THE INCIDENCE OF DIABETES MELLITUS IN WOMEN WHO GAVE BIRTH TO A LARGE FETUS

ABSTRACT

The frequency of childbirth with a large fetus has reached 4.5-20% over the past decade. Asphyxia during childbirth of a large fetus-9.2–34.2%, birth trauma-10.9-24%. About 15-45% of children born to pregnant women with diabetes may have macrosomia, which is 3 times higher than usual.

Material and methods: 2021-2022 yy. in September-November, a retrospective analysis of the medical history with a total of n= 75 was conducted on the basis of polyclinic №36 in Almaty.

Results: 1. In group I, the proportion of women aged 30 to 40 years prevailed according to age characteristics - 55.56%, this indicator was for women aged 18-29 years in group II - n=29 (60.42%) ;

2. "Type II diabetes mellitus" was confirmed in n=21 (77.08%) among women who gave birth to a large child in group I, and in 27.08% or n=13 women in group II;

3. Obesity occupied a leading position among women, in group I the percentage of women was higher by 40.74% (n = 11), respectively, in the control group - by 35.41%.

4. In women of group I n = 18 (66.67%), the method of delivery was carried out by cesarean section.

5. Perineal ruptures were recorded among the complications in the labor and subsequent period, in women of group I it was 18.51%, in group II it was 20.83%.

Conclusions: Thus, women who have given birth to a child with a large weight often have disorders of carbohydrate metabolism. Like other chronic diseases of the mother during pregnancy, diabetes can have a significant negative impact on the developing embryo and fetus, as well as on the course of pregnancy.

АННОТАЦИЯ

Частота родов крупным плодом за последнее десятилетие достигла 4,5-20%. Асфиксия при родах крупного плода-9,2–34,2%, родовая травма-10,9-24%. Около 15-45% детей, рожденных беременными женщинами с диабетом, могут иметь макросомию, что в 3 раза выше, чем обычно.

Материалы и методы исследования: 2021-2022 гг. в сентябре-ноябре на базе поликлиники №36 г. Алматы проведен ретроспективный анализ истории болезни с общим количеством n=75.

Результаты исследования: 1. в I группе преобладала доля женщин в возрасте от 30 до 40 лет по возрастным признакам - 55,56%, данный показатель был у женщин 18-29 лет во II группе - n=29 (60,42%);

2. «Сахарный диабета II типа» был подтвержден у n=21 (77,08%) среди женщин, родивших крупного ребенка в I группе, и у 27,08% или n=13 женщин во II группе;

3. Ожирение занимало лидирующие позиции среди женщин, в I группе процент женщин выше на 40,74% (n=11) соответственно, в контрольной группе - на 35,41%.

4. У женщин I группы n=18 (66,67%) способ родов осуществлялся с помощью кесарева сечения.

5. Среди осложнений в родовом и последующем периоде регистрировались разрывы промежности, у женщин I группы составил 18,51%, II группы-20,83%.

Заключение: Так, у женщин, родивших ребенка с большим весом, нередко выявляются нарушения углеводного обмена. Как и другие хронические заболевания матери во время беременности, диабет может оказывать значительное негативное влияние на развивающийся эмбрион и плод, а также на течение беременности.

Keywords: gestational diabetes, pregnancy, large fetus, diabetes during pregnancy.

Ключевые слова: гестационный диабет, беременность, крупный плод, сахарный диабет при беременности.

Introduction. In general, according to the recommendations of the American College of Obstetricians and Gynecologists (ACOG) in 2000, the term large fetus or fetal macrosomy is applied to fetuses weighing 4000 g. or more [1]. With the emergence of such problems as birth trauma, fetal asphyxia, this term has become one of the most pressing problems in the field of obstetrics and gynecology.

About 15% -45% of children born to mothers with diabetes can have macrosomia, which is 3 times higher than normal indicators [2-4].

The main risk factors for a large fetus are diabetes mellitus, obesity, arterial hypertension, multiple births, prolonged pregnancy, the presence of a large fetus in the history, late menarche, hypodynamia, taking vasoactive substances (pentoxifylline, curantil) in the II and III trimester of pregnancy play a leading role [4, 5].

