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Geburtshilfe Frauenheilkd 2003; 63(3): 223-229
DOI: 10.1055/s-2003-38424
Übersicht

Georg Thieme Verlag Stuttgart · New York

Diabetes-Screening in der Schwangerschaft

Screening for Diabetes Mellitus in PregnancyD. Bancher-Todesca 1 , H. Leipold 1 , P. Husslein 1 , A. Kautzky-Willer 2
  • 1Abteilung für Geburtshilfe, Universitäts-Frauenklinik Wien
  • 2Abteilung für Endokrinologie, Innere Medizin III, Universitätsklinik Wien
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Publication History

Eingang Manuskript: 19. August 2002 Eingang revidiertes Manuskript: 11. November 2002

Akzeptiert: 16. Dezember 2002

Publication Date:
02 April 2003 (online)

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Zusammenfassung

Der Gestationsdiabetes (GDM) wird auch die verborgene Epidemie genannt, da er ohne generelles Screening zumeist nicht erkannt wird. Von vielen Fachgesellschaften wird daher ein generelles Screening gefordert. Die Deutsche Gesellschaft für Geburtshilfe und Gynäkologie hat Anfang 2001 in Gemeinschaft mit der Deutschen Diabetesgesellschaft und der Deutschen Gesellschaft für perinatale Medizin eine Empfehlung zu einem generellen Screening mittels eines 75 g oGTT zwischen der 24. - 28. SSW herausgegeben. Mutmaßlich werden in Europa ohne Screening weniger als 10 % der Fälle aufgedeckt. Ein unerkannter GDM ist jedoch eine Bedrohung der Schwangerschaft, sein Anteil an der generellen perinatalen Mortalität beträgt zumindest 1/1000. Bei unerkanntem und unbehandeltem GDM entwickeln die Kinder bereits im Mutterleib eine Störung ihrer Insulinhomöostase, die ihrerseits eine erhöhte Diabetesneigung dieser Kinder im späteren Leben verursacht. Darüber hinaus ist die Schwangerschaft eine besondere physiologische Situation, die es ermöglicht, eine spätere Diabetesneigung der Frauen frühzeitig zu erkennen. Dies ist von großer volksgesundheitlicher Bedeutung, da Präventiv- und Früherkennungsmaßnahmen ergriffen werden können. Es muss daher ein generelles Screening nach Glukosetoleranzstörungen in der Schwangerschaft gefordert werden.

Abstract

Gestational diabetes has been referred to as a hidden epidemic. It is estimated that less than 10 % of cases are detected in Europe without generalized screening. But untreated gestational diabetes and disturbed insulin homeostasis in utero is a risk factor for perinatal morbidity and accounts for at least 1/1000 of overall perinatal mortality. Furthermore, offspring of pregnancies complicated by diabetes have a predisposition to diabetes in adolescence and adulthood. Pregnancy is also a unique physiologic opportunity to identify increased maternal risk for diabetes later in life. This is significant from a public health perspective, because preventive measures can be taken. Accordingly, in 2001 the German Society of Obstetrics and Gynecology recommended screening all pregnant women with a 75-g oral glucose tolerance test between the 24th and the 28th weeks of gestation.

