ʻO ka maʻi diabetes mellitus (GDM): kahi pōpilikia o kahi hāpai "momona"

I kekahi manawa, loaʻa nā wahine hāpai i ka maʻi gestational diabetes mellitus (GDM). Hiki ke ʻano kūlohelohe kēia ʻano o ka maʻi i ka wā hapai, a nalo i kekahi manawa ma hope o ka hānau ʻana. Akā inā ʻaʻole ʻoe e mālama i ka wā kūpono, a laila hiki i ka maʻi ke ulu i loko o ka maʻi diabetes type 2, he hopena kona hopena.

I ka hoʻomaka ʻana o ka hāpai ʻana, pono e hoʻopaʻa ʻia nā wahine a pau, ma laila, ma lalo o ka mālama ʻana o nā poʻe loea, e loaʻa ana i ka mana o ka pono o ka makuahine e hiki mai ana a me ka hoʻomohala ʻana o ka ʻōpio.

Pono kēlā me nā wahine hāpai e kiaʻi pinepine i ka hila ma o ka hoʻāʻo ʻana i ka hoʻāʻo a me ka hoʻokahe koko. Hōʻalo ʻia nā hihia o ka hoʻonui ʻia o ka nui o ka glucose i loko o nā kākana, no ka mea, ʻoiai ʻo ia mau ʻano he ʻano hana kūlohelohe ia. Akā, inā i ke kau ʻana i nā hoʻokolohua, ʻike ʻia ke kōpaʻa kiʻekiʻe i ʻelua mau manawa a i ʻole mea ʻē aʻe, a laila hōʻailona kēia i ka hele ʻana o ka maʻi gestational i ka wā hāpai. ʻAʻole ia he mea kūpono ke ʻike ʻia kahi kiʻekiʻe kiʻekiʻe i ka wā e hāʻawi ʻia ai ka mea i ka ʻōpū ʻole (ʻo ka piʻi o ke kōhi koko ma hope o ka ʻai maʻamau).

ʻO ka pōʻino o GDM i ka hoʻopuka

He aha nā mea e hoʻoweliweli ai i ka maʻi maʻamau i kahi mahele e hāpai ana? No ka mea ʻaʻole hoʻokomo ka pilikia nei i ka pilikia kūpono i ke ola o ka makuahine e kali ana, akā hiki wale nō i ka pōpilikia no ka pēpē, ke kuhikuhi nei ka mālama ʻana i ka pale ʻana i nā hoʻopiʻi o perinatal, a me nā hoʻopiʻi i ka wā o ka hānau ʻana.

Hōʻike ʻia nā hopena no kahi keiki me ka maʻi maʻi i nā wahine hāpai, i ka hopena maikaʻi ʻole o ka microcirculation o ke koko i nā kiko o ka wahine hāpai. ʻO nā kaʻina āpau āpau i hoʻokumu ʻia e ka microcirculation impaired, ma hope, alakaʻi i nā hopena hypoxic i ka pēpē.

Eia kekahi, ʻaʻohe meaʻino no ka loaʻa ʻana o ka nui o ka glucose i ka pēpē. ʻOiaʻiʻo, ʻo ka insulin i hana ʻia e ka makuahine, ʻaʻole hiki ke komo i ka ālai paʻa, a ʻaʻole hiki i ka pancreas o ke pēpē ke hana i ka nui o ka hormone.

Ma muli o ka hopena o ka maʻi hānai, ua hoʻohaunaele nā ​​kaʻina metabolic i loko o ka pūpū, a hoʻomaka ia e loaʻa ka lehulehu ma muli o ka ulu nui o ka adipose. Eia kekahi, ua loli ke ʻano o ke pēpē:

• aia ka nui o ka ʻūhā poʻohiwi,
• hoʻonui ae i ka ʻōpū,
• hoʻonui i ka nui o ka nui a me ka puʻuwai,

Hoʻololi kēia mau hoʻololi āpau i ke ʻano o ka ʻoiaʻiʻo o ke poʻo a me nā wāwae he kūlike mau (maʻamau). Hiki i kēia mea ke pili i ke kūkulu ʻana o ke kūlana ma ka wā e hiki mai ana, a ke kumu i kahi hopena penei:

• ma muli o ka hoʻonui i ke kāʻei o ka poʻohiwi o ke kuʻi, he paʻakikī ke hele i ka wā o ka hānau ʻana ma o ke kanawai hānau.
• ʻeha nā hōʻeha ʻana i nā ʻōpio a me ka makuahine i ka wā hānau keiki,
• hiki ke hoʻomaka ka hānau hānau ʻana, ma muli o ka nui o ka pūpū, ʻaʻole i ulu nui.
• i loko o nā ʻōpū o ka pēpē i loko o ka ʻōpū, hoʻemi ʻia ka hoʻoulu ʻana o ka surfactant, ʻaʻole e ʻae iā lākou e hui pū me ia. ʻO ka hopena, ma hope o ka hānau ʻana, loaʻa nō paha i nā pilikia hanu. I kēia hihia, ua hoʻopakele ʻia ke keiki me ke kōkua o kahi mea hana hanu hana maoli, a laila waiho ʻia i loko o kahi incubator kūikawā (couvez), kahi e noho ai ʻo ia ma lalo o ka mākaʻikaʻi kokoke o nā kauka no kekahi manawa.

