Publication: Gestasyonel diyabetes mellitusun serum hormon düzeylerine ve anne sütü bileşimine etkisi
Abstract
Gestasyonel diyabetes mellitusun serum hormon düzeylerine ve anne sütü bileşimine etkisi Amaç: Bu çalışmanın amacı, tıbbi beslenme tedavisi ile izlenen gestasyonel diyabet mellitus (GDM) tanılı gebeler ile sağlıklı gebelerin doğum sonrası 14. ve 30. günlerdeki anne sütü makro besin ögeleri, anne kan serumu ve anne sütü hormon düzeylerini (insülin, adiponektin, leptin, ghrelin, chemerin, dermcidin) değerlendirmektir. Gereç ve Yöntem: Kadın doğum polikliniğine başvuran, akut veya kronik hastalığı, gebelik komplikasyonu bulunmayan ve tekil gebeliğe sahip gönüllü gebeler dahil edilmiştir. Gebeliğin 26–28. haftasında OGTT ile hekim tarafından GDM tanısı alan gebeler GDM grubuna (n=20), tanı almayanlar KG (n=20)’ye alınmıştır. Gestasyonel diyabet grubundaki gebelere bireyselleştirilmiş tıbbi beslenme tedavisi uygulanmış, her iki gruptan doğumdan sonraki 14. ve 30. günlerde anne sütü ve kan örnekleri, 3 günlük geriye dönük besin tüketim kayıtları alınmıştır. Veriler SPSS 23.0 paket programında değerlendirilmiştir. Bulgular: Gestasyonel diyabet grubunda 30. günde enerji ve yağ içeriğinde (p = 0,04), KG’de ise laktoz içeriği anlamlı artış olmuştur (p < 0,001). Tüm annelerde serum insülin düzeyi 30. günde anlamlı şekilde azalmış (p < 0,001), ghrelin düzeyi artış göstermiştir (p = 0,04). GDM grubunda 14. gün serum insülin (p = 0,03), adiponektin (p = 0,01), chemerin (p = 0,05), dermcidin (p = 0,02) ve ghrelin (p < 0,001) düzeyleri kontrol grubuna göre anlamlı olarak daha yüksek bulunmuştur. Anne sütü hormon düzeyleri açısından, 30. günde tüm annelerde adiponektin (p < 0,001) ve chemerin (p < 0,001) düzeylerinde anlamlı artış gözlenmiş; ancak gruplar arasında bu hormonlar açısından istatistiksel olarak anlamlı fark saptanmamıştır. Sonuç: Gestasyonel diyabet tanılı annelerde doğum sonrası erken dönemde hem hormon düzeylerinde hem de anne sütü içeriğinde anlamlı değişiklikler gözlenmiştir. Özellikle anne kanı ve sütündeki adiponektin, chemerin ve dermcidin düzeylerinin GDM grubunda arttığı belirlenmiştir. Sonuç olarak, GDM tanılı annelerde doğum sonrası dönemde metabolik durumun izlenmesi ve bireyselleştirilmiş tıbbi beslenme tedavisinin sürdürülmesi anne – bebek sağlığı açısından kritik rol taşımaktadır.
Effect of gestational diabetes mellitus on serum hormone levels and composition of human milk macronutrients Objective: This study aimed to evaluate the levels of human milk macronutrients, maternal serum, and human milk hormones (insulin, adiponectin, leptin, ghrelin, chemerin, and dermcidin) on the 14th and 30th days postpartum in women with gestational diabetes mellitus (GDM) receiving medical nutrition therapy compared to healthy pregnant mothers. Materials and Methods: Voluntary pregnant women with singleton pregnancies who had no acute or chronic disease or pregnancy complications and applied to the obstetrics outpatient clinic were included in the study. Women diagnosed with GDM by a physician through OGTT between the 26th and 28th gestational weeks formed the GDM group (n=20), while those without a diagnosis constituted the control group (n=20). Individualized medical nutrition therapy was applied to the GDM group. Both groups were evaluated on the 14th and 30th days postpartum. Human milk and blood samples, along with a 3-day food consumption record, were collected from all participants. Data were analyzed using SPSS version 23.0. Results: In the GDM group, energy and fat content of human milk significantly increased on day 30 (p = 0.04), while in the control group, lactose content increased significantly (p < 0.00). Among all mothers, serum insulin levels significantly decreased (p < 0.001), while ghrelin levels increased (p = 0.04) on day 30. Serum insulin (p = 0.03), adiponectin (p = 0.01), chemerin (p = 0.05), dermcidin (p = 0.02), and ghrelin (p < 0.001) levels were significantly higher in the GDM group compared to the control group on day 14. Regarding human milk hormones, adiponectin (p < 0.001) and chemerin (p < 0.001) levels increased significantly on day 30 in all mothers; however, no significant difference was found between the groups. Conclusion: In mothers diagnosed with GDM, significant changes were observed in both hormone levels and human milk composition in the early postpartum period. Especially adiponectin, chemerin, and dermcidin levels in maternal serum and human milk were found to be higher in the GDM group. These results highlight the critical importance of monitoring metabolic status and continuing individualized medical nutrition therapy in the postpartum period to support maternal and infant health.
Effect of gestational diabetes mellitus on serum hormone levels and composition of human milk macronutrients Objective: This study aimed to evaluate the levels of human milk macronutrients, maternal serum, and human milk hormones (insulin, adiponectin, leptin, ghrelin, chemerin, and dermcidin) on the 14th and 30th days postpartum in women with gestational diabetes mellitus (GDM) receiving medical nutrition therapy compared to healthy pregnant mothers. Materials and Methods: Voluntary pregnant women with singleton pregnancies who had no acute or chronic disease or pregnancy complications and applied to the obstetrics outpatient clinic were included in the study. Women diagnosed with GDM by a physician through OGTT between the 26th and 28th gestational weeks formed the GDM group (n=20), while those without a diagnosis constituted the control group (n=20). Individualized medical nutrition therapy was applied to the GDM group. Both groups were evaluated on the 14th and 30th days postpartum. Human milk and blood samples, along with a 3-day food consumption record, were collected from all participants. Data were analyzed using SPSS version 23.0. Results: In the GDM group, energy and fat content of human milk significantly increased on day 30 (p = 0.04), while in the control group, lactose content increased significantly (p < 0.00). Among all mothers, serum insulin levels significantly decreased (p < 0.001), while ghrelin levels increased (p = 0.04) on day 30. Serum insulin (p = 0.03), adiponectin (p = 0.01), chemerin (p = 0.05), dermcidin (p = 0.02), and ghrelin (p < 0.001) levels were significantly higher in the GDM group compared to the control group on day 14. Regarding human milk hormones, adiponectin (p < 0.001) and chemerin (p < 0.001) levels increased significantly on day 30 in all mothers; however, no significant difference was found between the groups. Conclusion: In mothers diagnosed with GDM, significant changes were observed in both hormone levels and human milk composition in the early postpartum period. Especially adiponectin, chemerin, and dermcidin levels in maternal serum and human milk were found to be higher in the GDM group. These results highlight the critical importance of monitoring metabolic status and continuing individualized medical nutrition therapy in the postpartum period to support maternal and infant health.