BACKGROUND Medically assisted procreation (MAP) is the set of techniques used to facilitate conception in couples where the latter is impossible or extremely remote or in cases where other pharmacological and/or surgical interventions have proved inadequate. Gestational diabetes mellitus (GDM) is a glucose intolerance that develops or is diagnosed for the first time in pregnancy and usually resolves not long after delivery. It is a temporary condition but, if not properly diagnosed and treated, it can lead to an increased risk of maternal and foetal complications. With the rise of PMA techniques, the number of pregnancies complicated by endocrine disorders, notably gestational diabetes, has increased, but the related increased risk of maternal and foetal complications can be minimised through proper management and clinical observation. PURPOSE OF THE STUDY The aim of this study is to evaluate the outcomes of pregnancies complicated by GDM and arising via PMA compared to pregnancies arising naturally. MATERIALS AND METHODS 670 women with GDM, followed by the U.O. of Diabetology of ULSS 6 Euganea of Padua in the period 2010-2022, were considered. In particular, 229 patients with a positive anamnesis for modality of fertilization through MAP and 441 patients with a positive anamnesis for modality of natural fertilization were compared. Clinical-metabolic characteristics, maternal-foetal outcomes and characteristics of twin pregnancies were evaluated. RESULTS There were no statistically significant differences in the clinical-metabolic characteristics of the analysed patients and risk factors, except for the value of the first glycaemia, which was significantly higher in the women in the control group (88,1 ± 10,7 vs. 86,2 ± 12,5 mg/dl, p = 0,046), for the percentage of twin deliveries, which was significantly higher in women undergoing PMA (16,2% vs 2,5%, p < 0,001) and for previous GDM, which was found in a significantly higher percentage in patients with spontaneous fertilisation (20% vs 2,6%, p < 0,001). The lipid profile values at diagnosis are significantly higher in women undergoing PMA, as are the values of the diagnostic OGTT 75g at time 120' (152,8 ± 31,8 vs 147,4 ± 32,2 mg/dl, p = 0,043). The maternal outcome saw a statistically significant difference only in the presence of thyroid disease, which was recorded in a higher percentage in women undergoing PMA (21,4% vs 14,3%, p = 0,008). With regard to both single and twin pregnancies, a higher percentage of caesarean section delivery was reported in women undergoing PMA. With regard to the neonatal outcome there were no statistically significant differences, except for the birth weight of the second twin, which was significantly lower in women undergoing PMA (2267,8 ± 536,6 vs 2821,7 ± 296,9 g, p = 0,021). CONCLUSIONS Our study showed no differences in the outcomes of GDM-complicated pregnancies that occurred via PMA compared to GDM-complicated pregnancies that arose spontaneously as the patients were promptly diagnosed and treated.
BACKGROUND La procreazione medicalmente assistita (PMA) è l’insieme delle tecniche utilizzate per favorire il concepimento nelle coppie in cui quest’ultimo risulta impossibile o estremamente remoto o nei casi in cui altri interventi farmacologici e/o chirurgici si sono dimostrati inadeguati. Il diabete mellito gestazionale (GDM) è un’intolleranza al glucosio che si sviluppa o viene diagnosticata per la prima volta in gravidanza e si risolve solitamente non molto tempo dopo il parto. Si tratta di una condizione temporanea ma, se non adeguatamente diagnosticata e trattata, può comportare un aumentato rischio di complicanze materne e fetali. Con l’ascesa delle tecniche di PMA, il numero di gravidanze complicate da disturbi endocrini, tra cui spicca il diabete gestazionale, è aumentato, ma il correlato aumento del rischio di complicanze materne e fetali può essere ridotto al minimo grazie ad una adeguata gestione e osservazione clinica. SCOPO DELLO STUDIO Lo scopo di questo studio è valutare gli outcomes materni e neonatali delle gravidanze complicate da GDM e insorte tramite PMA rispetto alle gravidanze insorte naturalmente. MATERIALI E METODI Sono state considerate 670 donne con GDM, seguite dall’ambulatorio dell’U.O. di Diabetologia dell’ULSS 6 Euganea di Padova nel periodo 2010-2022. In particolare, sono state messe a confronto 229 pazienti con anamnesi positiva per modalità di fecondazione tramite PMA e 441 pazienti con anamnesi positiva per modalità di fecondazione naturale. Sono state valutate le caratteristiche clinico-metaboliche, gli outcomes materno-neonatali e le caratteristiche delle gravidanze gemellari. RISULTATI Non si sono evidenziate differenze statisticamente significative per quanto concerne le caratteristiche clinico-metaboliche delle pazienti analizzate e i fattori di rischio, se