Τι είναι ο διαβήτης κύησης (ΣΔΚ)
Ο διαβήτης που αναπτύσσεται κατά τη διάρκεια της εγκυμοσύνης είναι γνωστός ως διαβήτης κύησης. Αυτό συμβαίνει επειδή το σώμα σας δεν μπορεί να παράγει αρκετή ινσουλίνη (μια ορμόνη σημαντική για τον έλεγχο της γλυκόζης στο αίμα) για την κάλυψη επιπλέον αναγκών στη διάρκεια της κύησης. Αυτό οδηγεί σε υψηλά επίπεδα γλυκόζης στο αίμα. Ο διαβήτης κύησης συνήθως ξεκινά στη μέση ή προς το τέλος της εγκυμοσύνης.
Πόσο συχνός είναι ο διαβήτης της κύησης
Ο διαβήτης κύησης είναι πολύ συχνός. Μπορεί να επηρεάσει έως 18 στις 100 γυναίκες κατά τη διάρκεια της εγκυμοσύνης. Έχετε περισσότερες πιθανότητες να αναπτύξετε διαβήτη κύησης, αν έχετε κάποιον από τους παρακάτω παράγοντες κινδύνου:
• ο δείκτης μάζας σώματος (ΔΜΣ) είναι 30 ή υψηλότερος
• έχετε ήδη γεννήσει ένα μεγάλο μωρό >4,5 κιλά
• είχατε διαβήτη κύησης σε προηγούμενη κύηση
• έχετε ένα γονέα, αδελφό ή αδελφή που πάσχουν από διαβήτη
Έλεγχος για διαβήτη κύησης
Σε όλες τις έγκυες γυναίκες συνιστάται ένας βασικός έλεγχος των επιπέδων της γλυκόζης στο αίμα στο πρώτο τρίμηνο και μια δοκιμασία ανοχής της γλυκόζης (GTT) κοντά στην 28η εβδομάδα κύησης.
Μια GTT περιλαμβάνει ολονύκτια νηστεία (δεν έχετε φάει ή πιει τίποτα εκτός από νερό):
• Το πρωί, πριν από το πρωινό, κάνετε μια εξέταση αίματος. Σας δίνεται ένα ποτό γλυκόζης.
• Η εξέταση αίματος επαναλαμβάνεται 1-2 ώρες αργότερα για να δείτε πώς το σώμα σας αντιδρά στο ποτό γλυκόζης.
Αν είχατε διαβήτη κύησης σε προηγούμενη εγκυμοσύνη, μπορεί να σας προσφερθεί μια δοκιμασία γλυκόζης, ή ένα κιτ για ελέγχετε τα επίπεδα γλυκόζης στο αίμα σας, στην αρχή της εγκυμοσύνης, καθώς και GTT στις 24-28 εβδομάδες.
ΜΗ ΕΓΚΥΟΣ | ΕΓΚΥΟΣ | ΕΓΚΥΟΣ | |||
ΩΡΑ | ΦΥΣΙΟΛΟΓΙΚΗ ΑΝΟΧΗ | ΕΛΑΤΤΩΜΕΝΗ ΑΝΟΧΗ | Σ.Δ. ΚΥΗΣΗΣ | ΛΕΠΤΑ | |
Νήστις | ≤ 110 | 140 | ≥ 105 | 0 | |
1 η | ≤ 200 | 200 | ≥ 190 | 60΄ | |
2 η | ≤ 140 | 140-199 | ≥ 165 | 120′ | |
3 η | ≥ 145 | 180′ | |||
Επίπτωση του διαβήτη της κύησης για εσάς και το μωρό σας
Οι περισσότερες γυναίκες που αναπτύσσουν διαβήτη κατά την εγκυμοσύνη, έχουν μια υγιή εγκυμοσύνη και υγιή μωρά, αλλά περιστασιακά ο διαβήτης κύησης μπορεί να προκαλέσει σοβαρά προβλήματα, ειδικά αν δεν αναγνωρίζεται.
Διάγνωση και αντιμετώπιση του διαβήτη κύησης μειώνει αυτούς τους κινδύνους.
Εάν η γλυκόζη του αίματός σας είναι πολύ υψηλή το μωρό σας θα παράγει περισσότερη ινσουλίνη, η οποία μπορεί να κάνει το έμβρυο να μεγαλώνει δυσανάλογα (εμβρυική μακροσωμία) αυξάνοντας την πιθανότητα πρόκλησης τοκετού, καισαρικής τομής, προβλήματα στη γέννηση και θνησιγένεια.
