No ka wahine, ʻo ka hānau ʻana i kahi keiki, ʻaʻole ia he hōʻike maʻalahi, no ka mea i kēia manawa hana kona kino i kahi ʻano hoʻoikaika. No laila, i kēlā manawa, ʻike pinepine nā ʻano pathological ʻano, no ka laʻana, ka maʻi diabetes o nā wahine hāpai. Akā he aha ke maʻi maʻi gestational a pehea e hoʻopilikia ai i ke olakino o ka wahine a me ka maʻi wahine.
Hele mai kēia maʻi i ke kiʻekiʻe o ke kō koko koko i ka wā hāpai. Ua hala koke ka maʻi ma hope o ka hānau ʻana o ke pēpē. Eia naʻe, he mea weliweli kēia ʻano maʻi maʻi maʻamau no nā wahine, ʻoiai e hiki ke aʻo ʻia ke aʻo he mea kūpono loa no ka hoʻomohala ʻana o ka maʻi type 2 i ka wā e hiki mai ana.
Hoʻololi ka maʻi mellitus maʻi gestational i 1-14% o nā wahine. Hiki i nā maʻi ke kū i nā ʻokoʻa like o ka hāpai ʻana. I ka trimester mua, ua loaʻa ka maʻi diabetes i ka 2.1% o nā maʻi, ma ka lua - ma 5.6%, a ma ke kolu - ma ka 3.1%
Nā kumu a me nā hōʻailona
Ma keʻano holoʻokoʻa, ʻo kekahi ʻano o ka maʻi maʻi he endocrine maʻi kahi i hiki ʻole ai i ka hana o ka metabolism ke kū nei. E kue i kēia ʻike, aia kahi hoahānau pili ʻole a piha paha i ka insulin, pono e hana ʻia e ka pancreas.
ʻO ke kumu o ka hemahema o kēia hormone hiki ke ʻokoʻa. No ka laʻana, ʻo nā hemahema i loko o nā hana o ka hoʻololi ʻana i ka proinsulin i kahi hormone ikaika, kahi hoʻoliʻiliʻi o ka nui o nā huakaʻi beta i ka pancreas, ka nele o ka ʻike ʻana i ka insulin e nā huaola, a ʻoi aku ka nui.
Hoʻomaʻamaʻa ʻia ka hopena o ka insulin i ka pau aʻe o ka hoʻoliʻiʻana ma o ka hiki ʻana o nā mea hoʻonā glycoprotein kūikawā i nā umauma e pili ana i ka hormone. Ke hoʻoikaika ʻia nei lākou, piʻi ka huakaʻi glucose i loko o nā pūpū a hoʻēmi i ke kō koko koko.
Hoʻopili ia, simulate ka hoʻohana ʻana i ka hoʻohana ʻana o ke kō a me ka hōʻiliʻili ʻana me he glycogen i loko o nā kiko, i ka ʻalaʻā o nā ʻūlā a me nā puʻuwai. He mea pono ia e hoʻokuʻu ʻia ana ka hoʻokuʻu ʻana o ka glucose mai ka glycogen ma lalo o ka mana o ka insulin.
ʻO kekahi hāmeʻa pili i ka protein a me ka momona metabolism. Loaʻa ia i kahi hopena anabolic, e pale ai i ka lipolysis, hoʻōla i ka biosynthesis o ka DNA a me RNA i nā pūnao hilinaʻi i ka insulin.
Ke ulu nei ke lolo maʻi gestational, ʻo kāna kumu ke komo i kekahi mau kumu. ʻO ka mea nui loa i kēia hihia ka hana maikaʻi ma waena o ka hopena o ke kōmike o ka hiloʻana o ka insulin a me ka hopena hyperglycemic i hoʻopuka ʻia e nā hormones ʻē aʻe.
