Pirmā tipa cukura diabēts un tā sarežģījumi grūtniecības laikā
Date
2018
Authors
Kaļķe, Unda
Journal Title
Journal ISSN
Volume Title
Publisher
Latvijas Universitāte
Abstract
Grūtniecība 1.tipa CD pacientēm var noritēt veiksmīgi, ja glikozes līmenis asinīs ir tuvu normas robežai gan plānojot grūtniecību, gan tās laikā. Tādēļ ir svarīgi izprast glikozes metabolisma izmaiņas grūtniecības laikā un to ietekmi uz augļa un mātes veselību, samazinot komplikāciju risku grūtniecības laikā. Pētījuma mērķis bija analizēt ar 1.tipa CD saistītos sarežģījumus grūtniecēm un viņu jaundzimušajiem. Pētījuma uzdevumi bija izpētīt CD apmācības un HbA1c līmeņa saistību ar grūtniecības iznākumu, kā arī izpētīt iespējamos ar metabolo kompensāciju saistītos sarežģījumus katrā grūtniecības trimestrī un pēcdzemdību periodā un noskaidrot grūtnieces svara ietekmi uz grūtniecības iznākumu. Materiāli un metodes: tika veikts retrospektīvs pētījums, intervējot 34 pacientes ar 1.tipa CD, kurām grūtniecība bijusi laika posmā no 2013. līdz 2017. gadam un kuras dzemdējušas Paula Stradiņa Klīniskās universitātes slimnīcā. Datu analīzei tika izmantota SpSS Statistics 24 programma, un dati apstrādāti arī Excel 2010. Nozīmīgākie rezultāti: sievietēm, kurām informācija par 1.tipa CD un grūtniecību ir bijusi pietiekama, diabēta apmācības notikušas vidēji 2,74 reizes, salīdzinot ar pacientēm, kurām informācija nav bijusi pietiekama – 1,27 reizes, p=0,004. Analizējot HbA1c pirms grūtniecības atkarībā no CD apmācības reizēm, novēro negatīvu vidēju korelāciju – jo biežāk noritējusi apmācība, jo mazāks HbA1c pirms grūtniecības iestāšanās, pēc Spearman`s rho (r=–0,537, p=0,001). Sievietēm, kas neplānoja grūtniecību, vidējais HbA1c pirms grūtniecības bija 8,21%, savukārt sievietēm, kuras plānoja grūtniecību, vidējais HbA1c 7,34%, p>0,05. Pacientēm, kurām bija kāda no akūtām infekciju slimībām grūtniecības laikā, HbA1c vidēji bija 8,46%, bet grūtniecēm, kurām nebija, – 7,17% pirms grūtniecības, p=0,019. Pozitīvu vidēju korelāciju vēroja starp svaru pirms grūtniecības un HbA1c pirms grūtniecības, pēc Pearson`s korelācijas r=0,493; p=0,003. Sievietēm, kurām novēroja hipertensiju grūtniecības laikā, svars pirms grūtniecības vidēji bija 70,6 kg, salīdzinot ar sievietēm, kurām tās nebija, –61,3 kg, p=0,006. Pacientēm, kuru jaundzimušajiem bija hipoglikēmija, svars grūtniecības laikā vidēji pieauga par 20,38 kg, taču pacientēm, kuru bērniem tās nebija, svars pieauga par 14,23 kg, p=0,02. Secinājumi: sievietēm, kurām informācija par 1.tipa CD un grūtniecību ir bijusi pietiekama, diabēta apmācība notikusi biežāk. Rezultāti pierāda, ka apmācības biežums korelē ar zemāku HbA1c pirms grūtniecības iestāšanās. Neplānotas grūtniecības gadījumos vidējais HbA1c ir augstāks, salīdzinot ar plānotu grūtniecību. Palielināts HbA1c līmenis, grūtniecībai iestājoties, palielina akūtu infekciju iespējamību grūtniecības laikā. Paaugstināts ķermeņa svars pirms grūtniecības pozitīvi korelē ar HbA1c, hipertensiju, jaundzimušo hipoglikēmiju.
