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
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