ระบาดวิทยาของภาวะเบาหวานขณะตั้งครรภ์: การศึกษาตามรุ่นย้อนหลัง

Sunanthaporn Phaiphan; Metha Songthamwat; Yaowaret Kittithanesuan; Srisuda Songthamwat; Siriluk Norsuwan; Pimjai Maleerat; Koollachart Saejueng; Anuchat Sujitra; Nopporn Limwatanapan; Ueamporn Summart

Authors

Sunanthaporn Phaiphan โรงพยาบาลหล่มสัก จังหวัดเพชรบูรณ์
Metha Songthamwat กลุ่มงานสูตินรีเวชกรรม โรงพยาบาลอุดรธานี
Yaowaret Kittithanesuan โรงพยาบาลอ่างทอง จังหวัดอ่างทอง
Srisuda Songthamwat โรงพยาบาลสมเด็จพระยุพราชสว่างแดนดิน จังหวัดสกลนคร
Siriluk Norsuwan โรงพยาบาลกุมภวาปี จังหวัดอุดรธานี
Pimjai Maleerat โรงพยาบาลบ้านผือ จังหวัดอุดรธานี
Koollachart Saejueng โรงพยาบาลบ้านดุง จังหวัดอุดรธานี
Anuchat Sujitra โรงพยาบาลหนองหาร จังหวัดหนองหาร
Nopporn Limwatanapan โรงพยาบาลวานรนิวาศ จังหวัดสกลนคร
Ueamporn Summart -

Keywords:

ตั้งครรภ์, เบาหวาน, ภาวะแทรกซ้อน, ปัจจัยที่มีความสัมพันธ์, ผลลัพธ์, การศึกษาตามรุ่นย้อนหลัง, Pregnancy, Diabetes Mellitus, Complication, Associated Factor, Outcome, Retrospective Cohort Study

Abstract

Gestational diabetes mellitus is a common condition that cause both maternal and neonatal complications. The retrospective cohort study aims to study the prevalence of pregnancy with diabetes mellitus (DM), associated factors and to compare the pregnancy outcome between DM and normal group in Thai women by retrospective review of medical records from January 2015 to September 2023 in Lom Sak, UdonThani, Ang Thong, Kumphawapi, Nong Han, Ban Phue, Wanon Niwat, and Ban Dung Hospital, then the percentage of DM in pregnant women and the association factors were studied. The maternal and neonatal complications were compared between DM and normal groups using multiple logistic regression analysis.

From a total 46,039 women who delivered during the study period and were compatible with the study criteria, 4,391 cases (9.54%, 95%CI: 9.27-9.81) had DM. The associated factors of diabetes in pregnancy were maternal age 35 years or older (adjusted odds ratio (AOR)=2.82, 95% Confidence interval (CI): 2.51-3.16), multigravida (AOR=1.19, 95%CI: 1.05-1.34), overweight or obesity (AOR=2.30, 95%CI: 2.04-2.61 and AOR=4.91, 95%CI: 4.22-5.70, respectively), bachelor’s degree or higher education (AOR=1.42, 95%CI: 1.22-1.65) and having a social security fund (AOR=1.17, 95%CI: 1.01-1.36). In DM group, 56.50% received the caesarean delivery and 71.21% had one or more pregnancy complications. The increasing complications were shoulder dystocia, fetal macrosomia, large for gestational age baby, preeclampsia, preterm delivery and low one minute Apgar score.

There was high prevalence of DM in Thai pregnant women, and it associated with advanced maternal age, overweight and high educated pregnant women. DM increased both maternal and neonatal complications. The early detection in antenatal care especially in the risk group, and proper blood glucose control including the early diagnosis of large for gestational age, monitor for its complications and preparation for the treatment can reduce the adverse maternal and neonatal outcomes.

References

Aziz, F., Khan, M. F., & Moiz, A. (2024). Gestational diabetes mellitus, hypertension, and dyslipidemia as the risk factors of preeclampsia. Scientific Reports, 14(1), 6182.

Boriboonhirunsarn, D., & Tanpong, S. (2023). Rate of spontaneous preterm delivery between pregnant women with and without gestational diabetes. Cureus, 15(2), e34565.

Boriboonhirunsarn, D., Sunsaneevithayakul, P., & Nuchangrid, M. (2004). Incidence of gestational diabetes mellitus diagnosed before 20 weeks of gestation. Journal of the Medical Association of Thailand, 87(9), 1017-1021.

Borisut, P., & Kovavisarach, E. (2014). Standard intrauterine growth curve of Thai neonates delivered at Rajavithi hospital. Journal of the Medical Association of Thailand, 97(8), 798-803.

Bureau of Health Promotion Ministry of Public Health. (2023). Prenatal care guideline for health care personal. Retrieved March 3, 2024, from https://hp.anamai.moph.go.th/th/news-anamai/210292

Chanprapaph, P., & Sutjarit, C. (2004). Prevalence of gestational diabetes mellitus (GDM) in women screened by glucose challenge test (GCT) at Maharaj Nakorn Chiang Mai Hospital. Journal of the Medical Association of Thailand, 87(10), 1141-1146.

Cunningham F, L. K., Dashe J, Hoffman B, Spong CY, Casey B. (2022). Williams Obstetrics (26 ed.). McGraw-Hill.

Dode, M. A., & dos Santos, I. S. (2009). Non classical risk factors for gestational diabetes mellitus: a systematic review of the literature. Cadernos de Saúde Pública, 25(Suppl 3), S341-S359.

