Perinatal outcome in pregnant women with type 1 and type 2 diabetes mellitus

Abstract

Dijabetes je kronična metabolička bolest, to je stanje kronične hiperglikemije obilježeno poremećenim metabolizmom ugljikohidrata, proteina i masti. S obzirom na etiologiju razlikujemo četiri tipa, od kojih su najčešći dijabetes tip 1 i tip 2. U žena s pregestacijskim dijabetesom trudnoća se smatra rizičnom zbog mogućeg razvoja brojnih majčinih, fetalnih i neonatalnih komplikacija. Loša metabolička kontrola glikemije u takvih trudnica povezana je s povećanim rizikom spontanih pobačaja, preeklampsije, rađanja djece s kongenitalnim malformacijama, mrtvorođene, asfiktične, prematurne i makrosomne djece, te povećanom neonatalnom smrtnosti. Dobrom kontrolom glikemije učestalost komplikacija znatno se smanjuje, te se približava razini učestalosti u zdravoj populaciji trudnica. Optimalna metabolička kontrola trudnica postiže se intenzivnom inzulinskom terapijom, odgovarajućom prehranom, čestom kontrolom glikemije i dobrom antenatalnom skrbi. Trudnice oboljele od dijabetesa potrebno je nadzirati i liječiti u regionalnim centrima za liječenje dijabetesa u trudnoći, a u nadzoru i skrbi takvih trudnoća sudjeluje tim stručnjaka sastavljen od opstetričara, dijabetologa, neonatologa, dijetetičara, medicinske sestre i socijalnog radnika.Diabetes mellitus is a chronic metabolic disease which is characterized with chronic hyperglycemia and disturbed metabolism of carbohydrates, proteins and fats. There are four types of diabetes mellitus depending on the etiology. The most common are type 1 and type 2 diabetes mellitus. Women with pregestational diabetes mellitus have high-risk pregnancies due to the possible development of maternal, fetal and neonatal complications. Poor metabolic control of glucose levels in pregnant women is associated with an increased risk of miscarriage, preeclampsia, birth of children with congenital malformations, stillbirths, asphyctic, premature and macrosomic children, and increased neonatal mortality. Good metabolic control during pregnancy significantly reduces the incidence of complications and approaches the level of incidence in the normal population of pregnant women. The optimal metabolic control of pregnant women is achieved with intensive insulin therapy, adequate nutrition, frequent glucose control and good antenatal care. Pregnant women with diabetes should be monitored and treated in regional centers for the treatment of diabetes in pregnancy. The supervision and care of such pregnancies involve a team of experts composed of obstetricians, diabetologists, neonatologists, dietitians, nurses and social workers