Gestasyonel ve Pregestasyonel Diyabetli Kadınlarda Peripartum Dönemde Kan Glukoz Seviyesinin Kontrolü

Yıl 2020, Cilt: 17 Sayı: 1, 296 - 300, 31.03.2020

Hüsniye Başer Salih Başer Bekir Çakır

Öz

Peripartum dönemdeki maternal hiperglisemi neonatal hipoglisemi riskini artırdığı için bu dönemde diyabet kontrolü oldukça önemlidir. Genel olarak doğumun latent fazı sırasında metabolik ihtiyaçlar çok azdır. Aktif fazda metabolik ihtiyaçlar artar ve insülin ihtiyacı azalır. Doğum sırasında glukoz kontrolü için farklı insülin protokolleri kullanılabilir. Gestasyonel diyabetli hastalarda intrapartum dönemde insülin infüzyon ihtiyacını azalttığı için dönüşümlü sıvı stratejisi tercih edilmektedir. Pregestasyonel diyabetli gebelerde peripartum dönemde intravenöz insülin infüzyonu veya subkutan insülin tedavisini içeren protokoller kullanılabilir. Postpartum dönemde plesentanın çıkmasıyla insülin direnci hızla ortadan kalkar ve pregestasyonel diyabetli gebelerde insülin ihtiyaçları azalır. Gestasyonel diyabetli gebeler ise gebelik öncesi glisemik durumuna hızla geri dönerler ve genellikle insülin tedavisine ihtiyaç duymazlar. Bazı gestasyonel diyabetli gebelerde ise postpartum dönemde hiperglisemi devam edebilir ve tedavi gerekebilir. Amerikan Diyabet Birliği ve Amerikan Jinekoloji ve Obstetrik Derneği diyabet, bozulmuş açlık glukozu ve bozulmuş glukoz intoleransını saptamak için tüm gestasyonel diyabetli hastaların postpartum 4-12. haftalarda 75 gr glukoz kullanılarak yapılan 2 saatlik oral glukoz tolerans testi ile taranmasını önerir.

Anahtar Kelimeler

Gestasyonel diyabet, pregestasyonel diyabet

Kaynakça

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