اولین گزارش تشریحی واقعات نوزادان مادران دیابتیک در افغانستان


داکتر احمد علی افضلی ، داکتر وحید الله نعیمی


چکیده

دیابت یک مرض مزمن میتابولیکی بوده که حدود 0،5 تا 5 فیصد تمام حاملگی ها را متاثر می سازد. دیابت دوران حاملگی به‌دو بخش دیابت اشکار pre gestational diabetes)) و دیابت دوران حاملگی (gestational diabetes) تقسیم می گردد. طوریکه 81 فیصد آن دیابت دوران حاملگی و 19 فیصد آن دیابت آشکار یا قبل از حاملگی می باشد.

هدف تحقیق: هدف از این تحقیق مطالعه نمودن اختلاطات دیابت دوران حاملگی  نزد نوزادان مادران دیابتیک در افغانستان می باشد.

میتودولوژی: این تحقیق از نوع  Descriptiveبشکل Case series  می باشد. این تحقیق بالای 59 نوزاد IDM که در شفاخانه بستری گردیده اند، صورت گرفته است. در این تحقیق تمام نوزادان  IDM که از تاریخ  10/june/2017 الی 10/may/2018  در شفاخانه صحت طفل اندراگاندی بستری بوده اند را در بر می گیرد. دوسیه های تمام مریضان بشکل Prospective  مطالعه گردیده است.

میتود جمع آوری اطلاعات: جمع اوری ارقام از کتاب راجستر و دوسیه مریضان توسط یکData Collection Form بوده است. این فورم دارای شماره مسلسل، نمبر راجستر، سن، جنس، وزن، سکونت و معاینات لابراتواری بوده و در پروگرام Excel تحلیل و انالیز گردیده است.

نتیجه: ازجمله ی 5912 مریض داخل بستر بخش نوزادان، به تعداد 59 مریض مصاب IDM  بودند که 1 فیصد تمام مریضان وارد نوزادان را تشکیل می‌دهد. از این جمله 21 واقعه یا  37 فیصد دختر و 38 واقعه یا 63 فیصد پسر بودند. هم چنانبه تعداد 17 مریض (29 فیصد) قبل از وقت (premature) و به تعداد 42  مریض (71 فیصد) سر وقت (mature) تولد گردیده اند.

 در این تحقیق وزن زمان تولد 19 فیصد این مریضان بین 3،5 تا 4 کیلوگرم، وزن زمان تولد 50 فیصد این مریضان بین 4،5 تا 5 کیلوگرم و وزن زمان تولد 31 فیصد این مریضان بیشتر از 5 کیلوگرم می باشد.

واژه های کلیدی:‌ دیابت، هایپرگلایسمی، هایپرپلازی، زردی، پولی سایتمی.


رفرنس‌ها


Williams, Obstetrics, cunningham, leveno, bloom, dashe, hoffman, 24th edition, Mc Graw Hill education, 2018.

Meharban singh, care of the newborn, 8th edition, 2015, p:81-84

manual of neonatal care, seventh edition, john P, Erich C. Eichenwald,Lippincott Williams &wilkins, wolters Kluwer, 2012, P: 15 – 20 

 Lawrence JM, Contreras R, Chen W, Sacks DA. Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999-2005. Diabetes Care. 2008; 31:899-904.

Buchanan TA, Kitzmiller JL. Metabolic interactions of diabetes and pregnancy. Annu Rev Med. 1994; 45:245-60.

 Pinter E, Reece EA, Leranth CZ, GarciaSegura M, Hobbins JC, Mahoney MJ, Naftolin F. Arachidonic acid prevents hyperglycemia-associated yolk sac damage and embryopathy. Am J Obstet Gynecol. 1986;155(4):691-702.

 Obenshain S, Adam PAJ, King KC, Teramo K, Raivio KO, Räihä N, etal. Human Fetal Insulin Response to Sustained Maternal Hyperglycemia .N Engl J Med. 1970; 283:566-70

Adam PA, Teramo K, Raiha N, Gitlin D, Schwartz R. Human fetal insulin metabolism early in gestation: response to acute elevation of the fetal glucose concentration and placental transfer of human insulin-I131. Diabetes. 1969, 18(6), 409-16.

Philips AF, Dubin JW, Matty PJ, Raye JR. Arterial hypoxemia and hyperinsulinemia in the chronically hyperglycemic fetal lamb. Pediatr Res. 1982; 16:653-8.

Widness JA, Teramo KA, Clemons GK, Garcia JF, Cavalieri RL, Piasecki GJ, et al. Temporal response of immunoreactive erythropoietin to acute hypoxemia in fetal sheep. Pediatr Res. 1986; 20:15-19.