ʻO ke kū'ē o ka insulin i ka holomua, holomua holomua, hana i ka hemahema i ka insulin. Hoʻonohonoho hou ʻia nā mea i kēia:
- ʻoi aku ke kaumaha ma mua o ka maʻamau ma o 20% a ʻoi aku paha, loaʻa a hiki ke hoʻomaopopo mua;
- hoʻonui ʻia ke kō, koko, kahi i hōʻoia ʻia e nā hopena o ka nānā ʻana i ka urine;
- ka hānau mua ʻana o kahi keiki e kaupaona ana mai ka 4 kilograms;
- nūnūnū (e hele mai ana ka maʻi diabetes gestational asians asians, Hispanics, Blacks and Native America);
- o ka hanau ana mai o kahi keiki make i ke au;
- ka nele o ka hoʻohaʻahaʻa glucose;
- ka heleʻana o nā maʻi ovarian;
- polyhydramnios i hōʻike ʻia e ka nui o nā wai amniotic;
- moʻomeheu;
- nā maʻi endocrine e holo ana i ka wā o kahi hoʻoilina ma mua.
I ka wā hapai, hiki ke hoʻopau ʻia nā hopena endocrine ma muli o nā loli o ka physiological, no ka mea i ka mua o ka wā o ka gestation, ua kūkulu hou ʻia ka metabolism. Ma muli o kēia, me ka liʻiliʻi iki o ka glucose i ka maʻi hāpai, hoʻomaka ke kino e hoʻohana i nā mālama mālama, e loaʻa ana i ka ikehu mai nā lipids.
I nā wā mua o ka hāpai ʻana, kahi hoʻohālike me ka hoʻonaninani a me ka hoʻoneʻe ʻana o nā mea pono a pau o ka pūpū. Akā i ka wā e hiki mai ana, i mea e lanakila ai i ka kū ʻana o ka insulin, ke hypertrophy o nā hua beta pancreatic e hele mai, i lilo kekahi i mea ikaika loa.
Hoʻopili ʻia ka hoʻonui hoʻonui ʻia o ka hormone ma o ka luku wikiwiki ʻana iā ia. Eia nō naʻe, aia i ka 2nd trimester o ka hāpaiʻana, e hana ana ka plasenta i ka hana endocrine, i mea pinepine i ka hana metabolism.
ʻO ka estrogens i hoʻokumu ʻia e ka placenta, like-like me nā steroid, a me nā cortisol e lilo i antagonist insulin. I ka hopena, aia i ka hebedoma 20, ua loaʻa nā hōʻailona mua o ka maʻi maʻi gestational.
Eia naʻe, i kekahi mau hihia, hōʻike ka wahine i nā loli liʻiliʻi i ka hōʻiliʻili o ka glucose, kēia ʻano mea i kapa ʻia pre-gestational diabetes mellitus. Ma kēia hihia, ʻike ʻia ka nele o ka insulin me ka hōʻino wale ʻana i nā meaʻai o nā mea kalaka a me ke alo o nā mea ʻē aʻe.
He mea nui ia no ka maʻi maʻi i ka wā hāpai a ʻaʻole i hele pū ʻia e ka make o nā beta beta a i ʻole kahi hoʻololi o ka molekone o ka hormone. No laila, ua noʻonoʻo ʻia kēia ʻano o ka hana endocrine e hoʻohuli ʻia, i ke kau ʻana i ka wā e hele ai ka lawe ʻana, e uku ʻia ʻo ia iho.
ʻOka nā hōʻailona o ke maʻi maʻi gestational, no laila e hāʻawi pinepine ka poʻe wahine iā lākou i nā ʻano physiological o ka hāpai. ʻO nā hōʻike nui e hele mai ana i loko o kēia manawa ke ʻano maʻamau o kekahi ʻano hoʻohaunaele ʻana i nā pakanā kalaiʻu:
- makewai
- dysuria;
- ʻili;
- loaʻa ka waiwai momona a me nā mea i loaʻa.
ʻOiai ke ʻano ʻole nā hōʻailona o ka maʻi maʻi gestational, ʻo nā hoʻokolohua hoʻopaʻa lāʻau ke kumu no ka hoʻomaka ʻana i ka maʻi. Eia kekahi, ua hāʻawi pinepine ʻia ka wahine i kahi scan ultrasound, kahi hiki iā ʻoe ke hoʻoholo i ke kiʻekiʻe o ka maʻi pletenta a ʻike i ka maʻi o ka pēpē.
