Matenda a shuga okhudzana ndi pakati komanso malingaliro apakati: mayendedwe azachipatala, njira zamankhwala othandizira komanso kupewa

Matenda a shuga mellitus (DM) amatanthauza gulu la matenda omwe amapezeka ndi vuto la insulin secretion, insulin, insulin, kapena kuphatikiza kwa zinthuzi, komwe kumayendetsedwa ndi hyperglycemia. Matenda A Type I a shuga ndi matenda obwera chifukwa cha matenda a shuga. Ndi matenda a autoimmune omwe amayamba chifukwa cha virology etiology kapena zina zomwe zimapangitsa kuti chilengedwe chizikhala chovuta kwambiri. M'mitundu ina ya matenda ashuga amtundu wa I, palibe umboni wotsimikiza wa chikhalidwe cha autoimmune ndipo matendawa amatchedwa idiopathic. Matenda A shuga a Type I amathanso kuchitika mwa anthu onenepa kwambiri kapena onenepa kwambiri.

Kukula kwa mtundu woyamba wa II komanso mtundu wachiwiri wa matenda ashuga pakati pa azimayi amsinkhu wobereka ku Russia ndi 0.9-2%. Matenda a shuga a pregestational amapezeka 1% ya amayi apakati, mu 1-5% ya matenda osokoneza bongo omwe amapezeka kapena matenda a shuga amawonekera.

Malinga ndi World Health Organisation (WHO) Global Diabetes Report ya 2016 2, 16, mchaka cha 2014, anthu miliyoni 422 miliyoni amadwala matenda ashuga padziko lonse la shuga, omwe ndi okwera kanayi kuposa deta yofananira kuyambira 1980 - 108 miliyoni. Kuchulukitsa kwa anthu odwala matenda ashuga mwina kumachitika chifukwa cha kuchuluka kwa kunenepa kwambiri kapena kunenepa kwambiri, ndalama zochepa kapena zapakati mdziko muno. Mu 2012, kuchuluka kwa shuga m'magazi poyerekeza ndi komwe kunayambitsa kufa kwa miliyoni 2.2, matenda ashuga - 1.5 miliyoni. DM, mosasamala mtundu, ingayambitse matenda a mtima, stroke, kulephera kwa impso, kudula mwendo, kuwonongeka kwa masomphenya ndi kuwonongeka kwa mitsempha, kumawonjezera chiopsezo chonse cha kufa msanga. Kusalipidwa kwathunthu kwa matenda ashuga panthawi yomwe ali ndi pakati kumawonjezera mwayi wa kufa kwa fetal komanso kukula kwa zovuta zambiri 2, 16.

Kuyang'anira matenda a glycemic ndiye chiopsezo chofunikira kwambiri pakubereka, kubadwa kwa pathupi komanso kufa kwa amayi mwa mtundu wa II ndi matenda ashuga II. Zotsatira zopsinja mtima kwambiri mwa azimayi omwe ali ndi matenda amtundu wa I.

DM panthawi yapakati imawonjezera mwayi wokhala ndi vuto la kunenepa kwambiri kapena mtundu II matenda ashuga mwa ana 2, 16. Malinga ndi American Association of Clinical Endocrinologists ndi American College of Endocrinology - AACE / ACE (2015), akhazikitsidwa ubale womwe ulipo pakati pa kuchuluka kwa shuga m'magazi a mayi wapakati komanso kulemera kwa wakhanda, pafupipafupi kwa macrosomia wa fetal ndi kubereka kudzera mwa gawo la cesarean. National Institute for Health and Care Excellence (NICE), buku lamankhwala la amayi oyembekezera omwe ali ndi matenda ashuga, likugogomezera kuti ngakhale chiwopsezo chakubereka kawiri konse chokhala ndi mwana yemwe ali ndi vuto lotayika, kupitilira kwa kubereka kwa amayi omwe ali ndi matenda ashuga ndi mwana wake wosabadwa wasakanizidwa ndipo ikhoza kuwonetsedwanso. Lipotilo la WHO (2016) likuwonetsanso kuti shuga yosalamulirika panthawi yomwe ali ndi pakati imatha kukhala ndi vuto pa mayi ndi mwana wosabadwayo, zomwe zimawonjezera chiwopsezo cha kutayika kwa mwana wosabadwa, kusokonezeka kwa kubereka, kubereka mwana, kubereka kwa pang'onopang'ono, zovuta zakubadwa komanso kusabereka kwa amayi. Komabe, sizikumveka bwino kuti kuchuluka kwa kubadwa kovuta kapena kufa kwa amayi ndi ana komwe kungagwiritsidwe ntchito ndi hyperglycemia 2, 16.

Chinsinsi chokwaniritsa zotsatira za kubereka komanso kubereka kwa mayi ndi mwana wosabadwayo zimaperekedwa pakuwongolera matenda a metabolic (kunenepa kwambiri), kulipira mtundu uliwonse wa matenda osokoneza bongo a shuga, upangiri wokhazikika kwa amayi omwe ali ndi matenda a shuga 1, 4, 6, 13, 18. , kukwaniritsa mipherezero ya glycated hemoglobin (HbA1c), ndipo azimayi omwe ali ndi chiopsezo cha matenda osokoneza bongo amalimbikitsidwa kuti ayese mayeso okhudzana ndi glucose pakamwa 1, 3, 4, 20.

Ngakhale izi, pafupipafupi upangiri wamalingaliro sunakhale wokwera. Chifukwa chake, malinga ndi Fernandes R.S.et al. (2012), ndi azimayi 15,5% okha omwe ali ndi matenda a shuga omwe adakonzekera kukhala ndi pakati ndikukonzekera, kuwonjezera apo, 64% adafunsidwa koyamba pa milungu 10 ya mimba.

Madokotala a endocrinologists amalimbikitsa kukonzekera kubereka kwa mayi yemwe ali ndi matenda ashuga, omwe amaphatikizapo: kulera koyenera asanamalize kuyesa koyenera ndikukonzekera kutenga pakati, maphunziro ku sukulu ya shuga, kudziwitsa za zoopsa zomwe zingachitike kwa mayi ndi mwana wosabadwayo, ndikulipira chindapusa cha matenda ashuga m'miyezi 3-4 lingaliro lisanachitike (kuthamanga kwa plasma glucose / musanadye zosakwana 6.1 mmol / L, shuga wa plasma maola 2 mutatha kudya zosakwana 7.8 mmol / L, HbA ochepera 6.0%).

Malinga ndi malingaliro aku Britain, kwa amayi omwe ali ndi matenda a shuga a mtundu woyamba omwe akukonzekera kukhala ndi pakati, mphamvu za shuga zomwe zimakhala m'magazi am'magazi ziyenera kukhala mkati mwa 5-7 mmol / L pamimba yopanda kanthu komanso 4-7 mmol / L musanadye masana.

Mpaka pano, pali zosokoneza pakuwona kufunika kwa njira zina. Chifukwa chake, boma la Russia likugwirizana "Gestationalabetes mellitus: diagnostic, chithandizo, kuwunika pambuyo pake", yomwe idakhazikitsidwa ku Russia (2012), imati mayi wapakati akangofika kukaonana ndi dotolo wamtundu uliwonse kwa milungu 24 ya mimba (gawo loyamba la mayeso), ndizovomerezeka imodzi mwamafukufuku awa iyenera kuchitidwa: kutsimikiza kusala venous plasma glucose kapena glycated hemoglobin (HbA1c.). Buku la 2015 AACE / ACE Clinical Practice Guide likuti chifukwa cha kusintha kwa thupi chifukwa cha pakati komwe kungakhudze glycated hemoglobin, A1C sayenera kugwiritsidwa ntchito poyeza kapena kupima matenda a GDM.

Ku Russia, azimayi omwe ali ndi matenda a shuga a mtundu woyamba a nthawi yovutikira amalimbikitsidwa: kuwongolera kuthamanga kwa magazi (BP), kulingalira za mapikisheni ngati osapitirira 130/80 mm Hg. Art., Yokhala ndi matenda oopsa - kukhazikitsidwa kwa antihypertensive mankhwala (kusiya kwa ACE zoletsa mpaka kuthetsedwe kwa kugwiritsa ntchito njira za kulera). Komabe, kutsatira malingaliro a American Diabetes Association (2015), ndikofunikira kulingalira 110-129 mm Hg monga zomwe zikuwonetsera zomwe zimayambitsa kuthamanga kwa magazi panthawi yapakati yovuta ndi matenda ashuga kapena matenda oopsa. Art., Diastolic - 65-79 mm RT. Art. Komabe, kuthamanga kwa magazi kumatha kuphatikizidwa ndi kusokonekera kwa fetal kukula. Kuthamanga kwa magazi kwa systolic kumakhala kochepera 118 mm Hg. Art. kuthamanga kwa magazi kwa diastolic - 74 mm RT. Art. safuna poika mankhwala a antihypertensive.

Asanakhale ndi pakati, ndikofunikira kudziwa mtundu wa TSH komanso T4 yaulere, AT kwa TPO mwa amayi omwe ali ndi matenda a shuga a I chifukwa cha chiwopsezo cha matenda a chithokomiro, kutenga folic acid (500 mcg patsiku), potaziyamu iodide (250 mcg patsiku), chithandizo cha retinopathy , nephropathy, kusiya kusuta. Ndi HbA1c mulingo woposa 7%, nephropathy yayikulu yokhala ndi serum creatinine yoposa 120 μmol / L, GFR yochepera 60 ml / min / 1.73 m 2, proteinuria tsiku lililonse ≥ 3.0 g, matenda oopsa osasinthika, kuchuluka kwa retinopathy komanso maculopathy pamaso laser coagulation wa retina, pachimake ndi kuchulukitsa kwa matenda opatsirana otupa ndi yotupa (mwachitsanzo, chifuwa chachikulu, pyelonephritis) - mimba ndi osafunika.

Mwa amayi omwe ali ndi matenda a shuga a mtundu woyamba, kuyezetsa magazi mosiyanasiyana kumayesedwa ndi chiopsezo chokhala ndi neuro-, nephro-, retinopathy, ndi zina zambiri asanakhale ndi pakati.

Mwachitsanzo, mwayi wokhala ndi matenda ashuga a m'mimba ogwidwa kunja kwa mimba ndiwokwera kwambiri kotero kuti AACE / ACE (2015) kwa odwala ochepera zaka 30 pambuyo pa zaka 5 atazindikira koyamba mtundu wa matenda a shuga a mtundu wa II ndikulemba mtundu wa II matenda a shuga komanso odwala omwe ali ndi zaka zopitilira 30 atadwala matenda a shuga a I mulingo wa plasma creatinine, kuchuluka kwa kusefera kwa msambo ndi albumin mkodzo wowunika munthawi yake ndikuwunika gawo la matenda ashuga nephropathy, kukula kwake.