Among the risk factors, the mother's excess weight and related metabolic disorders, including Type II diabetes and gestational diabetes, occupy a leading position [5]. A cohort study of 350,311 pregnant women showed that the body mass index of more than 30 kg/m2 was much more common in women with obesity, diabetes or gestational diabetes [6-8].

The IDF organization presented a data that in 2021, 21.1 million (16.7%) pregnant women had some type of hyperglycemia during pregnancy, 80.3% of them suffered from gestational diabetes, 10.6% from diabetes detected before pregnancy, and 9.1% from diabetes detected for the first time during pregnancy [1].

Purpose of the study: to determine the frequency of occurrence of diabetes among pregnant women who gave birth to a large-weight fetus and publish the results of childbirth.

Objectives of the study: 1. to conduct a general literature review of the state of diabetes mellitus among pregnant women who have given birth to a large-weight fetus;

2. study of the state of diabetes mellitus in pregnant women who gave birth to a large-weight fetus through the electronic system “DamuMed” on the basis of Polyclinic №36 in Almaty;

3. conduct a statistical analysis of the data of women in labor and identify clinical features.

Materials and methods: We work in 2021-2022. from September to November, we conducted a retrospective statistical analysis of the medical history of pregnant women n=75 through the electronic system “DamuMed” on the basis of Polyclinic №36 in Almaty.

Criteria for inclusion in the study: a group of women who gave birth to a large-weight fetus aged 18-50 years. Exclusion criteria: pregnant women with gestational diabetes. In total, n=75 pregnant women were classified into Group II: the first group was the group of women who gave birth to large – weight fetus (n=27/36%), the second group was the group of women who gave birth to normal – weight fetus (n=48/64%).

Figure 1. Total number of women who participated in the study (%)

A large-weight fetus was selected according to the selection criterion - 4,000 grams and above, and a normal fetus weight - 2,500-3,900 grams.

Anamnesis of pregnant women, clinical data, results of laboratory studies, anthropometric parameters (body weight, height, body mass index), age characteristics, method of delivery, fetal weight, data on comorbidities were taken for the study.

Statistical methods were used that made it possible to verify the analyzed data, the accuracy of the differences between the average values (M±m), the arithmetic mean values were evaluated by the T – criterion of Studenten. the difference at the level of p˂0,05 was considered statistically reliable. Statistical edits were collected in the electronic application Microsoft Office Excel.

Results and discussion: In our study, the average age among women was studied, as a result of which the average age of women among women of Group I was 39.17±7.35 years, among Group II this figure was 35.61±5.09 years (p<0.05). Among the subjects, the number of women who gave birth again prevailed - n=53 (70.7%), and women who gave birth for the first time-n=22 or 29.3% (Table 1). In Group I, the proportion of women aged 30-40 years prevails - 55.56%, in Group II, the level of women aged 18-29 years was n=29 (60.42%) (Table 1).  In women of Group I according to the body mass index (DMI), the indicator (Table 1) was higher (p<0.05).

Table 1.

Statistical data of researchers

During the selection of women with diabetes mellitus, based on therapeutic protocols and consultations of endocrinologists, Group I confirmed the "diagnosis of Type II diabetes" in women who gave birth to large fetus in n=21 (77.08%), and Group II-in 27.08% or n=13 (Figure 2).

Figure 2. Detection rates of Type II diabetes in subjects (%)

In our research work, we analyzed somatic underlying diseases that complicate the course of pregnancy, taking into account the main risk factors among women. In this analytical work, the leading position among women was occupied by obesity, in Group I women the percentage was higher, respectively, by 40.74% (n=11), in the opposite control group - by 35.41% (n=17). According to the incidence of other comorbidities, women of Group I had a relatively high rate, including varicose veins of the lower extremities - 40.74%, arterial hypertension – 14.81%, overweight - 25.92%, anemia – 51.85% (Figure 3).

Figure 3. Statistical data of subjects (%)

The presence of diabetes in pregnant women threatens the course of pregnancy or the development of the fetus [9]. In this regard, endocrinologists call for careful monitoring of glycemia in order to avoid complications of diabetes or gestational diabetes during childbirth [8, 10]. When assessing the features of the course of pregnancy in women, it was confirmed that there are different obstetrics (Figure 3, 4).

