Gestationsdiabetes – noch immer ein nicht zu unterschätzender Risikofaktor

Zusammenfassung:

Ziel: Review der Literatur zu Schwangeren mit Gestationsdiabetes, die ein erhöhtes peripartales Risiko aufweisen, welches im Rahmen des geburtshilflichen Managements Beachtung finden sollte.

Methodik: Systematische Literaturrecherche.

Ergebnisse: Als Gestationsdiabetes wird ein erstmals in der Schwangerschaft auftretender bzw. diagnostizierter Diabetes bezeichnet. Die Pathophysiologie und das Risikoprofil entsprechen dem des Diabetes mellitus Typ 2. Eine entscheidende Rolle spielen dabei, neben einer genetischen Disposition, der mütterliche Body-Mass-Index, der Lebensstil sowie frühere Schwangerschaften mit Gestationsdiabetes. Die Diagnosestellung erfolgt durch einen 75 g oralen Glukosetoleranztest, meist bei 24–28 Schwangerschaftswochen. Die Folgen für die Mutter sind vor allem die schwangerschaftsinduzierte Hypertonie und Präeklampsie sowie im Verlauf die erhöhte Inzidenz für kardiovaskuläre Ereignisse. Intrapartal zeigen sich zudem eine erhöhte Sectio-Rate bei fetalem Large for gestational age und ein erhöhtes Risiko für höhergradige Geburtsverletzungen und atone Nachblutungen. Die Therapie schließt sowohl die Lifestyle-Modifikation als auch die medikamentöse Therapie mit Insulin ein.

Schlussfolgerungen: Durch die frühzeitige Diagnosestellung durch adäquate Testverfahren und konsequent eingeleitete Therapien kann das peripartale maternale und fetale Risiko reduziert werden.

Abstract

Purpose: Pregnant women with gestational diabetes mellitus have an increased peripartal risk. The aim of this article is to summarize the current state of the art for both the diagnosis and management in pregnancy and childbirth.

Methods: Systematic literature review.

Results: Gestational diabetes is defined as diabetes, which is diagnosed for the first time in pregnancy. The pathophysiology and risk profile are similar to diabetes mellitus type 2. A Genetic disposition, the maternal body-mass-index and lifestyle, as well as gestational diabetes in previous pregnancies, are risk factors. The diagnosis is made by a 75g oral glucose tolerance test, usually at 24 to 28 weeks of gestation. Maternal risks include pregnancy-induced hypertension, preeclampsia and an increased incidence for cardiovascular disease. The rate of cesarean section in the case of fetal macrosomia (large for gestational age) and of postpartum hemorrhage is increased. The therapy includes lifestyle modifications and a drug therapy with insulin.

Conclusion: An early diagnosis with adequate test methods and a consequent therapy can reduce the peripartum maternal and fetal risks.

Schlüsselwörter

Gestationsdiabetes - Diabetes mellitus - Large for gestational age - Schwangerschaft - Blutzucker

Key Words

Gestational diabetes - diabetes mellitus - large for gestational age - pregnancy - blood glucose

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