Сахарный диабет и беременность

 отменить инсулинотерапию;

 продолжать соблюдать рекомендации по рациональному питанию и модификации образа жизни;

 грудное вскармливание ребенка;

 через 6 недель после родов определить гликемию натощак, и при уровне гликемии  5,5 ммоль/л, провести ОГТТ с 75 г глюкозы. При сохранении нарушений углеводного обмена произвести реклассификацию согласно установленным цифрам гликемии по критериям ВОЗ и назначить необходимую терапию;

 при наличии факторов риска СД 2типа ОГТТ проводится ежегодно;

 при низком риске СД 2типа определение гликемии натощак ежегодно, ОГТТ только при уровне тощаковой гликемии  5,5 ммоль/л;

 планирование последующей беременности, контрацепция 1,0-1,5 года.

После завершения беременности женщины, перенесшие ГСД, имеют высокий риск развития СД 2 типа в ближайшие годы, реализация которого зависит от генетических и средовых факторов. Таким женщинам необходимо строго придерживаться модифицированного образа жизни с принципами рационального питания, при необходимости с назначением метформина для коррекции инсулинорезистентности [21, 68].

Вероятность развития ГСД у женщин при последующей беременности составляет 30-50% [48].

2. Дедов И.И., Балаболкин М.И. и др. Современные аспекты патогенеза, классификации, диагностики и лечения сахарного диабета. Пособие для врачей. – М., 2004. – 172с.

3. Дедов И.И., Шестакова М.В. Сахарный диабет. Руководство для врачей. Универсум Паблишинг, Москва – 2003. – 455с.

4. Забаровская З.В. Гестационный сахарный диабет. Учебно-методическое пособие. Минск, 2004 – 20с.

5. Забаровская З.В., Мулярчик О.В., Жданова Т.А. Проблема гестационного сахарного диабета: основные аспекты этиопатогенеза, клинико-диагностические критерии, принципы лечения. Медицинские новости. – 2002. - № 12. – С. 12-19.

6. Мулярчик О.В., Забаровская З.В. Диагностические особенности гестационного сахарного диабета и тактика ведения во время беременности. Бел. Мед журнал. – 2002. - № 2. - С. 41-42.

7. Медведь В.И., Бычкова Е.А. Гестационный диабет: история и современность. Российский вестник акушера-гинеколога. – 2009. - № 3. - С. 19-25.

8. Современные аспекты сахарного диабета и беременности в практической деятельности. Под редакцией Е.А Холодовой. Методическое пособие для врачей. Минск, 2002, 103 стр.

9. Сидельникова В.М. Эндокринология беременности в норме и при патологии. М.: МЕДпресс-информ, 2007.  352 стр.

10. Федорова М.В., Краснопольский В.И., Петрухин В.А. Сахарный диабет, беременность и диабетическая фетопатия. Справочное пособие. Медицина, - 2001, - 288 стр.

11. American Diabetes Association. Diagnosis and classification of diabetes mellitus (position statement). Diabetes Care 2009; 32 (Suppl 1): S62-S67.

12. American Diabetes Association. Gestational diabetes mellitus (position statement). Diabetes Care 2004; 27 (Suppl 1): S88-S90.

13. Bar J, Chen R, Schoenfeld A, et al. Pregnancy outcome in patients with insulin dependent diabetes mellitus and diabetic nephropathy treated with ACE inhibitors before pregnancy. J Pediatr Endocrinol Metab 1999; 12: 659-65.

14. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Pregnancy and Lactation. A Reference Guide to Fetal and Neonatal Risk. 7th edn. Philadelphia: Lippincott, Williams and Wilkins, 2005.

15. Bung P, Artal R, Khodiguian N, et al. Exercise in gestational diabetes: an optional therapeutic approach? Diabetes 1991; 40 (Suppl 2): 182-5.

16. Bung P, Bung C, Artal R, et al. Therapeutic exercise for insulin-requiring gestational diabetics: effects on the fetus – results of a randomized prospective longitudinal study. J Perinat Med 1993; 21: 125-37.

17. Clausen TD, Mathiesen ER, Hansen T, et al. High prevalence of type 2 diabetes and pre-diabetes in adult offspring of women with gestational diabetes mellitus or type 1 diabetes. The role of intrauterine hyperglycemia. Diabetes Care 2008; 31: 340-6.

18. Cooper WO, Hernandez-Diaz S, Arbogast PG, et al. Major congenital malformations after first-trimester exposure to ACE inhibitors. N Engl J Med 2006; 354: 2443-51.

19. Crowther CA, Hiller JE, Moss JR, et al., for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group. Effect of treatment of gestational diabetes mellitus on pregnancy outcomes. N Engl J Med 2005; 352: 2477-86.

20. De Veciana M, Major CA, Morgan MA, et al. Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. N Engl J Med 1995; 333: 1237-41.

21. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.

22. Di Cianni G, Torlone E, Lencione C. Perinatal outcomes associated with the use of glargine in pregnancy. Diabet Med 2008; 25: 993-6.

