Gestasyonel diyabetes mellitus'un fetal umblikal kord beyin kaynaklı nörotrofik faktör (BDNF) düzeylerine etkisi
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Gestasyonel diyabetes mellitus (GDM) gebeliğin en sık medikal komplikasyonlarından biridir.Ülkemizde ise GDM sıklığı %4-8 arasındadır ve toplumuzda GDM prevelansı gittikçe artmaktadır , prevalanstaki artışın en önemli nedenleri; genç yaşlarda giderek artan obezite ve maternal yaşta artış olarak gösterilmektedir. Beyin kaynaklı nörotrofik faktör, merkezi ve çevresel sinir sisteminde nöronların yaşamasını, büyümesini ve fonksiyonlarını etkileyen, sinapsların stabilizasyonunu sağlayan, sinaptik fonksiyonu, akson ve dentrit dallanmalarını düzenleyen bir nörotrofindir. Çalışmamızda GDM'nin fetal umblikal kord kanında BDNF kan düzeyi üzerine etkisinin olup olmadığının araştırılması amaçlamıştır. Gereç ve Yöntem : Bu çalışma 01.10.2018-25.11.2018 tarihleri arasında Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi Hastanesi Kadın Hastalıkları ve Doğum Kliniğine ve Konya Meram Eğitim Ve Araştırma Hastanesinde Uzm. Dr. Sevcan Sarıkaya'ya başvuran , gebelik haftası 37 hafta üstü olan hastalar, sade gestasyonel diabetes mellitus tanısı olanlar ile hiç ek hastalığı olmayan, olmayan hastalar olarak iki gruba ayrılmıştır.Hastalarımız sigara kullanmayan ve herhangi bir enfeksiyon bulgusu olmayan hastalar arasından seçildi.Hastaların doğum şeklinin sezeryan ya da normal doğum olmasına bakılmaksızın doğum sonrası fetal umblikal kord klemplendikten hemen sonra kord kanından alınan yaklaşık 5 cc'lik fetal kord kan örneği alınarak serumları ayrıldı ve BDNF çalışılmak üzere derin dondurucuda -80 0 C'de analiz gününe kadar saklandı. BDNF için ticari kit (USCNK® Human BDNF ELISA Kit, Inc.) kullanıldı. Fetal kord BDNF düzeyleri Enzyme Linked Immunosorbent Assay (ELISA) yöntemi ile analiz edildi. Veriler bilgisayar ortamına aktarıldıktan sonra, analizlerin yapımında SPSS paket programı ve rapor yazımında Microsoft Office Word programı kullanıldı. Sayısal verilerin özetlenmesinde aritmetik ortalama±standart sapma ve ortanca (Min-Max)kullanıldı. Kategorik verilerin özetlenmesi sayı ve yüzdeliklerle yapıldı. Verilerin normal dağılıma uygunluğunun saptanması için Kolmogorov-Simirnov ve Shapiro-Wilk testleri kullanıldı. İki bağımsız grup arası farkın anlamlılığının saptanması için nonparametrik bir test olan Mann-Whitney U yapıldı. İstatistiksel anlamlılık için p'nin 0,05'ten küçük olduğu durumlar anlamlı kabul edildi. Bulgular: Gestasyonel diyabetes mellitus'un fetal umblikal kord beyin kaynaklı nörotrofik faktör (bdnf) düzeylerine etkisi araştırtığımız çalışmamıza yaşları 16 ile 46 arasında değien 96 gebe hasta dahil edilmiştir. Bu katılımcıların 18'inin yaş, bebek cinsiyeti, doğum şekli, 1. Dk apgar skoru, doğum ağırlığı ve doğum sayısı ulaşılamamıştır.Katılımcıların 53'ünde ek hastalık yokken 43'ünde Gestasyonel Diyabetes Mellitus (GDM) vardı. GDM' olan annelerin 20 'si s.c. insülin kullanmakta olup gebelerimizin hiçbiri sigara kullanmamaktaydı. Çalışmamıza dahil edilen anneleri 22'si primipar iken 56'sı multıpar olup 56'sı sezeryan ile, 22'si normal doğum ile doğum yapmıştı. Çalışmamız dahilinde doğan bebelerin doğum tipine bakılmaksızın 42'si kız , 36'sı erkekti, erkek bebeklerin 1. Dk apgar düzeyi ortancası 7, doğum ağırlığı ortalaması 3127,63, fetal kord kanı BDNF düzeyi ortalaması 0,67 idi. Çalışmamız kapsamında doğan kız bebeklerin 1. dk apgarı