ʻO ke kō koko koko i loko o nā wahine hāpai a me ke ʻano o ka maʻi
He aha ke kiʻekiʻe o ke kō koko koko e mālama ʻia ana i ka wā hāpai? ʻAʻole pono ka glucose i ka wikiwiki ma mua o 5.1 mmol / L, ma hope o ka ʻaina kakahiaka hiki i ka hōʻailona ke hiki i ka 6.7 mmol / L.
A pehea ehia mau keneka e kū pono i ka hemoglobin glycated? ʻO ka palena o kēia hōʻailona e piʻi i ka 5.8%.
Akā pehea e hoʻoholo ai i kēia mau kuhikuhi? E ʻike inā ʻaʻole iʻoi aku ka maʻamau o ke kō i ka wā hāpai, lawe ʻia ka hoʻākāka kūikawā, me ka hoʻokaʻawale ʻana i ka nui o ka urine a me nā hoʻokolohua koko no ke kō, a acetone, hoʻāʻo ʻia ka hoʻohaʻahaʻa glucose a hoʻoholo i ke kiʻekiʻe o ka hemoglobin glycated.
Eia nō hoʻi, ʻo ka hoʻomanawanui ʻana o ka maʻi gestational ka mea ma hope o nā hoʻokolohua holoʻokoʻa, e like me ke kaila biochemistry a me ka OAC. Wahi a nā kuhikuhi, hiki ke kuhikuhi ʻia i ka moʻomeheu bacteriological urine, ʻo ka hoʻāʻo ʻia e like me Nechiporenko. Hele pū i ka ʻōlelo kūkākūkā o nā kauka, endocrinologist, kauka a me ka optometrist.
ʻO kahi hōʻailona mua o ka maʻi diabetes i ka wā hapai he glycemia kiʻekiʻe (mai ka 5.1 mmol / l). Inā hoʻonui ʻia nā mana o ke kō koko koko, a laila hoʻohana ʻia nā ʻano noiʻi hohonu e kōkua i ka maʻi maʻi i ka wā o ke gestation.
He mea nui ia inā inā hoʻonui ʻia ka hemoglobin glycated, a laila i kēia manawa, ʻaʻole like ka piʻi ʻana o ka glucose o ka glucose. No laila, hōʻike pinepine ʻia ka hyperglycemia i nā lā he 90.
Akā hiki ke ʻike ʻia ke kō i hū ʻia i loko o ka waiʻai i ka wā e heluhelu ʻia ai ka heluhelu glucose o ke koko mai 8 mmol / l. Ua kapa ʻia kēia ʻōkuhi a me ka paepae hoʻoʻau.
Eia nō naʻe, hiki ke ʻike ʻia nā kino ketone i loko o ka urine inā ʻaʻole i ka glucose koko. ʻOiai ke kūʻana o ka acetone i loko o ka urine, ʻaʻole ia he kuhikuhi pololei e ʻike ʻia ka wahine me ka maʻi mamao. Ma hope o nā mea a pau, hiki ke ʻike i nā ketones me:
- huʻipiʻi;
- ʻilihune maikaʻi ʻole ʻole;
- mea kino;
- ʻO SARS a me nā maʻi ʻē aʻe i hele pū ʻia e ke mahana;
- preeclampsia me edema.
E pili ana i ka pepeke glycemic, ʻo ka manaʻo nui o kēia noiʻi e ana i ke kahe o ke koko koko i loko o ka dinamics ma mua o 24 mau hola i nā manawa like ʻole, ma mua a ma hope o ka ʻai. ʻO ka pahuhopu ke koho i nā peaks o glycemia, i mea e kōkua i ka hoʻomohala ʻana i ka maʻi hyperglycemia.
He aha ka hoʻāʻo e hōʻike i ka glucose? He mea kūpono ke hoʻomanaʻo no ka hoʻomākaukau kūpono ʻole ʻana no ke aʻo ʻana he hopena i kona mau hopena. No laila, ma ka pō e ʻai pono ʻoe, e kāpae i ka kaumaha a me ke kaumaha.
I mea e ʻike ai i ka maʻi maʻi gestational, pono ʻoe e nīnau i kahi optometrist e nānā i ke kālā.
ʻOiaʻiʻo, me nā maʻi endocrine, nā pilikia e like me ka retinopathy diabetic e kū pinepine.
He aha ka pilikia o ka maʻi no ke keiki?