Widness JA, Teramo KA, Clemons GK, Voutilainen P, Stenman UH, McKinlay SM, et al. Direct relationship of antepartum glucose control and fetal erythropoietin in human type 1 (insulin-dependent) diabetic pregnancy. Diabetologia. 1990; 33:378-83.

Kuhle S, Massicotte P, Chan A, Mitchell L. A case series of 72 neonates with renal vein thrombosis. Data from the 1-800-NOCLOTS Registry. Thromb Haemost. 2004; 92:729-33.

Rosenn B, Miodovnik M, Tsang R. Common clinical manifestations of maternal diabetes in newborn infants: implications for the practicing pediatrician. Pediatr Ann. 1996; 25:215-22.

Peevy KJ, Landaw SA, Gross SJ. Hyperbilirubinemia in infants of diabetic mothers. Pediatrics. 1980; 66:417-9.

Cederberg J, Eriksson UJ. Antioxidative treatment of pregnant diabetic rats diminishes embryonic dysmorphogenesis. Birth Defects Res A Clin Mol Teratol. 2005;73(7):498-505.

El-Bassiouni EA, Helmy MH, Abou Rawash N, El-Zoghby SM, Kamel MA, Abou Raya AN. Embryopathy in experimental diabetic gestation: assessment of PGE2 level, gene expression of cyclooxygenases and apoptosis. Br J Biomed Sci. 2005;62(4):161- 5.

Nold JL, Georgieff MK. Infants of diabetic mothers. Pediatr Clin North Am. 2004; 51:619-37.

Kitzmiller JL. Sweet success with diabetes. The development of insulin therapy and glycemic control for pregnancy. Diabetes Care. 1993;

 Suppl 3:107-21. 16.Bourbon JR, Farrell PM. Fetal lung development in the diabetic pregnancy. Pediatr Res. 1985; 19:253-67.

Gewolb IH, O'Brien J. Surfactant secretion by type II pneumocytes is inhibited by high glucose concentrations. Exp Lung Res. 1997; 23:245-55.

Gewolb IH. Effect of high glucose on fetal lung maturation at different times in gestation. Exp Lung Res. 1996; 22:201-11.

Cordero L, Treuer SH, Landon MB, Gabbe SG. Management of infants of diabetic mothers. Arch Pediatr Adolesc Med. 1998; 152:249-54.

Michael Weindling A. Offspring of diabetic pregnancy: short-term outcomes. Semin Fetal Neonatal Med. 2009; 14:111-8.

Yang J, Cummings EA, O'connell C, Jangaard K. Fetal and neonatal outcomes of diabetic pregnancies. Obstet Gynecol. 2006; 108:644-50.

Aucott SW, Williams TG, Hertz RH, Kalhan SC. Rigorous management of insulindependent diabetes mellitus during pregnancy. Acta Diabetol. 1994; 31:126-9.

Kapoor N, Sankaran S, Hyer S, Shehata H. Diabetes in pregnancy: a review of current evidence. Curr Opin Obstet Gynecol. 2007; 19:586-90.

Becerra JE, Khoury MJ, Cordero JF, Erickson JD. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population-based case-control study. Pediatrics. 1990; 85:1-9.

Lauenborg J, Hansen T, Jensen DM, Vestergaard H, Mølsted-Pedersen L, Hornnes P, etal. Increasing incidence of diabetes after gestational diabetes: a long term follow-up in a Danish population. Diabetes Care. 2004;27(5):1194-9.

Miller E, Hare JW, Cloherty JP, Dunn PJ, Gleason RE, Soeldner JS, et al. Elevated maternal hemoglobin A1c in early pregnancy and major congenital anomalies in infants of diabetic mothers N Engl J Med. 1981. 28;304(22):1331-4.

Temple R, Aldridge V, Greenwood R, Heyburn P, Sampson M, Stanley K. Association between outcome of pregnancy and glycaemic control in early pregnancy in type 1 diabetes: population based study. BMJ. 2002. 30;325(7375):1275-6.

Weintrob N, Karp M, Hod M. Short- and long-range complications in offspring of diabetic mothers. J Diabetes Complications. 1996; 10:294-301.

Wren C, Birrell G, Hawthorne G. Cardiovascular malformations in infants of diabetic mothers. Heart. 2003; 89:1217-20.

Khoury MJ, Becerra JE, Cordero JF, Erickson JD. Clinical-epidemiologic assessment of pattern of birth defects associated with human teratogens: application to diabetic embryopathy. Pediatrics. 1989; 84:658-65.

Ellis H, Kumar R, Kostyrka B. Neonatal small left colon syndrome in the offspring of diabetic mothers-an analysis of 105 children. J Pediatr Surg. 2009; 44:2343-6.

