Diabetes und Schwangerschaft

Kleinwechter, Helmut; Schäfer‐Graf, Ute; Bührer, Christoph; Hösli, Irène; Kainer, F.; Kautzky‐Willer, Alexandra; Pawlowski, B.; Schunck, Karl‐Ulrich; Somville, T.; Sorger, M.

doi:10.1055/s-0034-1385413

Cited by 3 publications

(9 citation statements)

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“…The inclusion of fetal growth parameters in the management of pregnant women with type 1 diabetes is not yet part of the standard treatment protocol 15 , 27 . Although the DDG has been recommending since 2006 that supplementary ultrasound examinations be carried out every 2 – 4 weeks in addition to the standard ultrasound examinations required by the German Maternity Guidelines, these additional ultrasound examinations are only used to detect complications of pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Although the DDG has been recommending since 2006 that supplementary ultrasound examinations be carried out every 2 – 4 weeks in addition to the standard ultrasound examinations required by the German Maternity Guidelines, these additional ultrasound examinations are only used to detect complications of pregnancy. Regular determination of HbA 1c and monitoring of mean maternal blood glucose levels over the course of the pregnancy is recommended to monitor that management of diabetes is adequate 15 , 27 . Our study in a population of 199 women with type 1 diabetes showed that including fetal growth parameters to monitor metabolic status during pregnancy can offer significant benefits to mother and child.…”

Section: Discussionmentioning

confidence: 99%

“…The target blood glucose values for patients with type 1 DM should be 3.3 – 5.0 mmol/l when fasting, < 7.7 mmol/l at 1 h postprandially, and < 6.6 mmol/l at 2 h postprandially. According to the current guideline, mean blood glucose values, which are calculated using 6 values measured across the course of one day, should be between 4.7 – 5.8 mmol/l 15 , 27 .…”

Section: Introductionmentioning

confidence: 99%

“…The determination of fetal growth parameters and the use of these fetal growth parameters to guide treatment is an established approach when treating women with gestational diabetes 14 . The current recommendations on managing the treatment of pregnant women with manifest pregestational DM include fetal biometry based on ultrasound examinations carried out every 2 – 4 weeks from the 24th week of gestation (GW) in addition to standard diabetic monitoring of the maternal metabolism 15 , 27 . Although studies have shown the benefits of using fetal growth parameters to monitor the treatment of women with gestational diabetes (GDM) as it allows treatment to be individually adjusted, these data are still lacking for women with pregestational DM 12 , 13 .…”

Section: Introductionmentioning

confidence: 99%

“…Die Blutglukosezielwerte sollten bei Patientinnen mit DM 1 nüchtern 3,3 – 5,0 mmol/l, 1 h postprandial < 7,7 mmol/l, 2 h postpradial < 6,6 mmol/l betragen. Mittlere Blutglukosewerte, die aus 6 Messwerten eines Tages bestimmt werden, sollten laut aktueller Leitlinie zwischen 4,7 – 5,8 mmol/l liegen 15 , 27 .…”

Section: Introductionunclassified

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Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone

