Gestationalabetes mellitus (GDM): kuopsa kwa kutenga pakati "kokoma"

Nthawi zina, amayi apakati amakhala ndi gestationalabetes mellitus (GDM). Matendawa amatenga matendawa pokhapokha ngati ali ndi pakati, kenako ndikusowa pambuyo pobeleka mwana. Koma ngati simupereka chithandizo munthawi yake, ndiye kuti matendawa atha kukhala mtundu 2 wa shuga, womwe umakhala ndi zovuta zake.

Kumayambiriro kwa pakati, mayi aliyense ayenera kulembetsa, pomwe, moyang'aniridwa ndi akatswiri, padzakhala kulamuliridwa pa tsogolo la mayi wamtsogolo komanso kukula kwa mwana wosabadwayo.

Amayi onse oyembekezera amayenera kuwunika shuga nthawi zonse podutsa mkodzo ndi kuyesedwa kwa magazi. Zovuta zokhazokha zama glucose ochulukirapo pakuwunika siziyenera kuchita mantha, popeza kudumphira kotereku kumachitika ngati njira yachilengedwe. Koma, ngati mukudutsa mayeso, shuga wokwera amamuwona kawiri kapena kupitilira apo, ndiye kuti izi zikusonyeza kale kupezeka kwa matenda ashuga panthawi ya pakati. Ndizofunikira kudziwa kuti gawo lokwera limapezedwa pomwe zinthuzo zimaperekedwa m'mimba yopanda kanthu (kuwonjezeka kwa shuga wamagazi mukatha kudya ndizabwinobwino).

Kuopsa kwa GDM kwa mwana wosabadwayo

Kodi ndi chiyani chomwe chimawopseza matenda abwinobwino kwa mwana wosabadwayo? Popeza matendawa sakhala pachiwopsezo cha mayi woyembekezera, koma amakhala oopsa kwa mwana yekhayo, chithandizo chake ndikucholinga chopewa zovuta za m'mimba, komanso zovuta pakubala.

Zotsatira zake kwa mwana yemwe ali ndi matenda ashuga mwa amayi apakati zimawonetsedwa molakwika pakukhamukira kwa magazi m'misempha ya amayi apakati. Njira zonse zovuta zomwe zimayambika chifukwa cha kukoka kwa ma cellcirculation, pamapeto pake, zimabweretsa zotsatira za hypoxic pa mwana wosabadwayo.

Komanso, palibe vuto kulandira shuga wambiri kwa mwana. Zowonadi zake, ma insulin omwe amapangidwa ndi amayi sangathe kulowa mu chotchinga, ndipo mapamba amwanayo sangatulutse kuchuluka kwa timadzi tambiri timene timapanga.

Chifukwa cha mphamvu ya matenda ashuga, njira za metabolic mu fetus zimasokonekera, ndipo zimayamba kuchuluka chifukwa cha kukula kwa minofu ya adipose. Kupitirira apo, mwana amasintha izi:

• lamba lachifwamba likuwonjezereka,
• kuchuluka kwambiri pamimba,
• amakula kukula kwa chiwindi ndi mtima,

Kusintha konseku kumachitika motsutsana ndi maziko oti mutu ndi miyendo zimakhalabe zazofanana (zabwinobwino). Zonsezi zimatha kukhudza chitukuko chamtsogolo, ndikupangitsa zotsatirazi:

• Chifukwa cha kuchuluka kwa lamba la mwana wosabadwayo, ndikovuta kudutsa nthawi yobereka kudzera mu ngalande yobadwa,
• kuvulala kwa ziwalo za mwana ndi mayi ndikotheka pakubala,
• kubadwa msanga kumatha kuyamba, chifukwa cha unyinji waukulu wa mwana wosabadwayo, yemwe sanakhazikikebe bwino,
• m'mapapu a mwana wakhanda, kupangika kwa zinthu zochuluka kumatsitsidwa, komwe kumapangitsa kuti asamatikane. Zotsatira zake, atabereka, mwana amatha kukhala ndi mavuto opuma. Pankhaniyi, mwana amapulumutsidwa mothandizidwa ndi chida chopumira, kenako ndikuyika mu chofungatira chapadera (couvez), pomwe azikhala moyang'aniridwa ndi madokotala kwakanthawi.

Komanso, munthu sangalephere kunena zomwe zimachitika chifukwa cha matenda ashuga ochitika: ana obadwa kwa amayi omwe ali ndi GDM atha kukhala ndi vuto lachiberekero, ndipo ena atha kukhala ndi matenda a shuga a akuluakulu.

Placenta, yemwenso ili ndi katundu wowonjezereka ndi GDM, imayamba kugwira ntchito zake mosakwanira, ndipo imatha kudyeka. Zotsatira zake, mwana wosabadwayo samalandira oxygen yoyenera, hypoxia imalowa. Mwachidziwikire, pamapeto a pakati (wachitatu trimester) pamakhala ngozi yakufa kwa mwana wosabadwa.

Popeza matendawa amayambitsidwa ndi shuga wambiri, ndizomveka kuganiza kuti pochizira komanso kupewa matenda amafunika kuwongolera kuti chizindikirochi chili munthawi yoyenera.

Chopangitsa chachikulu cha chithandizo cha matenda ashuga pakatha nthawi yayitali ndikutsatira malamulo a zakudya:

• kuphika ndi confectionery, zomwe zingakhudze kuchuluka kwa shuga, sizimachotsedwa muzakudya. Koma simuyenera kusiyiratu chakudya, chifukwa amakhala ngati opatsa mphamvu. Ndikofunikira kuchepetsa kuchuluka kwawo tsiku lonse,
• chepetsa zakudya zomwe zimakhala ndi shuga wambiri
• osapatula Zakudyazi, mbatata zosenda ndi mbewu zapoizoni, komanso zinthu zina zomaliza.
• Chotsani nyama ndi mafuta mu zakudya (batala, margarine, mayonesi, mafuta anyama),
• Zakudya zomanga thupi ndizofunikira kudya, ndikofunikira pa thupi la amayi ndi mwana,
• kuphika, tikulimbikitsidwa kugwiritsa ntchito: kutumiza, kuphika, kuwotcha, kuphika mu uvuni,
• idyani chakudya maola atatu aliwonse, koma pang'ono.

Kuphatikiza apo, zotsatira zabwino pa thanzi la mayi woyembekezera zatsimikiziridwa:

• zovuta zolimbitsa thupi zopangidwira amayi apakati. Nthawi yochita masewera olimbitsa thupi imachepa ndimagazi a shuga, kusintha kwa kagayidwe kachakudya ka thupi ndi thanzi la mayi wapakati.
• kuyenda pafupipafupi kuchoka pamisewu yayikulu.

Woopsa matendawa, dokotala atha kukulembera kukonzekera kwa insulin. Mankhwala ena omwe amachepetsa shuga ndi oletsedwa.

Mankhwala okhala ndi insulin amagawidwa m'magulu awiri, malinga ndi malingaliro a FDA:

1. Mu - gulu. Zimaphatikizanso ndalama pofotokozera zomwe zalembedwa kuti poyesedwa mu nyama, palibe zoyipa zilizonse pa mwana wakhanda zomwe zimadziwika. Zotsatira za mankhwalawa pa mimba sizinayesedwe.
2. C ndi gulu. Mankhwala ophatikizidwa amaphatikizidwa omwe, akamayesedwa, amathandizira kukulira kwa fetus mu nyama. Mwa amayi apakati, kuyesanso sikunachitike.

Chifukwa chake, mankhwala onse ayenera kuyikidwa kokha ndi dokotala woyenera, ndi chisonyezo chovomerezeka cha dzina la malonda.

Kugonekedwa pachipatala ndi GDM ndikofunikira pokhapokha ngati akukayikira kuti pakubwera zovuta zovuta zoletsa.

GDM sichiri chifukwa cholimbikitsira kutulutsa kapena gawo la caesarean.

Postpartum

Pambuyo pobala, mkazi amayenera kuwonetsetsa kuchuluka kwa shuga, kuwunika kukhalapo kwa zizindikiro ndi pafupipafupi (ludzu, kukodza, ndi zina zambiri) mpaka athera kwathunthu. Macheke nthawi zambiri amawerengedwa ndi madokotala pambuyo pa milungu 6 ndi 12 atabadwa. Pofika nthawi ino, shuga wa mkazi ayenera kubwerera mwakale.

Koma, malinga ndi ziwerengero, mwa akazi 5-10% omwe adabereka, shuga sangakhale abwinobwino. Pankhaniyi, thandizo lachipatala limafunikira, lomwe siliyenera kunyalanyazidwa, apo ayi vuto losavuta la mahomoni limatha kukhala matenda osachiritsika.

Mimba ndimayambitsa chibwenzi?

American Diabetes Association imapereka umboni kuti 7% ya amayi apakati amakhala ndi matenda ashuga. Ena mwa iwo, atabereka, glucoseemia amabwerera mwakale. Koma mu 60% patatha zaka 10-15, mtundu wa 2 shuga (T2DM) ukuwonekera.

Mimbayo imakhala ngati yoyambitsa matenda osokoneza bongo. Makina a chitukuko cha matenda a shuga akakhala pafupi ndi T2DM. Mayi woyembekezera amakhala ndi insulin chifukwa cha zinthu zotsatirazi:

• kaphatikizidwe ka mahomoni a steroid mu placenta: estrogen, progesterone, lactogen yachilengedwe,
• kuchuluka kwa mapangidwe a cortisol mu adrenal cortex,
• kuphwanya insulin kagayidwe ndi kuchepa kwake zotsatira zake zimakhala.
• chimbudzi cha insulin kudzera mu impso,
• kutsegula kwa insulinase mu placenta (ma enzyme omwe amaphwanya mahomoni).

Vutoli likuipiraipira mwa azimayi omwe amakhala ndi insulin yolimbana ndi chitetezo cha m'thupi (insulin), omwe sanawonekere kuchipatala. Zinthu izi zimakulitsa kufunikira kwa mahomoni, ma cell a beta a kapamba amaphatikizira kuchuluka. Pang'onopang'ono, izi zimabweretsa kutsika kwawo ndikukhalitsa kwa hyperglycemia - kuwonjezeka kwamagazi a shuga.