Ndi isanayambike mimba, ndikofunikira kutsatira njira zina zamtundu wa glycemic. Mwachitsanzo, ku UK, m'mbuyomu, mu malingaliro a Nice, mipherezidwe ya glucose yachangu idawoneka kuti ndi yamtengo pakati pa 3.5 - 5.9 mmol / L, yomwe mu 2015 idasinthidwa ndikufika pamimba yopanda kanthu - pansi pa 5.3 mmol / L (4-5.2 mmol / L pankhani ya insulin) , Ola limodzi mutatha kudya - 7.8 mmol / L.

Pazotsatira zam'nyumba za matenda amtundu wa shuga, matenda a glycemic omwe ali pompo ndi otere: Madzi a m'magazi a glucose ayenera kukhala pamimba yopanda chakudya / pogona / maola atatu osakwana 5.1 mmol / l, ola limodzi mutatha kudya osakwana 7.0 mmol / l, HbA1c mtengo sayenera kupitirira 6.0%.

Mu National Guide "Obstetrics" (2014), njira zoyenera kuperekera chindapusa cha matenda ashuga panthawi ya bere ndi izi: kusala glycemia 3.5-5.5 mmol / l, atatha kudya glycemia 5.0-7.8 mmol / l, glycated hemoglobin ochepera 6, 5%, yomwe iyenera kutsimikizika nthawi iliyonse ya mimba.

Zovuta zomwe zimakhudzana ndi matenda a shuga a mtundu wa I pa nthawi yapakati zimaphatikizidwanso ndi chiopsezo chokhala ndi hypoglycemia mu trimester yoyamba yamimba. Hypoglycemia imatha kubweretsa kukula kwa intrauterine.

Maupangiri azachipatala a kasamalidwe ka amayi omwe ali ndi matenda a shuga a mitundu yosiyanasiyana 3, 4, 7-11, 15, 20, 24, 25 amasinthidwa pafupipafupi mdziko lapansi mu chaka cha 2015, njira zothandizira kupewa, kuzindikira ndi kuchiza matenda ashuga zinapangidwanso ku Russia ndikulandila Ma algorithms othandizira odwala mwapadera odwala matenda a shuga. " Zinanenedwa kuti pakati pathupi lomwe limayambika chifukwa cha matenda ashuga limakhudzana ndi zoopsa zokhudzana ndi thanzi la mayi ndi fetus (kufera kwam'mimba, kusokonezeka kwatsopano, zovuta zamkati). Kwa mwana wobadwa kwa mayi yemwe ali ndi matenda ashuga, chiopsezo chotenga matenda amtundu wa shuga m'moyo wotsatira ndi 2%. Ndizodziwikanso kuti ngati bambo a matenda a shuga amtundu wanga ndili nawo, chiwopsezo chimenecho chitha kufikira ana 6%, pamaso pa matenda a shuga a makolo onse awiri - 30- 35%.

DM imatha kuyambitsa matenda ashuga a fetopathy (DF). DF ikhoza kukhala yamitundu iwiri. Mtundu woyamba ndi hypotrophic, wowerengera wa 1/3 wa DF yonse, ndi zotsatira za angiopathy, hyalinosis ya ziwiya zazing'ono za placenta ndi ziwiya za mwana wosabadwayo, chifukwa cha momwe zimachitika kuti mwana wamunthu wosabadwayo aberekera, kukula kwa fetal, zolakwika za kukula. Mtundu wachiwiri wa DF ndi hypertrophic; umayamba mwa amayi apakati omwe amakhala ndi vuto la hyperglycemia, pakalibe zovuta za mtima. Macrosomy imayendera limodzi ndi kusakhazikika kwakukuru kwa wakhanda. DF mu makanda ndimomwe imayambitsa kusokonezeka koyambirira kwa neonatal.

Malinga ndi malingaliro aku Britain kuyambira 2015, nthawi yoperekera kwa amayi omwe ali ndi mitundu I ndi II matenda ashuga amatha kufikako kuchokera pa masabata 37 + 0 mpaka masabata 38 + 6, ndi GDM - imatha kupitilira masabata 40 + 6 pakalibe zovuta. Russian endocrinologists amakhulupirira kuti nthawi yoyenera kubereka ndi masabata 38 mpaka 40, njira yoyenera yoberekera imaberekera kudzera mu ngalande yachilengedwe yobadwa nawo pang'onopang'ono kuwunika kwa glycemia, ataberekanso. National Guide "Obstetrics" (2015) ikuti mtundu uliwonse wa matenda ashuga, nthawi yoyenera kwambiri yobereka imakhala milungu 37- 38 yam'mimba, ndipo amakonda kubala mwana kudzera mu ngalande yakubadwa.

Amayi omwe ali ndi matenda ashuga amafunikira njira zapadera atabereka. Kuyesedwa kwa postpartum. Pambuyo pake, tanthauzo la HbA1c NICE, 2015 likulimbikitsidwa. Mosiyana ndi malingaliro a 2008, amayi omwe ali ndi matenda a shuga a I nawonso alimbikitsidwa, pakalibe zovuta, kutumiza kwaumwini ndi gawo la antchito kapena gawo la cesarean ngati akuwonetsa.

Russian endocrinologists achenjeza kuti kuyambira tsiku loyamba la kubadwa pambuyo pake (pambuyo pa kubadwa) pali kuchepa kwakukulu kwa kufunika kwa insulin, komwe kumafunikira kusankha kwamomwe Mlingo wake (ndi 50% kapena kupitirira), womwe ungafanane ndi Mlingo womwe umagwiritsidwa ntchito asanakhale ndi pakati. Kuchulukitsa kwambiri kwa mkaka wa m'mawere kumagwirizanitsidwa ndi kuchepa kwa glucose othamanga komanso kuchepa kwa insulin masabata 6-9 pambuyo pake, kusintha kwa insulin. Lactation imatha kukhala ndi zotsatira zabwino pa glucose metabolism komanso sensulin insulin, yomwe imatha kuchepetsa chiwopsezo cha matenda ashuga pambuyo pa kutenga pakati kwa GDM (ERICA P. GUNDERSON, 2012, American Diabetes Association, 2015) 6, 17. Pamaso pa matenda a shuga a mtundu wa I, kuyamwa kumatha kumayendetsedwa ndi hypoglycemia pambuyo pake. zomwe mkaziyo ayenera kudziwitsidwa, ndipo glycemia iyenera kuyang'aniridwa.

Mu 1995, Chew E.Y. ndi kuyimba adaona kuti mwadzidzidzi zolimba glycemic zingayambitse kuwonongeka kwa retinopathy. Mimba ndi njira yotsimikiziridwa yothandizira kupitirira kwa retinopathy, chifukwa chake, kuyang'ana kwamaso kwa mayi yemwe ali ndi matenda ashuga kuyenera kuchitika mobwerezabwereza panthawi yapakati komanso mkati mwa chaka 1 atabereka.

Pambuyo pobereka, kulera kumawonekera osachepera zaka 1.5. Kuletsa kubereka kumasonyezedwa kwa azimayi oyembekezera omwe ali ndi zaka zakubadwa omwe ali ndi matenda ashuga omwe amamwa mankhwala omwe ali ndi zoopsa zozungulira (angiotensin-converting enzyme inhibitors, statins, etc.). Udindo wofunikira umaperekedwa ku njira zophunzitsira popewa kukhala ndi pakati osayenerera pamaso pa achinyamata ndi achinyamata. Kusankha kwa kulera kumatengera zomwe mkazi amakonda komanso kupezeka kwa zotsutsana. Malinga ndi malingaliro a 2015 Nice, azimayi omwe ali ndi matenda ashuga amatha kugwiritsa ntchito njira zakulera pakamwa.

Chifukwa chake, matenda a shuga a Type I amafunikira abetetrician-gynecologists, endocrinologists ndi neonatologists kuti asinthe maphunziro awo nthawi zonse, kukhazikitsa njira zatsopano zopewera, kuzindikira komanso kuchiza zovuta zomwe zimayambitsidwa ndi matenda ashuga limodzi ndi pakati.

Kuzindikira ndi kuzindikira njira

Nthawi zambiri, omwe amawaganizira kuti ali ndi shuga amapezeka theka lachiwiri lokhala ndi pakati. Komanso, izi zimasowa kwathunthu mwana akabadwa.

Mzimayi amatha kubereka mwana, pomwe akuchita kuphwanya kagayidwe kazakudya. Ndiye muyenera kuchita chiyani mutazindikira kuchuluka kwa shuga?

Mulimonsemo, cholinga cha mankhwalawa ndi chimodzimodzi - kusunga kuchuluka kwa shuga pamlingo woyenera. Izi zidzakuthandizani kuti mubereke mwana wathanzi kwathunthu. Kodi mungazindikire bwanji chiopsezo chogonana kwabwino kuti apatsidwe shuga? Izi zitha kupangitsa kuti mayi akhale woyembekezera.

Ngakhale pakukonzekera kubadwa kwa mwana wosabadwa, mkazi payekha amatha kuyesa kuchuluka kwa chiwopsezo cha matenda ashuga:

1. kukhalapo kwa mapaundi owonjezera kapena kunenepa kwambiri (msungwana aliyense payekha amatha kuwerengera cholembera chake)
2. Kulemera kwa thupi kwakula kwambiri pambuyo pa ukalamba,
3. mkazi woposa zaka makumi atatu
4. pathupi pakale panali matenda a shuga. Madokotala adapeza kuchuluka kwa shuga mu mkodzo. Chifukwa cha izi, mwana wamkulu kwambiri wabadwa.
5. pali abale omwe ali ndi vuto lalikulu la carbohydrate metabolism,
6. polycystic ovary syndrome.

Kodi matenda ashuga ammimba amadziwika bwanji? Amayi onse kuyambira pa 23 mpaka sabata la 30 la kubereka amapatsidwa mayeso apadera a kulolerana kwa glucose. Kuphatikiza apo, mkati mwake, shuga amayesedwa osati pamimba yopanda kanthu komanso maola ochepa, komanso pambuyo mphindi zowonjezera 50 atatha kudya.

Izi ndi zomwe zimatilola kudziwa kukhalapo kwa mtundu wa matenda ashuga omwe mukufunsidwa. Ngati ndi kotheka, dokotala amapereka malangizo ena okhudza chithandizo.

