بررسی پیامد بارداری در مادران مبتلا به دیابت حاملگی با و بدون سابقه‌ی ابتلا به سندرم تخمدان پلی‌کیستیک

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 مربی، گروه پرستاری، دانشکده‌ی علوم پزشکی شوشتر، شوشتر، ایران

2 گروه پرستاری، دانشکده‌ی پرستاری- مامایی، دانشگاه جندی‌شاپور اهواز، اهواز، ایران

3 استادیار، مرکز تحقیقات دیابت، پژوهشکده‌ی سلامت، دانشگاه علوم پزشکی جندی‌شاپور اهواز، اهواز، ایران

4 دانشجو، گروه پرستاری، کمیته‌ی تحقیقات دانشجویی، دانشکده‌ی علوم پزشکی شوشتر، شوشتر، ایران

5 مربی، گروه بهداشت، دانشکده‌ی علوم پزشکی شوشتر، شوشتر، ایران

چکیده

مقدمه: دیابت بارداری و سندرم تخمدان پلی‌کیستیک (Polycystic ovary syndrome یا PCOS)، شایع‌ترین اختلال در دوران باروری است که موجب بروز عوارض در مادر و جنین می‌گردد. هدف از انجام این مطالعه، تعیین عوارض مادری و نوزادی در مادران مبتلا به دیابت حاملگی با و بدون سابقه‌ی ابتلا به (PCOS) بود.روش‌ها: این مطالعه، یک مطالعه‌ی مورد- شاهدی بود که طی آن، 134 زن باردار مبتلا به دیابت حاملگی با یا بدون سابقه‌ی ابتلا به PCOS بستری در بخش زایمان بیمارستان امام خمینی اهواز طی سال‌های 96-1395 انتخاب و به دو گروه 67 نفر مورد (با سابقه‌ی ابتلا به PCOS) و شاهد تقسیم شدند. اطلاعات مورد نیاز شامل اطلاعات جمعیت‌شناختی، عوارض مادری (پره‌اکلامپسی، پارگی کیسه‌ی آمنیوتیک، آب‌ریزش و غیره) و نوزادی (کاهش رشد داخل رحمی، بستری در Neonatal intensive care unit یا NICU) از پرونده‌ها استخراج و در پرسش‌نامه‌ها ثبت شد. جهت تجزیه و تحلیل داده‌ها، از آزمون‌های آماری با نرم‌افزار SPSS استفاده شد.یافته‌ها: از بین پیامدهای بارداری در زمینه‌ی نوزاد، کاهش رشد جنین در داخل رحم (360/0 = P) و بستری در بخش NICU (473/0 = P) و در زمینه‌ی مادر نیز پارگی زودرس کیسه‌ی آمنیوتیک (530/0 = P) و آب‌ریزش (610/0 = P) در دو گروه مورد و شاهد تفاوت آماری معنی‌داری نداشت، اما از نظر پره‌اکلامپسی بین دو گروه تفاوت آماری معنی‌داری دیده شد (001/0 > P). با استفاده مدل Logistic regression، متغیرهای وزن مادر (007/0 = P)، سابقه‌ی دیابت بارداری (018/0 = P) و سن مادر (040/0 = P) توانستند حدود 25 درصد از متغیر وابسته را پیش‌بینی کنند.نتیجه‌گیری: نتایج، نشان دهنده‌ی تأثیر سابقه‌ی ابتلا به PCOS در حضور Gestational diabetes mellitus (GDM) در ایجاد عارضه‌ی پره‌اکلامپسی، زایمان زودرس و افزایش زایمان سزارین در مادران است، اما این سندرم، بر سایر عوارض مادری و نوزادی مورد مطالعه بی‌تأثیر است.

کلیدواژه‌ها

عنوان مقاله [English]

Pregnancy Outcomes in Mothers with Gestational Diabetes Mellitus with and without Polycystic Ovary Syndrome

نویسندگان [English]

  • Akram Hemmatipour 1
  • Seyedeh Mina Shafiee 2
  • Shahram Baraz 3
  • Shaghayegh Edivandi 4
  • Syed Ali Mosavi 5
1 Instructor, Department of Nursing, Shoushtar University of Medical Sciences, Shoushtar, Iran
2 Department of Nursing, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
3 Assistant Professor, Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4 Student, Department of Nursing, Student Research Committee, Shoushtar University of Medical Sciences, Shoushtar, Iran
5 Instructor, Department of Health, Shoushtar University of Medical Sciences, Shoushtar, Iran
چکیده [English]

