تأثیر کپسول پروبیوتیک بر پیشگیری از دیابت بارداری در زنان باردار پره‌دیابتیک پرخطر

نوع مقاله: اصیل پژوهشی

نویسندگان

1 کارشناس ارشد آموزش مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 استادیار گروه مامایی، مرکز تحقیقات مراقبت‌های پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

3 استادیار گروه مامایی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

4 استاد گروه اپیدمیولوژی و آمار زیستی، دانشکده بهداشت، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

5 استاد گروه داروسازی سنتی، دانشکده داروسازی، دانشگاه علوم پزشکی مشهد، مشهد، مشهد، ایران.

6 استاد گروه زنان و مامایی، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، مشهد، ایران.

10.22038/ijogi.2020.15964

چکیده

مقدمه: دیابت باردای، شایع‌ترین عارضه طبی در بارداری است. از آنجایی‌که پروبیوتیک‌ها، میکروارگانیسم‌های زنده هستند که با اثر بر روی فلور میکروبی روده باعث تأثیر بر متابولیسم گلوکز می‌شوند، لذا مطالعه حاضر با هدف تعیین تأثیر کپسول پروبیوتیک بر پیشگیری از دیابت بارداری در زنان پره‌دیابتیک پرخطر انجام شد.
روش‌کار: این مطالعه کارآزمایی بالینی تصادفی دو‌سوکور در سال 1397 بر روی 255 زن باردار پره‌دیابتیک پرخطر واجد شرایط در مراکز بهداشتی درمانی تحت پوشش مرکز بهداشت شماره 2 مشهد انجام شد. در گروه پروبیوتیک و گروه دارونما علاوه ‌بر مراقبت معمول، به‌ترتیب روزانه یک عدد کپسول پروبیوتیک و دارونما از 16-14 هفته بارداری به‌مدت 12 هفته تجویز شد. تست تحمل گلوکز (OGTT) در هفته 28-26 بارداری انجام شد. ابزارهای پژوهش شامل فرم اطلاعات فردی- مامایی، چک‌لیست آزمایشات غربالگری دیابت بارداری، چک‌لیست مصرف دارو، فرم معاینه و فرم رضایت‌مندی بود. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 22) و آزمون‌های آماری کای‌دو، کراسکال والیس، آنالیز واریانس یک‌طرفه و من‌ویتنی انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: در گروه کپسول پروبیوتیک 21 نفر (3/26%)، در گروه دارونما 49 نفر (8/59%) و در گروه کنترل 55 نفر (1/67%) مبتلا به دیابت بارداری شدند (001/0p<). دیابت بارداری در گروه مداخله کمتر از گروه دارونما و کنترل بود. بر اساس نتایج آزمون کای‌ دو پیرسون در مقایسه دوبه‌دوی گروه‌ها، دیابت بارداری بین گروه پروبیوتیک با دارونما (001/0p<) و گروه پروبیوتیک با کنترل (001/0p<) اختلاف آماری معنی‌داری داشت. دیابت بارداری در گروه مداخله کمتر از گروه دارونما و کنترل بود (05/0>p).
نتیجه‌گیری: مصرف کپسول‌ پروبیوتیک را می‌توان به زنان باردار پرخطر از نظر ابتلاء به دیابت بارداری پیشنهاد داد.

کلیدواژه‌ها


عنوان مقاله [English]

Effect of probiotic capsules on preventing gestational diabetes among high-risk prediabetic pregnant women

نویسندگان [English]

  • Mahdieh Ebrahimzadeh 1
  • Samira Ebrahimzadeh Zagami 2
  • Masoumeh Kordi 3
  • Mohmmad Taghi Shakeri 4
  • Seyed Ahmad Emami 5
  • Farideh Akhlaghi 6
1 M.Sc. in Midwifery Training, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Assistant Professor, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Assistant Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Professor, Department of Epidemiology & Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Professor, Department of Traditional Pharmacology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
6 Professor, Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
چکیده [English]

Introduction: Gestational diabetes is the most common medical condition in pregnancy. Since probiotics are viable microorganisms which have beneficial effects on microbial flora of the intestine, they affect glucose metabolism. Therefore, this study was performed with aim to determine the effect of probiotic capsule on the prevention of gestational diabetes in high risk pre-diabetes pregnant women.
Methods: This double-blind clinical trial study was performed on 255 high risk pre-diabetic pregnant women in health centers covered by health center No.2 of Mashhad in 2018. In the probiotic group and the placebo group, in addition to routine care, one probiotic capsule and placebo were daily prescribed respectively from 14-16 weeks of gestation for 12 weeks. Then, glucose tolerance test (OGTT) was performed at week 26-28. The research tools included demographic and midwifery information form, checklist of pregnancy diabetes screening tests, drug use checklist, examination form and satisfaction form. Data were analyzed using SPSS software (version 22), and Chi-square, One-way ANOVA, Kruskal – Wallis and Mann-Whitney tests. P<0.05 was considered statistically significant.
Results: 21 patients (26.3%) in the probiotic group, 49 (59.8%) in the placebo group, and 55 (67.1%) in the control group had gestational diabetes (P<0.001). Gestational diabetes in the intervention group was significantly less than the placebo and control group. The results of the Chi-square Pearson test for two by two comparison of the groups showed significant difference in gestational diabetes mellitus between probiotic group with placebo (P <0.001) and probiotic group with control (P <0.001). Gestational diabetes in the intervention group in significance level of lower than 5% was lower than the placebo and control group.
Conclusion: The use of probiotic capsules can be recommended to high risk pregnant women in preventing gestational diabetes.

