancy) and fetal macrosomia. OGTT alteration had no predictive value for afecting neonatal prognosis assessed by Apgar score under 7 at 5 minutes.