Έμβρυα εγκύων που αναπτύσσουν διαβήτη της κύησης, έχουν αυξημένη πιθανότητα να έχουν χαμηλά επίπεδα γλυκόζης στο αίμα μετά τη γέννηση (νεογνική υπογλυκαιμία) και είναι πιο πιθανό να χρειαστεί πρόσθετη φροντίδα σε μονάδα νεογνών.
Το μωρό σας δυνητικά διατρέχει μεγαλύτερο κίνδυνο να εμφανίσει παχυσαρκίας ή / και διαβήτη αργότερα στη ζωή.
Πιθανές υπερηχογραφικές ενδείξεις εμφάνισης διαβήτη κύησης
Είναι γνωστό ότι ο διαβήτης της κύησης δυνητικά συνδέεται με:
- Εμβρυική μακροσωμία (υπερηχογραφική εκτίμηση βάρους του εμβρύου >της αναμενόμενης για την ηλικία της κύησης)
- Υδράμνιο (αυξημένο αμνιακό υγρό)
Συμπερασματικά, σε κάθε περίπτωση όπου κυρίως μετά την 28η εβδομάδα κύησης παρατηρείται αυξημένο αμνιακό υγρό ή και εμβρυική μακροσωμία, θα πρέπει να γίνεται έλεγχος της εγκύου προς αποκλεισμό ανάπτυξης διαβήτη της κύησης.
Σε περίπτωση που η δοκιμασία γλυκόζης είναι φυσιολογική, τότε απομακρύνεται ο ΣΔΚ ως πιθανή αιτία και έχουμε να κάνουμε με ένα φυσιολογικά μεγάλο μωρό.
Πιθανά αίτια του αυξημένου αμνιακού υγρού πέραν του ΣΔΚ, μπορεί να είναι το ιδιοπαθές υδράμνιο, λοιμώξεις και ανωμαλίες του γαστρεντερικού συστήματος, τα οποία εξετάζονται από ειδικευμένους ιατρούς.
Υπερηχογραφική παρακολούθηση εγκύων με ΣΔΚ
Δεδομένου ότι στην συντριπτική πλειονότητα των περιπτώσεων ο ΣΔΚ εμφανίζεται στο τρίτο τρίμηνο, συνιστάται υπερηχογραφική παρακολούθηση του εμβρύου στην 32η και 36η εβδομάδα κύησης για να αξιολογείται ανάπτυξη και η ευημερία του εμβρύου.
Πότε και πώς πρέπει να γεννήσω
Έγκυες με εγκατεστημένο ΣΔΚ, συνιστάται τοκετός μετά την 38η εβδομάδα κύησης.
Ο ΣΔΚ δεν αποτελεί ένδειξη καισαρικής τομής.
Ο τρόπος του τοκετού πάντα αποφασίζεται επί κλινικών ενδείξεων από τον θεράποντα ιατρό.
Θεραπεία ΣΔΚ
Σε περίπτωση όπου μία έγκυος γυναίκα παρουσιάσει παθολογική καμπύλη σακχάρου, συνιστάται έλεγχος από ειδικό ενδοκρινολόγο, ο οποίος ανάλογα με την περίσταση προτείνει συγκεκριμένη διατροφή, μπορεί να προσθέσει αγωγή με ινσουλίνη, σε περίπτωση όπου το σάκχαρο δεν ελέγχεται με διατροφή μόνον.
Τι πρέπει να γνωρίζω μετά τον τοκετό
Η εμφάνιση του διαβήτη κύησης αυξάνει σε ένα ποσοστό 25% την πιθανότητα να εμφανίσετε διαβήτη τύπου ΙΙ στα επόμενα 15 με 20 χρόνια. Γι’ αυτό, θα πρέπει να ελέγχετε τακτικά το σάκχαρό σας και να κάνετε καμπύλη ανοχής στη γλυκόζη κάθε δύο χρόνια. Για να αποφύγετε αυτό το ενδεχόμενο, θα πρέπει να προσέχετε το βάρος σας, να τρώτε υγιεινά περιορίζοντας τη ζάχαρη, τα λιπαρά και τις μεγάλες ποσότητες τροφής και να γυμνάζεστε τακτικά. Η πιθανότητα επανεμφάνισης ΣΔΚ σε μελλοντική κύηση είναι δύο στις τρεις, γι’ αυτό συνιστάται έλεγχος από την αρχή της κύησης.
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