Рeзистин, интерлеукин 6 и витамин д кај гестациски дијабетес мелитус - корелација со перинатален исход

Abstract

Introduction Gestational diabetes mellitus (GDM) is glucose intolerance which is diagnosed for the first time in pregnancy. It may lead to potentially serious short term and long term complications for both mother and fetus. In GDM pregnancies inflammatory parameters and biomarkers may provide informations for both patophysiology and prediction of perinatal risk. Material and methods Prospective study was conducted at the University clinic for gynecology and obstetrics, Skopje for the period of one year. 100 pregnant women in the second trimester which performed oral glucose tolerance test (75g OGTT) were evaluated. The study included 50 women with GDM and control group of 50 women with negative OGTT at the same gestational age, parity and maternal age. The pregnant women were divided in 4 groups: 1. Normal OGTT and BMI< 25kg/m2, 2. Normal OGTT and BMI> 25kg/m2, 3. GDM and BMI< 25kg/m2 and 4. GDM and BMI> 25kg/m2. Resistin (ELISA), interleukin 6 (Immulite) and vitamin D (Advia Centaur) are performed form periphery blood specimens form the pregnant women. Questionary with demographic and informations about present pregnancy, personal, obstetric and family background were collected. Gestational weight gain, blood pressure and urine analysis for proteinuria were recorded monthly. Ultrasound monitoring for fetal growth and amniotic fluid volume was performed in 32 and 36 gestational week. Patients with GDM were more often followed according to the clinical protocol. Maternal and neonatal data was collected after birth from medical recors during discharge from the clinic. Influence of concentration of resistin, interleukin 6 and vitamin D in pregnant women with or without GDM on perinatal outcome was analysed. Results There was a significant difference in BMI, family history of diabetes and vitamin supplementation between the women with GDM and normoglycemic women. Polyhydramnious, large for gestational age fetus and thick placenta significantly more often occured in GDM pregnancies. Hipertensive disorders of pregnancy, preterm labour and delivery by caesarean section were significantly more often in GDM pregnancies vs control group. Respiratory distress, hypoglycemia, pH <25, lower Apgar score in the first minute and admisiion in the neonatal intensive care unit was significantly more often in the neonates form mothers with GDM vs controls. Average value of resistin (3.15 ± 2.02 ng/ml vs 1.94 ± 0.8 ng/ml) and interleukin 6 (2.77 ± 1.1 pg/ml vs 2.16 ± 0.5 pg/ml) were significantly higher in GDM vs normoglycemic women. Significantly lower values of vitamin D (16.91 ± 6.2nmol/l) were found in GDM women vs control group (24.54 ± 11.7nmol/l). Vitamin D deficiency had 82.5% of the women with GDM and 54.76% of the women with negative OGTT. Multivariant logistic regression analysis showed that predictive factors significantly associated with GDM are BMI (p=0.017), resistin (p=0.034) and vitamin D (p=0.007). In pregnant women with GDM and BMI> 25 average values of resistin and IL-6 were significantly higher in comparison with GDM and BMI< 25. In pregnant glucose tolerant women vitamin D is significantly lower in the group with BMI> 25 vs women with BMI< 25. Women with GDM and BMI> 25 vs normoglycemic and BMI> 25 had significantly higher resistin and IL-6. Women with GDM and BMI< 25 had significantly higher resistin, higher IL-6 and lower vitamin D vs normoglycemic women with BMI< 25. Resistin was significantly higher in women with GDM and LGA, polyhydramnios and neonatal hypoglycemia. Significantly higher values of IL-6 was detected in women with GDM and preterm birth, SGA and neonatal respiratory distress. Vitamin D was statistically significantly lower in women with GDM and SGA, polyhydramnios, preterm labour and neonatal hypoglycemia. Conclusion Resistin and IL-6 were significantly higher in women with GDM and vitamin D was significantly lower in this group. Resistin, interleukin 6 and vitamin D in GDM may have conection with some parametars of the perinatal outcome.