Obiekt
Tytuł: Gestational diabetes mellitus : analysis of selected aspects of its diagnosis, therapy, and complications
Abstrakt:
Diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels resulting from a defect in insulin secretion and/or action. Gestational diabetes mellitus (GDM) affects about 5% of all pregnancies in Europe. GDM develops as a result of pregnancy hormones and the presence of predisposing factors and usually disappears completely after delivery but poses an increased risk of developing type 2 diabetes in the future. The diagnostic criteria for GDM have been revised several times over the past 30 years, making universal global implementation difficult. Which approach strikes the right balance between the safety of the pregnant woman and the overdiagnosis of GDM remains an ongoing controversy. Hyperglycemia in pregnancy increases the risk of complications in the pregnant woman and the developing fetus, and impinges on the subsequent development of the child, so the glycemic values found in healthy pregnant women should be pursued during its treatment. Despite this, the criteria proposed by diabetic and obstetric societies for glycemic control during pregnancy in women with GDM are still not solidly supported by research findings. Problems in adhering to medical advice, including dietary recommendations, in women with diabetes during pregnancy are common. Changes in taste perception, and consequently dietary preferences, during a pregnancy complicated ; by diabetes may be one of the reasons for the low rate of adherence to nutritional recommendations in this group of natients. Changes in the sense of taste in women with GDM can potentially affect oral health. Periodontal disease encompasses abroad category of inflammatory conditions of perigingival tissues, including gingivitis and periodontitis, during which a local and generalized immune response occurs, with increased production of inflammatory mediators. The relationship between periodontal disease and diabetes in pregnancy is likely bidirectional - women with diabetes during pregnancy are more likely to develop periodontal disease than healthy pregnant women. To date, a systematic review on the relationship between periodontal disease, GDM and concentrations of circulating inflammatory cytokines has been lacking. The objectives of this dissertation included: (1) to evaluate the impact of different screening strategies on the incidence of GDM, (2) to evaluate the impact of different postprandial blood glucose targets on the frequency and timing of initiation of insulin therapy in women with GDM and on their obstetric outcomes, (3) assessing the function of the sense of taste and its changes in women with GDM and type 1 diabetes (diabetes mellitus type 1, DM1), and (4) performing a systematic review and network meta-analysis of data on the concentrations of inflammatory and ; oxidative stress markers in the serum of pregnant women with periodontal disease, including a subgroup of women with GDM. This dissertation includes four studies with diverse methodologies in a population of patients with GDM under the care of the GDM Outpatient Clinic at the Department of Metabolic Diseases and Diabetology, University Hospital in Krakow. The first study retrospectively analyzed data from 432 women with GDM, comparing clinical characteristics, incidence and obstetric outcomes using different strategies and criteria for diagnosing GDM. The second study retrospectively analyzed the data of 1,021 women with GDM, comparing clinical characteristics and obstetric outcomes according to the criteria used for blood glucose at 1 hour after a meal. The third study was a cohort study, and 91 participants were included - 28 women with GDM, 26 non pregnant women with DM1 and 37 non-pregnant women without diabetes as a control group. Among the participants, an evaluation of taste perception, saccadometric testing, and selected clinical and laboratory parameters and glycemic control data were conducted. The fourth study was a systematic review with network meta-analysis, all sources were included, comparing selected concentrations of inflammatory markers in blood in pregnant women with and without diabetes mellitus, with periodontal disease and with healthy periodontium. Bas ; ed on the results of the studies included in the dissertation, the range of factors affecting the diagnosis and metabolic control of GDM was identified. In terms of GDM diagnosis, it was shown that the commonly used WHO protocol may lead to overdiagnosis of GDM, leading to unjustified medicalization of a certain percentage of pregnant women. Future research should therefore focus on evaluating the GDM screening strategies and the cutoff values for its diagnosis and assessing the impact of different protocols on pregnancy and child outcomes. In terms of metabolic control of GDM, the introduction of more liberal therapeutic targets for postprandial blood glucose was shown to reduce the use of complicated treatment models containing postprandial insulin, with no impact on obstetric outcomes. This may suggest that liberalization of postprandial glycemic targets in GDM was safe for women and their offspring and may have led to a lower burden of diabetes. In terms of factors affecting metabolic control in GDM, the sense of taste was shown to be impaired to a similar degree in non-pregnant women with DM1 and those with GDM, compared to non-pregnant women without diabetes, potentially affecting dietary choices, adherence to dietary recommendations, and ultimately metabolic control of diabetes. Taste perception testing may be a potential means to improve metabolic control of diabetes an ; d reduce the risk of maternal and neonatal pregnancy complications. Finally, the first systematic review of studies of inflammatory marker concentrations and antioxidant stress in pregnant women with different stages of periodontal disease, including those with GDM, found that differences in inflammatory marker concentrations were not significant. A trend towards an increased inflammatory response in pregnant women complicated by periodontal disease was observed, with potential implications for a higher risk of obstetric complications. The number of papers examining the interaction of GDM with periodontal disease and the resulting changes in inflammatory markers was insufficient for analysis.
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Rada Dyscypliny Nauki medyczne
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Data ostatniej modyfikacji:
5 mar 2026
Data dodania obiektu:
5 mar 2026
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| Nazwa wydania | Data |
|---|---|
| ZB-143152 | 5 mar 2026 |
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