Dijabetes u trudnoći

master's thesis

• Title (english): Diabetes in pregnancy
• Author: Matija Štojs
• Mentor: Spomenka Ljubić (mentor)
• Committee member: Lea Smirčić-Duvnjak (predsjednik povjerenstva)
• Committee member: Ivančica Delaš (član povjerenstva)
• Committee member: Spomenka Ljubić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Dijabetes u trudnoći tema je kojoj se unazad 20-ak godina posvećuje sve više pažnje. Već se dugo zna da trudnice s dijagnosticiranim dijabetesom imaju veći rizik rađanja makrosomnog djeteta te povećanu učestalost porođajnih trauma, no nije se
znao patofiziološki mehanizam nastanka. Istraživanja su pokazala da majčina hiperglikemija dovodi do fetalne hiperglikemije, koja uz pojačano lučenje fetalnog inzulina dovodi do prekomjernog fetalnog rasta. Nastanak hiperglikemije u trudnica pripisuje se pojačanoj inzulinskoj rezistenciji koja se stvara u drugom djelu trudnoće pod utjecajem prodijabetogenog djelovanja određenih hormona čija koncentracija raste kako trudnoća napreduje. Dijabetes koji se razvije pod takvim okolnostima naziva se gestacijski dijabetes i povlači se nakon trudnoće. Djeca rođena s masom većom od 4000 grama označavaju se kao makrosomna novorođenčad. Makrosomna djeca tijekom poroda često pretrpe porođajne traume kao što je distocija ramena.
Također su nakon rođenja sklona razvoju hipoglikemije u prvih 24 sata nakon poroda, a to je opasno zbog mogućeg oštećenja mozga. Uz dijabetes vezane su brojne komplikacije u trudnoći koje mogu narušiti majčino zdravstveno stanje te dodatno ugroziti fetus. Najčešće komplikacije su hipertenzija i preeklampsija, dijabetička nefropatija, dijabetička retinopatija i veća sklonost infekcijama naročito urogenitalnog sustava. Kako bi se spriječili nepovoljni ishodi trudnoće s dijabetesom važno je što ranije postaviti dijagnozu i početi provoditi terapiju. Preporučeno je da sve trudnice između 24. i 32. tjedna trudnoće naprave oralni test za toleranciju na glukozu. U slučaju dijagnoze dijabetesa treba se odmah početi provoditi dijetetske mjere te terapiju oralnim antidijabeticima i/ili inzulinom.

Abstract (english)

In last 20 years the topic of diabetes in pregnancy has become more relevant than it used to be. For a long time, it has been known that pregnant women have a higher chance of giving birth to a macrosomic child and a higher incidence of birth trauma, but the pathophysiological mechanisms were unknown. Research has shown that maternal hyperglycemia leads to hyperglycemia in the fetus which influences a secretion of fetal insulin. The insulin stimulates an excessive fetal
growth. The development of hyperglycemia in pregnant women is associated with an insulin resistance which occurs in the second half of pregnancy due to the activity of certain hormones whose concentration continuously grow till the end of a pregnancy. If diabetes occurs under this circumstance it is called a gestational diabetes and it withdraws after a pregnancy. The infants who weight more than 4000 grams are called macrosomic infants. Macrosomic newborns are at a higher risk of suffering birth trauma such as shoulder dystocia as well as a development of hypoglycemia in the first 24 hours which can be very dangerous due to a possibility of brain damage. Numerous complications are associated with diabetes in pregnancy. The most common complications of diabetes in pregnancy are hypertension and preeclampsia, diabetic nephropathy, diabetic retinopathy and an increased tendency of infections, particularly urogenital infections. These complications can cause a huge burden on the health of a pregnant woman and can put the fetus in danger. It is important to establish the diagnosis of diabetes in pregnancy as soon as possible in order to prevent negative outcomes and complications. It is recommended that all pregnant women undergo an oral glucose tolerance test between 24 and 32 weeks of pregnancy. In case of diabetes, pregnant women should be advised to change their diet and the therapy with oral anti-diabetic drugs and/or insulin must be conducted.

• Keywords: dijabetes; gestacijski dijabetes; trudnoća
• Keywords (english): diabetes; gestational diabetes; pregnancy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:700604
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-03-14 12:03:32