| Abstract | Ustroj istraživanja: Retrospektivno istraživanje.
Mjesto istraživanja: Klinika za ženske bolesti i porode KBC-a Split.
Sudionici: Sve trudnice sa dijabetes melitusom ovisnim o inzulinu koje su rodile od prosinca 2009. do prosinca 2015. godine, uključujući i one dijagnosticirane u 2015. godini koje su rodile početkom 2016. godine. Iz istraživanja su isključene sve višeplodove trudnoće, mrtvorođena i malformirana novorođenčad, te one žene koje su bile hospitalizirane, ali nisu rodile u Klinici.
Glavne mjere ishoda: Ispitali smo učestalost i čimbenike rađanja trudnica sa dijabetes melitusom ovisnim o inzulinu koji su uključivali: povezanost pariteta i životne dobi majki, osnovna antropometrijska obilježja novorođenčadi, dob trudnoće, način rađanja, učestalost carskog reza i indukcije porođaja Prepidil gelom te pojavnost mekonijske plodove vode i prisutnost osobe u pratnji na porođaju.
Rezultati: U Klinici je analizirano 70 trudnoća i porođaja sa šećernom bolešću tipa 1, što je sačinjavalo 0.2% ukupnih poroda. Rodilje sa DM tipom 1 su bile u prosjeku godinu dana starije od kontrole (30.7 vs. 29.4), što nije statistički značajna razlika (t=1.5, P=0.13). Nije zamijećena niti statstički značajna razlika među skupinama u odnosu na paritet (χ²=2.8, P=0.09), prezentaciju (χ²=0.08, P=0.77) i spol (χ²=2.85, P=0.09). Novorođenčad majki sa šećernom bolešću tipa 1 bila su statistički značajno teža od kontrolne skupine (t=2.2, P=0.03), češće su bila hipertrofična (χ²=9.4, P=0.002) i makrosomna (χ²=4.1, P=0.03). Ako makrosomiju definiramo kao tjelesnu masu veću od 4500 g, u ispitivanoj skupini je također bilo statistički značajno više takve djece (χ²=5.2, P=0.02). Duljina i ponderalni indeks novorođenčadi nisu se statistički značajno razlikovali među skupinama. Nije zamijećena niti značajna razlika u učestalosti prijevremenih porođaja i gestacijske hipertenzije. Prosječna dob trudnoće u trenutku porođaja statistički se značajno razlikovala (t=3.6, P=0.004) te je u ispitivanoj skupini iznosila 37.9, a u kontrolnoj 38.8 tjedana. Porođaja u periodu od 37. do 39. tjedna trudnoće je bilo 84.3%, statistički značajno više u ispitivanoj skupini (χ²=11.3, P=0.001). Učestalost epiziotomije bila je približno jednaka u ispitivanoj skupini. Učestalost dovršenja trudnoće carskim rezom iznosila je 61.4%, što je statistički značajno više nego u kontrolnoj skupini (χ²=11.4, P=0.001). Učestalost prethodnih carskih rezova i korištenja epiduralne anestezije nisu se statistički značajno razlikovale među skupinama. Prepidil gel češće je korišten u ispitivanoj skupini (10% vs. 4.3%), ali bez statistički značajne razlike. Broj slučajeva pojave mekonijske plodove vode i pupkovine omotane oko vrata nisu se značajno razlikovali među skupinama. Pratnja je rjeđe bila prisutna u ispitivanoj skupini (8.6% vs. 15.7%), ali također bez statistički značajne razlike.
Zaključak: Dijabetes melitus ovisan o inzulinu predstavlja značajan čimbenik perinatalnog ishoda. Mogući problemi ne prestaju prilikom porođaja, već mogu pratiti dijete tijekom života, a pogoršati postojeće majčine komplikacije, što ovoj bolesti daje još veću važnost i ukazuje na potrebu multidisciplinarnog pristupa. |
| Abstract (english) | Study design: Retrospective study.
Study location: Department of Obstetrics and Gynecology, University hospital Split.
Participants: The study included all pregnant women with insulin-dependent diabetes mellitus who delivered newborns between December 2009 and December 2015, including ones diagnosed in 2015, who delivered in 2016. Multiple pregnancies, stillbirths and newborns with malformations were excluded, and women who were hospitalised at the Clinic but didn't deliver at the Clinic.
Main outcome measures: We examined the incidence and the factors of birth of newborns who's mothers had insulin-dependent diabetes mellitus that included: the connection between age and parity of mothers, the basic anthropometric characteristics of the newborns, age, pregnancy, birth method, the incidence of c-section, induction of childbirth Prepidil gel, occurrence of meconium amniotic fluid and the presence of accompaniment in childbirth.
Results: At the Clinic 70 pregnancies and deliveries were analised, which makes 0.2% of all deliveries. Women with IDDM were in general one year older than those in the control group (30.7 vs. 29.4), but this is not statistically significant (t=1.5, P=0.13). There was no statistical significance in parity (χ²=2.8, P=0.09), fetal presentation (χ²=0.08, P=0.77) or gender (χ²=2.85, P=0.09) between two groups. Newborns who's mothers had diabetes type 1 were statistically heavier (t=2.2, P=0.03), were more frequent hypertrophic (χ²=9.4, P=0.002) and macrosomic (χ²=4.1, P=0.03). If we define fetal macrosomy as fetal weight above 4500 grams, macrosomic newborns were also statistically more frequent in the IDDM group (χ²=5.2, P=0.02). Fetal length and ponderal index showed no significant difference between two groups, as well as the share in preterm deliveries and gestational hypertension. Gestational age was statistically lower (t=3.6, P=0.004) and was 37.9 weeks, compared to 38.8 weeks in the control group. From 37. to 39. gestational week, 84.3% women gave birth, which was statistically much more than in the control group (χ²=11.3, P=0.001). Frequency of episiotomy was similar in two groups. Cesarean delivery was used in 61.4% cases, which is statistically significant compared to the control group (χ²=11.4, P=0.001). There was no statistically significant difference in previous cases of cesarean delivery or the frequency of using epidural anesthesia between two groups. Prepidil gel was more often used in delivery of women with IDDM (10% vs. 4.3%), but without statistically significant difference. There was no statistical difference between groups in occurence of meconium amniotic fluid or umbilical cord wrapped around newborn's neck. Accompaniment during delivery was less present in women with type 1 diabetes, but with no statistically significant difference.
Conclusion: Insulin-dependent diabetes mellitus is a significant factor for perinatal outcomes. Possible problems do not stop after childbirth, can already follow the child throughout life, and worsen the existing maternal complications, as this disease gives even greater importance and shows a need for multidisciplinary approach. |