Kutanthauzira kwa mayeso am'magazi a pakamwa kuti mupeze matendawa:

1. pamimba yopanda kanthu, shuga azikhala mpaka 5 mmol / l,
2. patatha ola limodzi - ochepera 9 mmol / l,
3. patatha maola awiri - osakwana 7 mmol / l.

Mwa amayi omwe ali ndi mwayi wosangalatsa, kuchuluka kwa shuga mthupi pamimba yopanda kanthu kuyenera kukhala kwabwinobwino. Chifukwa cha izi, kuwunika kochitika pamimba yopanda kanthu sikolondola komanso molondola.

Matenda a shuga panthawi yoyembekezera

Matenda a shuga mellitus pa nthawi ya pakati ndi gulu la matenda a metabolic omwe amadziwika ndi hyperglycemia yomwe imayamba chifukwa cha zolakwika mu secretion ya insulin, zotsatira za insulin, kapena zonsezi. Matenda a hyperglycemia odwala matenda ashuga amatsogolera pakugonjetsedwa ndikukula kwa ziwalo zosiyanasiyana, makamaka maso, impso, mitsempha ndi mtima.

Maupangiri azachipatala a matenda a shuga

Amapereka chidziwitso choyambira chazomwe zimapangidwira matenda ndi matenda amiseche. Ngati mayi yemwe ali ndi vutoli wapezeka ndi matendawa, ndiye kuti amayamba kupatsidwa zakudya zapadera, zolimbitsa thupi zokwanira ndipo amalangizidwa kuyeza magazi ake pafupipafupi kangapo tsiku lililonse.

Izi ndi mfundo za kuchuluka kwa shuga wa m'magazi omwe amafunikira kuti azisamalidwa panthawi yopaka:

1. wopanda m'mimba - 2.7 - 5 mmol / l,
2. ola limodzi mutatha kudya - osakwana 7.6 mmol / l,
3. itatha maola awiri - 6.4 mmol / l,
4. musanagone - 6 mmol / l,
5. nthawi kuyambira 02:00 mpaka 06:00 - 3.2 - 6.3 mmol / l.

Ngati zakudya zoyenera komanso zolimbitsa thupi sizithandiza kwenikweni kubwezeretsa shuga m'thupi, ndiye kuti mkazi yemwe ali ndi chidwi amatha kupatsidwa jakisoni wa ma pancreatic hormone. Ndi mtundu wanji wa mankhwala omwe angasankhe - ndi dokotala yekha amene amasankha.

Epidemiology

Malinga ndi magwero osiyanasiyana, kuyambira 1 mpaka 14% ya amayi onse apakati (kutengera kuchuluka kwa anthu omwe aphunzira ndi njira zodziwonera) omwe ali ovuta kwambiri ndi matenda amisala.

Kukula kwa matenda amtundu 1 ndi mtundu wachiwiri wa ashuga mwa azimayi amisinkhu yosabereka ndi 2%, mu 1% ya amayi onse apakati omwe mayiyo amakhala ndi matenda ashuga, mu 4.5% ya omwe amadwala matenda ashuga amakula, kuphatikizapo 5% ya omwe amadwala matenda a shuga matenda ashuga.

Zomwe zimayambitsa kukula kwa fetal ndi macrosomia, hypoglycemia, kubereka kwakusintha, kupuma kosalephera, hyperbilirubinemia, hypocalcemia, polycythemia, hypomagnesemia. Pansipa pali gulu la P. White, lomwe limadziwikitsa kuthekera kwa kubadwa kwa mwana wakhanda, kutengera kutalika ndi vuto la shuga la amayi.

• Kalasi A. Kulekerera kwa glucose komanso kusowa kwa zovuta - p = 100,
• Kalasi B. Kutalika kwa matenda ashuga osakwana zaka 10, kudayamba zaka zapakati pa 20, palibe zovuta zam'mimba - p = 67,
• Kalasi C. Kutalika kuyambira pa 10 mpaka Schlet, yomwe idakwera zaka 10 mpaka 19, palibe zovuta zamagazi - p = 48,
• Class D. Kutalika kwa zaka zopitilira 20, kunachitika mpaka zaka 10, retinopathy kapena kuwerengetsa kwamatumbo a miyendo - p = 32,
• Kuwerengeredwa kwam'magawo a ziwiya za pa pelvis - p = 13,
• Class F. Nephropathy - p = 3.

Chithandizo cha mankhwala osokoneza bongo a amayi apakati

Mimba ikachitika pamene mukumwa Metformin kapena Glibenclamide, ndizotheka kutulutsa kubereka.

Mankhwala ena onse opangidwa kuti achepetse glucose ayenera kusiyidwa kapena kusinthidwa ndi insulin.

Pankhaniyi, ndikofunikira kuti mutenge kokha mahomoni a pancreatic a chiyambi chopanga. Chiri chololedwa kugwiritsa ntchito insulini kukonzekera kwa nthawi yochepa komanso yapakatikati, nthawi yochepa komanso yochepa yokhudzana ndi insulini yolimbikitsidwa ndi adokotala.

Mankhwala abwino ochepetsa shuga

Mankhwala ochepetsa shuga omwe amapangidwira pakamwa sayenera kugwiritsidwa ntchito panthawi ya bere.Amayi omwe ali ndi maudindo amayenera kusamutsidwa kupita ku insulin.

Pa matenda ashuga amtunduwu, insulin ndiye golide. Homoni wa pancreatic amathandiza kusunga glycemia pamlingo wovomerezeka.

Chofunika kwambiri: insulini siyitha kudutsa placenta. Mu shuga, monga lamulo, insulin yayikulu imasungunuka, yochepa.

Itha kupangidwira kupangidwanso mobwerezabwereza, komanso kulowetsedwa kosalekeza. Amayi ambiri omwe ali ndi maudindo amawopa kuti atengeka ndi mahomoni. Koma wina sayenera kuchita mantha ndi izi, chifukwa izi ndizowona zosatsimikizika.

Nthawi yotsendereza kapamba itatha, ndipo thupi limapezanso mphamvu, insulin ya munthu iyambanso kupanga.

Mankhwala othandizira

Zakudya zoyenera kwa odwala matenda ashuga ndi monga:

1. muyenera kudya kasanu ndi kamodzi patsiku. Zakudya za tsiku ndi tsiku ziyenera kukhala ndi zakudya zazikulu zitatu ndi zazing'ono ziwiri,
2. ndikofunikira kusiya kotheratu kugwiritsa ntchito chakudya chopatsa mphamvu. Izi zimaphatikizapo maswiti, katundu wophika ndi mbatata,
3. Onetsetsani kuti mwayezera shuga mwanu pafupipafupi monga momwe mungathere ndi glucometer. Palibe chowawa. Izi zikuyenera kuchitika pakatha mphindi makumi asanu ndi limodzi chakudya chikatha.
4. Zakudya zanu za tsiku ndi tsiku ziyenera kukhala ndi hafu ya chakudya chambiri, gawo limodzi mwa magawo atatu a lipids athanzi komanso kotala la mapuloteni,
5. Mphamvu yonse ya kadyedwe imawerengeredwa pafupifupi 35 kcal pa kilogalamu ya kulemera kwanu koyenera.

Zochita zolimbitsa thupi

Njira yothandiza yopewa matenda ashuga ndikokwanira kuchita masewera olimbitsa thupi. Monga mukudziwa, kusewera masewera kumachepetsa chiopsezo cha kuchepa kwa thupi.

Koma azimayi omwe saleka kuchita masewera olimbitsa thupi atanyamula mwana samatengera mwayi wofanana ndi gawo limodzi mwa magawo atatu.

Zithandizo za anthu

Mankhwala osokoneza bongo athandizira kusintha kagayidwe komanso kusintha kapangidwe ka insulin.

Nayi maphikidwe abwino:

1. Choyamba muyenera kupaka ndimu yatsopano pa grater yabwino. Muyenera kupeza supuni zitatu zakunyodoyi. Muzu wa parsley wokazinga ndi adyo wowotcha uyenera kuwonjezedwa pano. Zotsatira zosakaniza ziyenera kukakamizidwa kwa sabata limodzi. Ndikofunikira kugwiritsa ntchito supuni yotsekemera katatu patsiku. Chipangizochi ndichotetezedwa kwa azimayi onyamula mwana,
2. Mutha kupanga zamasamba zatsopano kuchokera ku masamba aliwonse atsopano. Imakhutitsa thupi ndi zinthu zambiri zofunikira komanso michere yambiri, komanso imapangitsanso kupanga kwa insulin ndi kapamba.

Zizindikiro zakuchotsa mimba

Zizindikiro zakuchotsa mimbayo zikuphatikiza:

1. zotchulidwa zowopsa za mtima ndi mtima,
2. matenda ashuga nephropathy,
3. shuga yophatikizika ndi Rh factor,
4. shuga kwa bambo ndi mayi,
5. shuga wophatikizidwa ndi ischemia.

Makanema okhudzana nawo

Pazinthu zamakono pakuzindikiritsa komanso kuchitira odwala matenda amisala mu kanema:

Ngati mudadwala matenda ashuga pamimba, kenako mwana atabadwa, anasowa, ndiye kuti simuyenera kupuma. Pali mwayibe kuti mudzapezeka ndi matenda a shuga 2 pakapita nthawi.

Mwambiri, mumatha kukana insulini - kusamva bwino kwa mahomoni a kapamba. Ndipo zinaoneka kuti nthawi zonse, thupi limagwira ntchito molakwika. Ndipo pa nthawi yomwe ali ndi pakati, katundu pa iye amakula kwambiri. Chifukwa cha izi, amasiya kutulutsa insulini yoyenera.

• Imakhazikika pamisempha ya shuga kwa nthawi yayitali
• Imabwezeretsa kapangidwe ka insulin

Phunzirani zambiri. Osati mankhwala. ->

Moscow 2019

Kalatayo yachidziwitso idakonzedwa kwa a abereki-gynecologists, madokotala a ultrasound ndi akatswiri wamba.Kalatayo imaperekanso njira zoyendetsera ndi kubereka kwa azimayi omwe ali ndi vuto la matenda a shuga (GDM) nthawi yonse ya bere komanso atatha kubereka. Limodzi mwa magawo a kalatayo limagwiritsidwa ntchito pa njira ya kupimidwa kwa matenda ashuga okhudzana ndi matenda ashuga komanso kutsimikiza kwa fetal mu II-III trimester ya gestation potengera kuyesa kwa fetal kuchuluka ndi kutsimikiza kwa visceral sign of diabetesic fetopathy.

