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1型糖尿病与妊娠:血糖控制及母婴结局面临的挑战

Type 1 Diabetes and Pregnancy: Challenges in Glycemic Control and Maternal-Fetal Outcomes.

作者信息

Apata Tejumola, Samuel Dennis, Valle Laticia, Crimmins Sarah D

机构信息

Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Rochester Medical Center, Rochester, New York.

Division of Endocrinology, Department of Medicine, University of Rochester Medical Center, Rochester, New York.

出版信息

Semin Reprod Med. 2024 Sep;42(3):239-248. doi: 10.1055/s-0044-1791704. Epub 2024 Oct 8.

Abstract

Managing type 1 diabetes during pregnancy presents significant challenges due to physiological and hormonal changes. These factors contribute to major changes in insulin sensitivity, complicating efforts to achieve and sustain optimal blood glucose levels. Poorly controlled glucose levels during pregnancy can result in diabetic embryopathy and elevate the risks of maternal complications such as hypertensive disorders and diabetic ketoacidosis. Fetal complications may include preterm birth, fetal demise, and admission to neonatal intensive care units. It is essential to recognize that there is no universal approach to managing glycemic control in pregnant women with T1DM and care should be individualized. Effective management requires a multidisciplinary approach involving regular monitoring, adjustments in insulin therapy, dietary modifications, and consistent prenatal care. Continuous glucose monitoring has emerged as a valuable tool for real-time glucose monitoring, facilitating tighter glycemic control. Education and support for self-management are important in addressing these challenges. Future developments in technology and personalized approaches to care show promising potential for advancing diabetes management during pregnancy. This provides a comprehensive overview of current literature on the challenges with the management of T1DM during pregnancy, focusing on its impact on maternal and neonatal outcomes and highlighting effective strategies for achieving optimal glycemic control.

摘要

由于生理和激素变化,孕期管理1型糖尿病面临重大挑战。这些因素导致胰岛素敏感性发生重大变化,使实现并维持最佳血糖水平的努力变得复杂。孕期血糖控制不佳可导致糖尿病胚胎病,并增加母体并发症的风险,如高血压疾病和糖尿病酮症酸中毒。胎儿并发症可能包括早产、胎儿死亡以及入住新生儿重症监护病房。必须认识到,对于患有1型糖尿病的孕妇,不存在通用的血糖控制管理方法,护理应个体化。有效的管理需要多学科方法,包括定期监测、调整胰岛素治疗、饮食调整以及持续的产前护理。持续血糖监测已成为实时血糖监测的宝贵工具,有助于更严格地控制血糖。自我管理的教育和支持对于应对这些挑战很重要。技术的未来发展和个性化护理方法在推进孕期糖尿病管理方面显示出有希望的潜力。本文全面概述了当前关于孕期1型糖尿病管理挑战的文献,重点关注其对母婴结局的影响,并强调实现最佳血糖控制的有效策略。

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