Diyabetik gebelerde gözlenen kronik fetal hipokside oksidatif stresin rolü
Başlık çevirisi mevcut değil.
- Tez No: 171634
- Danışmanlar: PROF.DR. RIZA MADAZLI
- Tez Türü: Tıpta Uzmanlık
- Konular: Kadın Hastalıkları ve Doğum, Obstetrics and Gynecology
- Anahtar Kelimeler: Gestational Diabetes, Villous immaturity, Eritropoetin, EPO, nucleated- Red Blood Cell, n-RBC percentage, Malonyl Dialdehyde, MDA, VEGF 52, Gestational Diabetes, Villous immaturity, Eritropoetin, EPO, nucleated- Red Blood Cell, n-RBC percentage, Malonyl Dialdehyde, MDA, VEGF 52
- Yıl: 2006
- Dil: Türkçe
- Üniversite: İstanbul Üniversitesi
- Enstitü: Cerrahpaşa Tıp Fakültesi
- Ana Bilim Dalı: Kadın Hastalıkları ve Doğum Ana Bilim Dalı
- Bilim Dalı: Belirtilmemiş.
- Sayfa Sayısı: 70
Özet
ABSTRACT Purpose: The aim of this study is to investigate the presence of chronic fetal hypoxia in pregnant women with gestational diabetes by measuring and comparing erythropoietin levels in maternal serum and cord-blood samples in normal and gestational diabetic mothers and n-RBC percentages in capillary blood samples obtained from newborns. Simultaneously, examinations on placentas have been performed to investigate probable histological abnormalities and maternal serum and cord-blood MDA levels have been measured to evaluate probable oxidative stress in all pregnant women. Subsequently, the relationship between chronic fetal hypoxia observed in gestational diabetic pregnancies and probable placental histological abnormalities and increased oxidative stress has been evaluated. Materials and Method: This prospective study has been performed at Istanbul University, Cerrahpaşa Faculty of Medicine, Obstetrics and Gynecology Department on 22 gestational diabetic patients and 22 healthy pregnant women between October 2004 and July 2005. All of the participants were chosen from Fetal Medicine outpatient clinic among term singleton pregnancies at Cerrahpaşa Faculty of Medicine whose labors were conducted at the same clinic. In order to prove chronic fetal hypoxia, maternal and umblical cord serum Erithropoetin (EPO) levels and nucleated- Red Blood Cell (n-RBC) percentages on newborn blood samples were used. In order to prove oxidative stress, maternal and umblical cord serum Malonyl Dialdehyde(MDA) levels were studied. The placental histological examinations were conducted for villous immaturity, chorioanginosis, fibrinoid necrosis, lymphohistiocytic villitis, ischemia, necrosis and presence of n-RBC in addition to placental ratios (placental weight / newborn weight). Moreover in order to illuminate molecular physiology of fetoplacental circulation, maternal and umblical cord serum Vascular Endothelial Growth Factor(VEGF) levels were studied. Results: As for chronic fetal hypoxia survaillance, in pregnancies complicated with gestational diabetes the blood samples from umblical cord had higher levels of EPO levels ( 48.63 ± 33.70 and 31.88 ± 13.11 respectively, p: 0.035) and n-RBC percentages on blood film ( 7 ± 6.5 and 1.36 ± 2.2 respectively, p: 0.000) compared to normal pregnancies. Maternal EPO levels were comparable to one another in both groups ( 24.58 ± 7.42 and 34.41 ± 23.0 respectively, p: insignificant). In addition, oxydative stresss markers such as maternal serum and umblical cord MDA levels are higher in gestational diabetic compared to normal pregnancies (3.44 ± 0.45 ve 2.04 ± 0.25, p:0.000 for maternal MDA) and (5.80 ± 0.67 ve 3.21 ± 0.38, p:0.000 for umblical cord MDA). Moreover there is a positive relation between maternal 51and umblical cord MDA levels versus maternal serum HbAlc levels (p:0.00 and p: 0,00 respectively), fetal n-RBC percentage( p:0,00, p:0,00 respectively) and eritropoetin levels in the newborn ( p:0,01 and p:0,02 respectively). However there is significant inverse correlation between the parameters listed above and fetal VEGF levels (p:0,038, p:0,006 respectively). Gestational diabetics contain placental pathologies more frequently when compared to normal pregnancies such as villous immaturity(59% and 9%, p:0,001 respectively), chorionginosis(27,2% and 4,5%, p:0,045 respectively) and ischemia(46% and 13,6%, p:0,027 respectively). The present study revealed significant positive relation between placental villous immaturity and maternal and umblical cord serum MDA levels(p:0,007 and p:0,000 respectively) and significant negative correlation between placental immaturity and maternal and umblical cord VEGF levels (p:0,046 and p:0,000 respectively). Conclusion: In gestational diabetics pregnacies high EPO levels and increased n- RBC percentage which precludes chronic fetal hypoxia is more frequent when compared to healthy pregnancies. Main pathological abnormality seen in these patient is villous immaturity. Increased MDA levels accompany placental villous immaturity together with increased oxidative stress. Similar to preeclempsia, the main problem in gestational diabetes is believed to be of placental origin.
