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Diabetes aktuell 2022; 20(08): 365-375
DOI: 10.1055/a-1976-8965
Schwerpunkt

Diabetes und Schwangerschaft

Präkonzeptionelle Betreuung, Beratung bei Kinderwunsch, Insulintherapie während der Schwangerschaft und geburtshilfliches Management
Michael Hummel
1   Internistische Gemeinschaftspraxis und Diabetologische Schwerpunktpraxis, Rosenheim, Deutschland
2   Forschergruppe Diabetes e.V. am Helmholtz-Zentrum München, München, Deutschland
,
Martin Füchtenbusch
2   Forschergruppe Diabetes e.V. am Helmholtz-Zentrum München, München, Deutschland
3   Diabeteszentrum am Marienplatz München, München, Deutschland
,
Wilgard Battefeld
4   Diabetologie und Endokrinologie, Medizinisches Versorgungszentrum Kempten-Allgäu, Kempten, Deutschland
,
Christoph Bührer
5   Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
Tanja Groten
6   Geburtsmedizin und maternale Gesundheit, Universitätsklinikum Jena, Jena, Deutschland
,
Thomas Haak
7   Diabetes Zentrum Mergentheim, Bad Mergentheim, Deutschland
,
Franz Kainer
8   Abteilung für Geburtshilfe und Pränatalmedizin, Klinik Hallerwiese, Nürnberg, Deutschland
,
Alexandra Kautzky-Willer
9   Klinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
,
Andreas Lechner
10   Medizinische Klinik und Poliklinik IV, Diabeteszentrum, Ludwigs-Maximilians-Universität München, München, Deutschland
,
Thomas Meissner
11   Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
,
Christine Nagel-Reuper
12   Diabetespraxis Northeim, Northeim, Deutschland
,
Ute Schäfer-Graf
13   Berliner Diabetes Zentrum für Schwangere, St. Joseph Krankenhaus Berlin Tempelhof, Berlin, Deutschland
,
Thorsten Siegmund
14   Diabetes-, Hormon-, und Stoffwechselzentrum, Privatpraxis am Isar Klinikum, München, Deutschland
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ZUSAMMENFASSUNG

Schwangerschaften mit präkonzeptionell bekanntem Typ-1- und Typ-2-Diabetes sind Hochrisiko-Schwangerschaften und bedürfen einer interdisziplinären Betreuung. Kinder diabetischer Mütter haben ein im Mittel 1,5- bis 3-fach erhöhtes Risiko für angeborene Fehlbildungen, Frühgeburtlichkeit, Hypertrophie, Atemstörungen, Plexusparese und Asphyxie. Das Risiko für Totgeburt und Tod in den ersten 7 Lebenstagen ist bei prägravidem Diabetes erhöht. Die mit Abstand häufigste Komplikation bei Neugeborenen diabetischer Mütter ist die postnatale Hypoglykämie. Diabetesassoziierte Begleiterkrankungen und maternale Adipositas sind unabhängige Risikofaktoren für Schwangerschaftskomplikationen und ein ungünstiges fetales Outcome. Für die Blutglukoseeinstellung während der Schwangerschaft wurde ein klarer Zusammenhang höherer Werte mit ungünstigen fetalen und maternalen Ereignissen gezeigt. Analoginsuline sind mittlerweile die Insuline der Wahl. Darüber hinaus konnte eine Überlegenheit einer CGM-Versorgung während der Schwangerschaft gegenüber der konventionellen Blutglukosemessung gezeigt werden. Die Rate an Sektiones ist bei Frauen mit Diabetes nach wie vor gegenüber der Grundgesamtheit in der Perinatalstatistik deutlich erhöht. Evidenzbasierte Erkenntnisse zum intrapartalen Vorgehen liegen nicht vor. Die Einstellungsziele orientieren sich daher an den während der Schwangerschaft geltenden Zielen.



Publication History

Article published online:
09 December 2022

© 2022. Thieme. All rights reserved.

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