Management of Gestational Diabetes Mellitus
Management of Gestational Diabetes Mellitus
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DOI：
10.1007/5584_2020_552
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发表时间：
2021-01-01
期刊：
影响因子：
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通讯作者：
Ozgu-Erdinc, A. Seval
中科院分区：
文献类型：
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作者：
Oskovi-Kaplan, Z. Asli;Ozgu-Erdinc, A. Seval
一旦妇女被诊断为妊娠期糖尿病（GDM），两种策略被认为是管理;生活方式的改变和药物治疗。GDM的管理旨在维持正常血糖状态并防止体重过度增加，以减少孕产妇和胎儿并发症。生活方式的改变包括营养治疗和锻炼。建议通过低血糖指数饮食限制热量摄入，以避免餐后高血糖和减少胰岛素抵抗。监测血糖水平、HbA 1c水平和酮尿，以分析保守治疗的疗效。如果保守治疗在随访期间不能提供预期的血糖水平，则开始药物治疗。胰岛素一直是治疗妊娠期糖尿病的首选。最近，二甲双胍在其安全性得到证实后，在无法开具胰岛素处方的情况下更常用于糖尿病孕妇。然而，高比例的女性，可能高达46%，可能需要额外的胰岛素来维持预期的血糖水平。其他口服降糖药的长期安全性证据尚缺乏，饮食控制的GDM患者在无产科指征的情况下，可等待自然分娩。然而，对于接受胰岛素治疗或血糖控制不佳的GDM患者，当局建议在足月时进行选择性诱导，妊娠期GDM患者应告知其糖耐量受损、2型糖尿病、高血压疾病、心血管疾病和代谢综合征的风险增加。
Once a woman is diagnosed with gestational diabetes mellitus (GDM), two strategies are considered for management; life-style modifications and pharmacological therapy. The management of GDM aims to maintain a normoglycemic state and to prevent excessive weight gain in order to reduce maternal and fetal complications. Lifestyle modifications include nutritional therapy and exercise. Calorie restriction with a low glycemic index diet is recommended to avoid postprandial hyperglycemia and to reduce insulin resistance. Blood glucose levels, HbA1c levels, and ketonuria are monitored to analyze the efficacy of conservative management. Pharmacological treatment is initiated if conservative strategies fail to provide expected glucose levels during follow-ups.Insulin has been the first choice for the treatment of diabetes during pregnancy. Recently, metformin has been used more commonly in diabetic pregnant women in cases when insulin cannot be prescribed, after its safety has been proven. However, a high percentage of women, which may be up to 46% may require additional insulin to maintain expected blood glucose levels. The evidence on the long-term safety of other oral antidiabetics has been lacking yet.Women with diet-controlled GDM can wait for spontaneous labor expectantly in case there are no obstetric indications for birth. However, in women with GDM under insulin therapy or with poor glycemic control, elective induction at term is recommended by authorities.The women who have GDM during pregnancy should be counseled about their increased risks of impaired glucose tolerance, type 2 diabetes mellitus, hypertensive disorders, cardiovascular diseases, and metabolic syndrome.