Persson M, Pasupathy D, Hanson U, Norman M. Birth size distribution in 3,705 infants born to mothers with type 1 diabetes: a population-based study. Diabetes Care. 2011; 34:1145-9.

Persson M, Fadl H, Hanson U, Pasupathy D. Disproportionate body composition and neonatal outcome in offspring of mothers with and without gestational diabetes mellitus. Diabetes Care. 2013; 36:3543-8.

Ahlsson F, Lundgren M, Tuvemo T, Gustafsson J, Haglund B. Gestational diabetes and offspring body disproportion. Acta Paediatr. 2010;99(1):89-93.

Keller JD, López-Zeno JA, Dooley SL, Socol ML. Shoulder dystocia and birth trauma in gestational diabetes: a five-year experience. Am J Obstet Gynecol. 1991;165(4 Pt 1):928-30.

Mimouni F, Miodovnik M, Rosenn B, Khoury J, Siddiqi TA. Birth trauma in insulin-dependent diabetic pregnancies. Am J Perinatol. 1992;9(3):205-8.

Ogata ES, Sabbagha R, Metzger BE, Phelps RL, Depp R, Freinkel N. Serial ultrasonography to assess evolving fetal macrosomia. Studies in 23 pregnant diabetic women. JAMA. 1980. 20;243(23):2405-8.

Ballard JL, Rosenn B, Khoury JC, Miodovnik M. Diabetic fetal macrosomia: significance of disproportionate growth. J Pediatr. 1993; 122:115-9.

McFarland MB, Trylovich CG, Langer O. Anthropometric differences in macrosomic infants of diabetic and nondiabetic mothers. J Matern Fetal Med. 1998; 7:292-5.

Esakoff TF, Cheng YW, Sparks TN, Caughey AB. The association between birthweight 4000 g or greater and perinatal outcomes in patients with and without gestational diabetes mellitus. Am J Obstet Gynecol. 2009; 200(6):672.e1-4.

Silverman BL, Rizzo TA, Cho NH, Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998; 21 Suppl 2:B142-9.

42.Dabelea D, Hanson RL, Lindsay RS, Pettitt DJ, Imperatore G, Gabir MM, etal. Intrauterine exposure to diabetes conveys risks for type 2 diabetes and obesity: a study of discordant sibships.Diabetes. 2000; 49 (12):2208-11.

Nesbitt TS, Gilbert WM, Herrchen B. Shoulder dystocia and associated risk factors with macrosomic infants born in California. Am J Obstet Gynecol. 1998;179(2):476-80.

Gilbert WM, Nesbitt TS, Danielsen B. Associated factors in 1611 cases of brachial plexus injury. Obstet Gynecol. 1999;93(4):536-40.

Acker DB, Sachs BP, Friedman EA. Risk factors for shoulder dystocia in the averageweight infant. Obstet Gynecol. 1986; 67:614.

Gregory KD, Henry OA, Ramicone E, Chan LS, Platt LD. Maternal and infant complications in high and normal weight infants by method of delivery. Obstet Gynecol. 1998; 92:507-13.

Gleason CA, Devaskar SU. Avery’s disease of the newborn. 9th ed. Philadelphia: Elsevier Saunders, 2012.

Mimouni F, Miodovnik M, Siddiqi TA, Khoury J, Tsang RC. Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J Pediatr. 1988; 113(2):345-53.

O W, Omori K, Emmanouilides GC, Phelps DL. Placenta to lamb fetus transfusion in utero during acute hypoxia. Am J Obstet Gynecol. 1975; 122(3):316-22.

Bental Y, Reichman B, Shiff Y, Weisbrod M, Boyko V, Lerner-Geva L, et al. Impact of maternal diabetes mellitus on mortality and morbidity of preterm infants (24-33 weeks' gestation). Pediatrics. 2011; 128(4):e848-55.

Martin RJ, Fanaroff AA, Walsh MC. Fanaroff and Martin's Neonata I-Peri natal Medicine, Diseases of the Fetus and Infant, 9 th ed. Missouri: Elsevier Mosby, 2011.

 Cowett RM, Susa JB, Giletti B, Oh W, Schwartz R. Glucose kinetics in infants of diabetic mothers. Am J Obstet Gynecol. 1983; 146(7):781-6.

Kalhan SC, Savin SM, Adam PA. Attenuated glucose production rate in newborn infants of insulin-dependent diabetic mothers. N Engl J Med. 1977; 296(7):375-6.

.Demarini S, Mimouni F, Tsang RC, Khoury J, Hertzberg V. Impact of metabolic control of diabetes during pregnancy on neonatal hypocalcemia: a randomized study. Obstet Gynecol. 1994; 83(6):918-222.  




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