Diabetes-Screening in der Schwangerschaft

Zusammenfassung

Der Gestationsdiabetes (GDM) wird auch die verborgene Epidemie genannt, da er ohne generelles Screening zumeist nicht erkannt wird. Von vielen Fachgesellschaften wird daher ein generelles Screening gefordert. Die Deutsche Gesellschaft für Geburtshilfe und Gynäkologie hat Anfang 2001 in Gemeinschaft mit der Deutschen Diabetesgesellschaft und der Deutschen Gesellschaft für perinatale Medizin eine Empfehlung zu einem generellen Screening mittels eines 75 g oGTT zwischen der 24. - 28. SSW herausgegeben. Mutmaßlich werden in Europa ohne Screening weniger als 10 % der Fälle aufgedeckt. Ein unerkannter GDM ist jedoch eine Bedrohung der Schwangerschaft, sein Anteil an der generellen perinatalen Mortalität beträgt zumindest 1/1000. Bei unerkanntem und unbehandeltem GDM entwickeln die Kinder bereits im Mutterleib eine Störung ihrer Insulinhomöostase, die ihrerseits eine erhöhte Diabetesneigung dieser Kinder im späteren Leben verursacht. Darüber hinaus ist die Schwangerschaft eine besondere physiologische Situation, die es ermöglicht, eine spätere Diabetesneigung der Frauen frühzeitig zu erkennen. Dies ist von großer volksgesundheitlicher Bedeutung, da Präventiv- und Früherkennungsmaßnahmen ergriffen werden können. Es muss daher ein generelles Screening nach Glukosetoleranzstörungen in der Schwangerschaft gefordert werden.

Abstract

Gestational diabetes has been referred to as a hidden epidemic. It is estimated that less than 10 % of cases are detected in Europe without generalized screening. But untreated gestational diabetes and disturbed insulin homeostasis in utero is a risk factor for perinatal morbidity and accounts for at least 1/1000 of overall perinatal mortality. Furthermore, offspring of pregnancies complicated by diabetes have a predisposition to diabetes in adolescence and adulthood. Pregnancy is also a unique physiologic opportunity to identify increased maternal risk for diabetes later in life. This is significant from a public health perspective, because preventive measures can be taken. Accordingly, in 2001 the German Society of Obstetrics and Gynecology recommended screening all pregnant women with a 75-g oral glucose tolerance test between the 24th and the 28th weeks of gestation.

Schlüsselwörter

Gestationsdiabetes - Diabetes - Schwangerschaft - Screening - oGTT

Key words

Gestational diabetes - pregnancy - Diabetes mellitus - screening - oGTT

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