Kalatayi imagwira ntchito ngati njira yakuwongolera ma GDM, yomwe ili ndi "zida" zowunika momwe amayi apakati omwe ali ndi GDM amaperekera chithandizo.

Kapangidwe ka gulu logwira ntchito

Wolemekezeka wa Sayansi ya Russian Federation, Wophunzira wa Russian Academy of Science, Pulofesa, Doctor wa Medical Science V. Radzinsky

Pulofesa wa Russian Academy of Science, Pulofesa V.I. Krasnopolsky, Doctor of Medical Science, Pulofesa V.A. Petrukhin

Dokotala wa sayansi ya zamankhwala Startseva N.M. Chiphunzitso. wokondedwa Sayansi V.M. Guryeva, F.F. Burumkulova, M.A. Chechneva, prof. S.R.Mravyan, T.S. Budykina.

Dotolo wamkulu wa Chipatala cha Clinical No. 29 adatchulidwa pambuyo pa N.E. Bauman, Wothandizira pa Medical Science, O. Papysheva, Wachiwiri kwa Adokotala A Ostetric and Gynecological Care, Clinicical Hospital No. 29 Esipova L.N.

Wachiwiri kwa Dokotala Wachipatala 1 Chipatala cha Zachipatala dzina lake N.I. Pirogov mu Obstetrics and Gynecology, Wofunsidwa wa Medical Science Oleneva M.A.

Mutu wa 6th department of Pregnancy Pathology, City Clinical Hospital №29 Lukanovskaya OB

Obstetrician-gynecologist Cand. wokondedwa Sayansi Kotaysh G.A.

Wopangika wa Science Science T.S. Kovalenko, S.N. Lysenko, T.V. Rebrova, Ph.D. Magilevskaya, M.V. Kapustina, Doctor of Physics. - Mat.Science Yu.B. Kotov.

Gestationalabetes mellitus (GDM) ndimatenda ofala kwambiri omwe amapezeka mwa amayi apakati, omwe nthawi zambiri amakhala woyamba kukumana nawo. Kuchulukana kwake ndi 4-22% ya chiwerengero chonse cha apakati.

Chofunikira cha GDM ndi kusowa kwathunthu kwa zizindikiro zamankhwala, zomwe zimapangitsa kuti kudziwa kwakeko kuchitike ndi kuchedwa kwakukulu kapena ayi. Kusintha kwa metabolic m'thupi la amayi apakati omwe sanakhazikitsidwe komanso / kapena GDM yoyendetsedwa bwino kumayambitsa zovuta zambiri za kubereka, kubereka ndi kusokonezeka kwakukulu kwa akhanda. Pamenepa, kuyambira chaka cha 2013 ku Russia, malinga ndi malingaliro a Unduna wa Zaumoyo ku Russia Federation 15-4 / 10 / 2-9478 pa 12/17/2013, kuwunika kwathunthu kwa azimayi onse oyembekezera aperekedwa kuti asayerekeze matenda osokoneza bongo odwala matendawa, komabe .

Gestationalabetes mellitus (GDM) ndi matenda, yodziwika ndi hyperglycemia, yemwe amapezeka woyamba ali ndi pakati, koma osakwaniritsa zomwe zimayambitsa matenda a shuga.

Zochita za obstetrician-gynecologist pozindikira GDM:

M'matenda a GDM atapezeka mu 1 trimester, zakudya zimayikidwa kupatulapo chakudya cham'mimba chambiri (Zakumapeto 1) ndikudziyang'anira nokha ndi glycemia, kusunga zolemba zodziyang'anira nokha za glycemia.

· Upangiri wapadera kuchokera kwa endocrinologist kukhazikitsa matenda a GDM ndi / kapena kuyesa mayeso ololera a glucose sikufunika.

· Kudzi kudziletsa kwa glycemia ndikusunga diaries kumapitiliza mpaka pobereka.

- Zolinga zowunikira

Zotsatira Zoyimira Plasma

Ola limodzi mutatha kudya

Matupi a urine a ketone

· Ngati matenda a shuga apezeka (pakati nthawi yomweyoamapita kwa endocrinologist kuti akamveketse mtundu wa matenda a shuga ndikupereka mankhwala. Mtsogolomo, kuyang'anira kwa amayi apakati otere kumachitika ndi obstetrician-gynecologist pamodzi ndi endocrinologist.

Popereka mankhwala a insulin, mayi woyembekezera amathandizidwa ndi endocrinologist / akatswiri othandizira odwala matenda am'mimba. Kugwiritsira ntchito kuchipatala kuchipatala kuti mupeze kupeza GDM kapena kukhazikitsidwa kwa mankhwala a insulin sikofunikira ndipo zimangotengera kukhalapo kwa zovuta za obstetric.

Kuchulukana kwa zomwe dokotala wina amaletsa:

Mu 1 trimester - osachepera 1 mu masabata 4, munthawi yachiwiri mumasabata atatu, atatha masabata 28 - osachepera 1 mu masabata awiri, atatha masabata 32 - osachepera 1 nthawi masiku 7-10 kuwunika chitukuko cha zotheka zovuta.

Kuti mupeze mayeso a ultrasound, chipangizo chofufuzira cha ultrasound chimafunikira chokhala ndi cholozera chomvekera chogwiritsidwa ntchito pamaphunziro a obstetric ndi pafupipafupi 3.5 MHz. Zotsatira zoyenera zimapezeka mukamayang'ana pa chida chapamwamba kapena cha akatswiri chomwe chili ndi 2-6 MHz mult-frequency convex sensor kapena 2-8 MHz mult-frequency convex sensor.

· Fetal macrosomy - owonjezera 90 peresenti ya fetal misa kwa nthawi yayitali. Pali mitundu iwiri ya macrosomia:

· Mtundu wa macrosomia - wofanana, wokhazikika pamtundu, womwe umatsimikiziridwa kuti siwotsimikizika ndi gawo la amayi ndipo amadziwika chifukwa cha kuchuluka kwazowonjezera ziwonetsero zonse za fetometric.

· Asymmetric mtundu wa macrosomia amawonedwa odwala matenda ashuga fetopathy. Pali kuwonjezeka kwa kukula kwam'mimba kupitirira 90 percentile kwa nthawi yopatsidwa nthawi yokhala ndi zizindikiritso zofanana ndi kukula kwa mutu ndi m'chiuno.

· Wosangalatsa mutu

· Kuchepa kwa mafuta ozungulira a khosi> 0,32 cm

· Kuchepa kwa mafuta ozungulira pachifuwa ndi pamimba> 0,5 masentimita.

Kuyambira masabata 26 osachepera nthawi imodzi m'masabata anayi, kuchokera pamasabata 34 osachepera nthawi imodzi m'masabata awiri, kuchokera pamasabata 37 - osachepera 1 nthawi m'masiku 7 kapena kupitilirapo monga momwe akunenera.

azimayi oyembekezera omwe ali ndi GDM amachitidwa molingana ndi ziwonetsero za abereki m'magawo a 2-3, ndipo pofotokoza mankhwala a insulini, kugonekedwa kwa chipatala kumachitika mu chipatala chapadera kapena ku dipatimenti yoletsa ana moyang'aniridwa ndi endocrinologist.

Kuyang'anira kuthamanga kwa magazi

· Imachitika pa nthawi yopuma komanso mothandizidwa ndi diary yodzionera wekha kuthamanga kwa magazi (kuyeza kuyeserera kwa magazi ndi wodwalayo pafupipafupi 2-4 patsiku), kenako ndikuwonetsedwa ndi adokotala pakubwera. Mu milandu yomwe imakhala yoposa 1/3 ya miyezo yonse pakudziyang'anira magazi ikupitilira 130/80 mm Hg, chithandizo cha antihypertensive ndi chofunikira.

· Malinga ndi zomwe zikuwonetsa, kuthamanga kwa magazi kumayang'aniridwa tsiku ndi tsiku (magawo a kuchuluka kwa kuthamanga kwa magazi pamaziko olimbitsa thupi, kuwonjezeka kwa kuthamanga kwa magazi malinga ndi zolemba zodziwonera za kuthamanga kwa magazi, mawonekedwe a proteinuria, edema, kapena preeclampia yokhala ndi mbiri yakale).

Kuchepetsa thupi

· Kuyang'anira thupi pochita sabata kumachitika sabata iliyonse. Kulemera kovomerezeka kumasonyezedwa mu Zakumapeto 2.

· Kuti muwongolere kunenepa kwambiri, kuchepa kwa zakudya za tsiku ndi tsiku za calorie kuyenera kutsimikiziridwa (kuchepa kwa kuchuluka kwa chakudya chomwe mumadya, kuphatikiza zakudya zama calorie ambiri pazakudya, ndi zina zambiri) ndi kuchuluka kwa magalimoto. Amayi oyembekezera amayenera kutsatira malangizo a kadyedwe kambiri kuti achulukane pafupipafupi.

Amayi oyembekezera omwe ali ndi matenda ashuga sayenera kukhala masiku osala kudya!

pa mimba yovuta ndi GDM, ndikofunikira chifukwa imalola kupititsa patsogolo kubwezeretsa shuga, kuletsa kuchuluka kwa kulemera kwa magazi, kuchepetsa macrosomia wa fetus komanso pafupipafupi kubereka kwam'mimba 6, 7. Mitundu yolimbikitsidwa ya kuchuluka, kuchuluka kwa zochita, kuchuluka kwake, mitundu ya zochitika ndi zotsutsana zikuwonetsedwa pa Zakumapeto 3 .

Ø Amayi omwe ali ndi matenda osokoneza bongo omwe adapezeka mu trimester yoyambirira amafunikira kuyang'anitsitsa piritsi lakuyambirira kwa masabata 11 mpaka 14 atatenga bere, popeza hyperglycemia imatha kukhala ndi mphamvu padziko isanatenge nthawi komanso m'masiku oyamba a bere. Pafupipafupi kusinthika mwa akazi otere kumakhala kochulukirachulukira kawiri kuposa kuchuluka kwa anthu.

Ø Mankhwala a Oral hypoglycemic pa nthawi yoyembekezera komanso yoyamwitsa saloledwa ku Russian Federation.

Chithandizo cha obstetric mavuto

Kuthandiza pakuwopseza kutenga pakati nthawi iliyonse ikuchitika molingana ndi malingaliro omwe amavomerezedwa kale. Kugwiritsa ntchito ma gestagen mu shuga sikupatsirana. Malinga ndi ziwonetsero, prophlaxis ya kupuma kwamatenda syndrome ya wakhanda imachitika molingana ndi njira zomwe ambiri amavomereza. Poyerekeza ndi maziko a mankhwala a corticosteroid, kuwonjezereka kwakanthawi kwa glycemia ndikotheka, komwe kumafunikira kudzipenda mosamala kwambiri, nthawi zina, kusintha kwa insulin.

