Center for Pregnant Women with Diabetes and Faculty of Health and Medical Sciences, Department of Endocrinology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
Diabetes Care. 2016 Dec;39(12):2111-2117. doi: 10.2337/dc16-1647.
Among women with diabetes, the worst pregnancy outcome is seen in the subgroup of women with diabetic nephropathy. Development of severe preeclampsia that leads to early preterm delivery is frequent. Predictors and pathophysiological mechanisms for the development of preeclampsia among women with diabetes and observational studies that support antihypertension treatment for pregnant women with microalbuminuria or diabetic nephropathy preventing preeclampsia and early preterm delivery are presented here. Obtaining and maintaining strict glycemic control before and during pregnancy is paramount to prevent preterm delivery. The cornerstones of diabetes management are appropriate diet and insulin, although the risk of severe hypoglycemia always needs to be taken into account when tailoring a diabetes treatment plan. Pathophysiological mechanisms of the increased risk of hypoglycemia during pregnancy are explored, and studies evaluating the use of insulin analogs, insulin pumps, and continuous glucose monitoring to improve pregnancy outcomes and to reduce the risk of severe hypoglycemia in pregnant women with type 1 diabetes are reported. In addition to strict glycemic control, other factors involved in fetal overgrowth are explored, and restricting maternal gestational weight gain is a promising treatment area. The optimal carbohydrate content of the diet is discussed. In summary, the lessons learned from this clinical research are that glycemic control, gestational weight gain, and antihypertension treatment all are of importance for improving pregnancy outcomes in pregnant women with preexisting diabetes. An example of how to use app technology to share the recent evidence-based clinical recommendations for women with diabetes who are pregnant or planning pregnancy is given.
在患有糖尿病的女性中，糖尿病肾病亚组患者的妊娠结局最差。常出现导致早产及早发子痫前期的严重先兆子痫。本文介绍了糖尿病女性先兆子痫的预测因素和病理生理机制，以及支持对微量白蛋白尿或糖尿病肾病孕妇进行降压治疗以预防先兆子痫和早产及早发的观察性研究。在妊娠前和妊娠期间获得并维持严格的血糖控制对于预防早产至关重要。糖尿病管理的基石是适当的饮食和胰岛素，尽管在制定糖尿病治疗计划时始终需要考虑严重低血糖的风险。本文探讨了妊娠期间低血糖风险增加的病理生理机制，并报告了评估使用胰岛素类似物、胰岛素泵和连续血糖监测来改善妊娠结局和降低 1 型糖尿病孕妇严重低血糖风险的研究。除了严格的血糖控制外，还探讨了与胎儿过度生长相关的其他因素，限制孕妇妊娠期体重增加是一个很有前途的治疗领域。还讨论了饮食中碳水化合物的最佳含量。总之，从这项临床研究中得出的经验教训是，血糖控制、妊娠期体重增加和降压治疗对于改善患有糖尿病的孕妇的妊娠结局都很重要。本文还举例说明了如何使用应用程序技术来分享针对妊娠或计划妊娠的糖尿病女性的最新循证临床建议。
