在怀孕期间治疗已有的糖尿病:一篇综述
Anastasia-Stefania Alexopoulos1, Rachel Blair2, Anne L Peters3
1Duke University Medical Center, Durham, North Carolina.
JAMA
|May 16, 2019
概括
在怀孕期间已经存在的糖尿病会增加母亲和婴儿的风险. 精心管理血糖,药物和健康状况至关重要,
科学领域:
- 产科和妇科
- 内分泌学
- 产妇和胎儿医学
背景情况:
- 已经存在的1型或2型糖尿病每年导致约0.9%的美国出生并发症.
- 孕期糖尿病显著增加孕妇和新生儿不良后果的风险,包括妊娠前,剖腹产,早产,巨和先天缺陷.
- 这两种类型的糖尿病都需要在怀孕期间进行密集的治疗.
研究的目的:
- 概述优化孕妇糖尿病护理的基本策略.
- 强调怀孕前规划和并发症管理的重要性.
- 提供关于药物,血糖控制和怀孕期间监测的指导.
主要方法:
- 关于怀孕糖尿病管理的当前指导方针和证据的审查.
- 强调怀孕前咨询,包括避孕和达到血糖目标 (HbA1c < 6. 5% 怀孕前, < 6. 0% 怀孕期间).
- 讨论药物调整,查并发症 (视网膜病变,病,阻塞性睡眠呼吸暂停),以及血压管理.
主要成果:
- 持续的血糖监测可以提高血糖控制和新生儿1型糖尿病的结果.
- 胰岛素仍然是第一线治疗,注射和治疗都有效.
- 建议在怀孕12周后服用低剂量阿司匹林,以降低妊娠前的风险;应为低血糖症提供葡萄糖.
- 需要仔细考虑血压目标,特别是在病时.
结论:
- 怀孕期间已经存在的糖尿病存在重大风险,需要全面管理.
- 优化血糖控制,调整药物治疗方案和管理伴随疾病是减轻风险的关键.
- 在怀孕前,怀孕期间和怀孕后提供优质的糖尿病护理对于改善母亲和新生儿的健康状况至关重要.
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