Schlüsselwörter

Gestationsdiabetes - Diabetes - Schwangerschaft - Screening - oGTT

Key words

Gestational diabetes - pregnancy - Diabetes mellitus - screening - oGTT

Literatur

  • 1 Kjos S, Buchanan T. Gestational diabetes mellitus.  N Engl J Med. 1999;  341 1749-1756
    CrossrefPubMedGoogle Scholar
  • 2 Stratton I M, Adler A I, Neil H, Matthews D R. et al . Association of glycemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35).  Br Med J. 2000;  321 405-412
    CrossrefPubMedGoogle Scholar
  • 3 Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients.  Diabetes Care. 2000;  23 (Suppl 2) B21-B29
    PubMedGoogle Scholar
  • 4 Harris M. Impaired glucose tolerance in the U. S. population.  Diabetes Care. 1989;  12 464-474
    CrossrefPubMedGoogle Scholar
  • 5 v. Kries R, Kimmerle R, Schmidt J, Hachmeister A, Böhm O, Wolf H. Pregnancy outcomes in mothers with pregestational diabetes: a population-based study in North Rhine (Germany) from 1988 to 1993.  Eur J Pediatr. 1997;  156 963-967
    CrossrefPubMedGoogle Scholar
  • 6 Weiss P, Walcher W, Scholz H. Der vernachlässigte Gestationsdiabetes: Risiken und Folgen.  Geburtsh Frauenheilk. 1999;  59 535-544
    PubMedGoogle Scholar
  • 7 Wen S W, Liu S, Kramer M. et al . Impact of prenatal glucose screening on the diagnosis of gestational diabetes and on pregnancy outcomes.  Am J Epidemiol. 2000;  152 1009-1014
    CrossrefPubMedGoogle Scholar
  • 8 Persson B, Hanson U. Neonatal morbidities in gestational diabetes.  Diabetes Care. 1998;  21 (Suppl 2) B79-84
    PubMedGoogle Scholar
  • 9 Langer O, Brustman L, Anyaegbuman A. The significance of one abnormal glucose test value on adverse outcome in pregnancy.  Am J Obstet Gynecol. 1995;  175 758-763
    PubMedGoogle Scholar
  • 10 Sermer M, Naylor D, Investigators T THGD. Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without diabetes.  Am J Obstet Gynecol. 1995;  175 146-156
    PubMedGoogle Scholar
  • 11 Weiss P. Diabetes in Pregnancy: Lessons from the fetus. Dornhorst A, Hadden D. Diabetes and Pregnancy An International Approach to Diagnosis and Management. Chichester; Wiley 1996: 221-240
    Google Scholar
  • 12 Parkks D G, Ziel H K. Makrosomia. A proposed indication for primary cesarian section.  Obstet Gynaecol. 1978;  52 407
    PubMedGoogle Scholar
  • 13 Major C, De Veciana M, Weeks J, Morgan H. Recurrence of gestational diabetes: Who is at risk?.  Am J Obstet Gynecol. 1998;  179 1038-1042
    CrossrefPubMedGoogle Scholar
  • 14 Philipson E, Super D. Gestational Diabetes mellitus: does it recur in subsequent pregnancy?.  Am J Obstet Gynecol. 1989;  160 1324-1331
    CrossrefPubMedGoogle Scholar
  • 15 Kjos Sl, Peters R K, Xiang A, Henry O A, Montoro M, Buchanan T A. Predicting future diabetes in Latino women with gestational diabetes. Utility of the early postpartum glucose tolerance testing.  Diabetes. 1995;  44 586-591
    CrossrefPubMedGoogle Scholar
  • 16 Coustan D R, Carpenter M W, O'Sullivan P S, Carr S R. Gestational diabetes: Predictors of subsequent disordered glucose metabolism.  Am J Obstet Gynecol. 1993;  168 1139-1145
    CrossrefPubMedGoogle Scholar
  • 17 Oats J N, Beischer N A, Grant P T. The emergence of diabetes and impaired glucose tolerance in women who had gestational diabetes. Weiss PA, Coustan DR Gestational Diabetes. New York; Springer Verlag 1988: 199-206
    Google Scholar
  • 18 O'Sullivan. Diabetes mellitus after GDM.  Diabetes. 1991;  40 (Suppl 2) 131-135
    PubMedGoogle Scholar
  • 19 Henry O A, Bleischer N A. Long-term implications of gestational diabetes for the mother.  Baillieres Clin Obstet Gynaecol. 1991;  5 461-483
    PubMedGoogle Scholar