کلیدواژه‌ها [English]

  • Gestational diabetes
  • Prediabetic
  • Prevention
  • Probiotic
  1. Spaight C, Gross J, Horsch A, Puder JJ. Gestational Diabetes Mellitus. Endocr Dev 2016; 31:163-78.
  2. Nguyen BT, Cheng YW, Snowden JM, Esakoff TF, Frias AE, Caughey AB. The effect of race/ethnicity on adverse perinatal outcomes among patients with gestational diabetes mellitus. Am J Obstet Gynecol 2012; 207(4):322.e1-6.
  3. Kanat M, DeFronzo RA, Abdul-Ghani MA. Treatment of prediabetes. World J Diabetes 2015; 6(12):1207-1222.
  4. Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab 2010; 95(2):471-8.
  5. Cunningham FG, Kenneth J, Bloom SL, Spong CY, Dash JS, Hoffman BL, et al. Williams obstetrics. 24th ed. New York: McGraw-Hill; 2014.
  6. Mohamadbeigi A, Tabatabaee HR, Mohamadsalehi N. Modeling the determinants of gestational diabetes in Shiraz. Feyz Journal of Kashan University of Medical Sciences 2009; 13.
  7. Almasi S, Salehiniya H. The prevalence of gestational diabetes mellitus in Iran (1993-2013): A systematic review. Journal of Isfahan Medical School 2014; 32(299):1396-1412.
  8. Ju H, Rumbold AR, Willson KJ, Crowther CA. Borderline gestational diabetes mellitus and pregnancy outcomes. BMC Pregnancy Childbirth 2008; 8:31.
  9. Langer O, Yogev Y, Most O, Xenakis EM. Gestational diabetes: the consequences of not treating. Am J Obstet Gynecol 2005; 192(4):989-997.
  10. McDowell J, Courtney M, Edwards H, Shortridge‐Baggett L. Validation of the Australian/English version of the diabetes management self‐efficacy scale. Int J Nurs Pract 2005; 11(4):177-84.
  11. Hashemi T, Aliloo MM, Poursharifi H, Bayrami M, Nemati Sogolitappeh F. The role of personality characteristics and coping strategies in self-care of patients with type 2 diabetes. Journal of Clinical Psychology 2013; 5(2):89-99.
  12. Hajifaraji M, Dolatkhah N. Probiotics and Metabolic Outcomes of Gestational Diabetes: A Review Article. Journal of Mazandaran University of Medical Sciences 2018; 28(162):155-174.
  13. Piirainen T, Isolauri E, Lagström H, Laitinen K. Impact of dietary counselling on nutrient intake during pregnancy: a prospective cohort study. British Journal of Nutrition 2006; 96(6):1095-1104.
  14. Laitinen K, Poussa T, Isolauri E; Nutrition, Allergy, Mucosal Immunology and Intestinal Microbiota Group. Probiotics and dietary counselling contribute to glucose regulation during and after pregnancy: a randomised controlled trial. Br J Nutr 2009; 101(11):1679-87.
  15. Amerian Córdoba Park Hotel. Health and Nutritional Properties of Probiotics in Food Including Powder Milk with Live Lactic Acid Bacteria – Joint FAO/WHO Expert Consultation. Literature Review; 2001.
  16. Tamime AY, Thomas LV. Probiotic dairy products: Wiley Online Library; 2005.
  17. Bonyadi F, Tukmechi A, Mohebalian H. An overview of probiotics and their role in cancer management. J Mazandaran Univ Med Sci 2014; 24(112):128-140.
  18. Bansal T, Alaniz RC, Wood TK, Jayaraman A, Demain AL. The bacterial signal indole increases epithelial-cell tight-junction resistance and attenuates indicators of inflammation. Proceedings of the National Academy of Sciences of the United States of America 2010; 107(1):228-233.
  19. Kaur IP, Kuhad A, Garg A, Chopra K. Probiotics: delineation of prophylactic and therapeutic benefits. J Med Food 2009; 12(2):219-35.
  20. Koren O, Goodrich JK, Cullender TC, Spor A, Laitinen K, Bäckhed HK, et al. Host remodeling of the gut microbiome and metabolic changes during pregnancy. Cell 2012; 150(3):470-80.
  21. Collado MC, Isolauri E, Laitinen K, Salminen S. Distinct composition of gut microbiota during pregnancy in overweight and normal-weight women. Am J Clin Nutr 2008; 88(4):894-9.
  22. Santacruz A, Collado MC, Garcia-Valdes L, Segura MT, Martin-Lagos JA, Anjos T, et al. Gut microbiota composition is associated with body weight, weight gain and biochemical parameters in pregnant women. Br J Nutr 2010; 104(1):83-92.
