NAJČEŠĆI ENDOKRINOLOŠKI POREMEĆAJI U TRUDNOĆI
Ključne reči:
trudnoća, endokrinološki poremećaji, diajabetes, hipotroidizam, hipertiroidizam
Sažetak
Trudnoća je stanje intenzivnih fizioloških promena koji utiču na gotovo sve organe i sisteme. Endokrini poremećaji u trudnoći mogu značajno uticati na zdravlje majke i fetusa, što zahteva sveobuhvatno razumevanje njihove etiologije, dijagnostike i lečenja.
Najčešći endokrini poremećaji u trudnoći su gestacijski dijabetes melitus i poremećaj funkcije štitaste žlezde. Gestacijski dijabetes povezan je sa povećanim rizikom od komplikacija, kao što su preeklampsija, prevremeni porođaj, makrozomija i porođaj carskim rezom. Međutim, uz pažljiv nadzor, trudnice sa dijabetesom mogu imati urednu trudnoću i roditi zdravo dete. Hipotireoza tokom trudnoće predstavlja smanjenje funkcije, zbog čega štitasta žlezda ne proizvodi dovoljno hormona, posebno tiroksina i trijodtironina. Ovo stanje može značajno uticati na zderavlje majke i razvoj ploda. Nelečeni hipotiroidizam može dovesti do ozbiljnih komplikacija, uključujući intelektualne i razvojne problema deteta, preeklampsiju, anemiju, spontani pobačaj ili prevremeni porođaj. Pored ova dva najčešća endokrinološka poremećaja, na zdravlje majke i fetusa mogu značajno uticati i drugi poremećaji endokrinih žlezda, kao što su disfunkcija paratiroidne, nadbubrežne žlezde i hipofize. Ukoliko se ne prepoznaju ili ne leče, sva ova stanja dovode do lošeg ishoda trudnoće.
Endokrinološki poremećaji u trudnoći su veoma kompleksna i specifična stanja zbog uticaija na zdravlje majke i razvoj ploda. Štaviše, oni mogu imati dalekosežne implikacije na kvalitet života majke i njenog potomstva nakon završetka trudnoće. Efikasno lečenje endokrinoloških poremećaja u trudnoći zahteva multidisciplinarni timski pristup koji uključuje perinatologe, endokrinologe, nutricioniste i druge zdravstvene radnike. Pravovremene intervencije, personalizovani terapija i pažljivo praćenje su suština optimalnog tretmana ovih pacijenata. Promena načina života, adekvatna terapija i redovne prenatalne kontrole igraju ključnu ulogu u očuvanju zdravlja buduće majke i poboljšanju ishoda trudnoće.
Reference
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19. Laredo-Aguilera JA, Gallardo-Bravo M, Rabanales-Sotos JA, Cobo-Cuenca AI, Carmona-Torres JM. Physical activity programs during pregnancy are effective for the control of gestational diabetes mellitus. International journal of environmental research and public health. 2020 Sep;17(17):6151.
20. Gorsch LP, Wen T, Lonier JY, Zork N, Mourad M, D’Alton ME, Friedman AM. Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000–2019. American Journal of Obstetrics and Gynecology. 2023 Jul 1;229(1):63-e1.
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25. Andersen SL, Andersen S. Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development. Endocrine Connections. 2021 Feb 1;10(2):R77-86.
26. Geno KA, Nerenz RD. Evaluating thyroid function in pregnant women. Crit Rev Clin Lab Sci. 2022 Nov;59(7):460-479. doi: 10.1080/10408363.2022.2050182. Epub 2022 Mar 16. PMID: 35293284.
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28. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec;22(12):1200-35. doi: 10.1089/thy.2012.0205. Epub 2012 Nov 6. Erratum in: Thyroid. 2013 Feb;23(2):251. Erratum in: Thyroid. 2013 Jan;23(1):129. PMID: 22954017.
29. Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC pregnancy and childbirth. 2020 Dec;20(1):1-7.