Eia kekahi, ʻaʻole hiki i kahi mea ke hōʻaihewa i ka hopena o nā maʻi mestitus gestational: nā keiki i hānau i nā makuahine me ka GDM paha i loaʻa nā mea huapuni o ka congenital, a aia paha kekahi e hoʻomohala i ka maʻi lua ma ka pākeke.

ʻO ka plasenta, he waiwai nō hoʻi e hoʻonui me GDM, e hoʻomaka i kahi hana pono ʻole i kāna mau hana, a hiki paha i ka edematous. I ka hopena, ʻaʻole e loaʻa ka hānau ʻana i ka nui o o oxygen, nā setuna hypoxia. Kaulana, ma ka hopena o ka wā e hāpai ʻia ai (ʻakolu kolamu) he pōpilikia o ka make o ka hānau fetal.

Ma muli o ka maʻi e ka maʻi o ke kō, ua kūpono ia i ka manaʻo no ka mālama ʻana a me ke pale ʻana i nā palema e pono ai ke kaohi a hiki i kēia mākaukau i loko o nā palena maʻamau.

ʻO ka mea nui i hoʻokomo i ka papa o ka mālama ʻana i ka maʻi diabetes i ka wā hapai, ʻo ka mālama pono ʻana i nā rula o ka papa ʻaina.

• kuke a me nā huahana confectionery, e pili pono ana i nā pae o ke kō, ua haʻalele ʻia mai ka meaʻai. Akā, ʻaʻole ʻoe e haʻalele āpau i nā kalaiʻe, no ka mea he lawelawe ia ma ka ikaika. Pono ʻoe e kau i kā lākou helu i ka lā,
• Hoʻopili i kāu kau ʻana o nā hua momona kalapona,
• kaawale ʻana i ka noodles, nā kālai ʻia a me nā ʻuala koke, a me nā huahana semi-hoʻopau.
• wehe i nā ʻai momona a me nā ʻaina mai ka meaʻai (ka pata, margarine, mayonnaise, lard),
• pono ke ʻai ʻia ka protein, he mea nui ia no ke kino o ka makuahine a me ke keiki,
• no ka kuke ʻana, ʻōlelo ʻia ʻia e hoʻohana i ka: kulala, kuke, ʻaila, ʻai ʻana i ka umu,
• lawe i ka meaʻai i kēlā me kēia 3 mau hola, akā ma kahi liʻiliʻi.

Eia kekahi, ua hōʻike ʻia ka hopena maikaʻi ma ke olakino o ka makuahine hāpai.

• i kahi paʻakikī o nā hana pilikino i hoʻolālāʻia no nā wahine hāpai. I ka wā o ka hoʻomaʻamaʻa ʻana, aia ka emi ʻana o ke kaila o ke kō, ʻoi aku ka hoʻomaikaʻi i nā kaʻina metabola i loko o ke kino a me ka pono o ka wahine hāpai.
• hele wāwae maʻamau loa mai nā alahele.

I nā hihia koʻikoʻi o ka maʻi, hiki i ke kauka ke kuhikuhi i ka hoʻomākaukau ʻana i nā insulin. ʻO nā lāʻau lapaʻau ʻē aʻe e hōʻemi i ka hilo ua pāpā ʻia.

Hoʻokaʻawale ʻia nā lāʻau lapaʻau e pili ana i nā wae 2, e like me nā ʻōlelo a ka FDA.

1. I loko - ʻāpana. Mālama pū ʻia nā kālā ma ka ho'ākāka a kahi i kākau ʻia ai i ka wā i hoʻāʻo ʻia ai ka holoholona, ​​ʻaʻole i ʻike ʻia nā hopena ʻino o ka pēpē. ʻAʻole ia i hōʻike ʻia ka hopena o ka lāʻau i ka wā hāpai.
2. Kūkū Hoʻokomo ʻia nā lāʻau me ka mea, i ka wā e hoʻāʻo ʻia, ka hopena i ka hoʻomohala ʻana o ka pūpū i nā holoholona. I nā wahine hāpai, ʻaʻole i lawe ʻia nā hoʻokolohua.