Background: Gestational diabetes mellitus and polycystic ovary syndrome (PCOS) are the most common disorders during fertility period, which causes complications in mother and fetus. The purpose of this study was to determine the maternal and neonatal complications in mothers with gestational diabetes mellitus (GDM) with and without PCOS.Methods: This was a case-control study on 134 pregnant women with gestational diabetes mellitus in Imam hospital, Ahvaz, Iran during the years 2016-2017 were selected and divided into two groups of 67 cases with or without PCOS. Required information including demographic information, and maternal (preeclampsia, amniotic membrane rupture, runny nose, and others) and infant [intrauterine growth retardation, and hospitalization in neonatal intensive care unit (NICU)] complications were extracted from the records and recorded in questionnaires. Data were analyzed using SPSS software.Findings: Among the complications of pregnancy, there was no significant difference between the case and control groups in cases the growth of the fetus in the uterus (P = 0.360) and hospitalization in NICU (P = 0.473) in neonates, and premature rupture of the amniotic sac (P = 0.530), waterlogging (P = 0.610) in mothers. However, there was a significant difference in preeclampsia between the two groups (P < 0.001). Using logistic regression model, maternal weight variables (P = 0.007), gestational diabetes mellitus (P = 0.018), and maternal age (P = 0.040) were able to predict approximately 25% of dependent variables.Conclusion: The results of this study indicate that the PCOS in presence of gestational diabetes mellitus has role in preeclampsia, preterm delivery, and cesarean delivery is mothers, but does not affect other maternal and neonatal complications.

کلیدواژه‌ها [English]