  • 20 Dornhorst A, Bailey P C, Anyaoku V, Elkeles R S, Johston D G, Beard R W. Abnormalities of glucose tolerance following gestational diabetes.  Q J Med. 1990;  284 1219-1228
    PubMedGoogle Scholar
  • 21 Ali Z, Alexis S D. Occurrence of diabetes mellitus after gestational diabetes mellitus in Trinidad.  Diabetes Care. 1990;  13 527-529
    PubMedGoogle Scholar
  • 22 Damm P, Kuhl C, Bertelsen A, Molsted-Pedersen L. Predictive factors for the development of diabetes in women with previous gestational diabetes mellitus.  Am J Obstet Gynecol. 1992;  167 607-616
    PubMedGoogle Scholar
  • 23 Stowers J M, Sutherland H W, Kerridge D F. Long-run implications for the mother. The Aberdeen experience.  Diabetes. 1985;  34 (Suppl 2) 106-110
    PubMedGoogle Scholar
  • 24 Bowes S B, Hennessy T R, Umpleby A M, Benn J J, Jackson N C, Boroujerdi M A, Sönksen P H, Lowy C. Measurement of glucose metabolism and insulin secretion during normal pregnancy and pregnancy complicated by gestational diabetes.  Diabetologia. 1996;  39 976-983
    CrossrefPubMedGoogle Scholar
  • 25 Kautzky-Willer A, Prager R, Thomaseth K, Pacini G, Streli C, Waldhäusl W, Wagner O, Ludvik B. Pronounced insulin resistance and inadequate B-cell insulin secretion characterize lean gestational diabetes mellitus.  Diabetes Care. 1997;  20 1717-1723
    CrossrefPubMedGoogle Scholar
  • 26 Buchanon T A, Metzger B E, Freinkel N, Bergman R N. Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetes.  Am J Obstet Gynecol. 1990;  162 1008-1014
    Google Scholar
  • 27 Byrne M M, Sturis J, O'Meara N M, Polonsky K S. Insulin secretion in insulin-resistant women with a history of gestational diabetes.  Metabolism. 1995;  44 1067-1073
    CrossrefPubMedGoogle Scholar
  • 28 Ward W K, Johnston C LW, Beard J C, Benedetti T J, Halter J B, Porte D. Insulin resistance and impaired insulin secretion in subjects with histories of gestational diabetes mellitus.  Diabetes. 1985;  34 861-869
    PubMedGoogle Scholar
  • 29 Pan X R, Li G W, Hu Y H, Wang J X, Yang Wy, An Z X. et al . Effects of diet and exercise in preventing type II diabetes in people with impaired glucose tolerance. The Da Quing IGT and Diabetes Study.  Diabetes Care. 1997;  20 537-544
    CrossrefPubMedGoogle Scholar
  • 30 Hu F B, Manson J E, Stampfer M J, Colditz G, Liu S, Solomon C G, Willett W C. Diet, lifestyle and the risk of type 2 diabetes mellitus in women.  N Engl J Med. 2001;  345 790-797
    CrossrefPubMedGoogle Scholar
  • 31 Tuomilehto J, Lindstrim J, Eriksson J, Valle T, Hamalainen H, Parikka I. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
    CrossrefPubMedGoogle Scholar
  • 32 Buchanon T A. Pancreatic B-cell defects in gestational diabetes: Implications for the pathogenesis and prevention of type 2 diabetes.  J Clin Endocrinol Metab. 2001;  86 989-993
    CrossrefPubMedGoogle Scholar
  • 33 Berkowitz K, Peters R, Goico J, Marroquin A, Dunn M E, Xiang A, Azen S, Buchanan T A. Effect of troglitazone on insulin sensitivity and pancreatic beta cell function in women at high risk for NIDDM.  Diabetes. 1996;  45 1572-1579
    PubMedGoogle Scholar
  • 34 Hu F B, Manson J E, Stampfer M J, Colditz G, Liu S, Solomon C G, Willett W C. Diet, lifestyle and the risk of type 2 diabetes mellitus in women.  N Engl J Med. 2001;  345 790-797
    CrossrefPubMedGoogle Scholar
  • 35 Tuomilehto J, Lindstrim J, Eriksson J, Valle T, Hamalainen H, Parikka I. et al . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.  N Engl J Med. 2001;  344 1343-1350
    CrossrefPubMedGoogle Scholar
  • 36 Moses R G, Shand J L, Tapsell L C. The recurrence of gestational diabetes. Could dietary differences in fat intake be an explanation?.  Diabetes Care. 1997;  20 1547-1650