Mitundu ya matenda ashuga nthawi yapakati ndi iti

Mitundu yosiyanasiyana ya shuga imatha kutsagana ndi kutenga pakati. Kugawika kwa matenda ndi nthawi yanthawi yomwe mwadzidzidzi akutanthauza mitundu iwiri:

1. matenda ashuga omwe analipo asanakhale ndi pakati (matenda 1 a shuga ndi matenda ashuga a 2) ndi asanafike pakubala,
2. matenda a shuga (GDM) mwa amayi apakati.

Kutengera chithandizo chofunikira cha GDM, pali:

• kuchepetsa zakudya
• kulipidwa ndi zakudya mankhwala ndi insulin.

Matenda a shuga amatha kukhala pa gawo la kulipidwa ndi kubwezeretseka. Kukula kwa matenda asanafike gestational matenda a shuga kumadalira kufunika kothandizila njira zosiyanasiyana zochizira komanso kuuma kwa zovuta.

Hyperglycemia, yomwe imakhalapo pa nthawi yobereka, siikhala nthawi zonse matenda ashuga. Nthawi zina, izi zitha kukhala mtundu wa matenda ashuga 2.

Ndani ali pachiwopsezo chotenga matenda ashuga panthawi yapakati?

Kusintha kwa ma Hormonal komwe kumatha kusokoneza kagayidwe ka insulin ndi glucose kumachitika mwa amayi onse oyembekezera. Koma si aliyense amene akusintha kukhala ndi matenda ashuga. Izi zimafunikira kudziwiratu zinthu:

• kunenepa kwambiri kapena kunenepa kwambiri,
• kulolerana kwa shuga
• magawo a shuga amadzuka asanabadwe,
• Mtundu wa shuga wachiwiri mwa makolo oyembekezera
• zaka zopitilira 35
• polycystic ovary syndrome,
• mbiri yakusakwila, kubereka,
• Kubadwa m'mbuyomu ana omwe anali ndi makilogalamu opitilira 4, komanso kuwonongeka.

Koma ndi ziti mwa zifukwa izi zomwe zimakhudzira kukula kwa matenda a zamatenda kwakukulu sikudziwika mokwanira.

Kodi matenda amishuga ndi chiyani

GDM imatengedwa ngati matenda omwe adakhalapo pambuyo pa masabata 15-16 atabereka mwana. Ngati matenda a hyperglycemia adapezeka kale, ndiye kuti pali matenda osokoneza bongo a latent, omwe adakhalapo asanakhale ndi pakati. Koma kuchuluka kwakukulu kumawonedwa mu 3 trimester. Chofanana pa nkhaniyi ndi matenda ashuga.

Matenda a shuga a pakati pa pakati amakhala osiyana ndi matenda osokoneza bongo chifukwa pakatha gawo limodzi la hyperglycemia, shuga amapezeka pang'onopang'ono ndipo samakhazikika. Matendawa amatenga matenda amtundu wa 1 kapena mtundu wa 2 wodwala akangobadwa kumene.

Kuti mudziwe njira zamtsogolo, azimayi onse oyembekezera pambuyo poti ali ndi GDM kumapeto kwa msambo amakhala ndi gawo la glucose yotsimikizika. Ngati sichikhala matenda ake, ndiye kuti titha kuganiza kuti mtundu 1 kapena mtundu 2 wabadwa.

Kukopa mwana wosabadwayo ndi zotsatira zake kwa mwana

Kuopsa kwa mwana yemwe akukula zimadalira kuchuluka kwa kubwezeredwa kwa matenda. Zotsatira zoyipa kwambiri zimawonedwa ndi mawonekedwe osakwanitsidwa. Zokhudza mwana wosabadwayo zikufotokozedwa motere:

1. Kusintha kwa mwana wosabadwayo wokhala ndi kuchuluka kwa shuga m'magawo oyambira. Mapangidwe awo amayamba chifukwa cha kuchepa kwa mphamvu. Poyambirira, zikondamoyo za mwana sizinapangidwe, kotero chiwalo chanyumba chikuyenera kugwira ntchito ziwiri. Kusokonezeka kwa ntchito kumabweretsa mphamvu yanjala yama cell, kusokonekera kwa magawikidwe awo ndikupanga zolakwika. Vutoli limatha kukayikiridwa ndi kukhalapo kwa polyhydramnios. Kusakwanira kwa glucose m'maselo kumawonetsedwa ndi kukula kwa intrauterine, kuchepa kwambiri kwa mwana.
2. Kuchuluka kwa shuga osagwiritsidwa ntchito mwa amayi apakati omwe ali ndi vuto la matenda osokoneza bongo a mellitus mu 2 ndi 3 trimester kumapangitsa kuti akhale ndi matenda osokoneza bongo. Glucose amadutsa placenta mopanda malire, zochulukirapo zimayikidwa mu mafuta. Ngati pakuchitika insulin yambiri, kufalikira kwamphamvu kwa fetal kumachitika, koma kuchuluka kwa ziwalo za thupi kumawonedwa: m'mimba, phewa lamapewa, miyendo ing'onoing'ono. Mtima ndi chiwindi zimakulanso.
3. Mafuta ambiri a insulini amasokoneza kupangika kwa mankhwala ophatikizira - chinthu chomwe chimakwirira alveoli m'mapapu. Chifukwa chake, mavuto kupuma angachitike pambuyo pobadwa.
4. Kuyika chingwe champhamvu cha wakhanda watsopano kumadodometsa kuchuluka kwa glucose owonjezera, kuchuluka kwa shuga kwa mwana kumatsika kwambiri. Hypoglycemia pambuyo pobala mwana kumabweretsa zovuta zamitsempha, kuphwanya kukula kwa malingaliro.

Komanso, ana obadwa kwa amayi omwe ali ndi matenda a shuga amakhala ndi chiopsezo chowonjezeka cha kubadwa kwa m'mimba, matenda a mtima, matenda a kupuma, calcium ndi magnesium metabolism, komanso zovuta zamitsempha.

Chifukwa chiyani shuga wowopsa amakhala woopsa kwa mayi woyembekezera

GDM kapena matenda ashuga omwe alipo kale amawonjezera kuthekera kwa toxicosis (gestosis), imadziwonekera mumitundu yosiyanasiyana:

• azimayi oyembekezera
• nephropathy 1-3 madigiri,
• preeclampsia,
• eclampsia.

Zotsatira ziwiri zomalizazi zimafuna kuti agonekere kuchipatala kwambiri.

Matenda oyenda mthupi omwe amayenda ndi matenda a shuga amatsogolera kumatenda a genitourinary system - cystitis, pyelonephritis, komanso kubwerezanso kwa venvovaginal candidiasis. Matenda aliwonse angayambitse matenda a mwana mu utero kapena nthawi yobereka.

Zizindikiro zazikuluzikulu za matenda ashuga akakhala ndi pakati

Zizindikiro za matenda osokoneza bongo samatchulidwa, matendawa amakula pang'onopang'ono. Zizindikiro zina za mkazi zimatengedwa kuti zisinthe nthawi yapakati:

• kutopa, kufooka,
• ludzu
• kukodza pafupipafupi
• kulemera kokwanira ndi chakudya.

Nthawi zambiri hyperglycemia imapeza mwangozi nthawi yoyesa magazi. Izi zimagwira monga chidziwitso pakuwunikiridwa mwakuzama.

Zifukwa zakuzindikira, mayeso a matenda am'mbuyomu

Unduna wa Zaumoyo wakhazikitsa nthawi yoyeselera magazi:

Ngati vuto lanu lilipo, kuyeserera kwa glucose kumachitika pakadutsa masabata 26-31. Ngati zizindikiro za matenda ashuga zikuwoneka panthawi yapakati, kuyezetsa shuga kumasonyezedwa.

Kupenda kamodzi komwe kumawulula hyperglycemia sikokwanira kungodziwitsa anthu ena. Kuwongolera ndikofunikira pakatha masiku angapo. Komanso, ndi mobwerezabwereza hyperglycemia, kufunsira kwa endocrinologist kumalembedwa. Dokotalayo amawona zofunikira komanso nthawi yakuyesa kwa mayeso a glucose. Nthawi zambiri amakhala osachepera sabata 1 pambuyo pa hyperglycemia wokhazikika. Kuyesaku kumachitidwanso mobwerezabwereza kuti utsimikizire kuti wapezeka.

Zotsatira zakuyesa zotsatirazi zikunena za GDM:

• kudya glucose wamkulu kuposa 5.8 mmol / l,
• ola limodzi mutatha kudya shuga - pamwamba pa 10 mmol / l,
• patatha maola awiri, kupitilira 8 mmol / l.

Kuphatikiza apo, monga momwe zikuwonekera, kafukufuku amachitika:

• glycosylated hemoglobin,
• kuyesa kwa mkodzo,
• cholesterol ndi mbiri ya lipid,
• kuyesa kwamwazi wamagazi,
• coagulogram,
• mahomoni am'magazi: progesterone, estrogen, lactogen yachilengedwe, cortisol, alpha-fetoprotein,
• Kusanthula kwa mkodzo malinga ndi Nechiporenko, Zimnitsky, mayeso a Reberg.

Amayi oyembekezera omwe ali ndi pre-gestational ndi gestationalabetes amapitiliza ku fetal kuchokera ku 2nd trimester, dopplerometry ya placenta ndi ma umbilical, nthawi zonse CTG.

Kuwongolera kwa amayi apakati omwe ali ndi matenda ashuga komanso chithandizo

Njira ya kubereka ndi shuga yomwe ilipo imadalira kuchuluka kwa kudziletsa komwe kungachitike ndi mkazi komanso kukonza kwa hyperglycemia. Omwe anali ndi matenda ashuga isanatenge pakati amayenera kudutsa Sukulu ya Matenda a shuga, makalasi apadera omwe amawaphunzitsa momwe angadye moyenera, momwe angayendetsere pawokha matenda a shuga.

Mosasamala mtundu wamatenda, amayi apakati amafunikira zowonera izi:

• kupita ku gynecologist milungu iwiri iliyonse kumayambiriro kwa bere, sabata - kuyambira theka lachiwiri,
• kufunsa kwa endocrinologist kamodzi pa sabata ziwiri zilizonse, zowola - kamodzi pa sabata,
• wowonera wazachipatala - aliyense wokhala ndi nyengo, komanso kupezeka kwa matenda agengenic,
• ophthalmologist - kamodzi trimester ndi pambuyo kubereka,
• neurologist - kawiri pa mimba.