ʻO nā wahine wahine āpau i loaʻa ka haʻalulu nui: he aha ka pōpilikia o ka maʻi maʻi gestational no ke keiki? ʻAʻole pinepine kēia maʻi i kahi hoʻoweliweli i ke olakino o ka makuahine, a ʻo kāna papa ʻaʻole i hoʻopilikia i kona pono. Akā ʻo nā loiloi o nā kauka e ʻōlelo nei ma ka lilo ʻole o ka mālama ʻana, hana pinepine ka hana me nā maʻi paʻakikī.
Ma kahi wahine hāpai i loaʻa i ka maʻi maʻi gestational, hiki i ka microcirculation i nā kiko. Me ka spasm o nā moku liʻiliʻi, ua hoʻopau ka endothelium, hoʻopōmaikaʻi ʻia ka lipid peroxidation, a ulu nā DIC. Hoʻopilikia kēia i nā hoʻopiʻi e like me ka hoʻomohala ʻana o ka insenture i ka plumbum me a hypoxia fetal e hiki mai ana.
ʻO ka hopena maikaʻi ʻole o ka maʻi hānai ma luna o kahi keiki e waiho pū ʻia ana i ka nui o ka hoʻokomo o ka glucose i ka pēpē. Ma hope o nā mea āpau, ʻaʻole i hiki i kāna pancreas ke hana i ka insulin i ka nui o ka nui, a me ka hoʻoneʻe ʻia o ka hormone i ke kino o ka makuahine, ʻaʻole hiki ke komo i ka pāpaʻi fetoplacental.
Ke hāʻawi aku nei ka hoʻokaʻawale i ke koko a hoʻōla i ka metabolic a me nā ʻokiʻoki i ʻike ʻia. A ma muli o ka hyperglycemia Secondary e hoʻolilo i ka loli a me ka hoʻololi i nā membran cell, e hoʻonui ana hoʻi i ka hypoxia o nā kīpopuna fetal.
Eia nō kekahi, nui i ka glucose i nā keiki ka mea hypertrophy o nā beta beta o ka pancreas. Ua alakaʻi ʻo Lilo i kā lākou poʻo mua. I ka hopena, ma hope o ka hānau ʻana, hiki i ka pēpē ke loaʻa nā maʻi maikaʻi loa i ka hoʻoneʻeʻana o nā kalaiwa a me nā hana ʻino e hoʻoweliweli ʻana i ke ola o ka pēpē.
Inā ʻaʻole e mālama ʻia ka maʻi mellitus maʻi gestational i ke kolu o ka hapala o ka hapai ʻana, he macrosomia ka pūpū me ka maʻi popole me ka hepato- a me ka splenomegaly. ʻOiai ma hope o ka hānau ʻana, ua loaʻa kahi keiki i ka nui o nā ʻōpū a me nā ʻōnaehana.
ʻO nā hopena nui ka maʻi maʻi gestational:
- hoʻopuka ʻōlohelohe;
- hypoxia fetal me ka ulu ʻana o ka ulu o intrauterine;
- pilikia kiʻekiʻe ka make i ka wā kamaliʻi;
- hanau mua;
- pinepine nā maʻi o ka urinary tract i ka wā hāpai;
- preeclampsia, eclampsia, a me ka preeclampsia i nā wahine;
- macrosomia a me ka hōʻino i ka waʻa hānau;
- nā maʻi ʻaihue o ka mucosa ʻōiwi.
Eia kekahi, ʻo nā hoʻopiʻi o ka maʻi maʻi i ka wā e hāpai ana i ka hoʻomaʻamaʻa spontan i loaʻa i ka hoʻomaka. Eia nō naʻe, mālama pinepine nā kumu i ka hala me ka decompensation o ka maʻi maʻi, ʻaʻole i hōʻike ʻia i ka manawa kūpono.
ʻOiai i ka haʻalele ʻana o ka lāʻau no ka hoʻopau ʻana i ka endocrine i ka wā hāpai, hiki i ka maʻi maʻi gestational ma hope o ka hānau ʻana hiki i ka maʻi maʻamau.
ʻO kēia ʻano o ka maʻi e makemake ai i kahi lōʻihi lōʻihi, ʻoi aku ka lōʻihi o ke ola.
