[Clinical significance, diagnosis and treatment of diabetes in pregnancy (gestational diabetes)].
Early diagnosis of glucose intolerance by glucosuria testing is unreliable and should be replaced by blood sugar screening in the 24th to 28th week of gestation. If screening results are pathological (blood sugar in capillary whole blood over 140 mg% one hour after oral ingestion of 50 g glucose), a standardized glucose tolerance test should be performed. This screening test will reveal a glucose intolerance in approx. 3% of pregnant women. High-risk patients for gestational diabetes (previous pregnancies, complicated by gestational diabetes, family history of diabetes mellitus (first degree relatives), obesity (greater than 120% of ideal body weight), maternal age greater than 30 years, unexplained stillbirths) should have their glucose tolerance checked in early pregnancy, possibly before conception, but also in the 32nd to 36th week, if blood sugar screening is normal in weeks 24 to 28. If the glucose tolerance test is abnormal, blood sugar values must be controlled by diet on levels below 5 mmol (90 mg%) and postprandial below 7 mmol (126 mg%), measured in capillary whole blood. If these values are higher, an insulin treatment has to be discussed, since high blood glucose values result in an increased risk of infant morbidity and mortality. During insulin treatment, it might be possible that higher doses become necessary in order to avoid fetal hyperinsulinism with consecutive macrosomy. Although after childbirth often a normal glucose tolerance is noted, a manifestation of diabetes within the next 20 years will occur in one third of all gestational diabetics. Regular control of the glucose tolerance, e.g. in yearly intervals, as well as preventive measures (regulation of body weight) are indicated.
Abteilung Endokrinologie und Stoffwechsel, Kantonsspital Basel.
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Berger
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Misteli
D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D003927:Diet, Diabetic; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007231:Infant, Newborn; D007328:Insulin / Q000008:administration & dosage; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000628:therapy*; D012307:Risk Factors
D007328:Insulin
Klinische Bedeutung, Diagnose und Behandlung des Schwangerschaftsdiabetes (Gestationsdiabetes).