Kugonekedwa kuchipatala kwa mayeso ndi kukonza kwa amayi apakati omwe ali ndi GDM amaperekedwa:

• 1 nthawi - mu trimester yoyamba kapena kuzindikira matenda,
• 2 - pakadutsa milungu 19 mpaka 20 kuti muthane ndi vutoli, pezani kufunika kosintha mankhwala,
• Nthawi zitatu - ndi mtundu wa 1 komanso matenda a shuga a 2 - pamasabata 35, GDM - pakatha masabata 36 kuti mukonzekere kubadwa kwa ana ndikusankha njira yobereka.

Ku chipatala, kuchuluka kwa maphunziro, mndandanda wazoyeserera ndi pafupipafupi pa kafukufuku zimatsimikiziridwa payekhapayekha. Kuyang'anira tsiku ndi tsiku kumafunikira kuyesa kwamkodzo kwa shuga, glucose wamagazi, ndi kayendedwe ka magazi.

Kufunika kwa jakisoni wa insulin kumatsimikiziridwa payekhapayekha. Sikuti zochitika zonse za GDM zimafuna njira imeneyi;

Zisonyezero zakuyamba insulin mankhwala ndi zizindikiro zotsatirazi shuga:

• kusala shuga m'magazi ndi zakudya zopitilira 5.0 mmol / l,
• ola limodzi mutadya pamwamba 7.8 mmol / l,
• Maola awiri atatha kumwa, glycemia pamtunda wa 6.7 mmol / L.

Yang'anani! Amayi oyembekezera komanso oyembekezera amaletsedwa kugwiritsa ntchito mankhwala aliwonse ochepetsa shuga, kupatula insulin! Ma insulin omwe amakhala nthawi yayitali sagwiritsidwa ntchito.

Maziko a mankhwalawa ndi insulin yokonzekera yochepa komanso ya ultrashort. Mtundu woyamba wa matenda ashuga, chithandizo chachikulu cha bolus chimachitika. Kwa matenda a shuga a 2 ndi GDM, ndizothekanso kugwiritsa ntchito njira zamtunduwu, koma mwa kusintha kwina komwe munthu wa endocrinologist amatsimikiza.

Mwa amayi apakati omwe sangathe kuwongolera hypoglycemia, mapampu a insulin amatha kugwiritsidwa ntchito, omwe amathandizira kutsata kwa mahomoni.

Zakudya za matenda ashuga gestational nthawi yapakati

Zakudya za mayi wapakati wokhala ndi GDM ziyenera kutsatira mfundo izi:

• Nthawi zambiri pang'onopang'ono. Ndikofunika kudya zakudya zazikulu zitatu ndi zitatu zazing'ono.
• Kuchuluka kwa zovuta zamankhwala okhala ndi chakudya kumakhala pafupifupi 40%, mapuloteni - 30-60%, mafuta mpaka 30%.
• Imwani pafupifupi 1.5 malita amadzi.
• Kuchulukitsa kuchuluka kwa fiber - imatha kutsatsa glucose kuchokera m'matumbo ndikuwachotsa.

Kodi matenda ashuga ndi chiani?

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Matenda a shuga ndi matenda amtundu wa endocrine okhala ndi kuphwanya koyamba kumene kwa kagayidwe kazakudya. Njira yake yayikulu ya pathogenetic ndichosakwanira kapena chosakwanira cha insulin - timadzi tomwe timapangidwa ndi maselo apadera a kapamba.

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Maziko akusowa insulini akhoza kukhala:

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• kuchepa kwa chiwerengero cha β-maselo a ma islets a Langerhans mu kapamba, yemwe amachititsa kuti insulini isungidwe,
• kuphwanya njira yosinthira proinsulin yogwira ntchito kukhala ehomoni yogwira ntchito,
• kaphatikizidwe ka molekyulu yachilendo yokhala ndi masinthidwe amino acid osinthika komanso ntchito yochepetsedwa,
• kusintha kwa chidwi cha ma cell receptors ku insulin,
• kuchuluka kwa mahomoni, omwe zochita zake zimatsutsana ndi zotsatira za insulin,
• kulakwitsa kwa kuchuluka kwa glucose woperekedwa pamlingo wa mahomoni opangidwa ndi kapamba.

Zotsatira za insulin pa kagayidwe kazakudya zimachitika chifukwa cha kupezeka kwa zolandilira zenizeni za glycoprotein. Kuyambitsa kwawo ndi kusintha kwapangidwe kotsatira kumapangitsa kuti shuga ayende bwino m'maselo ndi kuchepa kwa shuga wamagazi ndi malo okhala ndi ma cell. Komanso, mothandizidwa ndi insulin, magwiritsidwe onse a shuga ndi kutulutsidwa kwa mphamvu (njira ya glycolysis) ndi kudzikundikira kwake mu minofu munjira ya glycogen kumalimbikitsidwa. Malo akulu pofikira pamenepa ndi chiwindi ndi mafupa amkati. Kutulutsidwa kwa shuga kwa glycogen kumachitikanso mchikakamizo cha insulin.

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Hormone iyi imakhudza metabolism yamafuta ndi mapuloteni. Imakhala ndi anabolic, imalepheretsa kuwonongeka kwa mafuta (lipolysis) komanso imathandizira biosynthesis ya RNA ndi DNA m'maselo onse omwe amadalira insulin. Chifukwa chake, ndi insulin yocheperako, kusintha kwa zochitika zake kapena kuchepa kwa chidwi cha minofu, kusokonezeka kwa metabolism kumachitika. Koma zizindikilo zazikuluzikulu za matenda ashuga ndizosintha mu chakudya. Nthawi yomweyo, pali kuwonjezeka kwa shuga m'magazi ndikuwoneka kuti ndiwokwera kwambiri m'matumbo ake atatha kudya komanso kuthira shuga.

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Matenda a shuga osafupikitsidwa amabweretsa vuto la mtima ndi trophic mu minofu yonse. Pankhaniyi, ziwalo zodziyimira pawokha (impso, ubongo, mtima) zimavutika. The acidity of basic biological secrets changes, zomwe zimathandizira kukula kwa dysbiosis kumaliseche, pamlomo wamkati ndi matumbo. Ntchito zotchinga khungu ndi mucous nembanemba zimachepa, ntchito za chitetezo chamthupi zimachepetsa. Zotsatira zake, ndi matenda a shuga, chiwopsezo cha kuoneka ngati matenda opatsirana komanso otupa a pakhungu ndi genitourinary system, zovuta za purifani ndi njira zobadwanso mwatsopano zimawonjezerekanso.

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Mitundu yamatenda

Pali mitundu ingapo ya matenda ashuga. Amasiyana wina ndi mzake mu etiology, njira za pathogenetic za kuperewera kwa insulin ndi mtundu wa Inde.

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• lembani matenda ashuga 1 a shuga komanso kuchepa kwathunthu kwa insulin (insulin-insururative), chifukwa cha imfa ya maselo a khungu la Langerhans,
• lembani matenda ashuga a 2 a shuga, okhala ndi minulin insulin komanso kuwonongeka kwa insulin,
• matenda a shuga a mellitus, omwe ali ndi vuto la hyperglycemia woyamba kupezeka pa nthawi ya pakati ndipo nthawi zambiri amazimuka atabereka mwana.
• mitundu yina ya matenda a shuga chifukwa cha kuphatikizika kwa endocrine (endocrinopathies) kapena kukanika kwa pancreatic ndi matenda, kuledzera, zotsatira za mankhwala, kapamba, zochitika za autoimmune kapena matenda amtundu.

Amayi oyembekezera ayenera kusiyanitsa pakati pa matenda ashuga komanso kuwonongeka kwa matenda ashuga omwe anali kale.

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Zomwe zimachitika ndi matenda ashuga

The pathogenesis yakukula kwa matenda ashuga mwa amayi apakati ali ndi zigawo zingapo. Udindo wofunikira kwambiri umachitika chifukwa cha kusalinganika pakati pa hypoglycemic zotsatira za insulin ndi zotsatira za hyperglycemic ya gulu la mahomoni ena. Pang'onopang'ono kuchuluka kwa insulin kukana kwa minofu kumachulukitsa chithunzi cha inshuwaransi. Ndipo kusachita ntchito, kuchuluka kwa thupi ndi kuwonjezeka kwa kuchuluka kwa minofu ya adipose komanso kuwonjezeka kwa chakudya chochuluka.

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Mbiri yokhudzana ndi zovuta za endocrine pa nthawi ya pakati ndikusintha kwa thupi. Munthawi yoyambirira ya gestation, kagayidwe kamakonzedwanso. Zotsatira zake, pakuchepa pang'ono kwa kuchepa kwa glucose kudya kwa mwana wosabadwayo, njira yayikulu yopangira mafuta ochulukirapo imasinthira posungira lipid imodzi. Makina oteteza oterewa amatchedwa chodabwitsa cha kusala kudya. Imakhala ndi kayendedwe kosatha ka shuga kudutsa chotchinga cha fetoplacental ngakhale itatha kuchuluka kwa glycogen ndi gawo lapansi la glucogenesis m'chiwindi cha amayi.

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Kumayambiriro kwa pakati, kukonzanso kwa metabolic koteroko ndikokwanira kukwaniritsa zosowa zamagetsi za mwana yemwe akukula. Pambuyo pake, pofuna kuthana ndi insulin kukana, hypertrophy ya β-maselo a islets a Lagnergans ndikuwonjezeka kwa ntchito yawo yogwira ntchito kumayamba. Kuwonjezeka kwa kuchuluka kwa insulini yomwe imapangidwa kumalipidwa ndi kuthamanga kwa chiwonongeko chake, chifukwa cha kuchuluka kwa impso ndikuyambitsa placental insulinase. Koma munthawi yachiwiri ya mimba, kupangika kwayamba kukhazikika kumayamba kukwaniritsa ntchito ya endocrine, yomwe imatha kukhudza kagayidwe kazachilengedwe.

