Gestasyonel diabet için risk faktörü taşıyan ve taşımayan gebelerde 50 gr OGTT etkinliğinin  araştırılması
Investigation of the effectiveness of 50 gr OGTT in pregnancy with and without risk factor for gestational diabetes
Yazar: EKREM ERGENÇ
Danışman: DR. SAVAŞ ÖZDEMİR
Sağlık Bilimleri Üniversitesi / İstanbul Şişli Hamidiye Etfal Eğitim ve Araştırma Hastanesi / Kadın Hastalıkları ve Doğum Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2010
Konu: Kadın Hastalıkları ve Doğum = Obstetrics and Gynecology

Özet:
ÖZET

Amaç: Bu çalışmanın amacı 50g glukoz tarama testinin (tüm gebeler yerine sadece gestayonel diyabetes mellitus (GDM) için risk faktörüne sahip gebelere uygulanmasının yeterli olup olmayacağını araştırmaktır.
Gereç ve yöntem: Bu çalışma rutin gebelik takibi nedeni ile başvuran 24-28. haftalar arasındaki 204 gebenin katılımı  ile  retrospektif olarak yapıldı. Gebeler GDM açısından risk faktörlerine sahip olup olmamalarına göre iki ayrı guruba ayrıldı. 
Bulgular: Çalışmaya dahil edilen gebelerin yaş ortalaması 25,5 yıl olarak bulundu. 204 gebeden 84'ü ( %41.18'i)  risk faktörlerinden hiç birini taşımazken 120 gebe  (olguların %58,82 'i )  risk faktörlerinden en az birine sahipti. Risk faktörlerinden en az birine sahip olan 120 gebeden 62'sinin (%51,67) 1 saatlik 50 gr GCT sonucu 140 mg/dl üzerinde saptandı. Bu gebelere yapılan 100 gr glukoz yükleme testi sonucunda 30 gebeye GDM tanısı konuldu. Risk faktörlerinden en az birine sahip 120 gebede gestasyonel diyabet prevelansı %25.00 olarak hesaplandı. Risk faktörüne sahip olmayan 84 gebenin 10'nunda 50 gr GCT 1.saat sonunda kan glukoz düzeyi 140 mg/dl'nin üzerinde bulundu. Bu gebelere yapılan 100 gr GCT sonucuna göre 2 gebeye GDM tanısı konulmuş olup risk faktörü taşımayan gebelerde gestasyonel diyabet prevelansı %2,38 olarak hesplandı. Risk faktörü içermeyen gebelerde GDM prevalansı %2,38 olarak hesaplandı. Risk faktörü taşımayan  gebelerde 50 gr GCT' nin pozitif prediktif değeri  %20,00  iken , en az birini taşıyanlarda %48,39 olarak hesaplandı (p<0,05). 
Sonuç: GDM tarama testinin sadece risk faktörü taşıyan gebelere yapılması ile gereksiz yere yapılan taramaların ortadan kalkmasını sağlayabilirken, risk faktörü taşımayan gebelerin %2.3' nün ise  tanı alamayabileceğini ortaya koymaktadır.
Anahtar kelimeler: Gestasyonel diabetes mellitus, riskli grup, tarama.

Abstract:
ABSTRACT
Purpose: The purpose of this study is examining whether the application of 50g OGTT will be sufficient for the pregnant women with GDM risk factor instead of applying it to all pregnant women. 
Material and Methods: The study has been conducted retrospectively with the participation of 204 pregnant women who were pregnant for 24-28th weeks and who applied for routine pregnancy follow-up. The pregnant women were separated into two groups in terms of having the risk factor of gestational diabetes mellitus. 50 gr OGTT was applied to all pregnant women in the 24-228th weeks for GDM scanning. We accepted the plasma glucose threshold value as 140 mg/dl. After the 1st hour, 100 gr Oral Glucose Tolerance Test was applied to the women whose venous blood glucose level exceeded 140 mg/dl. If two of the results were over the given values, the pregnant women were diagnosed as GDM. The data were analyzed by using the SPSS Package Program. The positive predictive values of 50 gr OGTT were calculated in pregnant women who did not have the risk factor and the values. The significance test between the two percentages was used in independent groups. The P<0,5 value was accepted as being statistically significant.
Findings: The mean age of the pregnant women who was included in the study was found as 25,5 years. Out of 204 pregnant women 84 (41.18+) did not have any of the risk factors, 120 pregnant women who was included in the study had at least one of the risk factors (58, 82% of the cases). Out of the 120 pregnant women who was included in the study 62 who had at least one risk factor (51, 67%) had 1-hour 50 gr OGTT result as being over 140 mg/dl. After the 100 gr Oral Glucose Tolerance test which was applied to these pregnant women, 30 pregnant women were diagnosed with GDM. The gestational diabetes prevalence in 120 pregnant women who had at least one of the risk factors was computed as 25.00%. In 10 pregnant women out of the 84 women who did not have risks, the blood glucose level was found as over 140 mg/dl after 50 gr OGTT 1-hour application. According to the 100 gr OGTT result, which was applied to these pregnant women, 2 pregnant women were diagnosed with GDM, and the gestational diabetes prevalence in pregnant women with no risks was computed as 2,38%. In 32 out of the 204 pregnant women who were included in the study, GDM was detected, and the prevalence was computed as 15, 69%. The GDM prevalence in the pregnant women who did not have risk factors was computed as 2, 38%. The positive predictive value of 50 gr OGTT in pregnant women who did not have any risk factors was determined as 20, 00%, and as 48,39% in women who had at least one risk factor. The difference between these two groups was found to be statistically significant. 
Result: As a conclusion, the gestational diabetes scanning being performed only in pregnant women with risk factors instead of all pregnant women is a controversial issue, and having such a method in our study will not be a faulty approach. In case the scanning test is applied only to women with risk factors, the costs will be decreased at a substantial level, and the unnecessary scanning will be eliminated as well. 
Key Words:  Gestational diabetes mellitus, 50gr  GTT.

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