Ultragarsinio ir lipidų apykaitos tyrimų vertė vaisiaus svorio prognozei gestacinio diabeto atvejais

Show simple item record Biržietis, Tomas 2017-08-21T08:06:41Z 2017-08-21T08:06:41Z 2006
dc.description.abstract The term “gestational diabetes” first was used in 1967 by J.Pedersen [J.Pedersen, 1967]. Up till then a number of other names was used to describe this pathology in scientific literature. During the last four decades a lot of reseach was done on this pregnancy related metabolic disturbance, but it is discussed up till now if this condition is worth of attention in general and if setting the diagnose is more beneficial or more harmful. Controversy exists also concerning diagnosing methods and criteria of gestational diabetes (GD). It is still discussed about the usefullness of global screening, though the majority of authors agree that by examining only the women who have predisposing factors for GD, up till 25% of GD cases would remain undiagnosed with consequently worse pregnancy outcome compared to the diagnosed and treated cases [K.M.Adams et al., 1998; D.Baliutavičienė et al., 2005]. The major complication of GD – fetal macrosomy, appears 2-4 times more frequently compared to healthy pregnant women [O.Langer et al., 2000] and is related not only to higher probability of labour trauma to mother and newborn, but also with a higher incidence of obesity in childhood and adulthood [B.Vohr et al., 1997; D.Dabelea et al., 1999; M.W.Gillman et al., 2003]. Even though it was succeded to decreace the mortality and morbidity of newborns by normalising glucose level in blood in GD patients, the incidence of macrosomy in these risky pregnancies remains higher compared to healthy pregnant population [B. Perrson & U.Hanson, 1998; U.M.Schaefer-Graf. et al., 2002]. Therefore it was hypothized that the speed of fetal growth in GD cases is affected not only by metabolic disturbance of hidrocarbonates. The role of lipid metabolism in fetal growth has been in focus during the last few years. Little research is done on this topic and the studies available are of limited sample size. That is why there is still no agreement on the role of lipid metabolism in fetal body weight. Some research has provided with evidence of changes in lipid metabolism during pregnancy and showed its importance in GD pathogenesis and prognosing fetal macrosomy [ Arcos et al., 1998; M.Kitajima et al, 2001; G.Di Ciani et al., 2004; S.Bo et al., 2004]. However, research data is contradictory. In Lithuania no research has been done yet concerning either lipid metabolism during pregnancy or its effect on fetal macrosomy in GD. We could not find any studies done in Lithuania on factors predisposing fetal macrosomy. Some risk factors for macrosomy in case of GD as well as prognostic value of ultrasonography parameters for fetal macrosomy has been evaluated in this study. The prognostic value and error of ultrasound, clinical examination and patient‘s opinion in prediction of fetal weight in GD has also been compared. We hope that the results of this study will contribute to other researches done on GD and will help to detect fetal macrosomy earlier and more accurate and thereby to avoid a part of GD complications. THE AIM AND OBJECTIVES OF THE STUDY Aim of the study: to evaluate the possibilities to predict macrosomia in cases of gestational diabetic pregnancies. Objectives of the study: 1. To investigate patients history data and antropometric findings which could be helpful in prognosis of fetal macrosomia. 2. To determine and compare the prognostic value and accuracy of clinical examination, ultrasound examination and maternal estimates of neonatal birth weight in gestational diabetic patients. 3. To determine the prognostic value of additional sonographic measurements (fetal soft tissues measurements, the amniotic fluid index, the thickness of placenta) for prognosis of fetal macrosomia. 4. To evaluate the peculiarity of lipids metabolism in cases of gestational diabetes. 5. To establish the threshold values for different lipids fractions indices for the prediction of fetal macrosomia in pregnant women with diagnosed gestational diabetes. CONCLUSIONS 1.The independent risk factors of fetal macrosomy in our study were maternal body mass index (p<0,05), weight gain during pregnancy (p<0,05) and macrosomia in previous pregnancies (p<0,001). 2.Ultrasound fetometry had statistically significantly (p<0,05) the highest accuracy and the lowest bias in prognosis of fetal weight compared to clinical examination and maternal estimates. The accuracy of ultrasound fetometry falls with increase of fetal weight. 3.Of additional ultrasonic measurements, only frontal fetal abdominal wall thickness, AFI and placenta thickness can improve the predictive value of ultrasonography in prognosis of fetal macrosomy. The fetal mid-thigh and mid-upper arm soft tissues measurements with low sensitivity and specificity are not helpful in prognosis of fetal macrosomy. 4. Maternal plasma TG and LDL-Ch concentrations increase throughout the gestation, total cholesterol changes insignificantly and HDL-Ch decreases in case of gestational diabetes. 5. Maternal plasma triglycerides can predict fetal macrosomy in early third trimester of pregnancy in case of gestational diabetes. Other lipids fractions were not associated with fetal weight.
dc.language.iso lit
dc.subject Lipid profile
dc.subject Gestacinis diabetas
dc.subject Lipidų profilis
dc.subject Macrosomy
dc.subject Vaisiaus svorio prognozavimas
dc.subject Prediction of fetal weight
dc.subject Makrosomija
dc.subject Gestational diabetes
dc.title Ultragarsinio ir lipidų apykaitos tyrimų vertė vaisiaus svorio prognozei gestacinio diabeto atvejais
dc.title.alternative The ultrasound examination and lipid profile in prognosis of fetal macrosomia in gestational diabetic pregnancies
dc.type Daktaro disertacija

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