In cooperation with

Abstract

Diabetes and pregnancy

The various types of diabetes can influence pregnancy to differing degrees and can increase the risk of complications. In addition to the risk of diabetogenic fetopathy, in the case of a pre-existing type 1 or type 2 diabetes, there is a risk of diabetogenic embryopathy, which is characterized by malformations.The possibilities of prenatal diagnostics for malformations should therefore be thoroughly exhausted. The insulin requirements of pregnant women with type 1 diabetes already alter during the first and second trimester and should be adequately monitored in cooperation with a diabetologist.

In Germany, gestational diabetes, the most common pregnancy- related illness, is only diagnosed in every tenth patient. This is due to the inadequacy of urine screening test; the results of the test have proved to be influenced by diverse factors. As screening is recommended in the national maternal health guidelines (»Mutterschaftsrichtlinien«), it should be offered to all pregnant women, if necessary, it have to be paid by the patients themselves as so-called »IHS« (= Individual Healthcare Services; in German »Individuelle Gesundheitsleistungen« = IGeL) or may be paid by private health insurances.This procedure definitely does not match the significance of the illness. One-step diagnosis (direct use of the oGTT test) would appear to be more effective than/ to the two-step diagnostic test. In Germany, the intense efforts that have been made to provide good prenatal care for pregnant women have resulted in one of the best developed medical care systems worldwide.This system should be pursued and actualized according to the latest findings and measuring methods. Oral antidiabetics should only be prescribed, after appropriate patient counseling, to treat an unfulfilled desire to have a child in patients with the PCO syndrome.

Kai J. Bühling
Universitätsklinik Hamburg-Eppendorf
Reviewer: Ines Doll,Hamburg
und Christine Klapp, Berlin

Bühling K. J. Diabetes ... Gynakol Geburtsmed Gynakol Endokrinol 2008;4(3):226-239 publiziert 30.11.08 www.akademos.de/gyn ©akademos Wissenschaftsverlag 2008 ISSN 1614-8533