الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
 |  | from | 32 |  |  |
| | | from | 32 | | |
Abstract
Gestational diabetes mellitus is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. Gestational diabetes must be considered to be a disease entity that presents significant perinatal risks and carries an enhanced risk for the later development of manifest diabetes in the mother.
The appearance of diabetes-related autoantibodies has been shown to be able to predict the development of type 1 diabetes before even hyperglycemia arises, the main one being ICAS . A major issue regarding the presence of ICAs in women with GDM is the potentially increased risk for the development of diabetes either at short term after delivery or at longer follow-up. The majority of reports have agreed that positivity for ICAs during pregnancy increases the maternal risk of glucose intolerance/diabetes.
The aim of this study was to asses the prevalence of ICAs among sample of Egyptian females with GDM and relation of prescence of these antibodies to occurance of type 1 diabetes later on.
Our study was conducted on 150 pregnant females with age ranging from (19-39) years old , diagnosed to had GDM at 24th to 28th weeks of gestation ,who had their antenatal care visit in the outpatient clinic in Ain Shams University Maternity hospital from Novmber 2013 to April 2014. The study was conducted on two phases:
The 1st phase : Measurement of ICA for all 150 pregnant females with GDM. Then the pregnant females were divided into 2 groups according to the prescence of ICA: group I: (66) ICA positive . group II: (84) ICA negative . The 2nd phase: follow up of ICA positive group 6 month &1 year postpartum. After 6 month: ICA positive subjects were divided into 2 subgroups: group I a : it includes (25) ICA positive diabetic patients. group I b: it includes (41) ICA positive non diabetic subjects.
After 1 year: ICA positive subjects were divided into 2 subgroups: group I c: it includes (34) ICA positive diabetic patients. group I d : it includes (32) ICA positive non diabetic subjects.
All subjects will be subjected to the following: Full medical history, clinical examination, laboratory investigations including: FPG (mg/dl), 2h post prandial plasma glucose (mg/dl), 75 gm OGTT, Fasting insulin level(mU/ml) for calculation of HOMA I.R, ICA by ELISA.
The results were statistically analyzed and we observed the following:
Prevelance of islet cell antibodies among studied subjects was 44% (66 subjects), with follow up it was found there was 25 diabetic patients (37.9%) 6 month after delivery and 34 diabetic patients (51.52%) 1 year after delivery .
On comparing group 1(Islet cell antibody positive and group II (Islet cell antibody negative):
It includes (66) ICA positive & (84) ICA negative subjects.
There was a highly significant difference between both groups as regards age being higher in group I than group II (31.52+3.76 vs. 26.54+4.12) years respectively. BMI being higher in group I than group II (34.17+2.49 vs. 30.65+2.29) kg/m2 respectively .FBS being higher in group I than group II (125.97+11.60 vs. 118.88 + 9.04) mg/dl respectively ,2hr PP being higher in group I than group II (201.85+12.19 vs. 184.26+12.46) mg/dl respectively ,fasting insulin level being higher in group II than group I (12.57+2.64 vs.10.34+ 1.69) IU/L respectively. HOMA - IR being higher in group II than group I (3.6+0.78 vs 3.1+ 0.45) % respectively.
There was no significant difference between the two groups regarding systolic blood pressure (117.42 ± 7.71vs. 116.49±7.35) mmHg respectively. Diastolic blood pressure (72.95±6.44 vs. 72.32±6.92) mmHg respectively, 1hr postprandial plasma glucose (191.61 ± 8.24 vs. 191.77 ± 7.54) mg/dl respectively (p-value>0.05).
On comparing group Ia and group Ib (follow up 6 month postpartum):
It includes (25)diabetic patients &(41) non diabetic subjects.
There was a highly significant difference between both groups as regards age being higher in group Ia than group Ib (32.84+3.65 vs. 30.71+3.64) years respectively, BMI being higher in group Ia than group Ib (32.8+2.4 vs. 31.3+1.9) kg/m2 respectively, systolic blood pressure being higher in group Ia than group Ib (119.27 ± 6.38 vs. 114.40 ±8.82) mmHg respectively, FBS being higher in group Ia than group Ib (157.6+26.3 vs. 84.7 + 8.9) mg/dl respectively; 2hr PP being higher in group Ia than group Ib (224.6+18.4 vs. 126.4+7.6) mg/dl respectively, fasting insulin level being higher in group Ib than group Ia (8.73+1.29 vs. 4.28+ 0.81) IU/L respectively. (p-value < 0.001).
There was no significant difference between the two groups regarding diastolic blood pressure (71.40±7.29 vs. 73.90±5.76) mmHg respectively, HOMA - IR (1.67+0.46 vs 1.83+ 0.33) % respectively. (p-value>0.05).
On comparing group Ic and group Id (follow up 1 year postpartum):
It includes (34)diabetic patients & (32)non diabetic subjects
¬There was a significant difference between both groups as regards age being higher in group Ic than group Id (32.7+3.5 vs. 30.3+3.7) years respectively, BMI being higher in group Ic than group Id (31.9+1.9 vs. 30.8 + 1.9) kg/m2 respectively, FBG being higher in group Ic than group Id (137.9+10.5 vs. 82.5 + 19.1) mg/dl respectively,2hr PP being higher in group Ic than group Id (222.6+11.5
vs. 127.6+5.8) mg/dl respectively , fasting insulin level being higher in group Id than group Ic (7.34+1.16 vs. 4.99+ 2.07) IU/L respectively .(p-value < 0.001).
There was no significant difference between the two groups regarding systolic blood pressure (116.0 ± 8.4 vs. 118.9 ±6.7) mmHg respectively. Diastolic blood pressure (71.9±6.7 vs. 74.1±6.0) mmHg respectively, HOMA - IR (1.72+0.8 vs 1.51+ 0.55) % respectively. (p-value>0.05).)
In conclusion there was significant prevalence of ICA among pregnant females with GDM. ICA positive women with GDM have an increased risk of developing type 1 diabetes later in life. It is important to do screening for ICA among women with GDM, this should be recognized as a strong indicator that type 1 diabetes will develop at some later stage and therefore action should be taken to prevent this outcome after childbirth. However, the present study has some limitations - there were a relatively small sample size , and the tracing of postpartum diabetes development was performed in the early stage after delivery.