Gestasyonel ve Pregestasyonel Diyabetli Kadınlarda Peripartum Dönemde Kan Glukoz Seviyesinin Kontrolü

Year 2020, Volume: 17 Issue: 1, 296 - 300, 31.03.2020

Hüsniye Başer , Salih Başer , Bekir Çakır

Abstract

Peripartum dönemdeki maternal hiperglisemi neonatal hipoglisemi riskini artırdığı için bu dönemde diyabet kontrolü oldukça önemlidir. Genel olarak doğumun latent fazı sırasında metabolik ihtiyaçlar çok azdır. Aktif fazda metabolik ihtiyaçlar artar ve insülin ihtiyacı azalır. Doğum sırasında glukoz kontrolü için farklı insülin protokolleri kullanılabilir. Gestasyonel diyabetli hastalarda intrapartum dönemde insülin infüzyon ihtiyacını azalttığı için dönüşümlü sıvı stratejisi tercih edilmektedir. Pregestasyonel diyabetli gebelerde peripartum dönemde intravenöz insülin infüzyonu veya subkutan insülin tedavisini içeren protokoller kullanılabilir. Postpartum dönemde plesentanın çıkmasıyla insülin direnci hızla ortadan kalkar ve pregestasyonel diyabetli gebelerde insülin ihtiyaçları azalır. Gestasyonel diyabetli gebeler ise gebelik öncesi glisemik durumuna hızla geri dönerler ve genellikle insülin tedavisine ihtiyaç duymazlar. Bazı gestasyonel diyabetli gebelerde ise postpartum dönemde hiperglisemi devam edebilir ve tedavi gerekebilir. Amerikan Diyabet Birliği ve Amerikan Jinekoloji ve Obstetrik Derneği diyabet, bozulmuş açlık glukozu ve bozulmuş glukoz intoleransını saptamak için tüm gestasyonel diyabetli hastaların postpartum 4-12. haftalarda 75 gr glukoz kullanılarak yapılan 2 saatlik oral glukoz tolerans testi ile taranmasını önerir.