No laila, pono nā lāʻau lapaʻau e kau ʻia e nā kauka pono ʻole, me ka hōʻike pono ʻana i ka inoa kālepa o ka lāʻau lapaʻau.

ʻO ka hānaiʻana me ka GDM e kūpono wale nō inā inā he kānalua i ka loaʻa ʻana o nā pilikia paʻakikī.

ʻAʻole he kumu o GDM e hoʻoulu ai i ka hoʻopuka preterm a i kahi ʻāpana caesarean.

Nairi maʻi

Ma hope o ka hānau ʻana, ʻike pono ka wahine i nā pae wai, e nānā i ka ʻike o nā hōʻailona a me kā lākou pinepine (make wai, urination, etc.) a nalowale lākou. ʻO nā loiloi e kuhikuhi pinepine ʻia e nā kauka ma hope o 6 a me 12 mau pule ma hope o ka hānau ʻana. I kēia manawa, pono ke hoʻi i ke kō koko koko o ka wahine.

Akā, e like me nā helu helu, ma 5-10% o nā wahine i hānau ai, ʻaʻole maʻamau nā pae gula. I kēia hihia, koi ʻia ke kōkua olakino, ʻaʻohe pono e haʻalele ʻia, ke ʻole hiki ke hōʻemi ʻia kahi maʻi maʻi maʻalahi e ulu i kahi maʻi maʻi ʻoi loa.

He mea hoʻonāukiuki?

Ke hōʻike nei ka American Diabetes Association i nā hōʻike e 7% o nā wahine hāpai i ka hoʻomohala maʻi. I kekahi o lākou, ma hope o ka laweʻana, ua hoʻi ka glucose i ka maʻamau. Akā ma 60% ma hope o 10-15 mau makahiki, ua hōʻike ʻia ka maʻi diabetes type 2 (T2DM).

Hoʻohana ka gestation i kahi mea hoʻonāukiuki i ka hopena hoʻokūkū o ka glucose o ka maʻi. ʻO ka hoʻolālā o ka hoʻomohalaʻana o ka maʻi gestational e kokoke loa i T2DM. Hoʻokumu ka wahine hāpai i ka pale ʻana i ka insulin ma lalo o ka mana o nā ʻano o kēia ʻano:

• ka synthesis o nā hormone hāmeʻa i ka plenta: estrogen, progesterone, lactogen pl pae,
• ka hoʻonui ʻana o ka hana o ka cortisol i ka cortex adrenal,
• hōʻino i ka insulin metabolism a me kahi hoʻohaʻahaʻa i kona mau hopena i nā kiko,
• hoʻonui i ka hoʻonui ʻia o ka insulin ma o nā keiki,
• hoʻōla o ka insulinase i ka plasenta (kahi enzyme e wāwahi i ka hormone).

Pilikia ke kūlana i kēlā mau wāhine i loaʻa ka pale kino physiological (makeʻe) i ka insulin, ʻaʻole i hōʻike ʻia i ke ʻano maʻi. Hoʻonui kēia mau mea i ka pono o kahi hormone, beta cell o ka pancreas synthesize iā ia i kahi nui. Hoʻolaha, hele kēia i ka hōʻemi a me ka hyperglycemia i hoʻomau - e hoʻonui i nā pae o ka glucose koko.

He aha nā ʻano maʻi maʻi i ka wā e hāpai ana

Hiki i nā ʻano maʻi maʻi like me ka hānau ʻana. ʻO ke ʻano o ka palaka ʻana i ka manawa o ka hanana he ʻano ʻelua.

1. ma mua o ka maʻi i loaʻa ai ma mua o ka hāpai ʻana (ʻo ka maʻi type a me ke ʻano type type 2) he pre-gestational,
2. maʻi gestational diabetes (GDM) i nā wahine hāpai.

Wahi a ka mālama pono ʻana no GDM, aia:

• offset e ka ai
• hoihoi ʻia e ka lāʻauʻai a me ka insulin.

Aia paha ka maʻi maʻi ma ke kahua o ka uku a me ka hoʻokaʻawale. ʻO ka hōʻeha o ka maʻi maʻamau gestational e pili ana i ka pono e hoʻopili i nā ʻano ʻano like ʻole o ka mālama ʻana a me ka paʻakikī o nā hōʻahewa.

ʻO ka Hyperglycemia, i ulu i ka wā o ka hapai, ʻaʻole mau ke ʻano maʻi gestational mau. I kekahi mau hihia, hiki ke hōʻike i kahi mea maʻi type 2.

ʻO wai ka mea weliweli no ka hoʻomohala ʻana i ka maʻi maʻi i ka wā hāpai?