ortancası 7 , doğum ağırlılarının ortalaması 3179,85 ±365,45, fetal umblikal kord BDNF düzeyi ortalaması 0,83 idi. GDM'si olmayan kadınların yaş ortalaması 26,83 , GDM'si olan kadınların yaş ortalaması 33,68 idi Annesinde GDM tanısı olmayan bebeklerin 1. dakika apgarı ortancası 7 olup Annesinde GDM tanısı olan bebeklerin de 1. dakika apgar ortancası 7 idi. Annesinde GDM tanısı olmayan bebeklerin doğum ağırlığı ortalaması 3143,47, annesinde GDM tanısı olan bebeklerin doğum ağırlığı ortalaması 3181,80 idi.Annesinde GDM tanısı olmayan bebeklerin fetal umblikal kord BDNF düzeyleri ortalaması 0,78 , Annesinde GDM tanısı olan bebeklerin fetal umblikal kord BDNF düzeyleri ortalaması 0,69 idi. Sonuç : GDM varlığı durumuna göre Umblikal Kord kanında BDNF düzeyleri MANN-Whitney U testi ile karşılaştırıldığında gruplar arasında istatistiki açıdan anlamlı fark bulunmadı. Ancak ; yaptıgımız calışma sonucunda kan şekerleri diyet ve egzersiz ile regüle olan annelerin bebekleri ile ek hastalığı olmayan annelerin bebekleri arasında fetal umblikal kord BDNF düzeyi arasında anlamlı fark saptanmaz iken, kan şeker regülasyonu için insülin kullanan annelerin bebeklerinin fetal umblikal kord BDNF düzeyi arasında anlamlı fark izlendi. GDM varlığı durumuna göre annelerin yaşları arasında anlamlı fark saptandı, annelerin yaşları arttıkça GDM oranları artmaktadır . Bebeklerin cinsiyetine göre fetal umblikal kord kanı BDNF düzeyinde anlamlı fark saptanmıştır .Kız bebeklerde BDNF değerleri erkek bebeklere kıyasla daha yüksekti.Annelerin doğum tipine göre bebeklerin 1. dk apgar düzeyi arasında anlamlı fark saptanmıştır.Normal doğum yapan annelerin bebeklerinin 1. dk apgar ortancasının ,sezeryanla doğum yapan annelerin bebeklerinin ortancasından daha yüksek saptandı.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In our country, however, prevalence of GDM ranges between 4-8% and prevalence of GDM is gradually increasing. Most important reasons for that increase in prevalence have been shown to be increased prevalence of obesity among younger individuals and increased maternal age. Brain-derived neurotrophic factor is a neurotrophin which influences survival growth and functions of central and peripheral nervous system neurons, maintains stabilization of synapses and regulates axonal and dentritic branching. In our study, investigation of whether GDM has effects on fetal umblical cord BDNF levels is aimed. Material and Method: This study was conducted with patients over 37 weeks of gestation who admitted to Necmettin Erbakan University Meram Faculty of Medicine Department of Gynecology and Obstetrics and to Sevcan Sarıkaya, MD from Meram Training and Research Hospital between 01.10.2018 and 25.11.2018, and the patients were divided into two groups: patients with solely gestational diabetes mellitus and those with no known additional disease. Regardless of whether mode of delivery was Cesarean Section or vaginal birth, approximately 5 cc of fetal cord blood samples taken from cord blood just after clamping of the fetal umbilical cord postnatally were taken, the serums were separated and then kept to be studied under -800C in a deep freeze until being analyzed. A commercial kit (snsc® Human BDNF ELISA Kit, Inc.) for BDNF was used. Fetal cord BDNF levels were analyzed by using Enzyme Linked Immunosorbent Assay (ELISA) method. After transfer of the date to the electronic medium, SPSS package program was used for analyses and