بررسی پیامد نوزادی پره اکلامپسی در زنان باردار با و بدون ابتلاء به دیابت حاملگی همراه با سندرم تخمدان پلی‌کیستیک

نوع مقاله: اصیل پژوهشی

نویسندگان

1 کارشناس ارشد پرستاری، دانشکده علوم پزشکی شوشتر، شوشتر، ایران.

2 کارشناس ارشد آمار زیستی، دانشکده علوم پزشکی شوشتر، شوشتر، ایران.

3 دانشجوی کارشناسی مامایی، کمیته تحقیقات دانشجویی، دانشکده علوم پزشکی شوشتر، شوشتر، ایران.

چکیده

ﻣﻘﺪﻣﻪ: دﻳﺎبت بارداری، ﺷﺎﻳﻊ‌ﺗﺮﻳﻦ اﺧﺘﻼل ﻣﺘﺎﺑﻮﻟﻴﻚ و PCO از مهم‌ترین علل ناباروری در دوران بارداری اﺳﺖ ﻛﻪ به همراه پره‌اکلامپسی با عوارض متعددی برای مادر و جنین همراه هستند. با توجه به عوارض این اختلالات، مطالعه حاضر با هدف تعیین تأثیر پیامد پره‌اکلامپسی در زنان مبتلا به دیابت بارداری و سندرم تخمدان پلی‌کیستیک در بیمارستان الهادی شوشتر انجام شد.
روش‌ﻛﺎر: این مطالعه مورد- شاهدی بر روی 152 زن باردار مبتلا به پره‌اکلامپسی که طی سال‌های 96-1395 در بخش زایمان بیمارستان الهادی شهرستان شوشتر بستری بودند، انجام شد. افراد بر اساس ابتلاء یا عدم ابتلاء به دیابت حاملگی همراه با PCO به دو گروه 76 نفره مورد و شاهد تقسیم شدند. داده‌های مربوط به هدف مطالعه از پرونده بیماران استخراج و در پرسشنامه ثبت گردید. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 16) و آزمون‌های کولموگروف- اسمیرنوف، تی مستقل، آزمون کای دو انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: بر اساس نتایج مطالعه، بین دو گروه مورد و شاهد از نظر سابقه PCO، سابقه نازایی، سابقه دیابت بارداری، سابقه پره‌اکلامپسی و شاخص توده بدنی تفاوت معناداری وجود داشت (001/0p<). از بین عوارض نوزادی، کاهش رشد داخل رحمی بین گروه‌ها تفاوت معناداری داشت (03/0=‌p)؛ به‌طوری‌که نسبت ابتلاء نوزادان به کاهش رشد داخل رحم در گروه مورد 1/2 برابر گروه شاهد بود (46/2-76/1: CI، 2/1=OR)، اما بین تعداد سقط، تعداد بارداری، آپگار و وزن نوزاد و بستری در NICU تفاوت معناداری بین دو گروه وجود نداشت (05/0‌<p).
ﻧﺘﻴﺠﻪ‌ﮔﻴﺮی: دیابت بارداری و سندرم تخمدان پلی‌کیستیک در حضور پره اکلامپسی به‌طور معناداری با کاهش رشد داخل رحمی نوزادان همراه است.

کلیدواژه‌ها


عنوان مقاله [English]

Preeclampsia Neonatal Outcome in Pregnant Women with and without Gestational Diabetes Mellitus and Polycystic Ovary Syndrome

نویسندگان [English]

  • Akram Hemmatipur 1
  • Azam Jahangiri Mehr 2
  • Elham Touriaie 3
  • Masoumeh Salehi Kombu 1
1 M.Sc. in Nursing, Shoushtar School of Medical Sciences, Shoushtar, Iran.
2 M.Sc. in Biostatistics, Shoushtar School of Medical Sciences, Shoushtar, Iran.
3 B.Sc. Student of Midwifery, Student Research Committee, Shoushtar School of Medical Sciences, Shoushtar, Iran.
چکیده [English]

Introduction: Gestational diabetes mellitus is the most common metabolic disorder. Polycystic ovary syndrome (PCO) is one of the most important causes of infertility during the fertility period, resulting in preeclampsia and many maternal and fetal complications.
Methods: This case-control study was conducted on 152 pregnant women with preeclampsia admitted to the Maternity Ward of Shoushtar Al-Hadi Hospital in 2016-2017. The study population was assigned of case (n=76) and control (n=76) based on infliction with gestational diabetes mellitus and PCO. Data analysis was performed in SPSS (version 16) using Kolmogorov–Smirnov test, independent t-test, and Chi-square test. P-value less than 0.05 was considered statistically significant.
Results: The mean ages of the mothers and pregnancy termination were 31±6 years and 34±5.02 months, respectively. There was a statistically significant difference between the two groups in terms of the history of PCO, infertility, gestational diabetes, and preeclampsia, as well as, body mass index (P<0.001). Among the neonatal complications, the two groups were significantly different regarding the decreased intrauterine growth (P=0.03). In this regard, the ratio of decreased intrauterine growth was 2.1 times higher in the case group, compared to that in the control group (OR: -1.2, CI: 1.76-2.46).
Conclusion: Gestational diabetes mellitus and polycystic ovarian syndrome in the presence of preeclampsia are associated with a significant reduction in fetal intrauterine growth.