Schütze

Groten

Schleußner

et al. 2019

Geburtshilfe Frauenheilkd

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Introduction When planning the treatment of women with gestational diabetes, the current standard approach also takes fetal growth development into account. The treatment of pregnant women with type 1 diabetes mellitus (DM) used to be based exclusively on maternal blood glucose values. This study investigated the impact of including fetal growth parameters in the monitoring of pregnant women with type 1 diabetes mellitus. Patients/Method 199 pregnant women with type 1 DM were included in a cohort study. The patient population was divided into two study cohorts. In the mBG cohort (n = 94; investigation period: 1994 – 2005) treatment was monitored using only maternal blood glucose (mBG) values; the aim was to achieve standard target glucose values (mean BG < 5.5 mmol/l, postprandial: at 1 h < 7.7 mmol/l, at 2 h < 6.6 mmol/l). In the fUS collective (n = 101, investigation period: 2006 – 2014) fetal growth parameters were additionally included when monitoring treatment from the 22nd week of gestation, and maternal target glucose values were then individually adjusted to take account of fetal growth. This study aimed to investigate the impact of these two different ways of monitoring treatment on perinatal and peripartum outcomes. Results 91.4% of all patients were normoglycemic at the time of delivery (HbA1c < 6.7%); 58.9% of patients achieved strict normoglycemia (HbA1c < 5.7%). No differences were found between the two study cohorts (fUS vs. mBG: HbA1c < 6.7%: 93.9 vs. 88.4%, n. s.; mean blood glucose (BG): 5.4 ± 0.6 to 6.6 ± 1.1 vs. 5.9 ± 0.7 to 7.4 ± 1.9 mmol/l, n. s.). Patients from the fUS cohort required significantly lower weight-adjusted maximum insulin doses (0.9 ± 0.3 vs. 1.0 ± 0.4 IE/kg bodyweight, p < 0.05). Pregnancy complications occurred significantly less often in the fUS cohort (preeclampsia: 7.1 vs. 20.9%, p = 0.01; premature labor: 4.0 vs. 23.3%, p < 0.001; cervical insufficiency: 0.0 vs. 11.6%, p = 0.001), and there were significantly fewer cases with neonatal hyperbilirubinemia (19.2 vs. 40.7%, p = 0.001). There was no difference in the rates of LGA infants between the two cohorts (21.2 vs. 24.4%, n. s.). Conclusion Using maternal blood glucose values combined with fetal growth parameters to monitor DM treatment allows therapeutic interventions to be individualized and reduces the risk of maternal and infant morbidity. The metabolism of patients in the fUS cohort was significantly more stable and there were fewer variations in glucose values. It is possible that the detected benefits are due to this metabolic stabilization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionunclassified

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Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone

Schütze

Groten

Schleußner

et al. 2019

Geburtshilfe Frauenheilkd

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Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years

Weschenfelder

Herrmann

Schleußner

et al. 2021

Arch Gynecol Obstet

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Purpose To evaluate the independent factors associated with the success of a trial of vaginal birth (TVB) in women with type 1 diabetes. Despite all therapeutic efforts and technological innovations, rates of caesarean sections (CS) in pregnant women with type 1 diabetes remain unchanged above 60%. Our aim was to point out influencing factors to improve the quality of antepartum counseling. Methods We performed a retrospective cohort study of 195 pregnancies with type 1 diabetes treated between 2000 and 2019. After exclusions, 118 women with near-term singleton pregnancies intended vaginal birth (TVB). Group differences between CS and successful vaginal delivery were analyzed. Multivariate logistic regression was performed by including clinical and metabolic variables to determine the independent effects on a successful vaginal delivery. Subgroup analysis for nulliparous women. Results Of 118 women with TVB, 67 (56.8%) were delivered vaginally. History of previous vaginal delivery (OR 10.29; CI 2.39; 44.30), HbA1c changes during pregnancy (per % increase; OR 0.59; CI 0.36; 0.96) and gestational weight gain (per kg; OR 0.87; CI 0.80; 0.96) were independent predictors for a successful vaginal delivery. In nulliparous women, the duration of diabetes was independently and negatively associated with vaginal delivery. Conclusion Provided data can help to improve antepartum counseling in type 1 diabetic patients. It seems that women with type 1 diabetes should avoid postponing pregnancy and childbirth.

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Neue Ergebnisse zu Diabetes mellitus und seinen Komplikationen

Scherbaum

2015

Diabetologe

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Diabetes und Schwangerschaft

Cited by 3 publications

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Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone

Evaluation of Treatment Strategies to Manage Diabetes Mellitus in Pregnancy: Use of Fetal Sonography Compared to Monitoring of Maternal Blood Glucose Alone

Predictors of a successful vaginal delivery in women with type 1 diabetes: a retrospective analysis of 20 years

Neue Ergebnisse zu Diabetes mellitus und seinen Komplikationen

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