Diabetes mellitus in der Schwangerschaft

  • Thomas Vollmer
Chapter

Zusammenfassung

Schwangerschaften bei Frauen mit Diabetes mellitus sind Risikoschwangerschaften. Die Prävalenz eines präkonzeptionellen Diabetes lag 2008 bei 0,9%. Mehr als dreimal häufiger ist der Gestationsdiabetes, eine erstmals in der Schwangerschaft festgestellte Glukosestoffwechselstörung. Der Gestationsdiabetes wird wegen des unterschiedlichen Morbiditäts- und Mortalitätsrisikos von einem vorbestehenden Diabetes mellitus Typ 1 oder Typ 2 abgegrenzt.

This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. AG Diabetes und Schwangerschaft der Deutschen DiabetesGesellschaft, AG für materno-fetale Medizin (AGMFM) der DGGG, und Deutsche Gesellschaft für Perinatale Medizin (2001) Empfehlungen zur Diagnostik und Therapie des Gestationsdiabetes (GDM). Frauenarzt 42: 691–699Google Scholar
  2. AG für Neonatologie und Pädiatrische Intensivmedizin der Deutschen Gesellschaft für Perinatale Medizin, Deutschen Diabetes-gesellschaft , Deutsche Gesellschaft für Kinderheilkunde und Jugendmedizin , Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (2003) Betreuung von Neugeborenen diabetischer Mütter. Frauenarzt 44: 439–441Google Scholar
  3. American Diabetes Association – ADA (2000) Gestational diabetes mellitus. Diabet Care 23(Suppl 1): S77–S79Google Scholar
  4. American Diabetes Association – ADA (2004) Gestational diabetes mellitus. Diabet Care 27: S88–S90CrossRefGoogle Scholar
  5. Beck P, Daughaday W (1967) Human placental lactogen: studies of its acute metabolic effects and disposition in normal man. J Clin Invest 46:103PubMedCrossRefGoogle Scholar
  6. Best R, Chakravarthy U (1997) Diabetic retinopathy in pregnancy. Br J Opthalmol 81:249–251CrossRefGoogle Scholar
  7. Biesenbach G, Grafinger P, Zazgornik J Stoger H (2000) Perinatal complications and three-year follow up of infants of diabetic mothers with diabetic nephropathy stage IV. Ren Fail 22:573–580PubMedCrossRefGoogle Scholar
  8. BQS (2009) BQS-Bundesauswertung (2008) Geburtshilfe. Bundesgeschäftsstelle Qualitätssicherung gGmbH, Düsseldorf [http://www.bqs-outcome.de] Gesehen 26. Okt 2010
  9. Carr D, Koontz G, Gardelia C, Holing E, Brateng D, Brown Z, Easterling T (2006) Diabetic nephropathy in pregnancy: suboptimal hypertensive control associated with preterm delivery. Am J Hypertens 19:513–519PubMedCrossRefGoogle Scholar
  10. Colquitt J, Green C, Sidhu M, Hartwell D, Waugh N (2004) Clinical and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes. Health Technol Assess HTA 2004; 8: 1–171Google Scholar
  11. Confidential enquiry into maternal and child health (2005) Pregnancy in women with type 1 and type 2 diabetes in 2002–03, England, Wales, and Northern Ireland. CEMACH, LondonGoogle Scholar
  12. Crowther C, Hiller J, Moss J, McPhee A, Jeffries W, Robinson J (2005) Effect of treatment of gestational diabetes mellitus on pregnancies. N Engl J Med 352:2477–2486PubMedCrossRefGoogle Scholar
  13. Deutsche Diabetes Gesellschaft – DDG (2011) Praxisleitlinie Gestationsdiabetes. AWMF-Register Nr. 057/008 [http://www.awmf.org/…szleitlinien/057-008l_S3_Gestationsdiabetes_2011]Google Scholar
  14. Deutsche Diabetes Gesellschaft -DDF (2010a) Praxis-Leitlinien der Deutschen Diabetes-Gesellschaft. Diabetologie und Stoffwechsel 4 (Suppl 2): S109–S112Google Scholar
  15. Deutsche Diabetes Gesellschaft – DDG (2010b) Praxis-Leitlinien der Deutschen Diabetes-Gesellschaft. Diabetologie. Diabetologie und Stoffwechsel 4 (Suppl 2): S176–S182Google Scholar
  16. Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with life-style intervention or Metformin. N Engl J Med 346:393–403CrossRefGoogle Scholar
  17. Ekbom P, Damm P, Feldt-Rasmussen B, Feldt-Rasmussen U, Molvig J, Mathiesen E (2001) Pregnancy outcome in type 1 diabetic women with microalbuminuria. Diabetes Care 24:1739–1744PubMedCrossRefGoogle Scholar
  18. Füchtenbusch M, Ziegler A, Hummel M (2006) Differentialdiagnostik des Gestationsdiabetes: Welches Risiko besteht für einen Typ-1-oder Typ-2-Diabetes nach der Schwangerschaft? Geburtsh Frauenheilk 66:947–951CrossRefGoogle Scholar
  19. Hammes H (2005) Diabetische Retinopathie. In: Nauck M, Brabant G, Hauner H (Hrsg) Kursbuch Diabetologie. Kirchheim, Mainz, S 58–64Google Scholar
  20. Jovanovic L, Knopp R, Brown Z et al. (2001) Declining insuline requirement in the late first trimester of diabetic pregnancy. Diabetes Care 24:1130–1136PubMedCrossRefGoogle Scholar
