{"id":6094,"date":"2016-12-12T11:51:20","date_gmt":"2016-12-12T08:51:20","guid":{"rendered":"http:\/\/prodiab.md\/?p=6094"},"modified":"2016-12-12T11:52:47","modified_gmt":"2016-12-12T08:52:47","slug":"diabetul-zaharat-pune-pericol-viata-mamei-si-bebelusului","status":"publish","type":"post","link":"http:\/\/prodiab.md\/ro\/diabetul-zaharat-pune-pericol-viata-mamei-si-bebelusului\/","title":{"rendered":"Diabetul zaharat pune \u00een pericol via\u0163a mamei \u015fi a bebelu\u015fului!"},"content":{"rendered":"

<\/p>\n

Sarcina reprezint\u0103 un eveniment special \u00een via\u0163a unei femei, \u00een care au loc numeroase modific\u0103ri fizice \u015fi emo\u0163ionale cu rol de a o preg\u0103ti pe viitoarea m\u0103mic\u0103 pentru na\u015ftere \u015fi pentru perioada ce urmeaz\u0103. <\/strong><\/p>\n

Au loc importante schimb\u0103ri hormonale ce influen\u0163eaz\u0103 \u00eentreg metabolismul. Hormonii secreta\u0163i de placent\u0103 au un rol major, \u015fi ei determin\u0103, printre altele, apari\u0163ia unei rezisten\u0163e la insulin\u0103, hormonul care men\u0163ine glicemia \u00een limite normale.<\/p>\n

Datorit\u0103 acestei \u201crezisten\u0163e\u201d, pancreasul este nevoit s\u0103 secrete o cantitate mai mare de insulin\u0103 pentru a men\u0163ine glicemia \u00een limite normale. Atunci c\u00e2nd cantitatea de insulin\u0103 secretat\u0103 nu este suficient\u0103 pentru a \u00eenvinge rezisten\u0163a \u0163esuturilor, glicemia \u00eencepe s\u0103 creasc\u0103 \u015fi apare diabetul zaharat.<\/p>\n

Prezen\u0163a unei glicemii crescute \u00een timpul sarcinii cre\u015fte riscul apari\u0163iei anumitor complica\u0163ii, at\u00e2t la mam\u0103, c\u00e2t \u015fi la f\u0103t. Aceste complica\u0163ii sunt:<\/em><\/strong><\/p>\n

– pentru gravid\u0103: cre\u015fterea tensiunii arteriale (eclampsie),\u00a0 predispozi\u0163ie crescut\u0103 pentru infec\u0163ii genito-urinare, na\u015ftere prematur\u0103, travaliu prelungit.<\/p>\n

– pentru f\u0103t: avort spontan \u00een primele luni de sarcin\u0103, moarte intrauterin\u0103 – de obicei \u00een lun\u0103 mare de sarcin\u0103, diverse malforma\u0163ii congenitale cardiace, neurologice \u015fi renale,\u00a0 macrosomie (f\u0103t cu greutate mare la na\u015ftere > 4,5 kg), traumatisme la na\u015ftere, icter neonatal prelungit, hipoglicemii severe \u00een perioada neonatal\u0103 ce pot determina sechele neurologice importante,\u00a0 risc de a face diabet ulterior \u00een timpul vie\u0163ii.<\/p>\n

\u00cen clinic\u0103 exist\u0103 mai multe variante \u00een care ne putem \u00eent\u00e2lni cu diabet pe durata sarcinii:<\/em><\/p>\n

– la femei diagnosticate anterior cu diabet (diabet zaharat tip 1, diabet zaharat tip 2 sau alte tipuri de diabet zaharat).<\/p>\n

– la femei la care diabetul se descoper\u0103 pentru prima dat\u0103 pe parcursul sarcinii.<\/p>\n

Diabetul diagnosticat \u00een timpul sarcinii<\/strong><\/em><\/p>\n

Pe durata sarcinii exist\u0103 dou\u0103 situa\u0163ii \u00een care este diagnosticat pentru prima oar\u0103 diabetul:<\/p>\n