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Omwe akutsutsana ndi insulin ndi mahomoni opangidwa ndi placenta-steroid ndi steroid yofanana (progesterone ndi lactogen ya placental), estrogens ndi cortisol otulutsidwa ndi tiziwalo tating'ono ta adrenal. Amawerengedwa kuti ndi okonda kwambiri diabetogenic, omwe ali ndi chisonkhezero chachikulu kwambiri kukhala mahomoni a fetoplacental. Zowawa zawo zimayamba kuchuluka kuchokera pakadutsa milungu 16-18. Ndipo nthawi zambiri pofika sabata la 20 mayi woyembekezera wokhala ndi vuto losakwanira limawonekera woyamba chizindikiro cha matenda a shuga. Nthawi zambiri, matendawa amapezeka sabata la 24 mpaka 24, ndipo mkazi sangadandaule.

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Nthawi zina, kusintha kwa glucose kokha kumapezeka, komwe kumadziwika kuti ndi matenda a prediabetes. Pankhaniyi, kuperewera kwa insulin kumangowonekera pokhapokha kudya chakudya chamafuta kwambiri komanso zakudya zina.

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Malinga ndi zomwe zilipo pakalipano, shuga ya amayi apakati satsatiridwa ndi kufa kwa maselo a pancreatic kapena kusintha kwa molekyulu ya insulin. Ichi ndichifukwa chake zovuta za endocrine zomwe zimachitika mwa amayi zimasinthidwanso ndipo nthawi zambiri zimangokhala zokha zikangobadwa kumene.

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Kodi matenda ashuga akakhala pachiwopsezo kwa mwana ndi chiyani?

Matenda a bere akapezeka mwa mayi wapakati, nthawi zonse pamabuka mafunso: zimawakhudza bwanji mwana komanso ngati chithandizo chake chilidi chofunikira. Inde, nthawi zambiri matendawa sakhala pachiwopsezo cha moyo wa mayi woyembekezera ndipo sasintha ngakhale thanzi lake. Koma chithandizo ndichofunika kwambiri kuti mupewe zovuta zokhudzana ndi mimba komanso zovuta zina.

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Matenda a shuga amayambitsa kuphwanyidwa kwa tinthu tating'onoting'ono m'matumbo a amayi. Kupanikizana kwa ziwiya zing'onozing'ono kumayendera limodzi ndi kuwonongeka kwa endothelium mwa iwo, kutsegula kwa lipid peroxidation, komanso kumakwiyitsa DIC. Zonsezi zimapangitsa kuti pakhale kuchepa kwa fetoplacental ndi fetal hypoxia.

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Kuchuluka kwa shuga kwa mwana komanso sizinthu zovulaza. Kupatula apo, kapamba wake samatulutsira kuchuluka kwa mahomoni, ndipo insulin ya amayi sikulowa mu zotchinga za fetoplacental. Ndipo kuchuluka kwa glucose kosasinthika kumayambitsa zovuta zamtundu wa discrulatory ndi metabolic. Hyperlipidemia yachiwiri imakhala chifukwa cha masinthidwe achilengedwe komanso magwiridwe antchito a cell, imachulukitsa hypoxia ya minofu ya fetal.

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Hyperglycemia mwa mwana imakwiyitsa matenda oopsa a pancreatic β-cell kapena kufooka kwawo koyambirira. Zotsatira zake, mwana akhanda amatha kukhala ndi zovuta za carbohydrate metabolism zomwe zimakhala zowopsa m'moyo. Ngati matenda ashuga samakhazikitsidwa ngakhale mu nthawi yachitatu ya kubereka, mwana wosabadwayo amakula ndi macrosomia (kulemera kwakukulu kwa thupi) ndi kunenepa kwambiri, splenitis ndi hepatomegaly. Kuphatikiza apo, kusakhazikika kwa kupuma, mtima ndi m'mimba zimawonedwa nthawi zambiri pakubadwa. Zonsezi zimakhudzana ndi matenda a shuga.

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Mavuto akulu omwe amakhalapo ndi matenda ashuga wa m'mimba ndi monga:

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• fetal hypoxia ndi intrauterine kukula retardation,
• kuperekera nthawi isanakwane
• mwana wosabadwa wa mwana wosabadwa,
• kufa kwamwana pakati pa ana obadwa ndi amayi omwe ali ndi matenda ashuga,
• macrosomia, yomwe imabweretsa njira yovuta yobereka ndipo imawonjezera vuto la kubala mwa mwana (kupundika kwa kolala, kupunduka kwa ziwalo, kupunduka kwa ziwalo, kuwonongeka kwa chigaza ndi khomo lachiberekero) ndi kuwonongeka kwa mayeso a kubadwa kwa amayi,
• preeclampsia, preeclampsia ndi eclampsia mwa mayi wapakati,
• Nthawi zambiri mobwerezabwereza matenda a kwamkodzo pamimba,
• zotupa za mucous nembanemba (kuphatikizira kumaliseche).

Madokotala ena amatchulapo zovuta zomwe zimachitika chifukwa cha matenda ashuga okalamba ngati kuchotsa mimbanda koyambira koyambira. Koma chomwe chayambitsa vuto lakusokonekera ndi kubedwa kwa matenda ashuga omwe amapezekanso kale.

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Zizindikiro ndi Kudziwitsa

Amayi oyembekezera omwe ali ndi matenda ashuga nthawi zambiri samadandaula. Zizindikiro zake nthawi zambiri zimakhala zofatsa, ndipo azimayi nthawi zambiri amaziwona ngati ziwonetsero zathupi la 2 ndi 3. Dysuria, ludzu, khungu loyenda, kuperewera kwakuthupi kumatha kuchitika osati kokha ndi matenda a shuga. Chifukwa chake, chachikulu pakuzindikiritsa matendawa ndi mayeso a labotale. Ndipo obstetric ultrasound imathandizira kumveketsa kuwuma kwa kuchuluka kwa placental ndikuzindikiritsa zizindikiro za fetal development pathology.

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Kafukufuku wofufuza ndikuwona kuchuluka kwa shuga m'magazi a mayi wapakati pamimba yopanda kanthu. Imachitika pafupipafupi kuyambira pa sabata la 20 la bere. Mukalandira chisonyezo cha glycemia, kuyezetsa kumayesedwa kuti kumvekere shuga. Ndipo mwa amayi apakati omwe ali pachiwopsezo chachikulu chotenga matenda osokoneza bongo, ndikofunikira kuchita mayeso otere pakuwoneka paphwando komanso mobwerezabwereza kwa masabata 24-28, ngakhale ndi shuga wamba.

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Glycemia wochokera ku 7 mmol / L pamimba yopanda magazi m'matumbo athunthu kapena kuchokera ku 6 mmol / L pamimba yopanda kanthu m'magazi a venous plasma ali ndi magwero odalirika a labotale yodwala matenda ashuga. Chizindikiro cha matendawa ndicho kupezeka kwa hyperglycemia pamtunda wa 11.1 mmol / l ndi muyeso wosasintha masana.

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Kuchita mayeso okhudzika ndi glucose (glucose kulolerana) kumafunika kuyang'aniridwa mosamala ndi momwe zinthu zilili. Pakupita masiku atatu, mkazi azitsatira zakudya zake zokhazikika komanso zolimbitsa thupi, popanda zoletsedwa zomwe zimayambitsa matenda ashuga. Chakudya chamadzulo motsatira mayeso ayenera kukhala ndi 30-50 g yamafuta. Kusanthula kumachitika pang'onopang'ono pamimba yopanda kanthu, pambuyo pa maola 12-16 akusala kudya. Pa kuyesedwa, kusuta, kumwa mankhwala aliwonse, zolimbitsa thupi (kuphatikizapo kukwera masitepe), chakudya ndi zakumwa siziphatikizidwa.

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Kuyesa koyamba ndi magazi akusala kudya. Zitachitika izi, mayi woyembekezera amapatsidwa chakumwa chatsopano chokonzanso shuga (75 g chouma chambiri pa 300 ml ya madzi). Kuti muwone mphamvu ya glycemia ndikuwona nsonga zake zobisika, zitsanzo zosinthidwa zimatengedwa mphindi 30 zilizonse. Koma pafupipafupi kuchuluka kwa glucose komwe kumatsimikiziridwa, maola 2 mutatha kuyesa mayeso.

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Nthawi zambiri, ma 2 maola atatha shuga, glycemia sayenera kupitirira 7.8 mmol / L. Kutsika kwa kulekerera kumawonetsedwa pamitengo ya 7.8-10.9 mmol / L. Matenda a shuga a gestational amapezeka ndi zotsatira za 11.0 mmol / L.

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Kuzindikira kwa matenda a shuga a m'magazi sikungakhazikike pakutsimikiza kwa shuga mu mkodzo (glucosuria) kapena muyeso wama glucose ndi mita ya shuga m'magazi okhala ndi timizere ta mayeso. Kayezetsa magazi okhazikika okha omwe angatsimikizire kapena kupatula matendawa.

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Screening ndi Diagnostics Algorithm ya GSD

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Mankhwala a insulin

Kudziyang'anitsitsa pawokha kwa kuchuluka kwa shuga m'magazi a venous omwe amagwiritsa ntchito glucometer ndikofunikira. Mzimayi woyembekezera amapangiranso yekha pamimba yopanda kanthu ndipo atatha maola awiri atatha kudya, akulemba zomwezo ndimodzinso ndi zopatsa mphamvu za calorie mu diary yapadera.

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Ngati hypocaloric kudya ndi gestational matenda a shuga sikupangitsa kuti glycemia ikhale yodziwika bwino, adokotala amasankha kuikidwa kwa insulin. Pa nthawi yomweyo, ma insulin ofupika ndi a ultrashort zochita amadziwika mu njira zingapo za jakisoni, poganizira zomwe zili ndi chakudya chilichonse komanso kuchuluka kwa shuga.Nthawi zina ma insulini okhala ndi nthawi yayitali amagwiritsidwa ntchito. Nthawi iliyonse, dokotala amasintha njira zochizira, poganizira zodziwunikira, mphamvu za mwana wosabadwayo ndi chizindikiro cha matenda a shuga.

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Jakisoni wa insulin amachitika ndi ma syringes apadera modutsa. Nthawi zambiri, mkazi safuna thandizo kunja chifukwa cha izi, maphunzirowa amachitika ndi endocrinologist kapena ogwira ntchito pasukulu ya matenda ashuga. Ngati tsiku lililonse insulin yapamwamba imayenera kupitirira mayunitsi 100, angaganize kukhazikitsa pompopompo wa insulin. Kugwiritsa ntchito mankhwala a hypoglycemic pakamwa panthawi yoletsedwa ndizoletsedwa.