30. Ali T, Bahadur A, Bashir B, Hassan T, Ishaq B, Qasim M. Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes. Pakistan Journal of Medical & Health Sciences. 2022 May 26;16(03):1184-.
31. Pearce EN. Management of Hypothyroidism and Hypothyroxinemia During Pregnancy. Endocr Pract. 2022 Jul;28(7):711-718. doi: 10.1016/j.eprac.2022.05.004. Epub 2022 May 13. PMID: 35569735.
32. Rodriguez-Diaz E, Pearce EN. Iodine status and supplementation before, during, and after pregnancy. Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101430. doi: 10.1016/j.beem.2020.101430. Epub 2020 Jun 19. PMID: 32792134.
33. Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022 Mar;18(3):158-171. doi: 10.1038/s41574-021-00604-z. Epub 2022 Jan 4. PMID: 34983968; PMCID: PMC9020832.
34. Kobaly K, Mandel SJ. Hyperthyroidism and Pregnancy. Endocrinol Metab Clin North Am. 2019 Sep;48(3):533-545. doi: 10.1016/j.ecl.2019.05.002. Epub 2019 Jun 17. PMID: 31345521.
35. Hamidi OP, Barbour LA. Endocrine Emergencies During Pregnancy: Diabetic Ketoacidosis and Thyroid Storm. Obstet Gynecol Clin North Am. 2022 Sep;49(3):473-489. doi: 10.1016/j.ogc.2022.02.003. PMID: 36122980.
36. Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022 Mar;18(3):158-171. doi: 10.1038/s41574-021-00604-z. Epub 2022 Jan 4. PMID: 34983968; PMCID: PMC9020832.
37. Barbero P, Valdez R, Rodríguez H, Tiscornia C, Mansilla E, Allons A, Coll S, Liascovich R. Choanal atresia associated with maternal hyperthyroidism treated with methimazole: a case-control study. Am J Med Genet A. 2008 Sep 15;146A(18):2390-5. doi: 10.1002/ajmg.a.32497. PMID: 18698631.
38. Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, Laurberg P, McDougall IR, Rivkees SA, Ross D, Sosa JA, Stan MN. The Role of Propylthiouracil in the Management of Graves' Disease in Adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009 Jul;19(7):673-4. doi: 10.1089/thy.2009.0169. PMID: 19583480.
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40. Kovacs CS. Calcium and Phosphate Metabolism and Related Disorders During Pregnancy and Lactation. 2021 Aug 1. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905396.
41. Parkes I, Schenker JG, Shufaro Y. Parathyroid and calcium metabolism disorders during pregnancy. Gynecol Endocrinol. 2013 Jun;29(6):515-9. doi: 10.3109/09513590.2012.754880. Epub 2013 Jan 25. PMID: 23350730.
42. Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML; International Workshop on Primary Hyperparathyroidism. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17. PMID: 36245251.
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44. Ali DS, Dandurand K, Khan AA. Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management. J Clin Med. 2021 Mar 29;10(7):1378. doi: 10.3390/jcm10071378. PMID: 33805460; PMCID: PMC8038023.
45. Khan AA, Clarke B, Rejnmark L, Brandi ML. MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. Eur J Endocrinol. 2019 Feb 1;180(2):R37-R44. doi: 10.1530/EJE-18-0541. PMID: 30444723.
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2. Calina D, Docea AO, Golokhvast KS, Sifakis S, Tsatsakis A, Makrigiannakis A. Management of Endocrinopathies in Pregnancy: A Review of Current Evidence. Int J Environ Res Public Health. 2019 Mar 4;16(5):781. doi: 10.3390/ijerph16050781. PMID: 30836653; PMCID: PMC6427139.
3. Stern C, Schwarz S, Moser G, Cvitic S, Jantscher-Krenn E, Gauster M, Hiden U. Placental Endocrine Activity: Adaptation and Disruption of Maternal Glucose Metabolism in Pregnancy and the Influence of Fetal Sex. Int J Mol Sci. 2021 Nov 24;22(23):12722. doi: 10.3390/ijms222312722. PMID: 34884524; PMCID: PMC8657775.
