GESTACIJSKI DIJABETES MELITUS
Abstract
Gestacijski diabetes mellitus (GDM) se definiše kao bilo koji stepen glukozne intolerancije, sa početkom ili prvim pojavljivanjem tokom trudnoće, i razvija se kada funkcija pankreasa žene nije dovoljna da prevaziđe dijabetogeno okruženje trudnoće. Faktori rizika za GDM su: anamneza makrozomije deteta u prethodnoj trudnoći, sindrom policističnih jajnika, trudnoćom izazvana hipertenzija, anamneza spontanih abortusa i neobjašnjiva mrtvorođenost, gojaznost, više od 25 godina starosti i anamneza GDM u prethodnim trudnoćama. Dijagnoza se postavlja izvođenjem OGTT-a sa 100 g glukoze u 24 - 28.n.g., i zasniva se na prisustvu dve ili više sledećih vrednosti: glikemija našte > 5.3mmol/L, posle 1h > 10.0mmol/L, posle 2h >8.6mmol/L, posle 3h >7.8 mmol/L. GDM se obično prezentuje u trećem trimestru trudnoće kada sazreva placenta, obično je blag i ne ugrožava život trudnice, ali hiperglikemija povećava fetalni morbiditet. Standardni pristup u lečenju GDM je insulinska terapija kod trudnica koje ne mogu da postignu zadovoljavajuću glikemijsku kontrolu dijetom, i to konvencionalna intenzivirana insulinska terapija u četiri dnevne doze. Preporuka Američke Dijabetesne Asocijacije je da se porođaj obavi tokom 38.n.g.
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