Mankhwalawa owonjezera a matenda amtundu uliwonse wa GDM, ochita mankhwala osokoneza bongo (methyldopa), olimbana ndi calcium (nifedipine, amlodipine, etc.), beta-blockers amagwiritsidwa ntchito. Zoletsa za angiotensin-kutembenuza enzyme, angiotensin-II receptor blockers, ma alkaloids a rauwolfia sanalembedwe.

Kujowina matenda oopsa (GAG) kapena preeclampsia kumafuna chithandizo kuchipatala cha amayi. Chithandizo chimachitika molingana ndi njira zomwe nthawi zambiri zimavomerezeka.

· Ngati mawonetseredwe a ultrasound a matenda ashuga okhudzana ndi matenda a shuga ndi polyhydramnios atapezeka kuti mukulumikizidwa kwa glucose mkati sanawunike panthawi yowunikira, shuga yopanda kanthu m'mimba imayesedwa. Ngati chizindikiro ichi >5.1 mmol / l, ndikofunikira kupatsa zakudya komanso kudziletsa kwa glycemia, komanso kugwiritsa ntchito njira zoyang'anira akazi apakati omwe ali ndi GDM.

· Kuzindikira matenda ashuga fetupathy kapena polyhydramnios ndi ultrasound kuwunika ndi umboni kwa poika insulinngakhale ndi glycemia wabwinobwinomalinga ndi mbiri ya kudziletsa. Kupereka mankhwala a insulin, mayi woyembekezera amapita kwa endocrinologist.

Kuwongolera kwa amayi apakati omwe ali ndi GDM ndikofunikira

njira zophatikizirana pakati pa akatswiri (othandizira-gynecologist, dokotala wamkulu / endocrinologist / katswiri wamkulu)

Dokotala woletsa ziwonetsero ayenera kupereka kwa endocrinologist chidziwitso cha mapangidwe a macrosomia / diabetesic fetopathy

Kutumiza kwa amayi apakati omwe ali ndi GDM

Amayi oyembekezera omwe ali ndi GDM, chakudya chobwezeredwa, ndipo pakalibe zovuta za kubereka amapatsidwa chipatala chapakati mu gawo lachiwiri, omwe ali ndi insulin mankhwala kapena zovuta zina mu chipatala chapakati.

Madeti ofunikira kuchipatala a odwala omwe ali ndi GDM yobereka ndi okhazikika malinga ndi kupezeka kwa zovuta zina, zovuta za ngozi.

· Amayi oyembekezera omwe ali ndi vuto la matenda ashuga, zakudya zopindulitsa komanso osagwirizana ndi zovuta zina amakhala m'chipatala osakwanitsa milungu 40 kapena atangoyamba kumene kubereka.

· Ndi GDM pa insulin mankhwala, kusowa kwa njira zolerera, popanda zizindikiro za matenda ashuga komanso kuwongolera mafuta a metabolism - prenatal hospitalization pasanathe masabata 39 a mimba.

Pamaso pa macrosomia ndi / kapena matenda ashuga, polyhydramnios, akukonzekera kugonekedwa osapitilira masabata 37.

Migwirizano ndi njira zoperekera.

GDM mwa iyo yokha sichizindikiro cha gawo la caesarean ndi kutumiza koyambirira. Kukhalapo kwa matenda a chifuwa cha matenda ashuga sikuwonetsanso kuti mayi ndi mwana wosabadwa ayambitsidwa bwino.

Kutumiza kwa amayi apakati omwe ali ndi matenda ashuga.

Matenda a gestational sichizindikiro kuti atumizidwe ndi gawo la caesarean (CS).

Njira yoperekera imatsimikizika potengera zovuta zomwe mayi aliyense wapakati amakhala nazo.

Zizindikiro za gawo la cesarean mu GDM nthawi zambiri zimavomerezedwa m'mankhwala othamangitsidwa. Ngati mwana wosabadwayo walengeza za matenda ashuga a m'mimba kuti apewe kuvulala (dystocia ya mapewa), ndikofunika kukulitsa zidziwitso za CS nthawi zina (kulemera koyerekeza kwa mwana wosabadwayo ndi kupitirira 4000 g).

Zomwe gawo la cesarean lomwe limakonzekera GDM limatsimikiziridwa payekhapayekha, ndi mkhalidwe wokhutiritsa wa mayi ndi mwana wosabadwa, chiphuphu cha shuga komanso kusakhalapo kwa macrosomia / diabetesic fetopathy, zovuta zokhudzana ndi zovuta, kuchuluka kwa nthawi yayitali mpaka masabata 39 mpaka 40 ndi zotheka.

Pamaso pa macrosomia / diabetesic fetopathy, kuchuluka kwa nthawi yayitali kwa masabata 38-39 sikulondola.

Ndi GDM yolipiridwa bwino, kusowa kwa kubereka ndi zovuta zina, mkhalidwe wokhutiritsa wa mayi ndi mwana wosabadwayo, kukula kwa ziwalo zoberekera ndikokwanira. Popezeka, zimatha kutalikitsa pakati mpaka milungu 40 kwa masiku 5, ndikutsatiridwa ndi ntchito malinga ndi mapuloteni ovomerezeka ambiri.

Mawonekedwe a kasamalidwe ka antchito kudzera mu ngalande yakubadwa kwachilengedwe ndi GDM

Imachitika kumayambiriro kwa ntchito, pamlingo wabwinobwino - kusinthika kwa njira yofananira yoyang'anira mkhalidwe wa mwana wosabadwayo mogwirizana ndi ndondomeko ya ntchito. Ngati kulowetsedwa ndi oxytocin kulowetsedwa kapena epidural analgesia kumachitika, kuwunika kosatha kwa mtima kumachitika.

kutengera ndi mapuloteni omwe alipo.

Kulera mwana glycemia

Imachitika (mu labotale kapena kugwiritsa ntchito glucometer yonyamula) mwa amayi apakati omwe amalandila mankhwala a insulin, mu kaimidwe ka 1 nthawi iliyonse 2-2,5 maola.

Milandu yomwe mayi woyembekezera asanayambe ntchito wabweretsa insulin yayitali, kukulitsa kwa chipatala kapena matenda olembetsa matenda, omwe amafunikira kuyamwa kwa njira ya shuga, kumatheka pakubala.

Mankhwala a insulin pakubala kwa amayi apakati omwe ali ndi GDM sikuchitika.

Pamapeto pa ntchito yachiwiri, ntchito zoyenera kupewa ziyenera kuchitidwa kuti muchepetse dystocia ya mapewa a fetal.

· Chiyambi cha zoyesererana mosaganiza bwino ndikadula mutu

Kulowetsedwa kwa Oxetocin kumapeto kwa gawo lachiwiri la ntchito

Ngati dystocia ya mapewa ichitika, wina akuyenera kutsogozedwa ndi maluso omwe adafotokozedwa mu bukhuli la National.

Kupezeka kwa neonatologist pakubadwa kwa mwana ndi GDM ndikofunikira!

Pulogalamu yowunikira pambuyo pa ziwonetsero

Pambuyo pobereka, odwala onse omwe ali ndi GDM amasiya insulin. M'masiku atatu oyamba kubadwa, kuyeza kuchuluka kwa shuga m'magazi a venous ndikofunikira kuti muzindikire kuphwanya kwa kagayidwe kazachilengedwe.

Kuchepa kwa GDM sikunapatsidwe.

Masabata 6-12 atabereka azimayi onse omwe amasala kudya kwa plousma glucose

Ndikofunikira kudziwitsa ana adotolo ndi madokotala achinyamata kuti akuyenera kuwunika momwe kagayidwe kamatenda amathandizira komanso kupewa matenda ashuga amtundu wa 2 mwa mwana yemwe amayi ake adadwala GDM.

Zochitika zazikuluzikulu panthawi yakukonzekera kwabwino mwa amayi omwe adatenga GDM

· Chakudya chofuna kuchepetsa kunenepa kwambiri.

- Zolimbitsa thupi

· Kuzindikiritsa komanso kuchiza matenda a carbohydrate metabolism.

- Chithandizo cha ochepa matenda oopsa, kukonza lipid-cholesterol kagayidwe kachakudya.

Malangizo kwa wodwala

DIET PAKATI PA ZINSINSI ZABWINO ZONSE

Zinthu zomwe siziyenera kuphatikizidwa ndi zakudya:

Shuga, confectionery, makeke okoma, ayisikilimu, uchi, kupanikizana, zipatso zonse (ngakhale popanda shuga), zinthu zamkaka zokhala ndi shuga (zipatso yogurts, kefir, ndi zina, ma curds okongola, ma curling), nthochi , mphesa, zipatso zouma, madeti, nkhuyu, ma compote, odzola, msuzi, mayonesi, ketchup, fructose, xylitol ndi mankhwala a sorbite, chimanga chothiridwa ndi kutentha (pompopompo) kapena mpunga wosenda. Nyama yamafuta, soseji yamafuta, masoseji, ma pastes ...
Mayonesi, batala, tchizi chachikaso (45-50%)

Zogulitsa zomwe zimafunika kuchepa muzakudya, koma osaphatikizidwa kwathunthu:

Maapulo, malalanje, kiwi ndi zipatso zina (chipatso chimodzi cha nkhomaliro ndi chakudya chamadzulo) Zipatso ndizabwino kudya m'mawa.

durum tirigu pasitala (1 kudya tsiku lililonse).

mbatata (kudya 1 tsiku lililonse, ndibwino kugwiritsa ntchito mbatata zophika, m'malo yokazinga, yophika kapena mbatata yosenda),

buledi (zilibe kanthu kuti ndi zakuda kapena zoyera, magawo atatu patsiku), makamaka ndi chimanga kapena chinangwa)

chimanga (oat, buckwheat, mapira mapira, m'madzi kapena mkaka wopanda mafuta, wopanda batala), mpunga wa bulauni. (Chakudya chimodzi patsiku).

Mazira (omelet, mazira owiritsa) amathanso kugwiritsidwa ntchito 1-2 pa sabata.

Mkaka 1-2% (kamodzi patsiku) osaposa galasi limodzi.

Zakudya zomwe mungadye popanda malire.