  • Polycystic ovary syndrome
  • Gestational diabetes
  • Pregnancy complications

مراجع

  1. Nivedhitha V, Sankareswari R. Pregnancy outcome in women with polycystic ovary syndrome. Int J Reprod Contracept Obstet Gynecol 2017; 4(4): 1169-75.
  2. Heald AH, Livingston M, Holland D, Robinson J, Moreno GY, Donnahey G, et al. Polycystic ovarian syndrome: Assessment of approaches to diagnosis and cardiometabolic monitoring in UK primary care. Int J Clin Pract 2018; 72(1).
  3. Rohani M, Badiee Aval S, Taghipour A, Amirian M, Hamedi SS, Tavakkoli M, et al. Diagnostic model in polycystic ovarian syndrome based on traditional Iranian medicine and common medicine. Iran J Obstet Gynecol Infertil 2017; 20: 35-45. [In Persian].
  4. Mirghafourvand M, Mohammad-Alizadeh Charandabi S, Behroozi lak T, Aliasghari F. Assessment of health promoting lifestyle status and its socio-demographic predictors in women with polycystic ovarian syndrome. Hayat 2017; 22(4): 394-407. [In Persian].
  5. Akhtari E, Mokaberinejad R, Tajadini H. Treatment of menstrual disorder, depression and sexual dysfunction in a 27-year-old woman with polycystic ovary syndrome based on Iranian traditional medicine. Asian Journal of Clinical Case Reports for Traditional and Alternative Medicine 2017; 1(1): 43-50.
  6. Fulghesu AM, Porru C, Canu E. Diagnosis of polycystic ovarian syndrome in adolescence. In: Fulghesu AM, editor. Good practice in pediatric and adolescent gynecology. New York, NY: Springer; 2018. p. 143-59.
  7. McDonnell R, Hart RJ. Pregnancy-related outcomes for women with polycystic ovary syndrome. Womens Health (Lond) 2017; 13(3): 89-97.
  8. Yazdani S, Bouzari ZS, Esmailzadeh S, Navayi S. Investigating the relationship between pregnancy complications and polycystic ovary syndrome. Iran J Obstet Gynecol Infertil 2014; 16(89): 1-7. [In Persian].
  9. Boomsma CM, Fauser BC, Macklon NS. Pregnancy complications in women with polycystic ovary syndrome. Semin Reprod Med 2008; 26(1): 72-84.
  10. Yang HL, Zhou WJ, Gu CJ, Meng YH, Shao J, Li DJ, et al. Pleiotropic roles of melatonin in endometriosis, recurrent spontaneous abortion, and polycystic ovary syndrome. Am J Reprod Immunol 2018; 80(1): e12839.
  11. Dargham SR, Shewehy AE, Dakroury Y, Kilpatrick ES, Atkin SL. Prediabetes and diabetes in a cohort of Qatari women screened for polycystic ovary syndrome. Sci Rep 2018; 8(1): 3619.
  12. Muller PS, Nirmala M. Effects of pre-pregnancy maternal body mass index on gestational diabetes mellitus. International Journal of Engineering and Technology 2018; 7(1.9): 279-82.
  13. Ibanez L, Jaramillo AM, Ferrer A, de Zegher F. High neutrophil count in girls and women with hyperinsulinaemic hyperandrogenism: Normalization with metformin and flutamide overcomes the aggravation by oral contraception. Hum Reprod 2005; 20(9): 2457-62.
  14. Rahimi M, Karami Moghadam F. The prevalence of gestational diabetes mellitus and its related risk factors using one-step method in Kermanshah, 2016. Iran J Obstet Gynecol Infertil 2017; 20(4): 1-4. [In Persian].
  15. Sharifi N, Dolatian M, Mahmoodi Z, Mohammadi Nasrabadi F. Gestational diabetes and its relationship with social determinants of health according to World Health Organization Model: Systematic Review. Iran J Obstet Gynecol Infertil 2017; 19(40): 6-18. [In Persian].
  16. Vakili M, Modaressi M, Zahabi R, Aghakoochak A. Prevalence of gestational diabetes and its risk factors in Meibod-Yazd 2013-2014. Journal of Community Health Research 2016; 5(4): 270-8.
  17. Badakhsh M, Shahdadi H, Amirshahi M, Hashemi Benjar Z. Evaluation of maternal and fetal complications in healthy and diabetic pregnant women. J Diabetes Nurs 2016; 4(2): 79-88. [In Persian].
  18. Jamshidpour M, Izadi N, Najafi F, Khamoshi F, Roustaei Shirdel A, Jalili K. Maternal mortality rate and causes in Kermanshah Province (2001-2012). J Kermanshah Univ Med Sci 2014; 18(7): 409-15. [In Persian].
  19. Xu X, Liu Y, Liu D, Li X, Rao Y, Sharma M, et al. Prevalence and determinants of gestational diabetes mellitus: A cross-sectional study in China. Int J Environ Res Public Health 2017; 14(12).
  20. Glueck CJ, Wang P, Kobayashi S, Phillips H, Sieve-Smith L. Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril 2002; 77(3): 520-5.
  21. Yu HF, Chen HS, Rao DP, Gong J. Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2016; 95(51): e4863.
  22. Foroozanfard F, Moosavi SG, Mansouri F, Bazarganipour F. Obstetric and neonatal outcome in PCOS with gestational diabetes mellitus. J Family Reprod Health 2014; 8(1): 7-12.
  23. Wang Y, Zhao X, Zhao H, Ding H, Tan J, Chen J, et al. Risks for gestational diabetes mellitus and pregnancy-induced hypertension are increased in polycystic ovary syndrome. Biomed Res Int 2013; 2013: 182582.
  24. Mikola M, Hiilesmaa V, Halttunen M, Suhonen L, Tiitinen A. Obstetric outcome in women with polycystic ovarian syndrome. Hum Reprod 2001; 16(2): 226-9.
  25. Joffe GM, Esterlitz JR, Levine RJ, Clemens JD, Ewell MG, Sibai BM, et al. The relationship between abnormal glucose tolerance and hypertensive disorders of pregnancy in healthy nulliparous women. Calcium for Preeclampsia Prevention (CPEP) Study Group. Am J Obstet Gynecol 1998; 179(4): 1032-7.
  26. Anderson H, Fogel N, Grebe SK, Singh RJ, Taylor RL, Dunaif A. Infants of women with polycystic ovary syndrome have lower cord blood androstenedione and estradiol levels. J Clin Endocrinol Metab 2010; 95(5): 2180-6.
  27. Wang T, Fu H, Chen L, Xu Y. Pregnancy complications among women with polycystic ovary syndrome in China: a Meta-analysis. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2017; 42(11): 1300-10. [In Chinese].
  28. Koivunen RM, Juutinen J, Vauhkonen I, Morin-Papunen LC, Ruokonen A, Tapanainen JS. Metabolic and steroidogenic alterations related to increased frequency of polycystic ovaries in women with a history of gestational diabetes. J Clin Endocrinol Metab 2001; 86(6): 2591-9.
  29. Katulski K, Czyzyk A, Podfigurna-Stopa A, Genazzani AR, Meczekalski B. Pregnancy complications in polycystic ovary syndrome patients. Gynecol Endocrinol 2015; 31(2): 87-91.
  30. Cho GJ, Kim LY, Min KJ, Sung YN, Hong SC, Oh MJ, et al. Prior cesarean section is associated with increased preeclampsia risk in a subsequent pregnancy. BMC Pregnancy Childbirth 2015; 15: 24.
  31. Trogstad L, Magnus P, Skjaerven R, Stoltenberg C. Previous abortions and risk of pre-eclampsia. Int J Epidemiol 2008; 37(6): 1333-40.
مجله دانشکده پزشکی اصفهان
دوره 36، شماره 497 - شماره پیاپی 497
آذر و دی 1397
صفحه 1142-1148

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سابقه مقاله

  • تاریخ دریافت: 21 شهریور 1397
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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