First, let's publish the results of research work related to the methods of childbirth (Figure 3). In women of Group I n=18 (66.67%), the method of delivery was performed by caesarean section, including emergency caesarean section n=14 (51.85%), planned - n=4 (14.82%). In women of Group II, this indicator is n=21 (43.75%), acute - N=8 (16.67%), planned – n = 13 (27.08%) (Figure 3).

In women of Group II, physiological childbirth occurred n=19 (39.58%), respectively, in Group I - n=8 (29.63%). Additional information on Obstetric methods of delivery is supplemented in Figure 3 (Figure 4).

Figure 4. Statistical data of subjects (%)

This indicator is higher in women with undetected gestational diabetes (n=29/72.5%), and in Group i n=18/54. 5%. In pregnant women with gestational diabetes, cesarean sections were performed more often, respectively, emergency – 6%, planned – 27.2% (Figure 4).

According to the results of a number of studies, if the weight of the fetus exceeds 4500 g, it is necessary to perform a cesarean section to prevent injuries to the central nervous system and the humerus nerve, clavicle fractures and shoulder dystocia, etc. [5, 14]. Based on a retrospective history of childbirth, we analyzed the conditions during and after childbirth.  Of the complications in childbirth and subsequent periods, rupture of the septum was recorded, which was 18.51% in women of Group I and 20.83% in Group II (Figure 4). Complications from multiple and low-water pregnancies, bleeding, were found equally between the two groups. Shoulder dystocia (3.7%) and infant meconium suffocation (3.7%) were observed in women in Group I (Figure 5). The volume of total postpartum blood loss was 328.37±37.41 ml, 354.5±35.63 ml in Group I, and 310.49±40.08 ml in Group II. According to the results of the identified study, we note that in the group of women who gave birth to large-weight fetus, complications were more common.

Figure 5.  Childbirth and postnatal complications for women (%)

Gestational diabetes recommends that women take a 2-hour oral glucose tolerance test at a dose of 75 g 6-12 weeks after delivery [11, 14]. Meanwhile, in women who need drug treatment for persistent hyperglycemia due to increased perinatal risk, it is necessary to assess the condition of the fetus at the 32nd week of pregnancy [7, 14].  Future studies of pregnancy outcomes in this population will be more important as the obesity rates of mothers continue to grow. The most severe adverse outcomes of diabetic pregnancy are still congenital abnormalities, stillbirth, and overgrowth of the fetus. Poor control of glycemia during conception and in the first trimester is clearly associated with a high level of congenital abnormalities.

While it is clear that maternal blood glucose control and obesity contribute to excess fetal obesity, fetal factors, including fetal sex, genes, and the presence or absence of hyperinsulinemia, are also important determinants of fetal growth [12]. After detection, fetal hyperinsulinemia can contribute to an increase in fetal glucose levels [9, 11]. This hypothesis may explain the occurrence of macrosomia in pregnant women who have (almost) normal glucose values in the mother in late pregnancy [6, 9]. The mother's HbA1c level in the first trimester of pregnancy is a good predictor of fetal macrosomy [14].

Conclusion: 1. In group I, the proportion of women aged 30 to 40 years prevailed according to age characteristics - 55.56%, this indicator was for women aged 18-29 years in group II - n=29 (60.42%) ;

2. "Type II diabetes mellitus" was confirmed in n=21 (77.08%) among women who gave birth to a large child in group I, and in 27.08% or n=13 women in group II;

3. Obesity occupied a leading position among women, in group I the percentage of women was higher by 40.74% (n = 11), respectively, in the control group - by 35.41%.

4. In women of group I n = 18 (66.67%), the method of delivery was carried out by cesarean section.

5. Perineal ruptures were recorded among the complications in the labor and subsequent period, in women of group I it was 18.51%, in group II it was 20.83%.

Thus, women who have given birth to a child with a large weight often have disorders of carbohydrate metabolism. Like other chronic diseases of the mother during pregnancy, diabetes can have a significant negative impact on the developing embryo and fetus, as well as on the course of pregnancy.

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