  23. Schrezenmeir J, de Vrese M. Probiotics, prebiotics, and synbiotics--approaching a definition. Am J Clin Nutr 2001; 73(2 Suppl):361S-364S.
  24. Guidelines QC. Maternity and neonatal clinical guideline: Gestational diabetes mellitus. 2015.
  25. Soheylizad M, Khazaei S, Mirmoeini RS, Gholamaliee B. Determination of risk factors for gestational diabetes mellitus in the rural population of Hamadan Province in 2011: a case-control study. Pajouhan Scientific Journal 2014; 13(1):9-16.
  26. Nitert MD, Barrett HL, Foxcroft K, Tremellen A, Wilkinson S, Lingwood B, et al. SPRING: an RCT study of probiotics in the prevention of gestational diabetes mellitus in overweight and obese women. BMC Pregnancy Childbirth 2013; 13:50.
  27. Wickens KL, Barthow CA, Murphy R, Abels PR, Maude RM, Stone PR, et al. Early pregnancy probiotic supplementation with Lactobacillus rhamnosus HN001 may reduce the prevalence of gestational diabetes mellitus: a randomised controlled trial. Br J Nutr 2017; 117(6):804-813.
  28. Luoto R, Laitinen K, Nermes M, Isolauri E. Impact of maternal probiotic-supplemented dietary counselling on pregnancy outcome and prenatal and postnatal growth: a double-blind, placebo-controlled study. Br J Nutr 2010; 103(12):1792-9.
  29. Dolatkhah N, Hajifaraji M, Abbasalizadeh F, Aghamohammadzadeh N, Mehrabi Y, Abbasi MM. Is there a value for probiotic supplements in gestational diabetes mellitus? A randomized clinical trial. J Health Popul Nutr 2015; 33:25.
  30. Callaway LK, McIntyre HD, Barrett HL, Foxcroft K, Tremellen A, Lingwood BE, et al. Probiotics for the prevention of Gestational Diabetes Mellitus in overweight and obese women: Findings from the SPRING double-blind randomized controlled trial. Diabetes Care 2019; 42(3):364-371.
  31. Tajabady Ebrahimi M, Hejazy MA, Ghafary R, Jafari P. Antagonistic ability of acid and bile tolerance Lactobacillus were isolated from dairy products. Journal of Arak University of Medical Sciences 2009; 12(2):17-27.
  32. Charalampopoulos D, Rastall RA. Prebiotics and Probiotics Science and Technology. 1th ed.  Springer-Verlag New York; 2009.
  33. Jameshorani M, Rafiee E, Kamali K. Treatment effects of probiotic in non alcoholic fatty liver disease. J Adv Med Biomed Res 2017; 25(109):23-35.
  34. Karamali M, Dadkhah F, Sadrkhanlou M, Jamilian M, Ahmadi S, Tajabadi-Ebrahimi M, et al. Effects of probiotic supplementation on glycaemic control and lipid profiles in gestational diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Metab 2016; 42(4):234-41.
  35. Badehnoosh B, Karamali M, Zarrati M, Jamilian M, Bahmani F, Tajabadi-Ebrahimi M, et al. The effects of probiotic supplementation on biomarkers of inflammation, oxidative stress and pregnancy outcomes in gestational diabetes. J Matern Fetal Neonatal Med 2018; 31(9):1128-1136.
  36. Asemi Z, Zare Z, Shakeri H, Sabihi SS, Esmaillzadeh A. Effect of multispecies probiotic supplements on metabolic profiles, hs-CRP, and oxidative stress in patients with type 2 diabetes. Ann Nutr Metab 2013; 63(1-2):1-9.
  37. Mazloom Z, Yousefinejad A, Dabbaghmanesh MH. Effect of probiotics on lipid profile, glycemic control, insulin action, oxidative stress, and inflammatory markers in patients with type 2 diabetes: a clinical trial. Iran J Med Sci 2013; 38(1):38-43.
  38. Jafarnejad S, Saremi S, Jafarnejad F, Arab A. Effects of a multispecies probiotic mixture on glycemic control and inflammatory status in women with gestational diabetes: a randomized controlled clinical trial. J Nutr Metab 2016; 2016:5190846.
  39. Ahmadi S, Jamilian M, Tajabadi-Ebrahimi M, Jafari P, Asemi Z. The effects of synbiotic supplementation on markers of insulin metabolism and lipid profiles in gestational diabetes: a randomised, double-blind, placebo-controlled trial. Br J Nutr 2016; 116(8):1394-1401.