SUMMARY Type one diabetes mellitus and its complications during pregnancy Author: Unda Kaļķe, Scientific supervisor: MD Kristīne Ducena The pregnancy of the T1DM can pass successfully in case the glycose blood scale is within norm level both planning pregnancy and throughout it. Therefore, it is important to comprehend the metabolism recension throughout pregnancy as well as its impact both on foetus and mother, thus decreasing the risk of complications during pregnancy. The tasks of the research were to study T1DM practice and interconnectedness of HbA1c level and pregnancy result as well as to study the possible metabolic compensations involving complications in each pregnancy trimester and postnatal period, in addition, to clarify pregnant women weight impact on the result of pregnancy. The aim of the research was to analyze the T1DM complications of pregnant women and neonates. Materials and methods: the retrospective research has been accomplished by interviewing 34 patients being pregnant from 2013 – 2017 and procreating in Pauls Stradinsh Clinical University hospital. SpSS Statistics 24 and Excel 2010 was used to analyze the data. The most significant results: the women having information about the T1DM and pregnancy, diabetes practice has been made 2,74 times on average in comparison with the women not having sufficient information – 1,27 times, p=0,004. Analyzing HbA1c before pregnancy depending on the practice times, the negative average correlation is observed – the more frequent practices, the less HbA1c before pregnancy (r=–0,537,p=0,001). The women with planless pregnancy, the average HbA1c before pregnancy was 8,21%, conversely, the women planning pregnancy, HbA1c 7,34%, p>0,05. The average HbA1c was 8,46% for the women with acute infectious disease throughout pregnancy, however, women without diseases – 7,17% before pregnancy, p=0,019. Positive average correlation is observed between the weight before pregnancy and HbA1c before pregnancy (r=0,493; p=0,003). The women with hypertension throughout pregnancy had the average weight 70,6 kg, in comparison with the ones without hypertension – 61,3 kg, p=0,006. The patients’ weight whose neonates had hypoglycaemia, increased to 20,38 kg on average, but the patients’ weight whose neonates did not have hypoglycaemia, increased to 14,23 kg, p=0,02. Conclusions: The women having sufficient information about the T1DM and pregnancy had diabetes practice more frequently. The results prove that practice frequency correlates with lower HbA1c before pregnancy. The average HbA1c is higher in case of planless pregnancy in comparison with the planned one. The increased HbA1c level in the beginning of pregnancy maximizes the possibility of acute infections. Higher body weight before pregnancy positively correlates with HbA1c, hypertension, neonate hypoglycaemia.
SUMMARY Type one diabetes mellitus and its complications during pregnancy Author: Unda Kaļķe, Scientific supervisor: MD Kristīne Ducena The pregnancy of the T1DM can pass successfully in case the glycose blood scale is within norm level both planning pregnancy and throughout it. Therefore, it is important to comprehend the metabolism recension throughout pregnancy as well as its impact both on foetus and mother, thus decreasing the risk of complications during pregnancy. The tasks of the research were to study T1DM practice and interconnectedness of HbA1c level and pregnancy result as well as to study the possible metabolic compensations involving complications in each pregnancy trimester and postnatal period, in addition, to clarify pregnant women weight impact on the result of pregnancy. The aim of the research was to analyze the T1DM complications of pregnant women and neonates. Materials and methods: the retrospective research has been accomplished by interviewing 34 patients being pregnant from 2013 – 2017 and procreating in Pauls Stradinsh Clinical University hospital. SpSS Statistics 24 and Excel 2010 was used to analyze the data. The most significant results: the women having information about the T1DM and pregnancy, diabetes practice has been made 2,74 times on average in comparison with the women not having sufficient information – 1,27 times, p=0,004. Analyzing HbA1c before pregnancy depending on the practice times, the negative average correlation is observed – the more frequent practices, the less HbA1c before pregnancy (r=–0,537,p=0,001). The women with planless pregnancy, the average HbA1c before pregnancy was 8,21%, conversely, the women planning pregnancy, HbA1c 7,34%, p>0,05. The average HbA1c was 8,46% for the women with acute infectious disease throughout pregnancy, however, women without diseases – 7,17% before pregnancy, p=0,019. Positive average correlation is observed between the weight before pregnancy and HbA1c before pregnancy (r=0,493; p=0,003). The women with hypertension throughout pregnancy had the average weight 70,6 kg, in comparison with the ones without hypertension – 61,3 kg, p=0,006. The patients’ weight whose neonates had hypoglycaemia, increased to 20,38 kg on average, but the patients’ weight whose neonates did not have hypoglycaemia, increased to 14,23 kg, p=0,02. Conclusions: The women having sufficient information about the T1DM and pregnancy had diabetes practice more frequently. The results prove that practice frequency correlates with lower HbA1c before pregnancy. The average HbA1c is higher in case of planless pregnancy in comparison with the planned one. The increased HbA1c level in the beginning of pregnancy maximizes the possibility of acute infections. Higher body weight before pregnancy positively correlates with HbA1c, hypertension, neonate hypoglycaemia.
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Keywords
Medicīna , Pirmā tipa cukura diabēts , 1. tipa CD , grūtniecība , CD , insulīns