1. Diabet gesta\u0163ional – atunci cand diagnosticul se pune prin screening efectuat la toate gravidele \u00een s\u0103pt\u0103m\u00e2na 24-28 de sarcin\u0103 (trimestrul 3).<\/p>\n

Acest tip de diabet este de obicei tranzitoriu \u015fi se remite dup\u0103 na\u015ftere. Totu\u015fi, aceste femei au risc crescut de a face diabet zaharat tip 2 \u00een cursul vie\u0163ii, sau de a face din nou diabet gesta\u0163ional la o sarcin\u0103 viitoare.<\/p>\n

2. Diabet zaharat tip 2 (propriu-zis) – atunci c\u00e2nd diagnosticul se pune de la debutul sarcinii prin screening la toate pacientele cu risc. \u00cen aceast\u0103 situa\u0163ie este vorba, de fapt, de un diabet preexistent nediagnosticat anterior, care nu se va remite dup\u0103 na\u015ftere.<\/p>\n

Diabetul gesta\u0163ional<\/strong><\/em><\/p>\n

\u00cen prezent, pe plan mondial, diabetul complic\u0103 aproximativ 7% din toate sarcinile. Din acest motiv, organiza\u0163ii ale diabetologilor \u015fi ginecologilor au stabilit \u00een 2009 noile criterii de screening \u015fi diagnostic ale diabetului gesta\u0163ional.<\/p>\n

S-a convenit c\u0103 toate femeile care nu se cuno\u015fteau anterior cu diabet zaharat s\u0103 efectueze un test de toleran\u0163\u0103 la glucoz\u0103 oral \u00een s\u0103pt\u0103m\u00e2na 24-28 de sarcin\u0103.<\/p>\n

Testul de toleran\u0163\u0103 la glucoz\u0103 oral (TTGO) presupune c\u0103 gravida s\u0103 bea 75 gr. glucoz\u0103 pulbere dizolvat\u0103 \u00eentr-o can\u0103 de ap\u0103, m\u0103sur\u00e2nd glicemia \u00eenainte, la o or\u0103 \u015fi la 2 ore dup\u0103 ingestia glucozei. TTGO va fi efectuat diminea\u0163a, dup\u0103 un post nocturn de cel pu\u0163in 8 ore (gravida nu va m\u00e2nca \u00een timpul nop\u0163ii!!). Trei zile anterior testului pacienta va m\u00e2nca normal (f\u0103r\u0103 restric\u0163ie \u00een ceea ce prive\u015fte glucidele).<\/p>\n

Diagnosticul de diabet gesta\u0163ional va fi pus c\u00e2nd este \u00eendeplinit doar unul din urm\u0103toarele criterii:<\/p>\n

Glicemia a jeun \u2265 92 mg\/dl (5,1 mmol\/l)
\nGlicemia la 1 or\u0103 \u2265 180 mg\/dl (10,0 mmol\/l)
\nGlicemia la 2 ore \u2265153 mg\/dl (8,5 mmol\/l)<\/p>\n

Din cele c\u00e2teva studii recente se remarc\u0103 faptul c\u0103 gravidele diagnosticate cu diabet gesta\u0163ional dup\u0103 noile criterii pot fi echilibrate \u00een propor\u0163ie de 80-90% doar cu modificarea stilului de via\u0163\u0103 (diet\u0103, exerci\u0163iu fizic). Dac\u0103 glicemia nu scade prin modificarea stilului de via\u0163\u0103, singurul tratament aprobat momentan pentru utilizare \u00een sarcin\u0103 este insulina.<\/p>\n

\n

\u00a0\u00cen func\u0163ie de profilul glicemic al pacientei, medicul diabetolog va stabili o schem\u0103 de tratament cu una sau mai multe injec\u0163ii de insulin\u0103.<\/p>\n

Deoarece o parte din cazurile de gravide cu diabet gesta\u0163ional au, de fapt, un diabet zaharat tip 2 preexistent sau diabet zaharat tip 1 la care debutul s-a f\u0103cut concomitent cu sarcina, se recomand\u0103 retestarea la 6 -12 s\u0103pt\u0103m\u00e2ni dup\u0103 na\u015ftere, de obicei, tot prin efectuarea TTGO.<\/p>\n