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Monga chithandizo cha adjunct, mankhwala amatha kugwiritsidwa ntchito pokonzanso microcirculation ndi chithandizo cha kuchuluka kwa placental, Hofitol, mavitamini.

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Zakudya zopatsa thanzi matenda ashuga

Pa nthawi yoyembekezera, mankhwala othandizira pakudya ndi njira yabwino kwambiri yochizira matenda ashuga komanso kulekerera shuga. Izi zimaganizira kulemera kwa thupi ndi zochitika zolimbitsa thupi za mkazi. Malangizo a zakudya zimaphatikizapo kukonza zakudya, kapangidwe kake ka chakudya ndi zopatsa mphamvu. Zakudya za amayi apakati omwe ali ndi matenda osokoneza bongo amayenera, kuwonjezera, kuonetsetsa kuti zimapezekanso michere ndi mavitamini, komanso zimathandizira kuteteza matenda am'mimba. Pakati pa zakudya zazikulu zitatu muyenera kukonzekera zokhwasula-khwasula, ndipo zakudya zazikulu zopatsa mphamvu ziyenera kukhala theka loyamba la tsiku. Koma Zakudya zomaliza musanagone usiku zimaphatikizanso zopatsa mphamvu zamafuta 15-30 g.

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Ndingadye chiyani ndi matenda ashuga? Izi ndi mitundu yamafuta ochepa monga nkhuku, nyama ndi nsomba, zakudya zamafuta ambiri (masamba, nyemba ndi mbewu), zitsamba, mkaka wopanda mafuta ndi zinthu mkaka wowawasa, mazira, mafuta amasamba, mtedza. Kuti mudziwe zipatso zamtundu wanji zomwe zingayambitsidwe mu zakudya, muyenera kuwunika kuchuluka kwa shuga m'magazi pambuyo poti adye. Nthawi zambiri amalola maapulo, mapeyala, makangaza, zipatso za zipatso, mapichesi. Ndizololedwa kudya chinanazi chatsopano pang'ono kapena madzi a chinanazi popanda shuga wowonjezera. Koma ndibwino kupatula nthochi ndi mphesa ku menyu, zimakhala ndi zopatsa mphamvu zamagetsi ndipo zimathandizira kukula kwakukulu kwa glycemia.

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Kuperekera ndi kudalirika

Kubadwa kwa mwana mu matenda osokoneza bongo kumatha kukhala kwachilengedwe kapena gawo la caesarean. Njira zodalira matendawa zimatengera kulemera kwa mwana wosabadwayo, magawo a pelvis ya mayi, kuchuluka kwa kubwezeretsa matendawa.

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Ndi kubadwa kwodziyimira, kuchuluka kwa shuga kumayang'aniridwa maola 2 aliwonse, komanso ndi chizolowezi cha hypoglycemic ndi hypoglycemic, ora lililonse. Ngati mayi anali pa mankhwala a insulin panthawi yomwe ali ndi pakati, mankhwalawa amaperekedwa ndi infusomat pa nthawi yobereka. Ngati chithandizo cha zakudya chinali chokwanira kwa iye, lingaliro la kugwiritsa ntchito insulin limapangidwa mogwirizana ndi msinkhu wa glycemia. Ndi gawo la caesarean, kuyang'anira glycemic ndikofunikira musanamuthandize, musanachotse mwana, mutachotsa placenta, kenako maola 2 aliwonse.

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Ndi kudziwika kwa nthawi yayitali matenda ashuga komanso kukwaniritsidwa kwa chindapusa chokhazikika cha matendawa panthawi yomwe ali ndi pakati, kudalirika kwa mayi ndi mwana ndikwabwino. Komabe, akhanda ali pachiwopsezo cha kufa kwa makanda ndipo amafunika kuyang'aniridwa ndi dokotala wa ana komanso a ana. Koma kwa mzimayi, zovuta zomwe zimachitika chifukwa cha matenda ashuga omwe ali ndi pakati zimatha kuchitika patadutsa zaka zingapo pambuyo pobereka mwanjira ya matenda a shuga 2 kapena prediabetes.

Kodi matenda ashuga amachitika bwanji?

Palibe malingaliro osatsimikizika pazifukwa zomwe shuga imayamba panthawi yomwe imabereka mwana. Amakhulupirira kuti gawo lalikulu la izi limachitika ndi kukonzanso thupi la mkazi, komwe kumalumikizidwa ndi kufunika kosunga moyo ndi chitukuko cha mwana wosabadwayo.

Matenda a shuga pakapita nthawi yayikulu amafunika kudya mosamalitsa.

Mwana amadyetsedwa ndi placenta panthawiyi. Thupi ili limatulutsa mahomoni omwe amalimbikitsa kukula ndi kukula kwa mwana wosabadwayo, komanso kutsekereza zochita za insulin mwa mayi woyembekezera. Zotsatira zake, sikuti shuga onse omwe amaperekedwa ndi chakudya amawonongeka. Zikondamoyo sizitha kutulutsa insulin yambiri. Izi zimabweretsa kukula kwa hyperglycemia, chikhalidwe cha matenda ashuga.

Kuwopsa kwa GDM kumatsimikiziridwa ndi zifukwa:

• kuchuluka kwa thupi
• kuchuluka kwa thupi pakubala, mopitilira muyeso wabwino,
• zaka zopitilira 25
• kupezeka kwa GDM panthawi yapakati yapakati,
• shuga kwa abale apamtima.

Kuchepa kwa kuperewera kwa insulin kumatsimikiziridwa osati ndi izi. Pali zinthu zina zomwe zimapangitsa kuti pakhale GDM.

Kodi matenda ashuga okalamba ali bwanji?

Zizindikiro za GDM sizisiyana ndi mawonekedwe a shuga mellitus amtundu woyamba kapena wachiwiri. Mutha kukayikira kukhalapo kwa vutoli ndi izi:

• kulemera mwachangu popanda chifukwa,
• ludzu losalekeza
• kuchuluka kwamkodzo
• kuchepa kwamtima
• kuwonongeka konsekonse kwa thanzi.

Zizindikirozi zikawoneka, mayi woyembekezera ayenera kulumikizana ndi dokotala posachedwa.

Kuzindikira matenda ashuga mwa amayi apakati

Amayi pa nthawi yobereka mwana ayenera kumayesedwa pafupipafupi, zomwe zimaphatikizapo kudziwa kuchuluka kwa shuga. Chofunika ndizotsatira zakuwunikira kwakanthawi kwamasabata 24-28. Kwa odwala omwe ali ndi vuto lakukhazikika kwa GDM, madotolo amapereka mankhwala owonjezera a shuga.

Mwazi umatengedwa pamimba yopanda kanthu, pambuyo pake mkazi amapatsidwa kapu yamadzi otsekemera. Kachiwiri amatenga magazi pambuyo pa ola limodzi. Ngati kuchuluka kwa glucose m'magawo awiriwa kumaposa zomwe zovomerezeka, wodwala amapezeka ndi matenda a shuga.

Zotheka ndi GDM

Mukazindikira izi, ndikofunikira kuchita zinthu zolimbana ndi hyperglycemia posachedwa. Kupanda kutero, matenda osakhazikika omwe ali ndi shuga mwa mayi wapakati angayambitse zotsatira zake:

1. Kubadwa kwa mwana wokhala ndi thupi lolemera kuposa makilogalamu anayi ndi macrosomia. Chifukwa cha izi, kubereka mwana kumakhala kovuta kwambiri, pali ngozi yayikulu yovulala, yomwe ingafunike gawo la cesarean.
2. Isanayambike ntchito, kukula kwa kupuma nkhawa mu ana olumikizidwa ndi osakwanira kukula kwa kupuma dongosolo mu prematurity.
3. Hypoglycemia pambuyo pobadwa mwa mwana.
4. Kuchulukitsa kwina komwe kumapangitsa kukhala ndi vuto la preeclampia komanso zovuta zina mwa amayi pamene ali ndi pakati. Mikhalidwe imeneyi imapatsanso chiwopsezo kwa mwana wosabadwa.

Kuzindikira matenda amiseche kumayambira pa kusanthula kwa shuga m'magazi ndikatha kudya.

Mavuto omwe atchulidwa atha kupewedwa pokhapokha kutsatira malangizo a dokotala.

Chithandizo cha matenda ashuga

Malangizo a hyperglycemia mwa amayi apakati amayamba ndi njira zosagwiritsa ntchito mankhwala:

• Zakudya
• zolimbitsa thupi
• magazi magazi.

Mankhwala othandizira pakudya ndi njira yofunika kwambiri pochizira matenda ashuga. Amatanthawuza:

1. Kupatulidwa kwathunthu kwa zakudya zosakanikirana zomanga thupi - maswiti, shuga, timadziti, uchi, zinthu zophika.
2. Kukana kwa zotsekemera, kuphatikizapo zinthu zomwe zimakhala ndi fructose, monga zoletsedwa panthawi yokhala ndi pakati komanso msambo.
3. Amayi onenepa kwambiri amalephera kudya mafuta, amakana zakudya zopakidwa, mayonesi, ndi masoseji.
4. Chakudya chamagulu pang'ono - tikulimbikitsidwa kudya chakudya m'malo ochepa kuyambira 4 mpaka 6 pa tsiku. Njala siyenera kuloledwa.

Zochita zolimbitsa thupi zimaloledwa kwa odwala omwe alibe contraindication. Kuti matenda achulukuke m'magazi, ndikokwanira kuyenda mlengalenga tsiku lililonse kwa mphindi 30, kuchita masewera olimbitsa thupi. Zochita zomwe zimawonjezera kuthamanga kwa magazi ndizoletsedwa, chifukwa zimatha kuyambitsa uterine hypertonicity.

Pamodzi ndi izi, tikulimbikitsidwa kusunga zolemba tsiku ndi tsiku, komwe muyenera kuwonetsa:

1. Mwazi wamagazi musanadye, ola limodzi mutatha kudya kwa tsiku limodzi. Ndikofunikanso kulembetsa chizindikiro ichi musanagone.
2. Chakudya ndi zakudya zomwe zimadyedwa.
3. Pamaso pa mizere yapadera yoyeserera - mulingo wamatumbo a mkodzo am'mawa.
4. Kupsinjika kwa magazi m'mawa ndi madzulo - chizindikiro ichi sichiyenera kupitirira 130/80 mm RT. Art.
5. Ntchito zamagalimoto za mwana wosabadwa.
6. Unyinji wa mkazi.