کلیدواژه‌ها [English]

  • Polycystic ovary syndrome
  • Gestational Diabetes Mellitus
  • Preeclampsia
  • Neonatal complications
  1. Momeni Javid F, Simbar M, Dolatian M, Alavi Majd H. Comparison of lifestyles of women with gestational diabetes and healthy pregnant women. Global J Health Sci 2015; 7(2):162-9.
  2. Fekrat M, Kashanian M, Jahanpour J. Risk factors in women with gestational diabetes mellitus. Razi J Med Sci 2004; 11(43):815-20.
  3. Cosson E, Carbillon L, Valensi P. High fasting plasma glucose during early pregnancy: a review about early gestational diabetes mellitus. J Diabetes Res 2017; 2017:891712.
  4. 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. (Persian).
  5. Vakili M, Modaressi M, Zahabi R, Aghakoochak A. Prevalence of gestational diabetes and its risk factors in meibod-Yazd 2013-2014. J Community Health Res 2016; 5(4):270-8.
  6. Sharifi N, Dolatian M, Mahmoodi Z, Nasrabadi FM. 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. (Persian).
  7. Ros HS, Cnattingius S, Lipworth L. Comparison of risk factors for preeclampsia and gestational hypertension in a population-based cohort study. Am J Epidemiol 1998; 147(11):1062-70.
  8. Badakhsh M, Shahdadi H, Amirshahi M, Hashemi BZ. Evaluation of maternal and fetal complications in healthy and diabetic pregnant women. J Diabetes Nurs 2016; 4(2):79-88. (Persian).
  9. Kakoly NS, Earnest A, Moran LJ, Teede HJ, Joham AE. Group-based developmental BMI trajectories, polycystic ovary syndrome, and gestational diabetes: a community-based longitudinal study. BMC Med 2017; 15(1):195.
  10. Nikbakht R, Zargar M, Barekati Z, Jafari RM, Shahbazian N, Barati M. Adverse pregnancy and neonatal outcomes in polycystic ovary syndrome women. Tehran Univ Med J 2016; 73(11):827-31.
  11. Nivedhitha VS, Sankareswari R. Pregnancy outcome in women with polycystic ovary syndrome. Int J Reprod Contracept Obstet Gynecol 2017; 4(4):1169-75.
  12. Ziaie T, Rahebi SM, Rafat F, Savadzadeh S. The prevalence of polycystic ovaries in infertility by laparoscopy‎. J Holist Nurs Midwifery 2013; 23(1):38-44.
  13. Tehrani FR, Simbar M, Tohidi M, Hosseinpanah F, Azizi F. The prevalence of polycystic ovary syndrome in a community sample of Iranian population: Iranian PCOS prevalence study. Reprod Biol Endocrinol 2011; 9(1):39.
  14. 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 J Clin Case Rep Tradit Alternat Med 2017; 1(1):43-50.
  15. Mirghafourvand M, Mohammad-Alizadeh Charandabi S, 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. (Persian).
  16. Nazari T, Karimiyan Z, Nazari Z. Assessment of effect of glucose tolerance in pregnancy outcome in patients with polycystic ovarian syndrome. Iran J Obstet Gynecol Infertil 2006; 9(2):97-103. (Persian).
  17. 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.
  18. 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.
  19. 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 2016; 95(51):e4863.
  20. Gholami R, Nahidi F. Investigation of relationship between husband's occupation and preeclampsia in pregnant women admitted to selected hospitals in Tehran, 2011. J Sabzevar Univ Med Sci 2014; 20(4):10. (Persian).
  21. Vestgaard M, Sommer MC, Ringholm L, Damm P, Mathiesen ER. Prediction of preeclampsia in type 1 diabetes in early pregnancy by clinical predictors: a systematic review. J Matern Fetal Neonatal Med 2017; 31(14):1933-9.
  22. English FA, Kenny LC, McCarthy FP. Risk factors and effective management of preeclampsia. Integr Blood Press Control 2015; 8:7-12.
  23. Voto LS, Lapidus M, Margulies M. Effects of preeclampsia on mother, fetus and child. Gynaecol Forum 1999; 4:25-7.
  24. Safary M. Prevalence of preeclampsia and its correlation to maternal and fetal complications in women referred to Emam Sajjad Hospital of Yasuj. Armaghan Danesh 2001; 6(24):28-34. (Persian).
  25. Engeland A, Bjørge T, Daltveit AK, Skurtveit S, Vangen S, Vollset SE, et al. Risk of diabetes after gestational diabetes and preeclampsia. A registry-based study of 230,000 women in Norway. Eur J Epidemiol 2011; 26(2):157-63.