Masamba onse (kupatula mbatata) - (nkhaka, tomato, kabichi, saladi, radash, zitsamba, zukini, biringanya, nyemba)

Bowa, nsomba zam'nyanja (sizosankhidwa)

Zinthu zopangidwa ndi nyama (kuphatikiza nkhuku ndi nkhuku) ndi nsomba,

Tchizi chamafuta ochepera, opaka bwino popanda Whey (2-5%), tchizi (10-17%), zinthu zamkaka (zopanda shuga), osati zonunkhira, osati mafuta komanso soseji osuta, masoseji, masoseji, masamba a masamba (phwetekere, popanda mchere, ndi misuzi yosakanizidwa yamasamba).

Pamaso pa kunenepa - kuletsa kwa mafuta m'zakudya (zakudya zonse zokhala ndi mafuta ochepa, koma opanda mafuta kwathunthu). Ndi kuchuluka kwa kuthamanga kwa magazi - kuchepetsa kuchuluka kwa mchere pakuphika, osawonjezera ku chakudya chomalizidwa. Gwiritsani mchere wa ayodini.

Zakudya zisanu patsiku - zakudya zazikulu zitatu ndi zokhwasula-khwasula. Usiku, kapu ya kefir kapena yogurt yamafuta ochepa (koma osati chipatso!) Imafunika. Phatikizani zakudya zama protein komanso masamba azakudya zilizonse. Choyamba, ndibwino kudya mapuloteni ndi ndiwo zamasamba, kenako zakudya zamafuta. Samalani kuchuluka kwa chakudya (zomwe ndizochepa, koma osapatula) pachakudya chilichonse. 100-150 ga chakudya chambiri chamagulu (magawo a ngokusemthethweni a 10-12) amathanso kumwa tsiku lililonse, ndikugawa chimodzimodzi tsiku lonse. Gwiritsani ntchito kuphika, kudyetsa, kuphika, koma osaphika kuphika.

1 kutumiza = 1 kagawo ka mkate = 1 sing'anga zipatso = supuni ziwiri zokhala ndi mawonekedwe a phala lokonzekera, pasitala, mbatata = 1 chikho cha mafuta mkaka

magawo omwe amagwiritsidwa ntchito tsiku lonse:

Chakudya cham'mawa - 2 servings
Chakudya chamasana - 1 akutumikira
Chakudya chamasana - 2-3 servings
Zosakhazikika - 1 akutumikirani
Chakudya chamadzulo - 2-3 servings
Chakudya chachiwiri - 1 kutumizira

Chakudya cham'mawa sichikhala ndi mafuta ochulukirapo a 35-36 g (osaposa 3 XE). Chakudya chamadzulo ndi chakudya chamadzulo osapitilira 3-4 XE, zokhwasula-khwasula za 1 XE. Zakudya zomanga thupi zimapilira m'mawa kwambiri.

M'madongosolo azakudya, ndikofunikira kuti muwonetse nthawi yakudya kwambiri ndi kuchuluka kwa chakudya, magalamu, mafuta, makapu, ndi zina zambiri. Kapena kuwerengera zakudya zamafuta malinga ndi tebulo.

Kulemera kovomerezeka panthawi yapakati

BMI asanabadwe

OPV yapakati (kg)

OPV mu 2 ndi 3 tr. mu kg / sabata

Kuchepa kwa thupi (BMI 11, 5-16

Kunenepa kwambiri (BMI 25.0-29.9 kg / m²)

Kunenepa kwambiri (BMI≥30.0 ​​kg / m²)

Zochita zolimbitsa thupi panthawi yapakati

· Aerobic - kuyenda, kuyenda kwa Nordic, kusambira mu dziwe, kumayendera dziko, kuyenda panjinga.

Yoga kapena ma Pilates osinthika (kupatula zolimbitsa thupi zomwe zimalepheretsa venous kubwerera pamtima)

Kuchita zolimbitsa thupi zolimbitsa minofu ya thupi ndi miyendo.

Analimbikitsakuchuluka kwa zochita: Mphindi 150-270 pasabata. Makamaka, ntchitoyi imagawidwa mofanananso masiku a sabata (mwachitsanzo, tsiku lililonse kwa mphindi zosachepera 25-35).

Analimbikitsakukula: 65-75% ya kugunda kwa mtima _max . Kufika pamtima _max kuwerengetsa motere: kugunda kwamtima _max = 220 - zaka. Komanso, chidwi chitha kuyerekezera ndi kuyesedwa kwa "colloquial": pomwe mayi woyembekezera amatha kuyankhulana panthawi yochita masewera olimbitsa thupi, nthawi zambiri, samadzivutitsa.

Zosavomerezeka pa nthawi ya pakati: zochitika zowopsa (kusewera, kukwera matalala, kuyenda paulendo, kuyenda pamadzi, kusefukira, kuyenda panjinga, masewera olimbitsa thupi komanso kukwera pamahatchi), masewera ndi masewera (mwachitsanzo hockey, nkhonya, masewera andewu, mpira ndi basketball, tennis), kudumpha, kusewera pansi pa scuba.

Zochita zolimbitsa thupi ziyenera kukhala Chosiyidwandi zizindikiro zotsatirazi:

Maonekedwe akutuluka magazi kuchokera kumaliseche

Kupweteka kwamchiberekero

Amniotic madzimadzi kutulutsa

Kumva kutopa kwambiri

Dyspnea musanayambe ntchito

Zopanda malire kwathunthu zolimbitsa thupi pa mimba:

· Hemodynamically kwambiri matenda amtima (kulephera kwa mtima 2 funkts.

Isthmic-cervical insufficiency kapena cervical sutures

Amayi ambiri oyembekezera okhala ndi vuto lakubadwa asanakwane

- Ndime zoyang'ana wachiwiri kapena wachitatu trimester

Placenta previa pambuyo 26 milungu ya bere

Amniotic madzimadzi kutulutsa

Preeclampia kapena gestational arterial matenda oopsa

Chilonda Anemia (Hb

Mikhalidwe yomwe funso lofunsidwa kwa zolimbitsa thupi, mawonekedwe ndi voliyumu yawo limathetsedwa aliyense payekhapayekha:

Kuchepa magazi m'thupi

Matenda amtundu wamtima kwambiri

Matenda oletsa kupuma a m'mapapo

Kunenepa kwambiri kwakanenepa (pregravid BMI> 50).

Kunenepa kwambiri (BMI ochepera 12)

Moyo wokhalitsa kwambiri

· Kufotokozera kukula kwa fetal nthawi yapakati

Mankhwala oletsa matenda oopsa

Khunyu yoyendetsedwa bwino

Kusuta ndudu zoposa 20 patsiku.

1. Hod, M., Kapur, A., Sacks, D.A., Hadar, E., Agarwal, M., Di Renzo, G.C. et al, The International Federation of gynecology and obstetrics (FIGO) programme at gestationalabetes mellitus: chiwonetsero chazidziwitso cha kuzindikira, kasamalidwe, ndi chisamaliro. Int J Gynaecol Obstet. 2015, 131: S173-211.

2. Malangizo azachipatala (protocol ya chithandizo) "Gestationalabetes mellitus: diagnostic, chithandizo, kuwunikira pambuyo pake" MH RF 15-4 / 10 / 2-9478 kuyambira 12/17/2013).

3. Dongosolo la Unduna wa Zaumoyo ku Russia Federation Nambala 475 lomwe linali 12/28/2000 "Pakukonzanso kuzindikira kwa unamwino popewa matenda obadwa nawo ndi ana obadwa nawo"

4. Dongosolo la Unduna wa Zaumoyo ku Russia Federation ya Novembara 1, 2012 No. 572n "Njira yoperekera chithandizo chamankhwala pizindikiritso za" abereki ndi matenda azachipatala (kupatula kugwiritsa ntchito matekinoloje othandizira) ”

5. Dongosolo la Unduna wa Zaumoyo ku Russian Federation Lachisanu pa 10 February 2003 No. 50 "Pakonzanso chithandizo chazachipatala ndi zipatala zakuchipatala"

6. Sklempe Kokic I, Ivanisevic M, Biolo G, Simunic B, Kokic T, Pisot R. Kuphatikiza kwa mawonekedwe aerobic komanso kukana zolimbitsa thupi kumawongolera kuwongolera kwa glycemic mwa amayi apakati omwe amapezeka ndi matenda osokoneza bongo a mellitus. Yesero lolamulidwa mwachisawawa. Kubadwa Kwa Akazi. 2018 Aug, 31 (4): e232-e238. doi: 10.1016 / j.wombi.2017.10.10.004. Epub 2017 Oct 18.

7. Harrison AL, Shields N, Taylor NF, Frawley HC. Kuchita masewera olimbitsa thupi kumathandizanso kuwongolera glycemic mwa azimayi omwe amapezeka ndi matenda a shuga a m'magazi: Kubwereza mwadongosolo. J Physiother. 2016.62: 188-96.

8. Radzinsky V.E., Knyazev S.A., Kostin I.N. Chiwopsezo cha kupuma. Zambiri pazambiri - chiwopsezo chochepa cha mayi ndi mwana. - Moscow: Eksmo, 2009 .-- 288 p.

9. Obstetrics. Utsogoleri wa dziko. Adasinthidwa ndi G. M. Savelieva, V. N. Serov, G. T. Sukhikh, GEOTAR-Media. 2015.S. 814-821.

Zomwe zimayambitsa matenda a shuga pa nthawi yapakati

Matenda a shuga oyembekezera, kapena matenda a gestagen, ndikuphwanya kulekerera kwa glucose (NTG) komwe kumachitika panthawi yoyembekezera ndikusowa pambuyo pobereka. Chowunikira chowerengera cha matenda ashuga otere ndicho kuchuluka kwazomwe zikuwonetsa glycemia m'magazi a capillary pazinthu zitatu zotsatirazi, mmol / l: pamimba yopanda kanthu - 4,8, pambuyo pa 1 h - 9.6, ndipo pambuyo pa maola 2 - 8 pambuyo pamlomo wamatumbo a 75 g.

Kulekerera kwa shuga mkati mwa mimba kumawonetsa kukhudzika kwa mphamvu ya mahomoni am'magazi, komanso kukana kwa insulin, ndikupeza pafupifupi 2% ya amayi apakati. Kuzindikira koyambirira kwa kulekerera kwa glucose kosavomerezeka ndikofunikira pazifukwa ziwiri: choyambirira, 40% ya amayi omwe ali ndi matenda ashuga omwe ali ndi mbiri yokhala ndi pakati amakhala ndi matenda osokoneza bongo mkati mwa zaka 6-8 ndipo, motero, amafunikira kutsatira, ndipo chachiwiri, motsutsana ndi maziko a kuphwanya lamulo kulolerana kwa glucose kumawonjezera chiopsezo cha kufa kwa perinatal ndi fetopathy chimodzimodzi monga odwala omwe ali ndi matenda osokoneza bongo omwe amakhazikitsidwa kale.