    PubMedGoogle Scholar
  • 37 Haffner S M, Mittinen H, Stern M P. Relatively more atherogenic coronary heart disease risk factors in prediabetic women than in prediabetic men.  Diabetologia. 1997;  40 711-717
    CrossrefPubMedGoogle Scholar
  • 38 Ogata E S. Perinatal morbidity in offspring of diabetic mothers.  Diabetes Rev. 1995;  3 652-657
    PubMedGoogle Scholar
  • 39 Sacks D, Greenspoon J, Fotheringsham N. Gestational diabetes mellitus: Is it a clinical entity.  Diab Rev. 1995;  3 603-613
    PubMedGoogle Scholar
  • 40 Weiss P. Klinische Bedeutung des Geburtsgewichts bei Diabetes mellitus.  Gynäkologe. 1998;  31 58-67
    CrossrefPubMedGoogle Scholar
  • 41 Salzberger M, Liban E. Diabetes and antenatal fetal death.  Isr J Med Sci. 1975;  11 623-628
    PubMedGoogle Scholar
  • 42 Jovanovic P. Optimal insulin delivery for the pregnant diabetic patient.  Diabetes Care. 1982;  5 (Suppl 1) 24
    PubMedGoogle Scholar
  • 43 Karlsson K. The outcome of diabetic pregnancies in relation to the mothers blood sugar level.  Am J Obstet Gynecol. 1972;  112 213-220
    PubMedGoogle Scholar
  • 44 Ratzon N, Greenbaum C, Dulitzky M, Ornoy A. Comparison of the motor development of school-age children born to mothers with and without diabetes mellitus.  Phys Occup Ther Pediatr. 2000;  20 43-57
    PubMedGoogle Scholar
  • 45 Ornoy A, Ratzon N, Greenbaum C, Wolf A, Dulitzky M. School age children born to diabetic mothers and to mothers with gestational diabetes exhibit a high rate of inattention and fine and gross motor impairment.  J Pediatr Endocrinol Metab. 2001;  14 (Suppl 1) 681-689
    PubMedGoogle Scholar
  • 46 Freinkel N. Banting Lecture 1980: Of pregnancy and progeny.  Diabetes. 1980;  29 1023-1035
    CrossrefPubMedGoogle Scholar
  • 47 Silverman B, Metzger B, Cho N. et al . Impaired glucose tolerance in adolescent offspring of diabetic mothers: relationship to fetal hyperinsulinism.  Diabetes Care. 1995;  18 611-617
    CrossrefPubMedGoogle Scholar
  • 48 Silverman B L, Purdy L P, Metzger B E. The intrauterine environment: implications for the offspring of diabetic mothers.  Diabetes Reviews. 1996;  4 21-33
    PubMedGoogle Scholar
  • 49 Silverman B, Landsberg L, Metzger B. Fetal hyperinsulinism in offspring of diabetic mothers: association with the subsequent development of childhood obesity.  Ann N Y Acad Sci. 1993;  699 36-45
    CrossrefPubMedGoogle Scholar
  • 50 Plagemann A, Harder T, Kohlhoff R. et al . Glucose tolerance and insulin secretion in children of mothers with pregestational IDDM or gestational diabetes.  Diabetologia. 1997;  40 1094-1100
    CrossrefPubMedGoogle Scholar
  • 51 Vohr B R, Mc Garvey S T, Tucker R. Effects of maternal gestational diabetes on offspring adiposity at 4 - 7 years of age.  Diabetes Care. 1999;  22 1284-1291
    CrossrefPubMedGoogle Scholar
  • 52 Simmons D, Robertson S. Influence of maternal insulin treatment on the infants of women with gestational diabetes.  Diabetes Medicine. 1997;  14 762-765
    PubMedGoogle Scholar
  • 53 O'Sullivan J B, Mahan C M. Criteria for the orale glucose tolerance test.  Diabetes. 1964;  13 278-285
    PubMedGoogle Scholar
  • 54 National diabetes data group . Classification and diagnosis of the diabetes mellitus and other categories of glucose intolerance.  Diabetes. 1979;  28 1039-1057
    PubMedGoogle Scholar
  • 55 Langer O, Brustman L. The significance of one abnormal glucose tolerance test value on adverse outcome in pregnancy.  Am J Obstet Gynecol. 1987;  157 758-763
    PubMedGoogle Scholar
  • 56 World Health Organization . Diabetes mellitus: Report of a WHO study group.  World Health Organ Tech Rep Ser. 1985;  727 1-113