ʻO ka hoʻomaikaʻi ʻana a me ka hānau ʻana
Inā he wahine maʻi pākiki, mālama ʻia ka mālama ʻana me ka endocrinologist a me kahi gynecologist. I kēia hihia, hiki i ka mea maʻi ke hoʻomalu kūʻokoʻa i ka maʻi glycemia wikiwiki a ma hope o ka ʻai ʻana.
I mea e pōmaikaʻi ai ka hānau ʻana me ka maʻi maʻi gestational, ua kuhikuhi ʻia ka mea maʻi i kahi meaʻai kūikawā. I ke nānā ʻia ʻana, pono nui ka ʻai ʻana i ka meaʻai i nā wahi liʻiliʻi, ʻaʻole i ʻai i nā meaʻai momona a me nā iʻa, a ʻaʻole hoʻi e ʻai i ka kīʻaha ʻano, ʻo ia mau meaʻai koke. Ke lawe nei ʻoe i kahi kamaliʻi, nā huahana e hoʻonui i ke kao a me ka saturate i ke kino me nā huaora, nā minela a me nā fiber (nā hua, nā ʻalā āpau, nā ʻano ʻaiʻai, nā mea kanu) e pono.
Akā inā ʻaʻole i koʻikoʻi nā hopena ma hope o kaʻai ʻana i ka papaʻaʻai i ka hakakā ʻana me ka hyperglycemia maʻi, a laila ua kuhikuhi ʻia ka mea maʻi i ka insulin insulin. Hoʻohana ʻia ka Insulin no ka GDM hana-pōkole a lohi.
Pono e hoʻokomo pinepine i ka insulin, hāʻawi ʻia i ka ʻai o ka caloric o ka meaʻai a me ka glycemia. ʻO nā pauku a me nā ʻōlelo aʻoaʻo e pili ana i ke kuhi ʻana i ka lāʻau lapaʻau e pono e wehewehe ʻia e ka endocrinologist.
He mea kūpono ke hoʻomanaʻo o nā wahine hāpai me ka maʻi diabetes ua pāpā ʻia e lawe i nā papa haʻahaʻa i ke kō. I kekahi manawa ke mālama ʻia nā lawelawe kōkua.
- nā huaora;
- Hoʻonui nā microcirculation;
- Chophytol;
- nā lāʻau e pale aku ai i ka hoʻomohala ʻana o ka palau palaka.
Wahi a nā helu helu, ʻoi ka maʻi maʻi gestational ma hope o ka hānau ʻana i ka 80% o nā hihia a lele wale ma luna o ia iho a i ka wā e haʻalele ai ka wahine i ka hānai makuahine, hoʻololi maoli kona ʻano i kona ʻano. Akā hiki i ka paʻakikī ke kaʻina o ke ʻano o ke keiki.
No laila, ʻo ka nui o kahi pēpē nui. No laila, i nā manawa he nui, ua hoʻopau ʻia kēia pilikia e ka ʻāpana cesarean, no ka mea inā hānau ka wahine i kahi keiki ma luna o ia iho, hiki ke hōʻeha kona poʻohiwi.
Ka hānau hānai ʻana i ka maʻi mellitus no ka mālama ʻana i nā maʻi ma ka wā hāpai a mālama ʻia ka mālama mālama maʻi mau. Akā ʻokoʻa pinepine ka nui o ke kō koko koko i loko o nā keiki hou. No ka hele ʻana o kēia ʻano, lawa ia e hoʻouluulu ʻia ai a i ʻole nā ʻano hui kūikawā.
ʻO ka mālamaʻana i ka mellitus maʻi gestational ka hoʻokō ʻana me nā lula o ka meaʻai olakino, hana maʻamau me ka octopus a me ka normalization o ka hiamoe a hoʻomaha hoʻi. Eia kekahi, ʻo ka poʻe i loaʻa i ka maʻi gestational i ka wā o kahi hapai ma mua e pono i kahi manawa e nānā i ka neʻe o ka glucose i ke koko, e hahai i ka pāʻai haʻahaʻa-kālai a hoʻolālā i nā hāpai ʻana a pau.
Hāʻawi ʻia ka ʻike e pili ana i ka maʻi gestational i ke wikiō ma kēia ʻatikala.