Zowopsa

Pamaulendo oyamba a mayi woyembekezera kupita kwa dokotala, ndikofunikira kuti aziwonetsetsa kuti ali ndi vuto lodzala ndi matenda ashuga, popeza njira zowunikira zowonjezera zimatengera izi. Gulu lomwe lili pachiwopsezo chobwera ndi matenda osokoneza bongo limaphatikizapo azimayi ochepera zaka 25, omwe amakhala ndi thupi loyenera asadakhale ndi pakati, omwe alibe mbiri yodwala matenda ashuga pakati pa abale a degree yoyamba ya ubale, omwe sanakhalepo ndi zovuta zam'mbuyomu zama metabolism (kuphatikizapo glucosuria), mbiri yopanda chitetezo. Kupatsa mayi gulu lomwe lili ndi chiopsezo chochepa chotenga matenda a shuga, zonsezi zimafunikira. Mu gululi la azimayi, kuyesa pogwiritsa ntchito mayeso opsinjika sikuchitika ndipo kumangokhala kuwunika kokhazikika kwa kudya kwa glycemia.

Malinga ndi lingaliro losagwirizana ndi akatswiri azachipani komanso akunja, azimayi omwe ali ndi kunenepa kwambiri (BMI ≥30 kg / m 2), shuga mellitus mu abale a degree yoyamba ya kinship, mbiri ya matenda osokoneza bongo a gestational matenda osokoneza bongo kapena carbohydrate metabolism ali pachiwopsezo chachikulu chotenga matenda a shuga. kunja kwa mimba. Kugawa mkazi pagulu lomwe lili pachiwopsezo chachikulu, chimodzi mwazomwe zalembedwa ndizokwanira.Amayi awa amayesedwa paulendo woyamba kupita kwa dokotala (tikulimbikitsidwa kuti tidziwe kuchuluka kwa shuga m'magazi pamimba yopanda kanthu komanso kuyesedwa ndi 100 g ya shuga, onani njira ili pansipa).

Gululi lomwe lili ndi chiopsezo chotenga matenda a shuga ammimba limaphatikizira azimayi omwe sakhala ocheperako komanso omwe ali pachiwopsezo chachikulu: mwachitsanzo, kuchepa thupi pang'ono musanatenge pathupi, ndi mbiri yolemetsa yoletsa kubereka (mbiri yayikulu ya mwana wosabadwa, polyhydramnios, kuchotsa mimba kosabereka, gestosis, kusokonezeka kwa fetal, kubereka ) Ndi ena pagulu lino, kuyezetsa kumachitika panthawi yovuta kwambiri kuti pakhale chitukuko cha matenda osokoneza bongo - milungu 24-27 ya mimba (mayeso amayamba ndi mayeso owunika).

Matenda a shuga

Zizindikiro zake mwa amayi apakati omwe ali ndi mtundu woyamba 1 ndi mtundu wa 2 matenda a shuga amadalira kuchuluka kwa kubwezeredwa ndi kutalika kwa matendawa ndipo zimatsimikiziridwa makamaka ndi kukhalapo komanso gawo la zovuta zamatenda a shuga (ochepa matenda oopsa, matenda ashuga, matenda ashuga, nephropathy, matenda ashuga polyneuropathy, etc.).

Matenda a shuga

Zizindikiro za matenda amishuga gestational zimadalira kuchuluka kwa hyperglycemia. Itha kuonekera ndi kusala kudya kopanda tanthauzo la hyperglycemia, postprandial hyperglycemia, kapena chithunzi chapamwamba cha matenda ashuga omwe ali ndi milingo yayikulu ya glycemic imayamba. Nthawi zambiri, mawonetseredwe azachipatala samakhalapo kapena alibe tanthauzo. Monga lamulo, pali kunenepa kwambiri kwamitundu yosiyanasiyana, nthawi zambiri - kuwonda msanga panthawi yapakati. Ndi glycemia yayikulu, madandaulo amawonekera za polyuria, ludzu, chilakolako chambiri, ndi zina zambiri. Vuto lalikulu kwambiri lodziwikiratu ndi matenda a shuga ochita kuthamanga kwambiri omwe amakhala ndi hyperglycemia, pomwe glucoseuria ndi kudya mwachangu hyperglycemia sizipezeka.

M'dziko lathu, palibe njira zofala zambiri zodziwikiratu za matenda a shuga. Malinga ndi malingaliro aposachedwa, kuwunika kwa matenda amiseche kuyenera kukhazikikapo kutsimikiza kwa zinthu zomwe zingayambitse chiwopsezo chake komanso kugwiritsa ntchito mayeso okweza shuga m'magulu apakati komanso oopsa.

Pakati pa zovuta za kagayidwe kazakudya kwa amayi apakati, ndikofunikira kusiyanitsa:

1. Matenda a shuga omwe adalipo mwa mayi asanakhale ndi pakati (matenda a shuga) - mtundu 1 shuga, mtundu 2 shuga, mitundu ina ya matenda ashuga.
2. Gestational kapena matenda ashuga - chiwopsezo chilichonse cha vuto logaya (kuchokera kwa anthu osala kudya a hyperglycemia kupita kwa odwala matenda ashuga) ndi kumayambiriro komanso kudziwika koyamba panthawi yapakati.

Gulu la odwala matenda ashuga

Pali matenda a shuga a ku gestational, kutengera mtundu wa chithandizo chomwe chikugwiritsidwa ntchito:

• kulipidwa ndi mankhwala,
• kulipidwa ndi insulin mankhwala.

Malinga ndi kuchuluka kwa kubwezeretsa matendawa:

• kubwezera
• kubwezera.

• E10 Matenda a shuga omwe amadalira insulin (m'gulu lamakono - mtundu 1 wa shuga
• E11 Matenda a shuga osadalira insulini (mtundu 2 wa shuga m'magulu apano)
  • E10 (E11) .0 - ndi chikomokere
  • E10 (E11) .1 - ndi ketoacidosis
  • E10 (E11) .2 - ndi kuwonongeka kwa impso
  • E10 (E11) .3 - ndi kuwonongeka kwa maso
  • E10 (E11) .4 - ndi zovuta zamitsempha
  • E10 (E11) .5 - yokhala ndi vuto la kufalikira kwa kufalikira
  • E10 (E11) .6 - ndi zovuta zina zomwe zidatchulidwa
  • E10 (E11) .7 - ndi zovuta zingapo
  • E10 (E11) .8 - ndi zovuta zosadziwika
  • E10 (E11) .9 - popanda zovuta
• 024.4 Matenda a shuga amayi apakati.

Mavuto ndi zotsatirapo zake

Kuphatikiza pa matenda ashuga a pakati, kubereka kumadzipatula ku mtundu wa shuga kapena mtundu II. Kuti muchepetse zovuta zomwe zimapezeka mwa mayi ndi mwana wosabadwayo, gulu ili la odwala kuyambira mimba zoyambirira limafunikira chindapusa cha shuga. Kuti izi zitheke, odwala matenda a shuga amayenera kupita kuchipatala atazindikira kuti ali ndi pakati kuti azikhalanso ndi matenda ashuga, kuwunika ndi kuthetsa matenda opatsirana.Pa hospitalization yoyamba komanso mobwerezabwereza, ndikofunikira kuyang'ana ziwalo zamkodzo kuti mupeze nthawi komanso chithandizo chamankhwala pamaso pa pyelonephritis, komanso kuwunika ntchito ya impso kuti mupeze matenda a shuga, kulipira chidwi pang'onopang'ono kusefera kwa glomerular, proteinuria, ndi seruminein. Amayi oyembekezera ayenera kupendedwa ndi ophthalmologist kuti awone momwe matendawa akuwonekera komanso kuti adziwe retinopathy. Kupezeka kwa ochepa matenda oopsa, makamaka kuwonjezeka kwa kukakamizidwa kwa diastoli ndioposa 90 mm Hg. Art., Ndi chisonyezo cha antihypertensive therapy. Kugwiritsira ntchito okodzetsa mwa amayi apakati omwe ali ndi matenda oopsa samawonetsedwa. Pambuyo pa kuyesedwa, amasankha pakuyenera kukhalabe ndi pakati. Zizindikiro zake pakutha kwa matenda a shuga, omwe adachitika amayi asanabadwe, zimachitika chifukwa chakufa kwakukulu kwa mwana wosabadwa, zomwe zimagwirizana ndi nthawi komanso zovuta za matenda ashuga. Kuchuluka kwa kufa kwa fetal mwa azimayi omwe ali ndi matenda ashuga kumachitika chifukwa cha kubeleka komanso kubereka kwachitika chifukwa cha kupuma kulephera komanso kupunduka kwa kubereka.

Kuzindikira matenda ashuga nthawi yapakati

Akatswiri apakhomo ndi akunja amapereka njira zotsatirazi pofuna kudziwa kuti ali ndi matenda a shuga. Njira imodzi yokhayo ndiyothandiza kwambiri azimayi omwe ali pachiwopsezo chachikulu cha matenda ashuga. Amakhala ndikuchita zoyeserera ndi 100 g ya shuga. Njira ziwiri. Ndi njira iyi, kuyezetsa magazi kumachitika koyamba ndi 50 g ya glucose, ndipo ngati kuphwanya, kuyesedwa kwa gramu 100 kumachitika.

Njira yochitira mayeso owunikira ndi motere: mayi amamwa 50 g shuga osungunuka mu kapu yamadzi (nthawi iliyonse, osati pamimba yopanda kanthu), ndipo patatha ola limodzi, shuga mu venous plasma watsimikiza. Ngati pambuyo pa ola lathunthu glucose wochepera 7.2 mmol / L, kuyesedwa kumayesedwa ngati kopanda vuto ndikuwunika kumatha. (Ndondomeko zina zimafotokoza za kuchuluka kwa g8col 7.8 mmol / L monga gawo loyeserera koyesa, koma zikuwonetsa kuti kuchuluka kwa glycemic komwe kumakhala 7.2 mmol / L ndi chidziwitso chowopsa cha chiwopsezo cha matenda ashuga.) Ngati plasma glucose kapena oposa 7.2 mmol / l, kuyesedwa ndi 100 g glucose kumasonyezedwa.