Keywords

Gestasyonel diyabet, pregestasyonel diyabet

References

• 1- Mimouni F, Miodovnik M, Siddiqi TA, Khoury J, Tsang RC. Perinatal asphyxia in infants of insulin-dependent diabetic mothers. J Pediatr. 1988;113(2):345–53. 2- M. Grant E, Joshi GP. Glycemic control during labor and delivery: a survey of academic centers in the United States. Arch Gynecol Obstet. 2012; 285(2):305-10. 3- Jovanovic L. Glucose and insulin requirements during labor and delivery: the case for normoglycemia in pregnancies complicated by diabetes. Endocr Pract. 2004;10 Suppl 2: 40–5. 4- Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Eng J Med. 2005;352(24):2477-86. 5- Flores-Le Roux JA, Chillaron JJ, Goday A, Puig De Dou J, Paya A, Lopez-Vilchez MA, et al. Peripartum metabolic control in gestational diabetes. Am J Obstet Gynecol. 2010;202(6):568.e1–6. 6- Jovanovic L, Peterson CM. Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women. Am J Med. 1983;75(4):607. 7- Garabedian C, Deruelle P. Delivery (timing, route, peripartum glycemic control) in women with gestational diabetes mellitus. Diabetes Metab. 2010;36(6 Pt 2):515–21. 8- Castorino K, Jovanovic L. Pregnancy and diabetes management: Advances and controversies. Clin Chem. 2011;57(2):221–30. 9- Kline GA, Edwards A. Antepartum and intra-partum insulin management of type 1 and type 2 diabetic women: Impact on clinically significant neonatal hypoglycemia. Diabetes Res Clin Pract. 2007;77(2):223–30. 10- ACOG Commitee on Practice Bulletins. Practice Bulletin No. 180: Gestational Diabetes Mellitus. Obstet Gynecol 2017;130(1):e17–e37. 11- Blumer I, Hadar E, Hadden DR, Jovanovic L, Mestman JH, Murad MH, et al. Diabetes and pregnancy: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227–49. 12- Carron Brown S, Kyne-Grzebalski D, Mwangi D, Taylor R. Effect of management policy upon 120 Type 1 diabetic pregnancies: policy decisions in practice. Diabet Med. 1999;16(7):573–8. 13- Baret HL, Morris J, McElduff A. Watchful waiting: a management protocol for maternal glycaemia in the peripartum period. Aust N Z J Obstet Gynaecol. 2009; 49(2):162–7. 14- Taylor R, Lee C, Kyne-Grzebalski D, Marshall SM, Davison JM. Clinical outcomes of pregnancy in women with type 1 diabetes(1). Obstet Gynecol. 2002; 99(4):537–41. 15- Curet LB, Izquierdo LA, Gilson GJ, Schneider JM, Perelman R, Converse J. Relative effects of antepartum and intrapartum maternal blood glucose levels on incidence of neonatal hypoglycemia. J Perinatol. 1997;17(2):113–5. 16- Jovanovic L, Peterson CM. Management of the pregnant, insulin-dependent diabetic woman. Diabetes Care. 1980;3(1):63–8. 17- Rosenberg VA, Eglinton GS, Rauch ER, Skupski DW. Intrapartum maternal glycemic control in women with insulin requiring diabetes: a randomized clinical trial of rotating fluids versus insulin drip. Am J Obstet Gynecol 2006;195(4):1095–9. 18- Kaaja RJ, Greer IA. Manifestations of chronic disease during pregnancy. JAMA 2005;294(21):2751–7. 19- Chodick G, Elchalal U, Sella T, Heymann AD, Porath A, Kokia E, et al. The risk of overt diabetes mellitus among women with gestational diabetes: a population-based study. Diabet Med. 2010;27(7):779–85. 20- Bellamy L, Casas JP, Hingorani AD, Williams D. Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 2009; 373(9677): 1773–9. 21- American Diabetes Association. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care 2018;41(Suppl 1):137–143. 22- Gabbe SG, Carpenter LB, Garrison EA. New strategies for glucose control in patients with type 1 and type 2 diabetes mellitus in pregnancy. Clin Obstet Gynecol. 2007;50(4):1014–24. 23- Gyrlack LJ, Chu SS, Scanlon JW. Use of intravenous fluids before cesarean section: effects on perinatal glucose, insulin, and sodium homeostasis. Obstet Gynecol 1984; 63(5):654–8. 24- Knepp NB, Kumar S, Shelley WC, Stanley CA, Gabbe SG, Gutsche BB. Fetal and neonatal hazards of maternal hydration with 5% dextrose before caesarean section. Lancet 1982:22;1(8282):1150–2. 25- Kitzmiller JL, Gavin L. Preexisting diabetes and pregnancy. In: Lavin N, editor. Manual of Endocrinology and Metabolism. 3rd ed. Philadelphia: Lippincott Williams and Wilkins; 2002. Copyright © 2002 Lippincott Williams and Wilkins. 26- Ballas J, Moore TR, Ramos GA. Management of diabetes in pregnancy. Curr Diab Rep. 2012;12(1):33–42. 27- Caplan RH, Pagliara AS, Beguin EA, Smiley CA, Bina-Frymark M, Goettl KA, et al. Constant intravenous insulin infusion during labor and delivery in diabetes mellitus. Diabetes Care 1982;5(1):6–10. 28- Drever E, Tomlinson G, Bai AD, Feig DS. Insulin pump use compared with intravenous insulin during labour and delivery: the INSPIRED observational cohort study. Diabet Med. 2016; 33(9):1253–9. 29- Fresa R, Visalli N, Di Blasi V, Cavallaro V, Ansaldi E, Trifoglio O. Experiences of continuous subcutaneous insulin infusion in pregnant women with type 1 diabetes during delivery from four Italian centers: a retrospective observational study. Diabetes Technol Ther. 2013;15(4):328–34. 30- Ramos M, Khalpey Z, Lipsitz S, Steinberg J, Panizales MT, Zinner M, et al. Relationship of perioperative hyperglycemia and postoperative infections in patients whoundergo general and vascular surgery. Ann Surg. 2008;248(4):585–91. 31- Hanazaki K, Maeda H, Okabayashi T. Relationship between perioperative glycemic control and postoperative infections. Word J Gastroenterol. 2009;15(33):4122–5.