Femeile cu istoric de diabet gesta\u0163ional vor fi urm\u0103rite periodic prin screenig cel pu\u0163in la 3 ani deoarece au un risc crescut de a face diabet pe parcursul vie\u0163ii.<\/p>\n

Diabetul zaharat tip 2 (propriu-zis)<\/strong><\/em><\/p>\n

Peste 240 milioane de oameni din \u00eentreaga lume au diabet zaharat, iar 90-95 % dintre ace\u015ftia au diabet zaharat tip 2. Se remarc\u0103 instalarea bolii de la v\u00e2rste din ce \u00een ce mai mici, la copii, la adolescen\u0163i \u015fi la femei aflate la v\u00e2rsta procrea\u0163iei. La debutul bolii, atunci c\u00e2nd valorile glicemiei sunt doar u\u015for modificate, simptomele sunt minime, iar diabetul r\u0103m\u00e2ne nediagnosticat pentru o lung\u0103 perioad\u0103 de timp.<\/p>\n

Din acest motiv, se recomand\u0103 screenig-ul activ al persoanelor predispuse la a face diabet.<\/p>\n

Femeile predispuse la diabet sunt cele supraponderale \u015fi obeze (Indice de mas\u0103 corporal\u0103 \u226525 Kg\/m2) care au \u00een plus unul sau mai mul\u0163i factori de risc adi\u0163ionali:<\/em><\/strong><\/p>\n

1.Sedentarism<\/p>\n

2. Au rude de gradul I cu diabet zaharat tip 2 ( mam\u0103, tat\u0103, fra\u0163i, surori)<\/p>\n

3. Apar\u0163in unor grupuri etnice cu risc crescut: hispanici, afro-americani, indieni native, est \u2013 asiatici (Peninsula Arabia)<\/p>\n

4. Femei care au dat na\u015ftere la fe\u0163i macrosomi (greutate la nastere> 4 kg) sau cele cu diagnostic anterior de diabet gesta\u0163ional<\/p>\n

5. HTA ( TA \u2265140\/90 mmHG, sau tratament antihipertensiv)<\/p>\n

6. Dislipidemie : HDL colesterol < 35 mg\/dl \u015fi\/sau trigliceride > 250 mg\/dl<\/p>\n

7. Femei cu diagnostic anterior de SOPC (ovar polichistic)<\/p>\n

8. HbA1c \u2265 5,7 %, IGT sau IFG (prediabet)<\/p>\n

9. Alte condi\u0163ii clinice asociate cu insulinorezisten\u0163a (obezitate morbid\u0103, acanthosis nigricans, obezitate abdominal\u0103)<\/p>\n

10. Istoric de boal\u0103 cardiovascular\u0103<\/p>\n<\/div>\n

<\/div>\n
\n

(IGT = alterarea toleran\u0163ei la glucoza, IFG = glicemie a jeun modificat\u0103, HbA1c = hemoglobin\u0103 glicozilat\u0103)<\/p>\n

Indiferent de prezen\u0163a sau absen\u0163a acestor criterii, screening-ul pentru diabet se va efectua de la debutul sarcinii la toate gravidele cu v\u00e2rsta peste 45 de ani. (v\u00e2rsta este \u00een sine un factor de risc major pentru apari\u0163ia diabetului zaharat tip 2 ).<\/p>\n

Dac\u0103 o femeie \u00eens\u0103rcinat\u0103 se \u00eencadreaza \u00een categoria cu risc folosind criteriile de mai sus, va fi testat\u0103 pentru diabet \u00eenc\u0103 de la debutul sarcinii, la primul consult prenatal, folosind criteriile de diagnostic \u015fi screening pentru popula\u0163ia general\u0103 (determinarea glicemiei a jeun, TTGO\u00a0 cu 75 gr. glucoz\u0103, determinarea HbA1c).<\/p>\n