Microsoft Office Word program was used for typing of the report. For summarizing of numberical data, mean±standard deviation and median (Min-Max) were used. For determination of conformity to normal distribution of the data, Kolmogorov-Smirnov and Shapiro-Wilk tests were used. For determination of significance between two independent grouos, Mann-Whitney U test, a non-parametric test, was performed. Situations where p was under 0.05 were considered to be significant for statistical significance. Results: In our study by which we investigated effect of gestational diabetes mellitus on fetal umbilical cord brain-derived neurotrophic factor (BDNF) levels, 96 pregnant women aged between 16 and 46 years were included. The age, baby gender, type of delivery, 1st min apgar score, birth weight and number of births of 18 of these participants could not be reached.While there was no additional disease in 53 of the participants, 43 had gestational diabetes mellitus (GDM).20 of the mothers with GDM were using subcutaneous insulin and none of our pregnant patients were smoking. Of the mothers included in our study; 22 were primiparous and 56 were multiparous with 56 delivered by Cesarean Section and 22 by normal vaginal birth. Regardless of genders of the neonates included in our study, 42 were female and 36 were male. Of the male neonates included in our study; median 1st-minute APGAR score was 7, mean birth weight was 3127.63 and mean fetal cord blood BDNF level was 0.67. Of the female neonates included in our study; median 1st-minute APGAR score was 7, mean birth weight was 3179.85, mean fetal cord blood BDNF level was 0.67, mean age of women without GDM was 26.83 and mean age of women with GDM was 33.68. median 1st-minute APGAR score of the neonates born to a mother without diagnoses of GDM was 7, median 1st-minute APGAR score of neonates born to a mother diagnosed with GDM was 7, too. Mean birth weight of neonates born to a mother without diagnosis of GDM was 3143.47, whereas mean birth weight of neonates born to a mother with diagnosis of GDM was 3181.80. Mean fetal umbilical cord BDNF level of neonates born to a mother without diagnosis of GDM was 0.78, whereas mean fetal umbilical cord BDNF level of neonates born to a mother with diagnosis of GDM was 0.69. Conclusion: When umbilical cord BDNF levels compared by presence of GDM by using Mann-Whitney U test, no statistical significance was determined between the groups. However; In our study, there was no significant difference between the mothers of mothers who were regulated with blood sugar diet and exercise and mothers of mothers who had no additional disease. However, there was a significant difference between the fetal umbilical cord BDNF levels of the babies of mothers who used insulin for blood sugar regulation. A significance difference in maternal ages by presence of GDM was determined between the groups. As maternal ages increased, GDM rates also increased. A significant difference was determined in fetal umbilical cord BDNF levels by genders of neonates. BDNF values were higher in female neonates compared to the male neonates. A significant difference was determined in 1st-minute APGAR scores of neonates by mode of delivery of the mothers. Median 1st-minute APGAR score of neonates born to mothers delivered by normal vaginal birth was determined to be higher compared to the median of neonates born to mothers delivered by Cesarean Section.
Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In our country, however, prevalence of GDM ranges between 4-8% and prevalence of GDM is gradually increasing. Most important reasons for that increase in prevalence have been shown to be increased prevalence of obesity among younger individuals and increased maternal age. Brain-derived neurotrophic factor is a neurotrophin which influences survival growth and functions of central and peripheral nervous system neurons, maintains stabilization of synapses and regulates axonal and dentritic branching. In our study, investigation of whether GDM has effects on fetal umblical cord BDNF levels is aimed. Material and Method: This study was conducted with patients over 37 weeks of gestation who admitted to Necmettin Erbakan University Meram Faculty of Medicine Department of Gynecology and Obstetrics and to Sevcan Sarıkaya, MD from Meram Training and Research Hospital between 01.10.2018 and 25.11.2018, and the patients were divided into two groups: patients with solely gestational diabetes mellitus and those with no known additional disease. Regardless of whether mode of delivery was Cesarean Section or vaginal birth, approximately 5 cc of fetal cord blood samples taken from cord blood just after clamping of the fetal umbilical cord postnatally were taken, the serums were separated and then kept to be studied under -800C in a deep freeze until being analyzed. A commercial kit (snsc® Human BDNF ELISA Kit, Inc.) for BDNF was used. Fetal cord BDNF levels were analyzed by using Enzyme Linked Immunosorbent Assay (ELISA) method. After transfer of the date to the electronic medium, SPSS package program was used for analyses and Microsoft Office Word program was used for typing of the report. For summarizing of numberical data, mean±standard deviation and median (Min-Max) were used. For determination of conformity to normal distribution of the data, Kolmogorov-Smirnov and Shapiro-Wilk tests were used. For determination of significance between two independent grouos, Mann-Whitney U test, a non-parametric test, was performed. Situations where p was under 0.05 were considered to be significant for statistical significance. Results: In our study by which we investigated effect of gestational diabetes mellitus on fetal umbilical cord brain-derived neurotrophic factor (BDNF) levels, 96 pregnant women aged between 16 and 46 years were included. The age, baby gender, type of delivery, 1st min apgar score, birth weight and number of births of 18 of these participants could not be reached.While there was no additional disease in 53 of the participants, 43 had gestational diabetes mellitus (GDM).20 of the mothers with GDM were using subcutaneous insulin and none of our pregnant patients were smoking. Of the mothers included in our study; 22 were primiparous and 56 were multiparous with 56 delivered by Cesarean Section and 22 by normal vaginal birth. Regardless of genders of the neonates included in our study, 42 were female and 36 were male. Of the male neonates included in our study; median 1st-minute APGAR score was 7, mean birth weight was 3127.63 and mean fetal cord blood BDNF level was 0.67. Of the female neonates included in our study; median 1st-minute APGAR score was 7, mean birth weight was 3179.85, mean fetal cord blood BDNF level was 0.67, mean age of women without GDM was 26.83 and mean age of women with GDM was 33.68. median 1st-minute APGAR score of the neonates born to a mother without diagnoses of GDM was 7, median 1st-minute APGAR score of neonates born to a mother diagnosed with GDM was 7, too. Mean birth weight of neonates born to a mother without diagnosis of GDM was 3143.47, whereas mean birth weight of neonates born to a mother with diagnosis of GDM was 3181.80. Mean fetal umbilical cord BDNF level of neonates born to a mother without diagnosis of GDM was 0.78, whereas mean fetal umbilical cord BDNF level of neonates born to a mother with diagnosis of GDM was 0.69. Conclusion: When umbilical cord BDNF levels compared by presence of GDM by using Mann-Whitney U test, no statistical significance was determined between the groups. However; In our study, there was no significant difference between the mothers of mothers who were regulated with blood sugar diet and exercise and mothers of mothers who had no additional disease. However, there was a significant difference between the fetal umbilical cord BDNF levels of the babies of mothers who used insulin for blood sugar regulation. A significance difference in maternal ages by presence of GDM was determined between the groups. As maternal ages increased, GDM rates also increased. A significant difference was determined in fetal umbilical cord BDNF levels by genders of neonates. BDNF values were higher in female neonates compared to the male neonates. A significant difference was determined in 1st-minute APGAR scores of neonates by mode of delivery of the mothers. Median 1st-minute APGAR score of neonates born to mothers delivered by normal vaginal birth was determined to be higher compared to the median of neonates born to mothers delivered by Cesarean Section.
Açıklama
Anahtar Kelimeler
BDNF,, GDM, Fetal umblikal kord, Fetal umbilical cord
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Bayman, M. G. (2018). Gestasyonel diyabetes mellitus'un fetal umblikal kord beyin kaynaklı nörotrofik faktör (BDNF) düzeylerine etkisi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Meram Tıp Fakültesi Cerrahi Tıp Bilimleri Kadın hastalıkları ve Doğum Anabilim Dalı, Konya