Kusunga zolemba zamtunduwu kumathandizira kutsata kupatuka kwadongosolo lathanzi ngakhale isanayambike zizindikiro. Ndikofunikira kuti adotolo azitha kuyendetsa bwino njira yoyembekezera.

Ngati sikokwanira kwa mankhwala osagwiritsa ntchito mankhwala, mkazi ayenera kuthandizidwa ndi endocrinologist. Ngati misempha yayikulu ya shuga ilimbikira, kukonzekera kwa insulin kumasonyezedwa. Mlingo wosankhidwa bwino wa mankhwalawa ndiwotetezeka kwa akazi. Insulin sikuwoloka placenta, kotero sizivulaza mwana wosabadwayo.

Kutumiza ku GDM

Pambuyo pakupezeka kwa matenda a shuga a m'mimba, mayi aliyense amasankha njira yoyenera yoperekera. Kuunika komaliza kumachitika pasanathe milungu 38, malinga ndi zotsatira zake, dokotala amafufuza zotheka kubadwa kwa mwana.

Ndi GDM, sikulimbikitsidwa kutalikitsa pakati kwa milungu yopitilira 40. Izi zimakulitsa kwambiri zovuta za mwana, chifukwa nthawi imeneyi nkhokwe za placenta zimachepa, ndipo matupidwe ake amatha kubadwa. Pachifukwa ichi, nthawi kuyambira milungu 38 mpaka 40 imawerengedwa kuti ndiyo nthawi yabwino kwambiri yoperekera.

Malangizo pambuyo pobereka

Pambuyo pobereka, azimayi omwe ali ndi GDM ayenera:

1. Ngati mankhwala a insulin adachitidwa, siyani.
2. Mwezi wina ndi theka kutsatira chakudya.
3. Yang'anani kuchuluka kwa shuga m'magawo atatu pambuyo pobadwa.
4. Munthawi ya masabata 6-12 mutabereka mwana - funsani ndi endocrinologist, chitani kafukufuku wina wowunika kuti mupeze metabolism.

Amayi omwe adapezeka kuti ali ndi vuto la matenda amiseche amayenera kuchitapo kanthu pakukonzekera kutenga pakati kuti athetse mwayi wopangidwanso wa izi.

Pofuna kupewa zovuta za GDM, mayi ayenera kuwunika kuchuluka kwa shuga m'magazi ake.

Ana omwe adabadwira kwa amayi omwe ali ndi GDM nthawi zambiri amakhala ndi matenda ashuga a 2. Chifukwa chake, mu moyo wonse amayenera kudya zakudya zokhala ndi shuga wochepa, wowonera endocrinologist.

Kupewa matenda ashuga mwa amayi apakati

Kudziwa kukhalapo kwa zinthu zomwe zikuthandizira kukula kwa insulini, mutha kuchepetsa mwayi wazomwezi.

Pofuna kupewa kutukuka kwa GDM, azimayi onse munthawi yobala mwana amalimbikitsidwa kutsatira njira zodzitetezera:

1. Zakudya zomwe siziphatikiza mosavuta chakudya chamafuta, zimachepetsa kugwiritsa ntchito mafuta, mchere.
2. Matenda a normalization wa thupi - ndikofunika kuchita izi musanakhale ndi pakati.
3. Kuchita masewera olimbitsa thupi pafupipafupi, kuyenda mu mpweya wabwino.
4. Ngati muli ndi abale omwe ali ndi matenda ashuga, kamodzi pachaka muziwongolera kudya kwanu kwa magazi ndikatha kudya.

Matenda a shuga a gestational ndi matenda omwe amatha kupezeka nthawi ya bere. Hyperglycemia ndiowopsa pakupanga zovuta zambiri kwa mayi ndi mwana wosabadwayo. Chifukwa chake, ndikofunikira kuchitapo kanthu pofuna kuchepetsa matenda a shuga. Ngati zakudya ndi njira zina zosagwiritsa ntchito mankhwala sizothandiza, zimasonyezedwa kuti mugwiritse ntchito insulin kutengera kuchuluka kwa chakudya chamafuta.

Kodi chiwopsezo chodwala matenda ashuga ndichani pamimba? Kuzindikira kwa GDM ndi chithandizo.

Mimba, matenda osachiritsika amatha kukhala owonjezereka kapena chizindikiro cha zovuta zomwe sizikudziwika kale zimatha. Matenda a shuga okhathamira amatha kukhala vuto.

Malinga ndi gulu la World Health Organisation, "matenda osokoneza bongo" ndi matenda opatsirana a shuga omwe amapezeka panthawi yokhala ndi pakati, komanso kuvulaza kwa glucose (mawonekedwe a glucose a thupi), omwe amapezekanso panthawiyi. Cholinga chake ndikuchepa kwa chidwi kwama cell kupita ku insulin yawo (insulin kukana), yomwe imalumikizidwa ndi kuchuluka kwa mahomoni apakati m'magazi. Pambuyo pa kubala, kuchuluka kwa shuga m'magazi nthawi zambiri kumabwereranso kwachilendo. Komabe, mwayi wokhala ndi mtundu woyamba wa 2 ndi matenda ashuga 2 pakakhala pakati sungathe kudziwika. Kuzindikira matendawa kumachitika pambuyo pobadwa.

Pakufufuza zambiri kuchokera kumafukufuku angapo, madokotala adazindikira kuti oposa 50% ya amayi oyembekezera omwe ali ndi gestational matenda a shuga amakula bwino nthawi yayitali.

Kodi ndi chiopsezo chotani chobweretsa GDM?

• Kunenepa kwambiri, kunenepa kwambiri
• Matenda a shuga a m'mabanja apafupi
• Amayi oyembekezera zaka zopitilira 30
• Mbiri yakubethera:
• Mwana woyamba adabadwa wolemera kuposa 4000 g
• GDM m'mimba yapitayi
• Kulakwitsa kwambiri (poyambira komanso mochedwa)
• Polyhydramnios
• Kusabereka
• Zolakwika mwa ana am'mbuyomu

Kodi matenda ashuga owopsa ndi ati?

Matenda a shuga ochitika m'magazi nthawi zambiri amakhala pakati pa milungu 16 ndi 32 ya bere. Kuphwanya kwa kagayidwe kazakudya, omwe adadziwika kale, ngati lamulo, amalankhula za matenda ashuga omwe kale sanadziwike.

Inde, ndikwabwino kuphunzira za matenda osachiritsika musanakhale ndi pakati, kenako ndizotheka kuwalipirira momwe mungathere. Pazifukwa izi, madokotala amalimbikitsa mwamphamvu kukonzekera kutenga pakati. Pankhani yakukonzekera kutenga pakati, mayi amakalowa mayeso onse oyambira, kuphatikizira kudziwika ndi matenda ashuga. Ngati kuphwanya kwa kagayidwe kazakudya kamapezeka, dokotala amamulembera chithandizo, kupereka lingaliro, ndipo mtsogolo mtsogolo zidzachitika mosavomerezeka, ndipo mwana adzabadwa wathanzi.

Chofunikira kwambiri pakuwongolera mimba yovuta ndi matenda ashuga (onse mwamtundu ndi mitundu ina) ndikusunga kuchuluka kwa shuga m'magawo abwinobwino (3.5-5,5 mmol / L). Kupatula apo, mayi ndi mwana ali mumavuto ovuta kwambiri.

Zomwe zikuwopseza amayi? Kuberekera asanabadwe komanso kubereka mwana nkotheka. Chiwopsezo chachikulu chotenga gestosis (wodwala matenda a shuga amakula pafupipafupi komanso mpaka 30 - milungu 30), hydramnion, chifukwa chake kusakwanira kwa fetoplacental komanso vuto la kuperewera kwa fetal. Mwina chitukuko cha matenda ashuga a ketoacidosis (chikhalidwe chomwe pali kuwonjezeka kwambiri kwa glucose komanso kuchuluka kwa matupi a ketone m'magazi), matenda amtundu wamatumbo, omwe amalembedwa kawiri kawiri ndikuyambitsa matenda a mwana wosabadwayo komanso kubadwa msanga. Ndizothekanso kupitilira kwa micangiopathies yomwe imapangitsa kuti masoka asamaone, ntchito ya impso, magazi opatsika kudzera m'mitsempha ya placenta ndi ena. Mzimayi atha kufooka pobisalira, komwe kuphatikiza ndi chifuwa chaching'ono komanso khanda lalikulu, kumapangitsa kuti kubereka kosagonekedwa ndi gawo la caesarean. Mwa amayi omwe ali ndi matenda ashuga, zovuta zopatsirana pambuyo pobeleka zimachulukirachulukira.

Zoopsa kwa mwana

Zomwe zimapanga kagayidwe kazakudya pakati pa mayi ndi mwana ndizoti mwana wosabadwayo amalandira shuga kuchokera kwa mayi, koma samalandira insulin.Chifukwa chake, hyperglycemia (glucose ochulukirapo), makamaka pa trimester yoyamba, mwana wosabadwayo asanakhale ndi insulini yake, amakhumudwitsa kukula kwa zovuta zina za fetal . Pambuyo pa masabata 12, thupi la mwana wamtsogolo likakulitsa insulin yake, hyperinsulinemia imayamba, yomwe imawopseza kukula kwa asphyxia ndi kuvulala pakubala, kupuma kwamatenda (kupuma kwa vuto la kupuma) ndi zikhalidwe za ana obadwa kumene.

Kodi pali njira yoletsera zovuta izi? Inde Chachikulu ndikuzindikira vutoli komanso kukonza kwake nthawi.

