孕前糖尿病合并妊娠临床管理新进展

Advances in clinical management of pregnant women with preexisting diabetes

孕前糖尿病合并妊娠母儿不良结局增加。孕前糖尿病孕妇计划妊娠是避免和减少胎儿先天畸形等的重要一步。推荐的糖化血红蛋白控制目标孕前为<6.5%,孕期为<6.0%。糖尿病合并症的筛查及管理至关重要,血压控制目标应更谨慎,尤其是有糖尿病肾脏疾病者。对于1型糖尿病患者,孕期动态血糖监测有助于改善血糖控制水平。胰岛素是孕期糖尿病患者的一线治疗方案。优化血糖控制和药物治疗方案,并密切关注并发症,能够降低孕前糖尿病合并妊娠的母儿不良结局风险,并确保孕前、妊娠期间和产后的糖尿病管理质量。

Pregnant women with preexisting diabetes have increased adverse maternal and neonatal outcomes.Preconception planning is necessary for avoiding unintended pregnancies and mitigating risk of congenital defects.The recommended glycosylated hemoglobin goals are<6.5%before conception and<6.0%during pregnancy.Screening and management for diabetic complications are critical,strict blood pressure control goal need to be achieved,especially for those complicated by nephropathy.Continuous glucose monitoring during pregnancy might help improve blood glucose control for women with type 1 diabetes.Insulin is still the first-line therapy for pregnant women with preexisting diabetes.Optimization of glycemic control,appropriate medication regimens and close attention to comorbidities can help minimize the maternal and neonatal adverse outcomes and ensure the quality of clinical management for women with preexisting diabetes before,during,and after pregnancy.