Diabetes mellitus und Schwangerschaft

Gestationsdiabetes mellitus ist eine der häufigsten Erkrankungen während der Schwangerschaft. Eine Schwangerschaft bei Frauen mit präexistentem Diabetes mellitus ist dagegen selten und gilt als Hochrisikoschwangerschaft. Beide bedürfen einer strengen Blutzuckereinstellung und vor allem einer gemeinsamen, engmaschigen Betreuung durch Diabetologen, Geburtsmediziner und Neonatologen in enger Kooperation mit Hebammen und anderen Experten mit dem Ziel eines Ausgangs der Schwangerschaft für Mutter und Kind wie im Geburtenkollektiv der Hintergrundpopulation.

Abstract

Gestational diabetes mellitus is one of the most common diseases during pregnancy. However, pregnancy in women with pre-existing diabetes mellitus is rare and is considered a high-risk pregnancy. Both require strict blood glucose control and, above all, joint, close care by specialized diabetologists, obstetricians and neonatologists in close cooperation with midwives and other experts.

Kernaussagen

• Schwangerschaften bei bestehendem Typ-1- oder Typ-2-Diabetes mellitus (T1DM/T2DM) sind selten, gelten als Hochrisikoschwangerschaften und bedürfen einer engmaschigen Betreuung durch spezialisierte Diabetologen, Geburtsmediziner und anderen Experten.

• Das Risiko für kongenitale Fehlbildungen ist abhängig von der Güte der präkonzeptionellen Stoffwechseleinstellung und unterscheidet sich nicht, ob ein T1DM oder T2DM vorliegt.

• Präkonzeptionelle Betreuung und Beratung sind essenziell für eine guten Ausgang der Schwangerschaft.

• Ein Real-time continuous Glucose Monitoring (rtCGM) mit ununterbrochener Anwendung kann bei schwangeren Frauen mit T1DM Verlauf und Ausgang verbessern.

• Die Präferenzen der Frauen sollten beim Einsatz einer intensivierten konventionellen Insulintherapie (ICT) oder continuous subcutaneous Insulin Infusion (CSII) berücksichtigt werden, da keine der beiden Therapiestrategien der anderen überlegen ist.

• Schwangere mit T2DM weisen ein höheres metabolisches Risikoprofil auf und eine schlechtere präkonzeptionelle Betreuung im Vergleich zu Frauen mit T1DM.

• Allen Frauen mit T1DM oder T2DM soll eine Präeklampsieprävention mit Low-Dose-Azetylsalizylsäure angeboten und vor 16 Schwangerschaftswochen begonnen werden.

• Das in Deutschland übliche Zweistufenverfahren zum GDM-Screening, erst 50-g-Vortest und nur im positiven Fall 75-g-oGTT, führt nach derzeitiger Evidenzlage nicht zu einer Überversorgung.

• Zur GDM-Nachsorge wird primär ein 75-g-oGTT eingesetzt, bei Frauen mit erhöhten Risiken einmal im Jahr.

• Metformin ist seit Februar 2022 nur zugelassen für schwangere Frauen mit T2DM, die das Medikament schon vor der Schwangerschaft eingenommen haben.

• Frauen im reproduktiven Alter sollten sich vor einer geplanten Schwangerschaft oder nach dem 1. Trimester der Schwangerschaft gegen COVID-19 impfen lassen.

Schlüsselwörter

Gestationsdiabetes - Blutglukose - COVID-19 - Schwangerschaftsstoffwechsel

Publication History

Article published online:
20 February 2025

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