妊娠和糖尿病.pptVIP

* * * NST 胎儿无负荷试验 CST宫缩应激试验 * * * * GDM A1无并发症，39周左右，避免巨大儿生产 孕前DM和GDM A2，孕38~39周终止 病情控制不满意或有并发症，视病情促胎儿肺成熟后及时终止 糖尿病不是剖宫产的指征 胎儿偏大者(＞4500g)尤其胎儿腹围偏大，应放宽剖宫产指征 糖尿病伴微血管病变、合并重度子痫前期或胎儿生长受限(FGR)、胎儿窘迫等，行剖宫产 分娩时机和方式 产后6周重新评估GDM 产后大多数患者血糖恢复正常，但有10%仍为T2DM 产后检查FPG正常者行75g OGTT GDM患者产后应制定合理的饮食和运动计划，防止体重增加，进行一级和二级预防 产后随诊 哺乳可以降低GDM孕妇T2DM的发病率，降低婴儿、儿童期肥胖和糖耐量异常；钙摄入至少1500mg/d 哺乳可以减少DM胰岛素用量，有利于超重患者减重 一代磺脲类药物乳汁浓度高，缺乏安全资料；格列本脲、格列吡嗪和二甲双胍几乎不进入乳汁，如果使用应哺乳后服用避免峰值作用 有效避孕降低GDM再次妊娠增加的T2DM发病风险和妊娠对母体的危害 宫内避孕器不增加血糖控制较好DM的盆腔感染疾病 哺乳和避孕 谢 谢 * hyperinsulinemic-euglycemic clamp technique Glucose transport to the fetus occurs in direct proportion to maternal glucose levels, and is augmented by a five-fold increase in a placental glucose transporter, (GLUT-1) which increases transplacental glucose flux even in the absence of maternal hyperglycemia. At the same time it has been demonstrated that in the third trimester of normal pregnancy there is decreased expression of the GLUT-4 glucose transporter protein in maternal adipose tissue and decreased translocation of GLUT-4 to the plasma membrane in skeletal muscle, both of which contribute to the insulin resistance of pregnancy. * Human placental lactogen (HPL)；Human placental growth hormone (hPGH) ； pituitary growth hormone (pit GH) It almost completely replaces pit GH in the maternal circulation by 20 weeks, and it is unregulated by growth hormone releasing hormone. The placenta is responsible for the production of hormones which reprogram maternal physiology to become insulin resistant in the 2nd and 3rd trimester of pregnancy to ensure an adequate supply of nutrients to the growing fetus. * RDS 呼吸窘迫综合征 FGR 胎儿生长受限 * 低危者是具备所有特征，高危者是具备任一高危因素 * 高危者：初诊时进行；高危者初诊筛查正常，24－28周复查；低危者：妊娠24－28周首次，以后在产科检查中发现胎儿大，羊水多或出现症状随时复查；中危者：妊娠24－28周首次筛查。 * 2个以上时间点高于标准可确诊GDM，WHO标准二项中任何一项异常即诊断GDM。 NDDG 美国国家糖尿病资料组；美国应用100g OGTT * HAPO Hyperglycemia and Pregnancy Outcome 为此，美国国立卫生研究院（National Institutes ofHealth，NIH）组织进行了全球多中心、前瞻性关于高血糖与妊娠不良结局关系的研究（the hyperglycemiaand adverse preg