23. Drexel H, Bichler A, Sailer S, et al. Prevention of perinatal morbidity by tight metabolic control in gestational diabetes mellitus. Diabetes Care 1988; 11: 761-8.

24. Expert consensus document on management of cardiovascular diseases during pregnancy// Europ. Heart J. – 2003. – V. 24. – P. 761-781.

25. Ekpebegh CO, Coetzee EJ, van der Merwe, et al. A 10-year retrospective analysis of pregnancy outcome in pregestational Type 2 diabetes: comparison of insulin and oral glucose-lowering agents. Diabet Med 2007; 24: 253-8.

26. Evers IM, De Valk HW, Mol BWJ, et al. Macrosomia despite good glycaemic control in Type I diabetic pregnancy; results of a nationwide study in The Netherlands. Diabetologia 2002; 45: 1484-9.

27. Franks PW, Looker HC, Kobes S, et al. Gestational glucose tolerance and risk of type 2 diabetes in young Pima Indian offspring. Diabetes 2006; 55: 460-5

28. Gallas P.R., Stolk R.P., Bakker K. Et al. Thyroid dysfunction during pregnancy and in the first postpartum year in women with diabetes mellitus type 1. Europ. J. Endocrinol. – 2002. – Vol. 147. – P.443.

29. Gallen IW, Jaap AJ, Roland JM, et al. Survey of glargine use in 115 pregnant women with type 1 diabetes. Diabet Med 2008; 25; 165-9.

30. Garcia-Patterson A, Martin E, Ubeda J, et al. Evaluation of light exercise in the treatment of gestational diabetes (letter). Diabetes Care 2001; 24: 2006-7.

31. Gardiner SJ, Kirkpatrick CM, Begg EJ, et al. Transfer of metformin into human milk. Clin Pharmacol Ther 2003; 73: 71-7.

32. Greene MF. Screening for gestational diabetes mellitus (editorial). N Engl J Med 1997; 337: 1625 6.

33. Griffin ME, Coffey M, Johnson H, et al. Universal vs. risk factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome. Diabet Med 2000; 17: 26-32.

34.Guidelines for the management of arterial hypertension // Europ. Heart J. – 2007. – V. 28. – P. 1462-1536.

35. Hale TW, Kristensen JH, Hackett LP, et al. Transfer of metformin into human milk. Diabetologia 2002; 45: 1509-14.

36. Helen E.Turner, John A.H.Wass. Oxford Handbook of Endocrinology and Diabetes. Second Edition. Oxford, University Press, 2009, 792-801.

37. Hillier TA, Pedula KL, Schmidt MM, et al. Childhood obesity and metabolic imprinting. The ongoing effects of maternal hyperglycemia. Diabetes Care 2007; 30: 2287-92.

38. Hod M, Damm P, Kaaja R, et al. Fetal and perinatal outcomes in type 1 diabetes pregnancy: a randomized study comparing insulin aspart with human insulin in 322 subjects. Am J Obstet Gynecol 2008; 198 (2): 186.e1–186.e7.

39. Hod M, van Dijk DJ, Weintraub N, et al. Diabetic nephropathy and pregnancy: the effect of ACE inhibitors prior to pregnancy on fetomaternal outcome. Nephrol Dial Transplant 1995; 10: 2328-33. Global Guideline on Pregnancy and Diabetes 25 Pregnancy_EN2.indd 25 16/09/09 15:42

40. IDF Clinical Guidelines Task Force. Global Guideline for Type 2 diabetes. Brussels: International Diabetes Federation, 2005.

41. IDF Clinical Guidelines Task Force. Global Guideline on Pregnancy and Diabetes. Brussels: International Diabetes Federation, 2009.

42. Inkster ME, Fahey TP, Donnan PT, et al. Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies. BMC Pregnancy and Childbirth 2006; 6: 30.

43. Janz NK, Herman WH, Becker MP, et al. Diabetes and pregnancy: factors associated with seeking preconception care. Diabetes Care 1995; 18: 157-65.

44. Joint Formulary Committee. British National Formulary. 57th edn. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2009. (www.bnf.org)

45. Jovanovic L, Druzin M, Peterson CM. Effect of euglycemia on the outcome of pregnancy in insulindependent diabetic women as compared with normal control subjects. Am J Med 1981; 71: 921-7.

46. Jovanovic L, Ilic S, Pettitt DJ, et al. Metabolic and immunologic effects of insulin lispro in gestational diabetes. Diabetes Care 1999; 22: 1422-7.

47. Key TC, Giuffrida R, Moore TR. Predictive value of early pregnancy glycohemoglobin in the insulintreated diabetic patient. Am J Obstet Gynecol 1987; 156: 1096-100.

48. Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care 2007; 30: 1314-9.

49. Langer O, Rodriguez DA, Xenakis EMJ, et al. Intensified versus conventional management of gestational diabetes. Am J Obstet Gynecol 1994; 170: 1036-47.

50. Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343: 1134-8.

51. Langer O, Yogev Y, Most O, et al. Gestational diabetes: The consequences of not treating. Am J Obstet Gynecol 2005; 192: 989-97.

52. Magee MS, Knopp RH, Benedetti TJ. Metaboliceffects of 1200-kcal diet in obese pregnant women with gestational diabetes. Diabetes 1990; 39: 234-40.

53. Manderson JG, Patterson CC, Hadden DR, et al. Preprandial versus postprandial blood glucose monitoring in type 1 diabetic pregnancy: a randomized controlled clinical trial. Am J Obstet Gynecol 2003; 189: 507-12.

54. Mathiesen ER, Kinsley B, Amiel SA, et al. Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Diabetes Care 2007; 30: 771-6.

55. Metzger BE, Buchanan TA, Coustan DR, et al. Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus. Diabetes Care 2007; 30 (Suppl 2): S251-S260.

56. Mills JL, Simpson JL, Driscoll SG, et al. Incidence of spontaneous abortion among normal women and insulin-dependent diabetic women whose pregnancies were identified within 21 days of conception. N Engl J Med 1988; 319: 1617-23.

57. Moses RG, Barker M, Winter M, et al. Can a low– glycemic index diet reduce the need for insulin in gestational diabetes mellitus? A randomized trial. Diabetes Care 2009; 32: 996-1000.

58. Moses RG, Griffiths R, Davis W. Gestational diabetes. Do all women need to be tested? Aust NZ J Obstet Gynaecol 1995; 35: 387-9.

59. Moses RG, Lucas EM, Knights S. Gestational diabetes mellitus. At what time should the postprandial glucose level be monitored? Aust NZ J Obstet Gynaecol 1999; 39: 458-60.

60. Nathan D, Kuenen J, Borg R, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care 2008; 31: 1473-8.

61. Oddy WH, De Klerk NH, Miller M, et al. Association of maternal pre-pregnancy weight with birth defects: Evidence from a case-control study in Western Australia. Aust NZ J Obstet Gynaecol 2009; 49: 11-5.

62. Pettitt DJ, Aleck KA, Baird HR, et al. Congenital susceptibility to NIDDM. Role of the intrauterine environment. Diabetes 1988; 37: 622-8.

63. Pettitt D, Ospina P, Howard C, et al. Efficacy, safety and lack of immunogenicity of insulin aspart compared with regular human insulin for women with gestational diabetes mellitus. Diabet Med 2007; 24: 1129-35.

64. Plank J, Siebenhofer A, Berghold A, et al. Systematic review and meta-analysis of short-acting insulin analogues in patients with diabetes mellitus. Arch Intern Med 2005; 165: 1337-44.

65. Pöyhönen-Alho M, Rönnemaa T, Saltevo J, et al. Use of insulin glargine during pregnancy. Acta Obstet Gynecol Scand 2007 Aug 29: 1-4.

66. Price N, Bartlett C, Gillmer MD. Use of insulin glargine during pregnancy: a case–control pilot study. BJOG 2007; 114: 453-7.

67. Ramin K.D. Diabetic ketoacidosis in pregnancy. Obstet. Gynecol. Clin. Noth. Amer. – 1999. – Vol. 26(3). – P.481-487.

68. Ratner RE, Christophi CA, Metzger BE, et al., for The Diabetes Prevention Program Research Group. Prevention of diabetes in women with a history of gestational diabetes: effects of metformin and lifestyle interventions. J Clin Endocrinol Metab 2008;93: 4774-9.

69. Rowan JA, Hague WM, Gao W, et al. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med 2008; 358: 2003-15.

70. Silverman BL, Metzger BE, Cho NH, et al. Impaired glucose tolerance in adolescent offspring of diabetic mothers. Relationship to fetal hyperinsulinism. Diabetes Care 1995; 18: 611-7.

71. Simmons D, Devers MC, Wolmarans L, et al. Difficulties in the use of risk factors to screen for gestational diabetes mellitus (letter). Diabetes Care 2009; 32: e8.

72. Sobngwi E, Boudou P, Mauvais-Jarvis F, et al. Effect of a diabetic environment in utero on predisposition to type 2 diabetes. Lancet 2003; 361: 1861-5.

73. Stothard KJ, Tennant PWG, Bell R, et al. Maternal verweight and obesity and the risk of congenital anomalies: A systematic review and meta-analysis. JAMA 2009; 301: 636-50.

74. Rosenn B, Miodovnik M, Combs CA, et al. Preconception management of insulin-dependent diabetes: improvement of pregnancy outcome. Obstet Gynecol 1991; 77: 846-9.

75. Williams CB, Iqbal S, Zawacki CM, et al. Effect of selective screening for gestational diabetes. Diabetes Care 1999; 22: 418-21.

76. Wyatt JW, Frias JL, Hoyme HE, et al. Congenital anomaly rate in offspring of mothers with diabetes treated with insulin lispro during pregnancy. Diabet Med 2005; 22: 803-7.