الفهرس 
Gestational diabetes mellitusOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
Diabetes is a disease of metabolism clinically expressed by chronic hyperglycemia and blood lipid and protein disorders that have been extensively reported as linked to several complication that cause morbidity and mortality
Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. The definition applies whether insulin or only diet modification is used for treatment and whether or not the condition persists after pregnancy.
Gestational diabetes mellitus should be diagnosed at any time during pregnancy based on any one of the following values: (1) Fasting plasma glucose = 5.1-6.9 mmol/L (92-125 mg/dL), (2) 1h post 75 g oral glucose load ≥ 10.0 mmol/L (180 mg/dL), (3) 2 h ≥ 8.6 mmol/L (155 mg/dL) according to WHO criteria.
The infants of diabetic mothers (IDM) may have great risk for serious problems during pregnancy and at birth. Problems during pregnancy may include increased risk for birth defects and stillbirth. Also including problems with the formation of the brain, heart, lung, spinal cord, gastrointestinal system and urinary tract.
Maintain euglycemia by increasing insulin secretion and gestational diabetes occurs in women, whose body can‘t make enough insulin. Actually gestational diabetes occurs when a pregnant woman does not release enough insulin or respond to insulin is not enough; as a result, the patient is unable to have normal glucose status.
Several genetic polymorphisms and their effect on insulin activity are detected, including IRS-1 gene polymorphisms that are a signaling protein in humans and encoded by the gene IRS-1. This gene is located on chromosome 2q36, and encodes one of proteins of IRS family. Insulin is an important determinant of early growth and plays a prominent role in maintaining glucose homeostasis. IRS-1, plays a critical role in insulin signaling and its control has an important place in the development of insulin resistance.
One of the polymorphisms of this gene is glycine with arginine amino acid substitution at codon 972 (Gly972Arg) that associated with a high incidence of gestational diabetes due to insulin resistance, and impaired insulin secretion.
Summary
87
We conducted this cases control study to evaluated insulin receptor substrate-1gene (IRS-1) in 25 of pregnant diabetic mothers with gestational diabetes and mild gestational hyperglycemia during third trimester of pregnancy and their infants in comparison to healthy and equally matched group (control group).
The patients were subjected to full history taking, clinical examination, anthropometric measurements, laboratory investigations (complete blood count (CBC), HBA1C, post prandial blood sugar, fasting blood sugar for mother and their infants) and molecular genetic study for (IRS-1 gene) Gly 972Arg variant.
The aim of this work is to study the genetic effect of insulin receptor substrate-1gene (IRS-1) in pregnant mothers with gestational diabetes and their degree of glycemic control and possible impact on their infants.
Patient and methods:
The present study was carried out on 80pregnant women 40 of them have gestational diabetes mellitus during third trimester of pregnancy and their infants attending the department of obstetrics and department of pediatrics, Faculty of Medicine, Menoufia University Hospital.
The 40 apparently healthy, pregnant women and their infants matched with diabetic mothers and their infants in the same age from our obstetrics and pediatric general clinic in Menoufia University Hospital as a control group.
The mothers with GDM:
Their ages ranged from 21-38 years with mean age (30.23±5.428).
The infants of diabetic mothers:
Included 31 males and 9 females, 80% of them their weight were at gestational age.
All patients and controls were subjected to the following after taking informed written consent:
1. Detailed history taking.
2. Complete general examination of all body systems.
3. Laboratory investigations:
a. from mothers:
Estimation of Fasting plasma glucose level.
Estimation of 2hr Postprandial plasma glucose level.
Summary
88
Estimation of glycosylated hemoglobin (HbA1C).
Estimation of liver and renal function tests.
b. from infants of diabetic mothers:
Estimation of complete blood count (CBC) at 1hr and 24hr of age.
Estimation of random blood sugar (RBS) at 1,2 ,3, 6, 12, 24, 36, 48hrof age.
Estimation of calcium level.
4. Molecular study of (IRS-1) gene polymorphism by PCR.
5. Family counseling.
6. Data management.
7. Statistical analysis.
- Our results showed that,
- In the current study, the mothers with GDM (21-38years) were significantly older with higher Positive family history, higher systolic & diastolic blood pressure, HbA1C, 2hr post prandial blood sugar& fasting blood sugar lower gestational age of DM in mothers with GDM than in control group.
- The complication presented among mothers with GDM during pregnancy as followed: hypertension, premature rupture of membrane, and hyperglycemia at percentage of 52.5%, 5%, and 17.5% respectively which significantly higher than in control groups.
- IRS-1 genetic variant in mothers with GDM frequency of CC genotype was (45%, and CT genotype was 22.5% TT genotype was 32.5%) was significantly higher than in control group (CC 65%, CT 35%) as P value = 0.001. Frequency of T-alleles (43.7% versus 18%) &TT -alleles (32.5% versus 0%) were significantly increased among diabetic mothers (Cases) compared to controls. Also, Hb A1C was higher in TT genotyping (7.16±1.48) than CC genotyping (5.85±1.044) and CT genotyping (5.76±1.24) as P- value 0.003.
- As regarding to neonatal outcomes, newborn Apgar score at 1 minute and random blood sugar at 1st hour & at 2hour of life significantly lower, weight of infants, respiratory rate significant higher, hemoglobin level and hematocrit
Summary
89
percentage at 1st hour of life, While after 24 hours, the mean value of hemoglobin level was significantly lower in infants of diabetic mothers than control group
- In the current study, frequency of CC genotype 50%, CT genotype 35%, and TT genotype 6 % in infants of diabetic mothers was significantly higher than in control group that was CC genotype 50%, CT genotype 50%, TT 0%. While frequency of T-alleles was statistically insignificant. Also, there is significant negative correlation between IRS-1 TT genotype diabetic mothers and the respiratory rate of their infant (p=0.046) means IRS-1 TT genotype diabetic mothers associated with increasing their infant respiratory.
- There is significant negative correlation between HbA1c of mothers with GDM and Apgar scare at 1 minute of their infant means higher level of HbA1c of mothers associated with decreasing 1minute APGAR score of their infant. And significant positive correlation between 2hr PP blood glucose of mothers with GDM and respiratory rate of their infant means higher level of 2hr post prandial blood sugar of mother associated with increasing respiratory rate of their infants.