Diagnosticul de diabet zaharat tip 2 pe sarcin\u0103 se va pune dac\u0103 sunt prezente urm\u0103toarele criterii:<\/em><\/strong><\/p>\n

1. glicemie a jeun \u2265 126 mg\/dl ( 7,0 mmol\/l), dupa un post nocturn de cel pu\u0163in 8 ore,\u00a0 sau<\/em>
\n2. glicemie la 2 ore dup\u0103 TTGO\u00a0 cu 75 gr. glucoz\u0103\u00a0 \u2265 200mg\/dl,\u00a0 \u00a0sau<\/em>
\n3. HbA1c \u2265 6,5 %,\u00a0sau<\/em>
\n4. glicemie\u00a0 \u2265 200 mg\/dl la o pacient\u0103 cu criz\u0103 hiperglicemic\u0103 sau care prezint\u0103 simptome clasice de diabet (poliurie, polidipsie, polifagie, sc\u0103dere ponderal\u0103).<\/p>\n

O valoare modificat\u0103 \u00een sensul diagnosticului de diabet zaharat va fi repetat\u0103 pentru a exclude o eventual\u0103 eroare de laborator (except\u00e2nd varianta \u00een care sunt prezente simptomele clasice de hiperglicemie). Este de preferat ca acela\u015fi test care a ie\u015fit modificat s\u0103 fie repetat.<\/p>\n

Femeile care vor \u00eendeplini criteriile de diagnostic prin screening efectuat la prima vizit\u0103 prenatal\u0103, vor primi diagnosticul de Diabet zaharat tip 2 \u015fi nu de Diabet Gesta\u0163ional. Ele nu vor fi retestate \u00een s\u0103pt\u0103m\u00e2na 24-28.<\/p>\n

Femeile \u00eencadrate \u00een categoria de risc care au fost testate \u00een primul trimestru \u015fi care nu au \u00eendeplinit criteriile de diagnostic, vor fi retestate ulterior, \u00een s\u0103pt\u0103m\u00e2na 24-28 de sarcina \u015fi diagnosticate dup\u0103 noile criterii de diabet gesta\u0163ional.<\/p>\n<\/div>\n

<\/div>\n
Sursa:\u00a0www.eva.ro<\/div>\n

<\/p>","protected":false},"excerpt":{"rendered":"

Sarcina reprezint\u0103 un eveniment special \u00een via\u0163a unei femei, \u00een care au loc numeroase modific\u0103ri fizice \u015fi emo\u0163ionale cu rol de a o preg\u0103ti pe viitoarea m\u0103mic\u0103 pentru na\u015ftere \u015fi pentru perioada ce urmeaz\u0103. Au loc importante schimb\u0103ri hormonale ce influen\u0163eaz\u0103 \u00eentreg metabolismul. Hormonii secreta\u0163i de placent\u0103 au un rol major, \u015fi ei determin\u0103, printre…<\/p>\n","protected":false},"author":3,"featured_media":6095,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"ngg_post_thumbnail":0},"categories":[5],"tags":[],"yoast_head":"\nDiabetul zaharat pune \u00een pericol via\u0163a mamei \u015fi a bebelu\u015fului! - PRODIAB<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"http:\/\/prodiab.md\/ro\/diabetul-zaharat-pune-pericol-viata-mamei-si-bebelusului\/\" \/>\n<meta property=\"og:locale\" content=\"ro_RO\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Diabetul zaharat pune \u00een pericol via\u0163a mamei \u015fi a bebelu\u015fului! - PRODIAB\" \/>\n<meta property=\"og:description\" content=\"Sarcina reprezint\u0103 un eveniment special \u00een via\u0163a unei femei, \u00een care au loc numeroase modific\u0103ri fizice \u015fi emo\u0163ionale cu rol de a o preg\u0103ti pe viitoarea m\u0103mic\u0103 pentru na\u015ftere \u015fi pentru perioada ce urmeaz\u0103. Au loc importante schimb\u0103ri hormonale ce influen\u0163eaz\u0103 \u00eentreg metabolismul. 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