    PubMedGoogle Scholar
  • 57 Carpenter M W, Coustan D R. Criteria for screening tests for gestational diabetes.  Am J Obstet Gynecol. 1982;  144 768-773
    CrossrefPubMedGoogle Scholar
  • 58 Weiss P. Der orale Glukosetoleranztest (oGTT) in der Schwangerschaft.  Gynäkologe. 1998;  31 12-24
    CrossrefPubMedGoogle Scholar
  • 59 Empfehlungen zu Diagnostik und Therapie des Gestationsdiabetes . DDG, AGMFM der DGGG und Deutsche Gesellschaft für Perinatale Medizin.  Frauenarzt. 2001;  42 891-899
    PubMedGoogle Scholar
  • 60 Study cooperative Research group H APO. The hyperglycemia and adverse pregnancy outcome (HAPO) Study.  Int J Gyn Obstet. 2002;  87 69-77
    PubMedGoogle Scholar
  • 61 Hadden D. Evidence-based screening for gestational diabetes?.  Diabetic Med. 2000;  17 402-404
    CrossrefPubMedGoogle Scholar
  • 62 Pettie D J, Benett P H. Comparsion of WHO and NDDG procedures to detect abnormalities of glucose tolerance during pregnancy.  Diabetes Care. 1994;  17 1264-1268
    PubMedGoogle Scholar
  • 63 Schwarz J G, Phillips W T. Reversion of the oral glucose tolerance test: a pilot study.  Clin Chem. 1990;  36 125-128
    PubMedGoogle Scholar
  • 64 Fachnie J D, Whitehouse F W. Vometing during oGTT in the third trimester of pregnancy.  Diabetes Care. 1988;  11 818-819
    PubMedGoogle Scholar
  • 65 Magee M S, Walden C E. Influence of diagnostic criteria on the incidence of gestational diabetes and perinatal morbidity.  JAMA. 1993;  269 609-615
    CrossrefPubMedGoogle Scholar
  • 66 Deerochanawong C, Putiyanum C. Comparison of National Diabetes Data Group and World Health Organization criteria for detecting gestational diabetes.  Diabetologia. 1996;  39 1070-1073
    PubMedGoogle Scholar
  • 67 American Diabetes Association . Report of the expert Committee on the Diagnosis and Classification of Diabetes Mellitus.  Diabetes Care. 1998;  21 (Suppl 1) 5-19
    PubMedGoogle Scholar
  • 68 Williams C, Iqbal S. Effect of selective screening for gestational diabetes.  Diabetes Care. 1999;  22 418-422
    PubMedGoogle Scholar
  • 69 Griffin M E, Coffey M. Universal vs. risk-factor-based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome.  Diabet Med. 2000;  17 26-32
    CrossrefPubMedGoogle Scholar
  • 70 Mazze R S, Krogh C L. Gestational diabetes mellitus: now is time for detection treatment.  Mayo Clin Proc. 1993;  68 408-409
    PubMedGoogle Scholar
  • 71 Soares A C, Dornhorst A, Beard R W. Should we screen for gestational diabetes? The case for screening for gestational diabetes.  BMJ. 1997;  315 737-739
    PubMedGoogle Scholar
  • 72 Perucchini D, Fischer U. Using fasting plasma glucose concentration to screen for gestational diabetes mellitus: prospective population based study.  BMJ. 1999;  319 812-815
    CrossrefPubMedGoogle Scholar
  • 73 Reichelt A J, Spichler E, Branchtein L, Nucci L, Franco L, Schmidt M. Fasting plasma glucose is a useful test for the detection of gestation diabetes mellitus: Brazilian Study of Gestational Diabetes (EBDG) Working Group.  Diabetes Care. 1998;  21 1246-1249
    PubMedGoogle Scholar
  • 74 Sacks D, Greenspoon J, Fotheringham N. Could the fasting plasma glucose assay be used to screen for gestation diabetes?.  J Reprod Med. 1992;  37 907-909
    PubMedGoogle Scholar
  • 75 Juutinen J, Hartikainen A. A Retrospective study on 435 women with gestational diabetes.  Diabetes Care. 2000;  23 1858-1859
    PubMedGoogle Scholar

Univ-Prof. Dr. Dagmar Bancher-Todesca

Abteilung für Geburtshilfe · Universitäts-Frauenklinik Wien

Währingergürtel 18 - 20

1090 Wien

Österreich

Email: dagmar.bancher-todesca@akh-wien.ac.at

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