Kautzky-Willer Alexandra, Harreiter Jürgen, Winhofer-Stöckl Yvonne, Weitgasser Raimund, Lechleitner Monika
Gender Medicine Unit, Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.
Wien Klin Wochenschr. 2019 May;131(Suppl 1):103-109. doi: 10.1007/s00508-019-1456-y.
In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in diabetic and non-diabetic women. However, currently women with pre-gestational diabetes still feature a higher risk of perinatal morbidity and even increased mortality. This fact is mostly ascribed to a persistently low rate of pregnancy planning and pre-pregnancy care with optimization of metabolic control prior to conception. All women should be experienced in the management of their therapy and on stable glycemic control prior to the conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded before pregnancy or treated adequately in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Especially in women with type 1 diabetes mellitus in early pregnancy the risk of hypoglycemia is highest and decreases with the progression of pregnancy due to hormonal changes causing steady increase of insulin resistance. In addition, obesity increases worldwide and contributes to increasing numbers of women at childbearing age with type 2 diabetes mellitus and further deterioration of pregnancy outcomes in diabetic women. Maternal glycemic control should aim to achieve normoglycemia and normal HbA levels, possibly without hypoglycemia, but is associated with the development of diabetic embryopathy and fetopathy if dysglycemia occurs. Intensified insulin therapy with multiple daily insulin injections and pump treatment are effective in reaching good metabolic control during pregnancy. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but should be also prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring.
1989年的《圣文森特宣言》旨在实现糖尿病女性和非糖尿病女性相似的妊娠结局。然而，目前患有孕前糖尿病的女性围产期发病风险仍然较高，甚至死亡率也有所增加。这一事实主要归因于妊娠计划和孕前护理的持续低比率，以及受孕前代谢控制的优化不足。所有女性在受孕前都应熟练掌握自身治疗的管理并实现稳定的血糖控制。此外，应在怀孕前排除甲状腺功能障碍、高血压以及糖尿病并发症，或进行充分治疗，以降低孕期并发症进展以及母婴发病的风险。特别是在孕早期患有1型糖尿病的女性中，低血糖风险最高，且随着孕期进展，由于激素变化导致胰岛素抵抗稳步增加，低血糖风险会降低。此外，全球肥胖率上升，导致育龄期患有2型糖尿病的女性数量增加，糖尿病女性的妊娠结局进一步恶化。母体血糖控制应旨在实现血糖正常和糖化血红蛋白水平正常，可能避免低血糖，但如果出现血糖异常，则会增加糖尿病胚胎病和胎儿病的发生风险。每日多次注射胰岛素强化治疗和胰岛素泵治疗在孕期实现良好的代谢控制方面是有效的。对于患有2型糖尿病的肥胖女性，可考虑使用口服降糖药（二甲双胍）来提高胰岛素敏感性，但由于其可穿过胎盘且缺乏对后代的长期随访数据，也应谨慎处方。