  26. Erez O, Vardi IS, Hallak M, Hershkovitz R, Dukler D, Mazor M. Preeclampsia in twin gestations: association with IVF treatments, parity and maternal age. J Matern Fetal Neonatal Med 2006; 19(3):141-6.
  27. Naver KV, Grinsted J, Larsen SO, Hedley PL, Jørgensen FS, Christiansen M, et al. Increased risk of preterm delivery and pre‐eclampsia in women with polycystic ovary syndrome and hyperandrogenaemia. BJOG 2014; 121(5):575-81.
  28. Boomsma CM, Eijkemans MJ, Hughes EG, Visser GH, Fauser BC, Macklon NS. A meta-analysis of pregnancy outcomes in women with polycystic ovary syndrome. Hum Reprod Update 2006; 12(6):673-83.
  29. Ai J, Esfandiari N, Casper R. The relationship between preeclampsia and polycystic ovarian syndrome is not affected by obesity. Cell J 2009; 11(1):64.
  30. 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. (Persian).
  31. Haakova L, Cibula D, Rezabek K, Hill M, Fanta M, Zivny J. Pregnancy outcome in women with PCOS and in controls matched by age and weight. Hum Reprod 2003; 18(7):1438-41.
  32. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005; 330(7491):565.
  33. Sharemi SH, Milani F, Zahiri Z, Zendedel M, Salamat F, Rafipour B, et al. Comparison of pre-eclampsia risk factors regarding to its severity in pregnant women referred to Alzahra hospital of Rasht, Iran, 2012. Iran J Obstet Gynecol Infertil 2013; 16(69):1-8. (Persian).
  34. Kashanian M, Baradaran HR, Bahasadri S, Alimohammadi R. Risk factors for pre-eclampsia: a study in Tehran, Iran. Arch Iran Med 2011; 14(6):412.
  35. Shahidifar S, Sharifnia H, Taghipoor B, Hekmat Afshar M, Motevalli R, Khalili Y. Association between seasonal pattern and preeclampsia. Iran J Obstet Gynecol Infertil 2014; 17(125):8-14. (Persian).
  36. Wendland EM, Duncan BB, Belizán JM, Vigo A, Schmidt MI. Gestational diabetes and pre-eclampsia: common antecedents? Arq Bras Endocrinol Metabol 2008; 52(6):975-84.
  37. Lee J, Ouh YT, Ahn KH, Hong SC, Oh MJ, Kim HJ, et al. Preeclampsia: a risk factor for gestational diabetes mellitus in subsequent pregnancy. PloS One 2017; 12(5):e0178150.
  38. Xiong X, Demianczuk NN, Saunders LD, Wang FL, Fraser WD. Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol 2002; 155(3):203-9.
  39. 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(1):24.
  40. Wataganara T, Boriboonhirunsarn D, Titapant V, Kanokpongsakdi S, Sunsaneevithayakul P, Vantanasiri C. Maternal body mass index at term does not predict the severity of preeclampsia. Med J Med Assoc Thai 2008; 91(8):1166-71.
  41. Xiong X, Fraser WD, Demianczuk NN. History of abortion, preterm, term birth, and risk of preeclampsia: a population-based study. Am J Obstet Gynecol 2002; 187(4):1013-8.
  42. Mohammadi S, Pazhohideh SZ, Abedi P, Maraqi E. Evaluation of risk factors in preeclamptic patients admitted to 22 Bahman hospital of Masjed Soleiman 2006-2010. Iran J Obstet Gynecol Infertil 2012; 15(16):20-8. (Persian).
  43. Trogstad L, Magnus P, Skjærven R, Stoltenberg C. Previous abortions and risk of pre-eclampsia. Int J Epidemiol 2008; 37(6):1333-40.
  44. Tessema GA, Tekeste A, Ayele TA. Preeclampsia and associated factors among pregnant women attending antenatal care in Dessie referral hospital, Northeast Ethiopia: a hospital-based study. BMC Pregnancy Childbirth 2015; 15(1):73.
  45. Ray JG, Wanigaratne S, Park AL, Bartsch E, Dzakpasu S, Urquia ML. Preterm preeclampsia in relation to country of birth. J Perinatol 2016; 36(9):718-22.
  46. Fox NS, Saltzman DH, Oppal S, Klauser CK, Gupta S, Rebarber A. The relationship between preeclampsia and intrauterine growth restriction in twin pregnancies. Am J Obstet Gynecol 2014; 211(4):422.e1-5.
  47. Friedman SA, Schiff E, Kao L, Sibai BM. Neonatal outcome after preterm delivery for preeclampsia. Am J Obstet Gynecol 1995; 172(6):1785-8.
  48. 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.
  49. Schneider S, Freerksen N, Maul H, Roehrig S, Fischer B, Hoeft B. Risk groups and maternal-neonatal complications of preeclampsia–current results from the national German Perinatal Quality Registry. J Perinat Med 2011; 39(3):257-65.
  50. Saadat M, Nejad SM, Habibi G, Sheikhvatan M. Maternal and neonatal outcomes in women with preeclampsia. Taiwan J Obstet Gynecol 2007; 46(3):255-9.