4. Frise CJ, Williamson C. Endocrine disease in pregnancy. Clin Med (Lond). 2013 Apr;13(2):176-81. doi: 10.7861/clinmedicine.13-2-176. PMID: 23681868; PMCID: PMC4952636.
5. Sachdeva P, Patel BG, Patel BK. Drug use in pregnancy; a point to ponder! Indian J Pharm Sci. 2009 Jan;71(1):1-7. doi: 10.4103/0250-474X.51941. PMID: 20177448; PMCID: PMC2810038.
6. Ito S. Mother and Child: Medication Use in Pregnancy and Lactation. Clin Pharmacol Ther. 2016 Jul;100(1):8-11. doi: 10.1002/cpt.383. PMID: 27272612.
7. Nelson-Piercy C. Handbook of obstetric medicine. CRC press; 2020 Aug 26.
8. London V, Grube S, Sherer DM, Abulafia O. Hyperemesis Gravidarum: A Review of Recent Literature. Pharmacology. 2017;100(3-4):161-171.
9. Ali DS, Davern R, Rutter E, Coveney C, Devine H, Walsh JM, Higgins M, Hatunic M. Pre-gestational diabetes and pregnancy outcomes. Diabetes Therapy. 2020 Dec;11:2873-85.
10. Eizirik DL, Pasquali L, Cnop M. Pancreatic β-cells in type 1 and type 2 diabetes mellitus: different pathways to failure. Nature Reviews Endocrinology. 2020 Jul;16(7):349-62.
11. Sushko K, Menezes HT, Strachan P, Butt M, Sherifali D. Self-Management education among women with pre-existing diabetes in pregnancy: a scoping review. International Journal of Nursing Studies. 2021 May 1;117:103883.
12. McCance DR. Pregnancy and diabetes. Best Pract Res Clin Endocrinol Metab. 2011 Dec;25(6):945-58. doi: 10.1016/j.beem.2011.07.009. PMID: 22115168.
13. Sweeting A, Wong J, Murphy HR, Ross GP. A clinical update on gestational diabetes mellitus. Endocrine reviews. 2022 Oct 1;43(5):763-93.
14. McIntyre HD, Catalano P, Zhang C, Desoye G, Mathiesen ER, Damm P. Gestational diabetes mellitus. Nature reviews Disease primers. 2019 Jul 11;5(1):47.
15. Haththotuwa RN, Wijeyaratne CN, Senarath U. Worldwide epidemic of obesity. InObesity and obstetrics 2020 Jan 1 (pp. 3-8). Elsevier.
16. Klein S, Gastaldelli A, Yki-Järvinen H, Scherer PE. Why does obesity cause diabetes?. Cell metabolism. 2022 Jan 4;34(1):11-20.
17. Karaçam Z, Çelİk D. The prevalence and risk factors of gestational diabetes mellitus in Turkey: a systematic review and meta-analysis. The Journal of Maternal-Fetal & Neonatal Medicine. 2021 Apr 18;34(8):1331-41.
18. Yu Q, Aris IM, Tan KH, Li LJ. Application and utility of continuous glucose monitoring in pregnancy: a systematic review. Frontiers in Endocrinology. 2019 Oct 11;10:697.
19. Laredo-Aguilera JA, Gallardo-Bravo M, Rabanales-Sotos JA, Cobo-Cuenca AI, Carmona-Torres JM. Physical activity programs during pregnancy are effective for the control of gestational diabetes mellitus. International journal of environmental research and public health. 2020 Sep;17(17):6151.
20. Gorsch LP, Wen T, Lonier JY, Zork N, Mourad M, D’Alton ME, Friedman AM. Trends in delivery hospitalizations with pregestational and gestational diabetes mellitus and associated outcomes: 2000–2019. American Journal of Obstetrics and Gynecology. 2023 Jul 1;229(1):63-e1.
