Diyabetes Mellitus ve Gebelik
Özet
Diyabetes mellitus (DM), insülin salınımı veya etkisindeki yetersizlik sonucu kan şekeri yüksekliğiyle seyreden metabolik bir bozukluktur. Klinik olarak poliüri, polidipsi ve halsizlik gibi semptomlarla kendini gösteren hastalık; laboratuvar tanısında açlık kan şekeri (≥126 mg/dl), HbA1C (≥%6.5) ve OGTT verilerine göre teşhis edilir. Gebelik süreci, plasental hormonlar nedeniyle doğal bir insülin direncine yol açarak pregestasyonel DM ve Gestasyonel DM (GDM) olmak üzere iki ana diyabet tablosunu belirginleştirir. Gebelik öncesi diyabeti olan hastalarda perikonsepsiyonel dönemden itibaren sıkı glisemik kontrol, folat desteği ve organ komplikasyonlarının taranması hayati önem taşır; hedef HbA1C’nin %6.0-6.5 altında tutulmasıdır. GDM ise gebeliğin 24-28. haftalarında 50g, 75g veya 100g glukoz tolerans testleriyle (OGTT) teşhis edilir. Tedavinin temelini eğitim, tıbbi beslenme düzenlemesi, uygun aerobik egzersizler ve gerekli durumlarda plasentayı geçmeyen güvenli insülin rejimleri oluşturur. Kontrolsüz maternal hiperglisemi; anne adayında preeklampsi, DKA ve enfeksiyon riskini artırırken; fetüste makrozomi, kardiyak/iskelet sistemi anomalileri, neonatal hipoglisemi, polisitemi ve respiratuar distres sendromu gibi ciddi komplikasyonlara yol açabilir. Bu nedenle multidisipliner izlem şarttır.
Diabetes mellitus (DM) is a metabolic disorder characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Presenting with classic symptoms like polyuria, polydipsia, and fatigue, DM is diagnosed via fasting plasma glucose (≥126 mg/dl), HbA1C (≥6.5%), or OGTT criteria. Pregnancy induces transient insulin resistance due to placental hormones, manifesting either as pregestational DM or Gestational DM (GDM). In pregestational patients, strict glycemic control starting from the preconception period, along with folate supplementation and complication screening, is vital, aiming for an HbA1C below 6.0-6.5%. GDM is screened between the 24th and 28th weeks of gestation using 50g, 75g, or 100g oral glucose tolerance tests (OGTT). Management primarily relies on patient education, medical nutrition therapy, regular aerobic exercise, and safe insulin regimens when lifestyle modifications fail to meet glycemic goals. Poorly controlled maternal hyperglycemia substantially increases maternal risks, including preeclampsia, DKA, and urinary tract infections, while predisposing the fetus to serious complications such as macrosomia, congenital anomalies (cardiac and skeletal), neonatal hypoglycemia, polycythemia, and respiratory distress syndrome. Therefore, comprehensive multidisciplinary surveillance is crucial.
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