  21. Jovanovic L, Knopp R, Kim H, Cefalu W, Zhu X, Lee Y, Simpson J, Mills J for the Diabetes in Early Pregnancy Study Group (2005) Elevated pregnancy losses at high and low extremes of maternal glucose in early normal and diabetic pregnancy. Evidence for a protective adaption in diabetes. Diabetes Care 28:1113–1117PubMedCrossRefGoogle Scholar
  22. Khoury J, Miodovnik M, LeMasters G, Sibai B (2002) Pregnancy outcome and progression of diabetic nephropathy. What s next? J Matern Fetal Neonatal Med 11:238–244PubMedCrossRefGoogle Scholar
  23. Kirwan J, Hauguel-De Mouzon S, Lepercq J et al. (2002) TNF-a is a predictor of insulin resistance in human pregnancy. Diabetes 51:2207–2213PubMedCrossRefGoogle Scholar
  24. Klein B, Moss S Klein R (1990) Effect of pregnancy on progression of diabetic retinopathy. Diabet Care 13:34–40CrossRefGoogle Scholar
  25. Kleinwächter H, Schäfer-Graf U (2008) Diabetes mellitus und Schwangerschaft. Diabetologe 3: R69–R93CrossRefGoogle Scholar
  26. Körner U, Rösch R (2004) Physiologische und metabolische Veränderungen in Schwangerschaft und Stillzeit. In: Körner U, Rösch R (Hrsg) Ernährungsberatung in Schwangerschaft und Stillzeit. Hippokrates, Stuttgart, S 19–26Google Scholar
  27. Ladner H, Danielsen B, Gilbert W (2005) Acute myocadial infarction in pregnancy and the puerperium: a populationbased study. Obstet Gynecol 105:480–484PubMedCrossRefGoogle Scholar
  28. Langer O (1996) Is normoglycemia the correct treshold to prevent complications in the pregnant diabetic patient? Diabetes Rev 4, Diabetes and pregnancy pt 2: 2–10Google Scholar
  29. Langer O, Levy J, Brustman L, Anyaegbunam A, Merkatz R, Divon M (1989) Glycemic control in gestational diabetes mellitus – how tight is tight enough: small for gestational age versus large for gestational age? Am J Obstet Gynecol 161:646–653PubMedCrossRefGoogle Scholar
  30. Langer O, Conway D, Berkus M, Xenakis E, Gonzales O (2000) A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 343:1134–1138PubMedCrossRefGoogle Scholar
  31. Langer O, Yogev Y, Xenakis E, Brustman L (2005) Overweight and obese in gestational diabetes: the impact on pregnancy outcome. Am J Obstet Gynecol 192:1768–1776PubMedCrossRefGoogle Scholar
  32. Löbner K, Knopff A, Baumgarten A et al. (2006) Predictors of postpartum diabetes in women with gestational diabetes mellitus. Diabetes 55:792–797PubMedCrossRefGoogle Scholar
  33. Major C, Veciana M de, Weeks J, Morhan M (1998) Recurrence of gestational diabetes: who is at risk? Am J Obstet Gynecol 179:1038–1042PubMedCrossRefGoogle Scholar
  34. Martinez-Frias M, Frias JP, Bernejo E, Rodriguez-Pinilla E, Prieto L, Frias JL (2005) Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes. Diabet Med 22: 775–781PubMedCrossRefGoogle Scholar
  35. Plank J, Siebenhofer A, Berghold A, Jeitler K, Horvath K, Mrak P, Pieber T (2005) Systematic review and meta-analysis of short-acting insulin analogues in patients with diabetes mellitus. Arch Int Med 165:1337–1344CrossRefGoogle Scholar
  36. Reece E, Leguizamon G, Homko C (1998) Pregnancy performance and outcome associated with diabetic nephropathy. Am J Perinatol 15:413–421PubMedCrossRefGoogle Scholar
  37. Rowan J, Hague W, Goa W et al. for the MiG Trial Investigators (2008) Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 358: 2003–2015PubMedCrossRefGoogle Scholar
  38. Schaefer-Graf U, Kjos S, Bühling K, Henrich W, Brauer M, Heinze T, Dudenhausen J, Vetter K (2003) Amniotic Fluid Insulin levels and Fetal Abdominal circumference at time of Amniocentesis in Pregnancies with Diabetes. Diabet Med 20:349–354PubMedCrossRefGoogle Scholar
  39. Schaefer-Graf U, Kjos S, Fauzan O et al. (2004) A randomized trial evaluating a predominately fetal growth-based strategy to guide management of gestational diabetes in caucasian women. Diabetes Care 27:297–302PubMedCrossRefGoogle Scholar
  40. Stotland N, Cheng Y, Hopkins L, Caughey A (2006) Gestational weight gain and adverse neonatal outcome among term infants. Obstet Gynecol 108:635–643PubMedCrossRefGoogle Scholar
  41. The HAPO Study Cooperative Research Group (2008) Hyperglycemia and adverse pregnancy outcomes. N Engl J Med 358:1991–2002CrossRefGoogle Scholar
  42. Wyatt J, Frias L, Hoyme H et al. (2005) Congenital anomaly rate in offspring of mothers with diabetes treated with insulin lispro during pregnancy. Diab Med 22:803–807CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Thomas Vollmer
    • 1
  1. 1.Praxis für Innere Medizin, Angiologie, DiabetologieBruchsal

Personalised recommendations