21. Lende M, Rijhsinghani A. Gestational diabetes: overview with emphasis on medical management. International journal of environmental research and public health. 2020 Dec;17(24):9573.
22. Ringholm L, Stougaard EB, Nørgaard SK, Damm P, Mathiesen ER. Diabetes management during breastfeeding in women with type 1 diabetes. Current diabetes reports. 2020 Aug;20:1-8.
23. Muhwava LS, Murphy K, Zarowsky C, Levitt N. Perspectives on the psychological and emotional burden of having gestational diabetes amongst low-income women in Cape Town, South Africa. BMC Women's Health. 2020 Dec;20:1-2.
24. Milovanović Z, Filimonović D, Soldatović I, Karadžov Orlić N. Can Thyroid Screening in the First Trimester Improve the Prediction of Gestational Diabetes Mellitus? J Clin Med. 2022 Jul 5;11(13):3916.
25. Andersen SL, Andersen S. Hyperthyroidism in pregnancy: evidence and hypothesis in fetal programming and development. Endocrine Connections. 2021 Feb 1;10(2):R77-86.
26. Geno KA, Nerenz RD. Evaluating thyroid function in pregnant women. Crit Rev Clin Lab Sci. 2022 Nov;59(7):460-479. doi: 10.1080/10408363.2022.2050182. Epub 2022 Mar 16. PMID: 35293284.
27. Hershman JM. Physiological and pathological aspects of the effect of human chorionic gonadotropin on the thyroid. Best Pract Res Clin Endocrinol Metab. 2004 Jun;18(2):249-65. doi: 10.1016/j.beem.2004.03.010. PMID: 15157839.
28. Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, Pessah-Pollack R, Singer PA, Woeber KA; American Association Of Clinical Endocrinologists And American Thyroid Association Taskforce On Hypothyroidism In Adults. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012 Dec;22(12):1200-35. doi: 10.1089/thy.2012.0205. Epub 2012 Nov 6. Erratum in: Thyroid. 2013 Feb;23(2):251. Erratum in: Thyroid. 2013 Jan;23(1):129. PMID: 22954017.
29. Mahadik K, Choudhary P, Roy PK. Study of thyroid function in pregnancy, its feto-maternal outcome; a prospective observational study. BMC pregnancy and childbirth. 2020 Dec;20(1):1-7.
30. Ali T, Bahadur A, Bashir B, Hassan T, Ishaq B, Qasim M. Prevalence of Hypothyroidism in Pregnancies and its Obstetric Outcomes. Pakistan Journal of Medical & Health Sciences. 2022 May 26;16(03):1184-.
31. Pearce EN. Management of Hypothyroidism and Hypothyroxinemia During Pregnancy. Endocr Pract. 2022 Jul;28(7):711-718. doi: 10.1016/j.eprac.2022.05.004. Epub 2022 May 13. PMID: 35569735.
32. Rodriguez-Diaz E, Pearce EN. Iodine status and supplementation before, during, and after pregnancy. Best Pract Res Clin Endocrinol Metab. 2020 Jul;34(4):101430. doi: 10.1016/j.beem.2020.101430. Epub 2020 Jun 19. PMID: 32792134.
33. Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022 Mar;18(3):158-171. doi: 10.1038/s41574-021-00604-z. Epub 2022 Jan 4. PMID: 34983968; PMCID: PMC9020832.
34. Kobaly K, Mandel SJ. Hyperthyroidism and Pregnancy. Endocrinol Metab Clin North Am. 2019 Sep;48(3):533-545. doi: 10.1016/j.ecl.2019.05.002. Epub 2019 Jun 17. PMID: 31345521.
35. Hamidi OP, Barbour LA. Endocrine Emergencies During Pregnancy: Diabetic Ketoacidosis and Thyroid Storm. Obstet Gynecol Clin North Am. 2022 Sep;49(3):473-489. doi: 10.1016/j.ogc.2022.02.003. PMID: 36122980.
