Kautzky-Willer Alexandra, Winhofer Yvonne, Weitgasser Raimund, Lechleitner Monika, Harreiter Jürgen
Gender Medicine Unit, Abt. für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
Abteilung für Innere Medizin/Diabetologie, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich.
Wien Klin Wochenschr. 2023 Jan;135(Suppl 1):129-136. doi: 10.1007/s00508-023-02188-2. Epub 2023 Apr 20.
In 1989 the St. Vincent Declaration aimed to achieve comparable pregnancy outcomes in women with diabetes and those with normal glucose tolerance. 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 conception. In addition, thyroid dysfunction, hypertension as well as the presence of diabetic complications should be excluded or treated adequately before pregnancy in order to decrease the risk for a progression of complications during pregnancy as well as maternal and fetal morbidity. Near normoglycaemia and HbA in the normal range are targets for treatment, preferably without the induction of frequent resp. severe hypoglycaemic reactions. Especially in women with type 1 diabetes mellitus the risk of hypoglycemia is high in early pregnancy, but it decreases with the progression of pregnancy due to hormonal changes causing an increase of insulin resistance. In addition, obesity increases worldwide and contributes to higher numbers of women at childbearing age with type 2 diabetes mellitus and adverse pregnancy outcomes. Intensified insulin therapy with multiple daily insulin injections and pump treatment are equally effective in reaching good metabolic control during pregnancy. Insulin is the primary treatment option. Continuous glucose monitoring often adds to achieve targets. Oral glucose lowering drugs (Metformin) may be considered in obese women with type 2 diabetes mellitus to increase insulin sensitivity but need to be prescribed cautiously due to crossing the placenta and lack of long-time follow up data of the offspring (shared decision making). Due to increased risk for preeclampsia in women with diabetes screening needs to be performed. Regular obstetric care as well as an interdisciplinary treatment approach are necessary to improve metabolic control and ensure the healthy development of the offspring.
1989年的《圣文森特宣言》旨在使糖尿病女性和糖耐量正常的女性获得相似的妊娠结局。然而，目前孕前糖尿病女性的围产期发病率仍然较高，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比例持续较低，以及受孕前代谢控制未得到优化。所有女性在受孕前都应熟练掌握自身治疗的管理并实现血糖稳定控制。此外，应在孕前排除或充分治疗甲状腺功能障碍、高血压以及糖尿病并发症，以降低孕期并发症进展以及母婴发病的风险。治疗目标是接近正常血糖水平且糖化血红蛋白处于正常范围，最好不引发频繁或严重的低血糖反应。尤其是1型糖尿病女性在孕早期低血糖风险较高，但随着孕期进展，由于激素变化导致胰岛素抵抗增加，低血糖风险会降低。此外，全球肥胖率上升，导致育龄期2型糖尿病女性数量增加以及不良妊娠结局增多。在孕期通过每日多次注射胰岛素强化治疗和胰岛素泵治疗在实现良好的代谢控制方面同样有效。胰岛素是主要的治疗选择。持续血糖监测通常有助于实现目标。对于肥胖的2型糖尿病女性，可考虑使用口服降糖药（二甲双胍）以提高胰岛素敏感性，但由于其可穿过胎盘且缺乏对后代的长期随访数据，需要谨慎处方（共同决策）。由于糖尿病女性患先兆子痫的风险增加，需要进行筛查。定期产科护理以及多学科治疗方法对于改善代谢控制和确保后代健康发育是必要的。