Fontana, L., Eagon, J. C., Trujillo, M. E., Scherer, P. E., & Klein, S. (2007). Visceral fat adipokine secretion is associated with systemic inflammation in obese humans. Diabetes, 56(4), 1010-1013.

Fulop, T., Larbi, A., & Douziech, N. (2003). Insulin receptor and ageing. Pathologie Biologie, 51(10), 574-580.

Guariguata, L., Linnenkamp, U., Beagley, J., Whiting, D. R., & Cho, N. H. (2014). Global estimates of the prevalence of hyperglycemia in pregnancy. Diabetes Research and Clinical Practice, 103(2), 176-185.

Han, Z., Mulla, S., Beyene, J., Liao, G., McDonald, S. D., & Knowledge Synthesis, G. (2011). Maternal underweight and the risk of preterm birth and low birth weight: a systematic review and meta-analyses. International Journal of Epidemiology, 40(1), 65-101.

Harinsalai, T. (2022). Maternal and neonatal outcomes in pregnant women with gestational diabetes mellitus compared pregnant women without gestational diabetes mellitus in Kumphawapi Hospital. Udon Thani Medical Journal, 30(1), 131-138.

Jatavan, P., Luewan, S., Sirilert, S., & Tongsong, T. (2023). Trends in the Prevalence of Diabetes Mellitus in Pregnancy during the Past Two Decades in Northern Thailand. Healthcare, 11(9), 1315.

Jeyaparam, S., Agha-Jaffar, R., Mullins, E., Pinho-Gomes, A.-C., Khunti, K., & Robinson, S. (2024). Retrospective cohort study of the association between socioeconomic deprivation and incidence of gestational diabetes and perinatal outcomes. BMC Public Health, 24(1), 184.

Kc, K., Shakya, S., & Zhang, H. (2015). Gestational diabetes mellitus and macrosomia: a literature review. Annals of Nutrition and Metabolism, 66(Suppl 2), 14-20.

Kolovou, G. D., & Bilianou, H. G. (2008). Influence of aging and menopause on lipids and lipoproteins in women. Angiology, 59(2 suppl), 54S-57S.

Lertsakornsiri, M. (2022). Prevalence and risk factors of GDM at Lampang Hospital. Lampang Medical Journal, 29(2), 87-95.

Li, P., Shan, Z., Zhou, L., Xie, M., Bao, W., Zhang, Y., Rong, Y., Yang, W., & Liu, L. (2016). Mechanisms in endocrinology: Parity and risk of type 2 diabetes a systematic review and dose-response meta-analysis. European Journal of Endocrinology, 175(5), R231-R245.

Li, Y., Ren, X., He, L., Li, J., Zhang, S., & Chen, W. (2020). Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants. Diabetes Research and Clinical Practice, 162, 108044.

Ngamjarus, C. (2016). Sample size calculation for an epidermiological study on a smart Device. Siriraj Medical Journal, 68(3), 160-170.

Phattanachindakun, B., Watananirun, K., & Boriboonhirunsarn, D. (2022). Early universal screening of gestational diabetes in a university hospital in Thailand. Journal of Obstetrics and Gynaecology, 42(6), 2001-2007.

Roustaei, Z., Anttonen, S., Räisänen, S., Gissler, M., & Heinonen, S. (2023). Socioeconomic status, maternal risk factors, and gestational diabetes mellitus across reproductive years: A Finnish register-based study. BMJ Open Diabetes Research & Care, 11(4), e003278.

Royal Thai College of Obstetricians and Gynecologists. (2024). RTCOG clinical practice guideline. Retrieved April 9, 2024, from https://www.rtcog.or.th/content/viewid/276

Serirat, S., Deerochanawong, C., Sunthornthepvarakul, T., & Jinayon, P. (1992). Gestational diabetes mellitus. Journal of the Medical Association of Thailand, 75(6), 315-319.

Šimják, P., Cinkajzlová, A., Anderlová, K., Pařízek, A., Mráz, M., Kršek, M., & Haluzík, M. (2018). The role of obesity and adipose tissue dysfunction in gestational diabetes mellitus. Journal of Endocrinology, 238(2), R63-R77.

Srichumchit, S., Luewan, S., & Tongsong, T. (2015). Outcomes of pregnancy with gestational diabetes mellitus. International Journal of Gynecology & Obstetrics, 131(3), 251-254.

Suntorn, R , Panichkul, P. (2015). Prevalence of gestational diabetes mellitus detected by International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria in Phramongkutklao Hospital Thai Journal of Obstetrics and Gynaecology, 23, 144-150.

Torloni, M. R., Betrán, A. P., Horta, B. L., Nakamura, M. U., Atallah, A. N., Moron, A. F., & Valente, O. (2009). Prepregnancy BMI and the risk of gestational diabetes: a systematic review of the literature with meta-analysis. Obes Rev, 10(2), 194-203.

Venkatesh, K. K., Lynch, C. D., & Grobman, W. A. (2022). Risk of adverse pregnancy outcomes among US Individuals with gestational diabetes by race and ethnicity-reply. JAMA, 328(4), 397-398.

Wang, G., Xu, R., Zhang, B., Hong, X., Bartell, T. R., Pearson, C., et al.. (2023). Impact of intrauterine exposure to maternal diabetes on preterm birth: fetal DNA methylation alteration is an important mediator. Clinical Epigenetics, 15(1), 59.

World Health Organization. (2023). A roadmap to combat postpartum hemorrhage between 2023 and 2030. Geneva: World Health Organization.