36. Lee SY, Pearce EN. Assessment and treatment of thyroid disorders in pregnancy and the postpartum period. Nat Rev Endocrinol. 2022 Mar;18(3):158-171. doi: 10.1038/s41574-021-00604-z. Epub 2022 Jan 4. PMID: 34983968; PMCID: PMC9020832.
37. Barbero P, Valdez R, Rodríguez H, Tiscornia C, Mansilla E, Allons A, Coll S, Liascovich R. Choanal atresia associated with maternal hyperthyroidism treated with methimazole: a case-control study. Am J Med Genet A. 2008 Sep 15;146A(18):2390-5. doi: 10.1002/ajmg.a.32497. PMID: 18698631.
38. Bahn RS, Burch HS, Cooper DS, Garber JR, Greenlee CM, Klein IL, Laurberg P, McDougall IR, Rivkees SA, Ross D, Sosa JA, Stan MN. The Role of Propylthiouracil in the Management of Graves' Disease in Adults: report of a meeting jointly sponsored by the American Thyroid Association and the Food and Drug Administration. Thyroid. 2009 Jul;19(7):673-4. doi: 10.1089/thy.2009.0169. PMID: 19583480.
39. Nguyen CT, Mestman JH. Postpartum Thyroiditis. Clin Obstet Gynecol. 2019 Jun;62(2):359-364. doi: 10.1097/GRF.0000000000000430. PMID: 30844908.
40. Kovacs CS. Calcium and Phosphate Metabolism and Related Disorders During Pregnancy and Lactation. 2021 Aug 1. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, de Herder WW, Dhatariya K, Dungan K, Hofland J, Kalra S, Kaltsas G, Kapoor N, Koch C, Kopp P, Korbonits M, Kovacs CS, Kuohung W, Laferrère B, Levy M, McGee EA, McLachlan R, New M, Purnell J, Sahay R, Shah AS, Singer F, Sperling MA, Stratakis CA, Trence DL, Wilson DP, editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000–. PMID: 25905396.
41. Parkes I, Schenker JG, Shufaro Y. Parathyroid and calcium metabolism disorders during pregnancy. Gynecol Endocrinol. 2013 Jun;29(6):515-9. doi: 10.3109/09513590.2012.754880. Epub 2013 Jan 25. PMID: 23350730.
42. Bilezikian JP, Khan AA, Silverberg SJ, Fuleihan GE, Marcocci C, Minisola S, Perrier N, Sitges-Serra A, Thakker RV, Guyatt G, Mannstadt M, Potts JT, Clarke BL, Brandi ML; International Workshop on Primary Hyperparathyroidism. Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop. J Bone Miner Res. 2022 Nov;37(11):2293-2314. doi: 10.1002/jbmr.4677. Epub 2022 Oct 17. PMID: 36245251.
43. Kort KC, Schiller HJ, Numann PJ. Hyperparathyroidism and pregnancy. Am J Surg. 1999 Jan;177(1):66-8. doi: 10.1016/s0002-9610(98)00302-x. PMID: 10037311.
44. Ali DS, Dandurand K, Khan AA. Hypoparathyroidism in Pregnancy and Lactation: Current Approach to Diagnosis and Management. J Clin Med. 2021 Mar 29;10(7):1378. doi: 10.3390/jcm10071378. PMID: 33805460; PMCID: PMC8038023.
45. Khan AA, Clarke B, Rejnmark L, Brandi ML. MANAGEMENT OF ENDOCRINE DISEASE: Hypoparathyroidism in pregnancy: review and evidence-based recommendations for management. Eur J Endocrinol. 2019 Feb 1;180(2):R37-R44. doi: 10.1530/EJE-18-0541. PMID: 30444723.
46. Manoharan M, Sinha P, Sibtain S. Adrenal disorders in pregnancy, labour and postpartum–an overview. Journal of Obstetrics and Gynaecology. 2020 Aug 17;40(6):749-58.
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2025/10/30
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