non per il valore della prima glicemia, significativamente superiore nelle donne del gruppo di controllo (88,1 ± 10,7 vs 86,2 ± 12,5 mg/dl, p = 0,046), per la percentuale di parti gemellari, significativamente più elevata nelle donne sottoposte a PMA (16,2% vs 2,5%, p < 0,001) e per il pregresso GDM, riscontrato in percentuale significativamente maggiore nelle pazienti con fecondazione spontanea (20% vs 2,6%, p < 0,001). I valori del profilo lipidico alla diagnosi sono significativamente superiori nelle donne sottoposte a PMA, così come i valori dell’OGTT 75g diagnostico al tempo 120’ (152,8 ± 31,8 vs 147,4 ± 32,2 mg/dl, p= 0,043). L’outcome materno vede una differenza statisticamente significativa solo per quanto riguarda la presenza di tireopatie, registrata in percentuale maggiore nelle donne sottoposte a PMA (21,4% vs 14,3%, p = 0,008). Sia per quanto riguarda le gravidanze singole sia per quelle gemellari, nelle donne sottoposte a PMA si evidenzia una percentuale maggiore di parto cesareo. Per quanto concerne l’outcome neonatale non si rilevano differenze statisticamente significative, se non per il peso alla nascita del secondo gemello, che risulta significativamente inferiore nelle donne sottoposte a PMA (2267,8 ± 536,6 vs 2821,7 ± 296,9 g, p = 0,021). CONCLUSIONI Il nostro studio non ha mostrato differenze per quel che riguarda gli outcomes delle gravidanze complicate da GDM ed insorte tramite PMA rispetto alle gravidanze complicate da GDM ma insorte spontaneamente poiché le pazienti sono state tempestivamente diagnosticate e trattate.
Outcomes delle gravidanze da Procreazione Medicalmente Assistita complicate da Diabete Gestazionale
MARCHETTO, ANNA
2021/2022
Abstract
BACKGROUND Medically assisted procreation (MAP) is the set of techniques used to facilitate conception in couples where the latter is impossible or extremely remote or in cases where other pharmacological and/or surgical interventions have proved inadequate. Gestational diabetes mellitus (GDM) is a glucose intolerance that develops or is diagnosed for the first time in pregnancy and usually resolves not long after delivery. It is a temporary condition but, if not properly diagnosed and treated, it can lead to an increased risk of maternal and foetal complications. With the rise of PMA techniques, the number of pregnancies complicated by endocrine disorders, notably gestational diabetes, has increased, but the related increased risk of maternal and foetal complications can be minimised through proper management and clinical observation. PURPOSE OF THE STUDY The aim of this study is to evaluate the outcomes of pregnancies complicated by GDM and arising via PMA compared to pregnancies arising naturally. MATERIALS AND METHODS 670 women with GDM, followed by the U.O. of Diabetology of ULSS 6 Euganea of Padua in the period 2010-2022, were considered. In particular, 229 patients with a positive anamnesis for modality of fertilization through MAP and 441 patients with a positive anamnesis for modality of natural fertilization were compared. Clinical-metabolic characteristics, maternal-foetal outcomes and characteristics of twin pregnancies were evaluated. RESULTS There were no statistically significant differences in the clinical-metabolic characteristics of the analysed patients and risk factors, except for the value of the first glycaemia, which was significantly higher in the women in the control group (88,1 ± 10,7 vs. 86,2 ± 12,5 mg/dl, p = 0,046), for the percentage of twin deliveries, which was significantly higher in women undergoing PMA (16,2% vs 2,5%, p < 0,001) and for previous GDM, which was found in a significantly higher percentage in patients with spontaneous fertilisation (20% vs 2,6%, p < 0,001). The lipid profile values at diagnosis are significantly higher in women undergoing PMA, as are the values of the diagnostic OGTT 75g at time 120' (152,8 ± 31,8 vs 147,4 ± 32,2 mg/dl, p = 0,043). The maternal outcome saw a statistically significant difference only in the presence of thyroid disease, which was recorded in a higher percentage in women undergoing PMA (21,4% vs 14,3%, p = 0,008). With regard to both single and twin pregnancies, a higher percentage of caesarean section delivery was reported in women undergoing PMA. With regard to the neonatal outcome there were no statistically significant differences, except for the birth weight of the second twin, which was significantly lower in women undergoing PMA (2267,8 ± 536,6 vs 2821,7 ± 296,9 g, p = 0,021). CONCLUSIONS Our study showed no differences in the outcomes of GDM-complicated pregnancies that occurred via PMA compared to GDM-complicated pregnancies that arose spontaneously as the patients were promptly diagnosed and treated.File | Dimensione | Formato | |
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https://hdl.handle.net/20.500.12608/30601