Özet (Çeviri)
ABSTRACT Purpose: The aim of this study is to investigate the presence of chronic fetal hypoxia in pregnant women with gestational diabetes by measuring and comparing erythropoietin levels in maternal serum and cord-blood samples in normal and gestational diabetic mothers and n-RBC percentages in capillary blood samples obtained from newborns. Simultaneously, examinations on placentas have been performed to investigate probable histological abnormalities and maternal serum and cord-blood MDA levels have been measured to evaluate probable oxidative stress in all pregnant women. Subsequently, the relationship between chronic fetal hypoxia observed in gestational diabetic pregnancies and probable placental histological abnormalities and increased oxidative stress has been evaluated. Materials and Method: This prospective study has been performed at Istanbul University, Cerrahpaşa Faculty of Medicine, Obstetrics and Gynecology Department on 22 gestational diabetic patients and 22 healthy pregnant women between October 2004 and July 2005. All of the participants were chosen from Fetal Medicine outpatient clinic among term singleton pregnancies at Cerrahpaşa Faculty of Medicine whose labors were conducted at the same clinic. In order to prove chronic fetal hypoxia, maternal and umblical cord serum Erithropoetin (EPO) levels and nucleated- Red Blood Cell (n-RBC) percentages on newborn blood samples were used. In order to prove oxidative stress, maternal and umblical cord serum Malonyl Dialdehyde(MDA) levels were studied. The placental histological examinations were conducted for villous immaturity, chorioanginosis, fibrinoid necrosis, lymphohistiocytic villitis, ischemia, necrosis and presence of n-RBC in addition to placental ratios (placental weight / newborn weight). Moreover in order to illuminate molecular physiology of fetoplacental circulation, maternal and umblical cord serum Vascular Endothelial Growth Factor(VEGF) levels were studied. Results: As for chronic fetal hypoxia survaillance, in pregnancies complicated with gestational diabetes the blood samples from umblical cord had higher levels of EPO levels ( 48.63 ± 33.70 and 31.88 ± 13.11 respectively, p: 0.035) and n-RBC percentages on blood film ( 7 ± 6.5 and 1.36 ± 2.2 respectively, p: 0.000) compared to normal pregnancies. Maternal EPO levels were comparable to one another in both groups ( 24.58 ± 7.42 and 34.41 ± 23.0 respectively, p: insignificant). In addition, oxydative stresss markers such as maternal serum and umblical cord MDA levels are higher in gestational diabetic compared to normal pregnancies (3.44 ± 0.45 ve 2.04 ± 0.25, p:0.000 for maternal MDA) and (5.80 ± 0.67 ve 3.21 ± 0.38, p:0.000 for umblical cord MDA). Moreover there is a positive relation between maternal 51and umblical cord MDA levels versus maternal serum HbAlc levels (p:0.00 and p: 0,00 respectively), fetal n-RBC percentage( p:0,00, p:0,00 respectively) and eritropoetin levels in the newborn ( p:0,01 and p:0,02 respectively). However there is significant inverse correlation between the parameters listed above and fetal VEGF levels (p:0,038, p:0,006 respectively). Gestational diabetics contain placental pathologies more frequently when compared to normal pregnancies such as villous immaturity(59% and 9%, p:0,001 respectively), chorionginosis(27,2% and 4,5%, p:0,045 respectively) and ischemia(46% and 13,6%, p:0,027 respectively). The present study revealed significant positive relation between placental villous immaturity and maternal and umblical cord serum MDA levels(p:0,007 and p:0,000 respectively) and significant negative correlation between placental immaturity and maternal and umblical cord VEGF levels (p:0,046 and p:0,000 respectively). Conclusion: In gestational diabetics pregnacies high EPO levels and increased n- RBC percentage which precludes chronic fetal hypoxia is more frequent when compared to healthy pregnancies. Main pathological abnormality seen in these patient is villous immaturity. Increased MDA levels accompany placental villous immaturity together with increased oxidative stress. Similar to preeclempsia, the main problem in gestational diabetes is believed to be of placental origin.
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