Njira yoyeserera ndi 100 g ya glucose imapereka protocol yovuta kwambiri. Kuyesaku kumachitika m'mawa m'mimba yopanda kanthu, mutatha kusala usiku kwa maola 8 mpaka 14, motsutsana ndi zakudya zomwe sizinachitike (pafupifupi 150 g yamafuta tsiku) ndi masewera olimbitsa thupi osachepera masiku atatu asanafike phunzirolo. Mukamayesedwa, muyenera kukhala, kusuta ndikoletsedwa. Pa kuyesedwa, kusamba kwa venous plasma glycemia kumatsimikiziridwa, pambuyo pa ola limodzi, maola 2 ndi maola atatu mutachita masewera olimbitsa thupi. Kuzindikiridwa kwa matenda a gestational shuga kumakhazikitsidwa ngati 2 kapena kuposa glycemic ofanana ndi ofanana kapena kupitirira ziwerengero zotsatirazi: pamimba yopanda kanthu - 5.3 mmol / l, pambuyo pa 1 h - 10 mmol / l, atatha maola 2 - 8.6 mmol / l, atatha maola atatu - 7.8 mmol / L. Njira ina ingakhale kugwiritsa ntchito mayeso a maola awiri ndi 75 g shuga (protocol yofanana). Kuti mudziwe matenda amishuga pakamiyi, ndikofunikira kuti milingo ya venous plasma glycemia mu 2 kapena kutanthauzira kofanana ndikulingana kapena kupitirira izi zotsatirazi: pamimba yopanda kanthu - 5.3 mmol / l, pambuyo pa 1 h - 10 mmol / l, patatha maola 2 - 8.6 mmol / l. Komabe, malinga ndi akatswiri a American Diabetes Association, njira iyi ilibe kuvomerezeka kwa 100 gram samp. Kugwiritsa ntchito kukonzekera kwa glycemia wachinayi (maola atatu) pakupanga mayeso ndi 100 g ya glucose imakuthandizani kuti muyesenso bwino matenda a kagayidwe kamphamvu mwa mayi wapakati.Dziwani kuti kuwunika mwachangu kudya kwa glycemia mwa amayi omwe ali pachiwopsezo cha matenda osokoneza bongo nthawi zina sangathe kupatula shuga wambiri, chifukwa kusala kwachizolowezi m'mimba mwa amayi apakati kumakhala kocheperako poyerekeza ndi mwa azimayi osakhala oyembekezera. Chifukwa chake, kusala kudya kwa proteinoglycemia sikumapatula kukhalapo kwa postprandial glycemia, komwe ndi chiwonetsero cha matenda osokoneza bongo komanso titha kuwonekanso chifukwa cha mayeso opsinjika. Ngati mayi woyembekezera akuwonetsa kuchuluka kwa glycemic mu plousma wam'mimba: pamimba yopanda 7 mmol / l komanso mwachitsanzo cha magazi - osaposa 11.1 ndikutsimikizira za izi tsiku lotsatira la mayeso azidziwitso safunikira, ndikuwonetsetsa kuti matenda a shuga apezeka.

Matenda a shuga pamimba

Pafupifupi 7% ya mimbayo yonse imakhala yovuta ndi gestationalabetes mellitus (GDM), yomwe imaposa 200 miliyoni padziko lapansi pachaka. Pamodzi ndi matenda oopsa komanso kubadwa msanga, GDM ndi imodzi mwazovuta zambiri zapakati.

• Kunenepa kwambiri kumawonjezera mwayi wokhala ndi matenda oopsa a shuga panthawi yokhala ndi pakati kawiri.
• Kuyeserera kwa glucose kuyenera kuchitidwa kwa amayi onse apakati pakatha masabata 24-27.
• Ngati kuchuluka kwa shuga m'magazi opanda kanthu pakadutsa 7 mmol / l, amalankhula za kukula kwa shuga.
• Mankhwala a Oral hypoglycemic a GDM amatsutsana.
• GDM sitiwona ngati chisonyezo cha gawo la caesarean, makamaka makamaka pakubweretsa koyambirira.

Pathophysiology ya zovuta za gestational matenda ashuga ndi zomwe zimachitika pa mwana wosabadwayo

Kuyambira kuyambira koyambirira kwa nthawi yomwe mayi ali ndi pakati, mwana wosabadwayo ndi mawonekedwe ake amakhala ndi kuchuluka kwa shuga, komwe kumapitilizidwa kuperekedwa kwa mwana wosabadwayo pogwiritsa ntchito mapuloteni opatsirana. Mwanjira iyi, kugwiritsa ntchito shuga pamimba kumathandizira kwambiri, zomwe zimathandiza kuchepetsa mulingo wake m'magazi. Amayi oyembekezera amakhala ndi vuto la hypoglycemia pakati pa chakudya komanso nthawi yogona, popeza mwana wosabadwayo amalandila glucose nthawi zonse.

Kodi chiwopsezo cha matenda ashuga pamimba pa mwana ndi mayi ndi chiani?

Pamene mimba ikupita, chidwi cha minofu kuti insulin ichepetse, ndipo kuchuluka kwa insulin kumakulirakulira. Pankhani imeneyi, insulin yolimba (pamimba yopanda kanthu) imakwera, komanso kuchuluka kwa insulin yolimbikitsidwa pogwiritsa ntchito mayeso a glucose (magawo oyambira ndi achiwiri a kuyankha kwa insulin). Ndi kuchuluka kwa kubadwa kwa gestational, kuthetsedwa kwa insulin m'magazi kumapanganso.

Kupanda insulin yokwanira, amayi apakati amakhala ndi matenda osokoneza bongo a mellitus, omwe amadziwika ndi kukana insulin. Kuphatikiza apo, kuwonjezeka kwa proinsulin m'magazi ndi chikhalidwe cha GDM, chomwe chikuwonetsa kuwonongeka kwa ntchito ya maselo a pancreatic beta.

Kuzindikira kwa matenda a shuga a m'matumbo: zizindikiro ndi chizolowezi

Mu 2012, akatswiri ochokera ku Russian Association of Endocrinologists ndi akatswiri ochokera ku Russia Association of Obstetricians and Gynecologists atenga Russian National Consensus "Gestational Diabetes: Diagnosis, Treatment, Postpartum Monitoring" (pano amatchedwa Russian National Consensus). Malinga ndi chikalatachi, GDS imadziwika motere:

Pa chithandizo choyambirira cha pakati

• kudya plasma glucose, kapena
• glycated hemoglobin (njira yotsimikizika malinga ndi National Glycohemoglobin Standartization Program NGSP ndikuyimira molingana ndi mfundo zomwe zapezeka mu DCCT - Diabetes Control and Complication Study, kapena
  shuga wa plasma nthawi iliyonse masana, mosasamala kanthu za kudya.

Pa 24-27 sabata la mimba

• Amayi onse oyembekezera, kuphatikiza omwe sanadwale matumbo a kagayidwe koyambirira, amapatsidwa mayeso okhudzana ndi shuga wa pakamwa (PHGT) pakatha milungu 24 mpaka 28.Nthawi yabwino ndi masabata 24-26, koma HRTT imatha kuchitidwa mpaka masabata 32 achisangalalo.

M'mayiko osiyanasiyana, PGTT imachitika ndi mitundu yosiyanasiyana ya shuga. Kutanthauzira kwa zotsatira kumatha kumasukanso pang'ono.

Ku Russia, PGTT imachitika ndi 75 g ya glucose, ndipo ku USA ndi mayiko ambiri a EU, kuyesedwa ndi 100 g ya glucose kumadziwika kuti ndi muyezo wazidziwitso. American Diabetes Association imatsimikizira kuti mitundu yonse yoyamba ndi yachiwiri ya PHTT ilinso ndi kuzindikira komweko.

Kutanthauzira kwa PGTT kutha kuchitika ndi endocrinologists, obstetrician-gynecologists and Therapists. Ngati zotsatira zoyesedwa zikuonetsa kukula kwa matenda a shuga, mayi woyembekezera amatumizidwa kwa endocrinologist.

Kuwongolera odwala omwe ali ndi GDM

Pakupita masabata 1-2 atazindikira, wodwalayo amawonetsedwa ndi akatswiri azachipatala, othandizira, akatswiri onse.

1. Kuyesedwa kumachitika motsutsana ndi maziko azakudya zabwino. Osachepera masiku atatu mayeso asanachitike, osachepera 150 g wamagulu azakudya ayenera kuperekedwa tsiku lililonse.
2. Chakudya chomaliza chisanachitike phunziroli chiyenera kukhala ndi mafuta osachepera 30-50 g.
3. Kuyesaku kumachitika pamimba yopanda kanthu (maola 8-14 mutatha kudya).
4. Kumwa madzi musanawerengetsedwe sikuletsedwa.
5. Pa phunziroli, simungathe kusuta.
6. Panthawi yoyesedwa, wodwala ayenera kukhala.
7. Ngati ndi kotheka, tsiku lisanafike komanso mkati mwa kafukufukuyu, ndikofunikira kupatula kugwiritsa ntchito mankhwala omwe angasinthe kuchuluka kwa shuga m'magazi. Izi zimaphatikizapo multivitamini ndi kukonzekera kwachitsulo, zomwe zimaphatikizapo chakudya cham'mimba, komanso corticosteroids, beta-blockers, beta-adrenergic agonists.
8. Musagwiritse ntchito PGTT:
   • ndi poyizoni wakale wa amayi apakati,
   • ngati kuli kotheka mugone mwamphamvu,
   • motsutsana ndi matendawo a matenda oopsa a kutupa,
   • ndi kuchulukitsa kwa matenda kapamba kapena mawonekedwe a m'mimba.

Malangizo kwa mayi woyembekezera wokhala ndi GDS yovumbulutsidwa malinga ndi mgwirizano wapadziko lonse wa Russia:

Kukonza kwamunthu payekha malinga ndi kulemera kwa thupi ndi kutalika kwa mkazi. Ndikulimbikitsidwa kuti muchepetse chakudya chamafuta mosavuta ndikuchepetsa kuchuluka kwamafuta. Chakudya chizigawika wogawana m'magawo a 4-6. Zosapatsa thanzi zopanda thanzi zitha kugwiritsidwa ntchito pang'ono.

Kwa amayi omwe ali ndi BMI> 30 kg / m2, pafupifupi tsiku lililonse calorie kudya amayenera kuchepetsedwa ndi 30- 33% (pafupifupi 25 kcal / kg patsiku). Zimatsimikiziridwa kuti izi zimatha kuchepetsa hyperglycemia ndi plasma triglycerides.