Kuzindikira kwa GDM panthawi yapakati

Mfundo yoyamba pakupezeka kwa matenda ashuga gestational ndikuwunika kuopsa kwa chitukuko chake. Mukalembetsa mayiyo kukalembetsa kuchipatala cha anakubala, zizindikiro zingapo zimayesedwa, mwachitsanzo, zaka ndi kulemera kwa amayi apakati, mbiri ya abereki (kukhalapo kwa matenda ashuga panthawi ya pakati, kubadwa kwa ana olemera kuposa makilogalamu 4, kubereka ndi zina), mbiri ya mabanja (kukhalapo kwa matenda ashuga abale) ndi zina. Gome lotsatirali ndi la anthu:

Tiyeni tipeze chidwi chachikulu ndi "Kubadwa kwa mwana wolemera oposa 4 kg". Sizowopsa kuti zimaphatikizidwa pakuwunika kwa anthu odwala matenda ashuga. Kubadwa kwa mwana kotereku kumatha kuwonetsa kukula kwa matenda ashuga komanso matenda ashuga m'tsogolo. Chifukwa chake, mtsogolomo mtsogolo mukumana, ndikofunikira kukonzekera ndikuwunikira kuchuluka kwa shuga m'magazi.

Atazindikira kuopsa kokhala ndi matenda ashuga, dokotala amasankha njira yoyang'anira.

Gawo lachiwiri ndikutsatira magazi kuti mupeze kuchuluka kwa shuga, omwe amayenera kuchitika kangapo panthawi yapakati. Ngati kamodzi pazopezeka glucose zadutsa 5 mmol / l, kuwunikiranso kwina kumachitika, monga kuyesa kwa glucose.

Kodi mayeso amadziwika kuti ndi abwino? Pochita mayeso ndi katundu wa 50 g shuga, m'magazi a glycemia amawerengeka pamimba yopanda kanthu komanso pambuyo pa ola limodzi. Ngati shuga osala kudya amaposa 5.3 mmol / L, ndipo pambuyo pa ola limodzi mtengowo umakhala woposa 7.8 mmol / L, ndiye kuti kuyesedwa ndi 100 g shuga kuyenera kulembedwa.

Mellitus ya Gestational diagnostics imapezeka ngati glucose yothamanga ndioposa 5.3 mmol / l, pambuyo pa ola limodzi imakhala yapamwamba kuposa 10.0 mmol / l, atatha maola 2 apamwamba kuposa 8.6 mmol / l, atatha maola atatu ali pamwamba pa 7.8 mmol / l. Chofunikira: kuwonjezeka kwa chisonyezo chimodzi chokha sikumapereka chidziwitso pakuzindikira. Pankhaniyi, kuyesaku kuyenera kubwerezedwanso patatha milungu iwiri. Chifukwa chake, kuwonjezeka kwa zizindikiro ziwiri kapena zingapo kumawonetsa matenda a shuga.

Malamulo Oyesa:

1. Masiku atatu mayeso asanachitike, mayi woyembekezera ali ndi zakudya zake zanthawi zonse ndipo amatsata zolimbitsa thupi
2. Kuyesaku kumachitika m'mawa m'mimba yopanda kanthu (mutatha kusala usiku kwa maola osachepera 8).
3. Pambuyo pakupeza magazi pamimba yopanda kanthu, wodwalayo ayenera kumwa njira yothetsera shuga, wophatikiza 75 magalamu a shuga owuma osungunuka mu 250-300 ml ya madzi, kwa mphindi 5. Muyeso wachiwiri wamagazi kuti mupeze shuga umatengedwa patatha maola awiri mutatsitsa shuga.

Makhalidwe abwinobwino glycemia:

1. kusala glycemia - 3,3-5,5 mmol / l,
2. glycemia asanadye (basal) 3.6-6.7 mmol / l,
3. glycemia patatha maola 2 mutadya 5.0-7.8 mmol / l,
4. glycemia asanagone 4.5-5.8 mmol / l,
5. glycemia ku 3.00 5.0-5.5 mmol / L.

Ngati zotsatira za phunzirolo ndizabwinobwino, ndiye kuti mayeserowo amabwerezedwanso pamasabata 24-28 oyembekezera, pomwe mahomoni asinthidwe. M'mbuyomu, GDM nthawi zambiri samapezeka, ndipo kuzindikira pambuyo pa masabata 28 sikuti nthawi zonse kumalepheretsa kukula kwa zovuta mu fetus.

Komabe, amayi apakati samangokumana ndi shuga wambiri. Nthawi zina kuyezetsa magazi "kumawonetsa" hypoglycemia - shuga wamagazi ochepa. Nthawi zambiri, hypoglycemia imayamba kusala. Pa nthawi ya pakati, kuchuluka kwa shuga kwama cell kumawonjezeka, chifukwa chake, kupuma kwakutali pakati pa chakudya sikuyenera kuloledwa, ndipo palibe chifukwa choti munthu azidya zakudya zomwe zimapangitsa kuti achepetse thupi. Komanso, nthawi zina mukamawunika mutha kupeza mfundo za malire zomwe nthawi zonse zimawonetsa kuyambitsa matenda, chifukwa chake, ndikofunikira kuyang'anira kuwerengera magazi, kutsatira malangizo a dokotala ndikutsatira zakudya zomwe katswiri adapereka.

Mawu ochepa pofotokoza chithandizo cha matenda ashuga

Mayi woyembekezera yemwe ali ndi matenda ashuga, ayenera kudziwa kudziletsa kwa glycemia. Mu 70% ya milandu, shuga ya gestational imakonzedwa ndi zakudya. Inde, kupanga insulini kumachitika, ndipo palibe chifukwa chokwanira cha insulin.

Mfundo zazikuluzakudya za GDM:

1. Zakudya za tsiku ndi tsiku ziyenera kugawidwa pakati pa chakudya, mafuta ndi mapuloteni - 35-40%, 35-40% ndi 20-25%, motero.
2. Zopatsa mphamvu zamagulu ochulukirapo ziyenera kukhala 25 kcal pa 1 kg yolemera kapena 30 - 35 kcal pa kilogalamu 1 yodziwika bwino. Amayi onenepa kwambiri amapatsidwa lingaliro za momwe angachepetse kapena kukhazikika. Ndikofunikira kuchepetsa calorie kudya mwachidwi, popanda kuchita zinthu zovuta.
3. Zakudya zopatsa mphamvu mosavuta, ndiye kuti, maswiti aliwonse, samachotsedwa pamenyu ya tsiku ndi tsiku.
   Kodi mayi wathanzi ayenera kufuula ngati akufuna maswiti? "Kukonda maswiti" kuyenera kuwachenjeza ngati kusintha kwasintha. Koma mulimonsemo, muyenera kutsatira malangizo a kadyedwe ndipo musamawonjezere maswiti kapena china chilichonse. Muyenera kukumbukira kuti mukufuna kudya "china chokoma" nthawi zambiri chifukwa chongofuna kudya. Chifukwa chake, "zotsekemera" zitha kusinthidwa ndi zipatso.
4. Chepetsani kuchuluka kwamafuta omwe mumamwetsa zakudya m'thupi ndi zipatso (zipatso ndi ndiwo zamasamba) ndi mapuloteni mpaka 1.5 g / kg.

Poona kuti sizingatheke kukonza glycemia ndi chakudya chimodzi, insulini yofunikira ndiyofunika, yomwe imawerengeredwa komanso kusinthanitsa (ndi kusinthidwa) ndi adokotala.

Matenda a gestational amatchedwa osati chifukwa chobala (chiwonetsero) pa nthawi yapakati. Chowonjezera china chake ndikuti zizindikiro zake zimatha pambuyo pobadwa kwa mwana. Komabe, ngati mzimayi wadwala matenda ashuga gestational nthawi yapakati, chiopsezo chokhazikika chowona chimawonjezeka katatu. Chifukwa chake, ndikofunikira kuyang'anira mkazi atabereka. Patatha masabata 6 chibadwire, kuphunzira za momwe zimapangidwira thupi la mayi ndizovomerezeka. Ngati palibe kusintha komwe kumachitika, chiwongolero chimaperekedwa kamodzi pazaka zitatu, ndipo ngati vuto la kusokonekera kwa glucose - kuperekedwa kwa malingaliro olimbitsa thupi ndikuwonetsetsa kamodzi pa chaka.

Potere, onse omwe ali ndi pakati mtsogolo ayenera kukonzekera bwino.

Kodi matenda ashuga owopsa ndi ati?

Kuopsa kwa matendawa ndi kawiri. Choyamba, muyenera kukumbukira za momwe thupi la wodwalayo limakhudzira. Chofunika kwambiri ndi momwe mwana amakhudzidwira. Matenda a shuga m'mimba mwa mayi wapakati amatha kuyambitsa gestosis (toxosis yokhala ndi pakati), preeclampsia syndrome (kuthamanga kwa magazi ndi vuto laimpso). Kupanda kutero, matenda ashuga osokoneza bongo sawopseza amayi. Miyezo yodziwika ndi shuga panthawi yomwe muli ndi pakati nthawi zambiri simakhala yotalikirapo kuposa mtundu wa 2 shuga, ndipo kubereka ndi nthawi yochepa pomwe mavuto osautsa, nthawi zambiri amakhala osakhudzika. Koma ngati simukumana ndi chithandizo cha matenda amishuga, ndiye kuti pamakhala vuto ngati kusokonezeka kwa matenda ashuga 2. Ndipo ichi ndi matenda omwe angasokoneze munthu moyo wake wonse, ndipo kuchokera pamenepo sichingavute kuchotsedwa.

Zotsatira za mwanayo

Koma vuto lalikulu limakhudzidwa ndi mwana wosabadwayo. Chowonadi ndi chakuti glucose imayenda momasuka kwa icho kudzera mu chotchinga chachikulu. Kumayambiriro kwa kutenga pakati, mwana wosabadwayo sanadzipange kapamba kake komwe. Chifukwa chake, ma cell a pancreatic beta a amayi amagwira ntchito modabwitsa, kudzipanga insulin ya iwo eni ndi mwana. Popita nthawi, zinthu zimasintha, chifukwa pamapeto pa mimba, maselo omwe amapanga insulin a mwana amayamba kugwira ntchito. Komabe, ngati pali shuga wambiri m'magazi a mwana wosabadwayo, ndiye kuti amagwira ntchito mopitirira muyeso. Zotsatira zake, mwana akhanda amatha kukhala osakwanira ndi matenda a shuga 1.

