Der Internist

, 52:1149

Gestationsdiabetes

Schwerpunkt

Zusammenfassung

Der Gestationsdiabetes ist eine der häufigsten Schwangerschaftskomplikationen in Deutschland. Seine Inzidenz nimmt in den letzten Jahrzehnten deutlich zu, mitbedingt durch bessere Screeninguntersuchungen und strengere Diagnosekriterien. Mit den gerade aktualisierten Grenzwerten ist davon auszugehen, dass bei mindestens 5–10% der Schwangeren ein Diabetes mellitus diagnostiziert wird. Grundlage der neuen Blutzuckerziele sind aktuelle Studien, welche bereits bei gering erhöhten Blutzuckerwerten in der Schwangerschaft eine Zunahme fetaler und maternaler Komplikationen zeigen. Erstmalig steht nun eine gute Evidenzbasis für die Diagnosestellung und die Behandlung des Schwangerschaftsdiabetes zur Verfügung.

Schlüsselwörter

Schwangerschaftsdiabetes Diabetes mellitus Schwangerschaft Screening Fetale Komplikationen 

Gestational diabetes

Abstract

Gestational diabetes is one of the most common complications during pregnancy. Its incidence has increased in recent decades. This is partly due to improved screening strategies and more stringent diagnostic criteria. Using the updated diagnostic thresholds, it is expected that 5–10% at least of all pregnant women will be diagnosed with diabetes mellitus. The rationale for the novel blood glucose criteria are data from prospective studies reporting an increase of fetal and maternal complications even when the blood glucose is only slightly increased. For the first time, solid evidence now exists for the diagnosis and treatment of gestational diabetes.

Keywords

Diabetes in pregnancy Diabetes mellitus Pregnancy Screening Fetal complications 

Literatur

  1. 1.
    Bühling KJ, Wäscher C, Bergmann R, Dudenhausen JW (2005) Gestationsdiabetes – Ernährung in der Schwangerschaft. Akademos Wissenschaftsverlag, Hamburg Berlin. ISBN 9783934410695Google Scholar
  2. 2.
    Catalano PM, Tyzbir ED, Wolfe RR et al (1993) Carbohydrate metabolism during pregnancy in control subjects and women with gestational diabetes. Am J Physiol 264:E60–E67PubMedGoogle Scholar
  3. 3.
    Crowther CA, Hiller JE, Moss JR et al (2005) Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 352:2477–2486PubMedCrossRefGoogle Scholar
  4. 4.
    Deierlein AL, Siega-Riz AM, Chantala K, Herring AH (2011) The association between maternal glucose concentration and child BMI at age 3 years. Diabetes Care 34:480–484PubMedCrossRefGoogle Scholar
  5. 5.
    HAPO Study Cooperative Research Group (2009) Hyperglycemia and adverse pregnancy outcome (HAPO) study: associations with neonatal anthropometrics. Diabetes 58:453–459Google Scholar
  6. 6.
    Horvath K, Koch K, Jeitler K (2010) Effects of treatment in women with gestational diabetes mellitus: systematic review and meta-analysis. BMJ 340:c1395PubMedCrossRefGoogle Scholar
  7. 7.
    Jarvie E, Hauguel-de-Mouzon S, Nelson SM et al (2010) Lipotoxicity in obese pregnancy and its potential role in adverse pregnancy outcome and obesity in the offspring. Clin Sci (Lond) 119:123–129Google Scholar
  8. 8.
    Kjos SL, Schaefer-Graf UM (2007) Modified therapy for gestational diabetes using high-risk and low-risk fetal abdominal circumference growth to select strict versus relaxed maternal glycemic targets. Diabetes Care 30 (Suppl 2):S200–S205PubMedCrossRefGoogle Scholar
  9. 9.
    Kleinwechter H, Schäfer-Graf U, Bührer C et al (2011) Gestationsdiabetes mellitus (GDM). Evidenzbasierte Leitlinie (Entwurf) zu Diagnostik, Therapie und Nachsorge der Deutschen Diabetes-Gesellschaft (DDG) und der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). www.deutsche-diabetes-gesellschaft.de/redaktion/news/EbLL_GDM_ENDFASSUNG_2011_01_28_E1.pdfGoogle Scholar
  10. 10.
    Landon MB, Spong CY, Thom E et al (2009) A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med 361:1339–1348PubMedCrossRefGoogle Scholar
  11. 11.
    Lawlor DA, Fraser A, Lindsay RS et al (2010) Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort. Diabetologia 53:89–97PubMedCrossRefGoogle Scholar
  12. 12.
    Löbner K, Knopff A, Baumgarten A (2006) Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes 55:792–797PubMedCrossRefGoogle Scholar
  13. 13.
    Metzger BE, Lowe LP, Dyer AR et al (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002PubMedCrossRefGoogle Scholar
  14. 14.
    Metzger BE, Gabbe SG, Persson B et al (2010) International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 33:676–682PubMedCrossRefGoogle Scholar
  15. 15.
    O’Sullivan JB (1992) Diabetes mellitus after GDM. Diabetes 40 (Suppl 2):131–135Google Scholar
  16. 16.
    Pirkola J, Pouta A, Bloigu A (2010) Prepregnancy overweight and gestational diabetes as determinants of subsequent diabetes and hypertension after 20-year follow-up. J Clin Endocrinol Metab 95:772–778PubMedCrossRefGoogle Scholar
  17. 17.
    Rieck S, Kaestner KH (2010) Expansion of beta-cell mass in response to pregnancy. Trends Endocrinol Metab 21:151–158PubMedCrossRefGoogle Scholar
  18. 18.
    Sachdeva MM, Stoffers DA (2009) Minireview: Meeting the demand for insulin: molecular mechanisms of adaptive postnatal beta-cell mass expansion. Mol Endocrinol 23:747–758PubMedCrossRefGoogle Scholar
  19. 19.
    Schaefer-Graf UM, Kjos SL, Kilavuz O et al (2003) Determinants of fetal growth at different periods of pregnancies complicated by gestational diabetes mellitus or impaired glucose tolerance. Diabetes Care 26:193–198PubMedCrossRefGoogle Scholar
  20. 20.
    Schaefer-Graf UM, Pawliczak J, Passow D et al (2005) Birth weight and parental BMI predict overweight in children from mothers with gestational diabetes. Diabetes Care 28:1745–1750PubMedCrossRefGoogle Scholar
  21. 21.
    Schaefer-Graf UM, Graf K, Kulbacka I et al (2008) Maternal lipids as strong determinants of fetal environment and growth in pregnancies with gestational diabetes mellitus. Diabetes Care 31:1858–1863PubMedCrossRefGoogle Scholar
  22. 22.
    Schaefer-Graf UM, Wendt L, Sacks DA et al (2010) How many sonograms are needed to reliably predict the absence of fetal overgrowth in GDM pregnancies? Diabetes Care 34:39–43PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Diabetes Zentrum, Medizinische Klinik InnenstadtLudwig-Maximilians-UniversitätMünchenDeutschland

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