Diabetes mellitus und Schwangerschaft

Therapiebedürftige Hyperglykämien gehören weltweit zu den häufigsten Schwangerschaftskomplikationen. Die größte Gruppe bilden Frauen mit Gestationsdiabetes mellitus, gefolgt von Frauen mit bekanntem Typ-1- und Typ-2-Diabetes mellitus. Die Betreuung ist komplex und verlangt ein gutes Zusammenspiel verschiedener Fachgebiete. Dieser Beitrag bietet eine Übersicht zu bewährten Therapie-Strategien und erläutert neue Erkenntnisse, u. a. zur SARS-CoV-2-Pandemie.

Abstract

The quality of metabolic control at the beginning of pregnancy already determines the course and outcome of pregnanies with type 1 and type 2 diabetes mellitus. The preconceptional counseling and support provided by experienced teams is more important than modern technical equipment with insulin pumps and sensors for continuous glucose measurement. The incidence of congenital malformations is significantly reduced by a periconceptional HbA1c level < 6.5 % and folic acid supplementation started preconceptionally. To prevent preeclampsia, all women with type 1 and type 2 diabetes mellitus should be offered low-dose ASA, starting before 16 weeks of pregnancy. If the pregnant woman has a BMI < 25 kg/m² and persistently elevated fasting blood glucose levels, a GCK-MODY should be considered. For the diagnosis of asymptomatic gestational diabetes mellitus, all women in Germany with 24 + 0 to 27 + 6 weeks of pregnancy are offered a two-stage screening. Structured follow-up care is required after gestational diabetes mellitus, because these women have an increased risk of developing type 2 diabetes mellitus and cardiovascular complications. Pregnant women with COVID-19 and hyperglycemia have an increased risk of a severe course of the infection, which is further increased by obesity – they are an important target group for vaccination with an mRNA vaccine.

Schlüsselwörter

Diabetes mellitus - Schwangerschaft - Prävention - präkonzeptionelle Beratung - Nachsorge - COVID-19

Key words

diabetes mellitus - pregnancy - prevention - periconceptional counseling - follow up - COVID-19

• Literatur

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