Kuchuluka kwa shuga woperekedwa kwa mwana wosabadwa kungayambitse zovuta zina. Glucose wambiri wotereyu amasinthidwa kukhala minofu ya adipose, ndipo unyinji wa mwana umayamba kuchuluka kuposa momwe zimakhalira. Amatha kukulitsa ziwalo zina za thupi, pomwe zina zimakhalabe zabwinobwino. Ndipo izi zikuwopseza mayi ndi kubereka kovuta, ndi mwana ndi vuto lakubala. Zovulaza zowopsa ku chigaza ndi msana. Nthawi zina mayi woyembekezera sangaberekepo mwana payekha, ndipo amayenera kukhala ndi gawo la cesarean. Zotupa zoterezi pakukweza kwa mwana wosabadwayo monga kuchepa kwa magazi, kupangika kwa mtima, kugaya kwam'mimba, komanso kusapezeka kwa zochita (chinthu chomwe chimateteza kupuma). Chifukwa chake, kufa kwa ana akhanda obadwa ndi amayi omwe ali ndi matenda osokoneza bongo kumachulukirachulukira.

Kuphatikiza apo, kwa mwana wakhanda, mimba yolemedwa ndi GDM imakhala ndi:

• kuphwanya kuchuluka kwa thupi,
• kutupa kwa minofu,
• jaundice
• hypoglycemia.

Kuzindikira matenda ashuga mwa amayi apakati

Zizindikiro za matenda amiseche omwe amaphatikizidwa ndi kusintha kwa mahomoni m'thupi nthawi zambiri amayamba kuonekera osati pambuyo pokhazikika kwa amayi, koma kuyambira sabata la 20. Zowona, ngati mayi woyembekezera wabisala shuga m'mimba m'mimba asanabadwe, ndiye kuti zingathenso kusokoneza kukula kwa mwana wosabadwayo.

Pali njira imodzi yokha yodziwira kupezeka kwa matenda a shuga - kuyezetsa magazi kwa shuga. Zoonadi, panthawi yokhala ndi pakati, zizindikiro za matenda a shuga zimatha kusakhalapo, popeza pali kuchuluka kochepa kwambiri kwa shuga m'magazi. Ndipo ngati zizindikiro zilipo (mwachitsanzo, ludzu, kukodza pafupipafupi, kutopa, kuyabwa pakhungu, chilakolako chokwanira), ndiye kuti amapatsidwa chiwonetsero cha toxicosis, vuto la kadyedwe, kusintha kwa ma horoni, nkhawa, ndi zina zambiri.

Kuti mupeze matenda ashuga oyambika mwa amayi apakati, kuyezetsa magazi kwa shuga ndikofunikira. Kuyesedwa kwa shuga panthawi ya pakati nthawi zambiri kumachitika katatu. Nthawi yoyamba - kulembetsa, chachiwiri - mu trimester yachiwiri (mkati mwa sabata la 24-28), chachitatu - atatsala pang'ono kubadwa. Ngati zizindikiro zoyeserera sizili zofananira, kuyezetsa kwachiwiri kumachitika.

Magazi amatengedwa pamimba yopanda kanthu m'mawa. Tisanayesedwe, tifunika kupewa kuchita masewera olimbitsa thupi, kumwa mankhwala.

Magazi a shuga panthawi ya pakati nthawi zambiri amatengedwa kuchokera m'mitsempha, chifukwa zotsatira zomwe zimapezeka pazomenyera chala sizimasintha.

Mtengo wa glucose kwa amayi apakati ndi wochepera 5.1 mmol / l. Ndi zizindikiro za 5.1-7.0 mmol / l, GDM imapezeka. Ndi kupatuka kwakukulu kuchokera pazizolowezi (zopitilira 7.0 mmol / l), pali chifukwa chokayikira chiwonetsero (i.e., chopezeka koyamba) mtundu wa 2 shuga.

Kuphatikiza apo, kuyesedwa kwa glucose kungachitike. Ndi kuyesedwa uku, wodwalayo amapatsidwa kapu ya glucose (nthawi zambiri 75 g ya glucose pa 300 g yamadzi) pamimba yopanda kanthu ndipo kuyezetsa magazi kumachitika pambuyo pa maola 2. Nthawi imeneyi, wodwalayo amapatsidwanso chakudya, zakumwa, komanso masewera olimbitsa thupi. GDM imapezeka pamitengo yoposa 8.5 mmol / L.

Mayeso ena a shuga:

• glycated hemoglobin
• mafuta m'thupi
• shuga mkodzo
• kuyesa kwamwazi wamagazi,
• kusanthula kwa mkodzo malinga ndi Nechiporenko,
• kusanthula kwa kuchuluka kwa mahomoni achikazi.

Ultrasound ndi CT ya mwana wosabadwayo, plopental dopplerography amathanso kuchitidwa.

Zakudya za matenda ashuga

Komabe, amayamba kugwiritsa ntchito mankhwala a insulini pokhapokha ngati njira ina yochizira, kudya, singagwire ntchito. Monga mitundu ina ya shuga, cholinga chazakudya za GDM makamaka kutsitsa glucose wamagazi. Zakudya "zofewa" zokha ndizomwe zimaloledwa, ndizoletsa pang'ono zamafuta, chifukwa pali chiopsezo chowonjezereka cha ketoacidosis, chomwe chingayambitse zakudya zopanda chakudya. Tisaiwale kuti kukula kwa mwana wosabadwayo kuyenera kukhala kwabwinobwino, chifukwa cha ichi ayenera kulandira michere yonse yofunikira. Chifukwa chake, chakudyacho chikuyenera kukhala chokwanira.

Confectionery, shuga, maswiti, makeke okoma, zipatso zomwe zimakhala ndi shuga wambiri, zipatso zotsekemera, zinthu zomwe zimakhala ndi mafuta okwanira - margarine ndi mbale zomwe zimapangidwira, zakumwa zotsekemera (kuphatikiza khofi ndi tiyi ndi shuga) ndizoletsedwa. Pasitala, mbatata (ngakhale yophika) ziyenera kukhala zochepa. Kuchokera ku nyama ndi nkhuku ndikofunika kusankha mitundu yamafuta ochepa (nyama yamkati, Turkey). Ndikulimbikitsidwa kuwonjezera zakudya zamafuta ambiri, makamaka masamba.

Kudya tsiku ndi tsiku kwa caloric sikuyenera kupitirira 1800 kcal. Chiwerengero choyenera cha mafuta, mafuta ndi mapuloteni ndi 45%, 30% ndi 25%. Muyenera kumwa mokwanira - osachepera malita 1.5 patsiku.

Zakudya ndizofunikanso. Payenera kukhala pafupipafupi komanso pang'ono pang'onopang'ono (zakudya zitatu zazikuluzikulu ndi zitatu zazinkhanira), osakudya kwambiri.

Pankhani ya hypoglycemia (kwa iwo omwe akupatsidwa mankhwala a insulin), timalimbikitsidwa kukhala ndi zotsekemera, mwachitsanzo, apulo kapena botolo lamadzi, zomwe zingathandize kubwezeretsa shuga kukhala yabwinobwino.

Kuyang'anira kwa adotolo

Chithandizo cha matenda osokoneza bongo chimachitika makamaka kunyumba. Komabe, kukakamizidwa kugonekedwa kuchipatala koyeserera kumachitidwanso - mu trimester yoyamba, pa sabata la 19-20 ndi 35-36. Pankhaniyi, mkhalidwe wa mayi ndi mwana wake wakhanda wakhazikika.

Wodwala amayenera kuperekera mkodzo nthawi ndi nthawi kuti adziwe zomwe zili m'matumbo a ketone. Kukhalapo kwa matupi a ketone kumatanthauza kuti pali kuwonongeka kwa matendawa.

Mimba ndi matenda ashuga ziyenera kuyang'aniridwa ndi dokotala. Pachifukwa ichi, ndikofunikira kukaonana ndi gynecologist ndi endocrinologist kamodzi pa masabata awiri kapena kamodzi pa sabata ndikulipira matenda a shuga.

Kudziletsa

Tiyenera kukumbukira kuti kugwiritsa ntchito insulin kumatanthauza kudziyang'anira pawokha ndi wodwala. Ndiye kuti, mayi woyembekezera ayenera kuyang'anira kuchuluka kwa shuga m'magazi masana. Ndikulimbikitsidwa kuti muchite izi nthawi zosachepera 7 patsiku (ola limodzi ndi ola limodzi mutatha kudya kadzutsa, nkhomaliro ndi chakudya chamadzulo, komanso musanagone). Kupanda kutero, pamakhala chiopsezo chachikulu cha mikhalidwe ya hypoglycemic. Ngati wodwalayo amangodya, ndiye kuti glucose amayeza pamimba yopanda kanthu m'mawa ndi ola limodzi atatha kudya.

Kuphatikiza apo, ndikofunikira kuyang'anitsitsa kuthamanga kwa magazi, kulemera kwa thupi.

Masewera olimbitsa thupi

Wodwala yemwe ali ndi matenda osokoneza bongo amatha kuthandizidwa kuchita masewera olimbitsa thupi omwe amathandizira kuwotcha shuga wambiri komanso kuchepetsa thupi. Komabe, ziyenera kukumbukiridwa kuti kubereka sikulola masewera aliwonse ovuta, chifukwa amatha kukhala owopsa kwa mwana wosabadwa. Masewera olimbitsa thupi salimbikitsidwanso.

Ngati chithandizo choyenera chimaperekedwa, ndiye kuti zotsatirapo zake zoyipa sizimapezeka. Kubadwa kwa mwana mu shuga nthawi zambiri kumayenda bwino, koma mavuto osiyanasiyana samathetsedwa. Ngati ndi kotheka, kubadwa koyambirira, gawo la cesarean.

Odwala ambiri amalola matendawa popanda zotsatirapo ndikuchotsa matenda ashuga nthawi yomweyo mimba ikatha. Komabe, GDM ndi belu lochititsa mantha lomwe likuwonetsa chiwopsezo chachikulu (choposa 50%) cha chitukuko cha matenda ashuga amtundu wa m'tsogolo (pazaka 15 zikubwerazi).Izi ndizofunikira makamaka kwa azimayi omwe amawunika kulemera kwawo pang'ono ndikukhala ndi mapaundi owonjezera. Komabe, nthawi zina GDM pambuyo pobadwa mwana imakhala yodzaza matenda a shuga 2. Izi zimachitika mu 10% ya odwala. Zomwe sizimawonekera kwambiri ndikusintha kwa matenda ashuga amtundu wa matenda amtundu woyamba. Mimba ikadzachitikanso, ndiye kuti mwanjira yayitali padzakhalanso kuyambanso kwa GDM.