ʻO nā loli o ka hormonal e hiki ke hoʻonāukiuki i ka metabolism o ka insulin a me ka glucose e kū i nā wahine hāpai. Akā ke hoʻololi nei ka poʻe a pau i ka maʻi diabetes. Pono kēia i nā mea predisposing:

• nā kau momona a i ʻole ke kala ʻana,
• ke kō ʻole ke ahonui glucose
• nā makahiki e piʻi ana i ke kō ma mua o ka hāpai ʻana,
• Pākuʻi ʻaʻai ʻoi aku i nā maʻi hānai 2
• ʻoi aku i nā makahiki 35
• polycystic ovary syndrome,
• ka mōʻaukala kolohe
• hanau ma ka mua o na keiki e kaupaona ana ma mua o 4 kg, a me nā malformations.

Akā ʻo ia mau kumu ke hoʻopilikia nei i ka hoʻomohala ʻana o ka pathology ma kahi ākea ʻē aʻe.

He aha ka maʻi maʻi gestational

Ua manaʻo ʻia ʻo GDM i ka palola i kūkulu ʻia ma hope o nā 15-16 mau pule o ka hānau ʻana i kahi keiki. Inā hōʻike mua ʻia ka hyperglycemia ma mua, a laila aia i ka latine mellitus diabetes, i noho ʻia ma mua o ka wā hapai. Akā ʻike ʻia ka piʻi poʻokela kiʻekiʻe i ka lā 3ri. ʻO kahi hōʻailona like o kēia ʻano no ka maʻi maʻi gestational.

Ka maʻi ʻokoʻa ma ke ʻano hānai ma waena o ka wā hānai e ʻokoʻa i ka maʻi maʻi gestational ma hope o hoʻokahi manawa o ka hyperglycemia, piʻi nui ke kōhula a ʻaʻole hoʻi e paʻohi. ʻO kēia ʻano o ka maʻi me ka hopena kiʻekiʻe e hiki ke hele i ka type 1 a i ʻole type 2 paha ma hope o ka hānau ʻana.

No ka hoʻoholo ʻana i nā loiloi o ka wā e hiki mai ana, aia nā makuahine postpartum a me GDM i ka manawa postpartum i loaʻa i kahi pae glucose. Inā ʻaʻole ia e hoʻohuli maoli, a laila hiki iā mākou ke manaʻo i ke ʻano o ka maʻi diabetes type 1 a i ʻole ua make.

Hoʻopilikia i ka fānau a me ka hopena no ka pēpē

ʻO ka pilikia o ka hiki ʻana o ke keiki e hilinaʻi ana i ka kiʻekiʻe o ka uku o nā pathology. ʻO nā hopena koʻikoʻi nui loa e nānā me kahi palapala uncompensated. Hōʻike ʻia ka hopena ma ka ʻōpiopio:

1. ʻO ka hoʻohuli ʻana o ka pūpū me nā kiʻekiʻe glucose kiʻekiʻe i nā papa mua. ʻO ko lākou uluʻana ma muli o ke ikehu. I ka hoʻomaka mua, ʻaʻole paha i kūkulu ʻia ka pancreas o ke keiki, no laila pono ke hana pono ka mea maʻi ʻehā no ʻelua. ʻO ka hoʻohuli ʻana i ka hana e alakaʻi i ka starvation energy o nā pūna, hoʻonāukiuki i kā lākou mahele a me ke kūkulu ʻana o nā meaʻino. Hiki ke kahakaha kēia ʻano e ka hele ʻana o polyhydramnios. Hōʻaike ʻia ka nui o ka glucose i loko o nā pū i hōʻike ʻia e ka ulu ʻana i ka ulu ʻana o intrauterine, haʻahaʻa haʻahaʻa o ke keiki.
2. ʻO ka nui o ka kō kōkō hokeʻeole i nā wahine hāpai me ka maʻi mellitus maʻi gestational i ka trimester 2 a me 3 ke alakaʻi nei i ka fetopathy maʻi. Hoʻopapa ka Glucose i ka plasenta i ka nui o ka nui o nā mea i kau ʻia. Inā he nui loa i ka inikini intrinsic, wikiwiki ka ulu ʻana o ka pēpē, akā he disproption o nā ʻāpana kino i ʻike ʻia: ka ʻōpū nui, ke kāʻei poʻohiwi, nā limu liʻiliʻi. Hoʻonui hou ka naʻau a me ka puʻuwai.
3. Hoʻopilikia ka mea kiʻekiʻe o ka insulin i ka hana o ka surfactant - kahi waiwai e uhi ai i nā alveoli o nā māmā. No laila, pilikia nui ka hanu ma hope o ka hānau ʻana.
4. Hoʻopili i ka kaula o ka umbilical o kahi wahine hou e hōʻole ana i ka hoʻokomo o ka glucose nui loa, e hoʻohiolo pinepine ka paʻu o ke keiki. Hiki i ka hypoglycemia ma hope o ka hānau keiki ʻana i nā pilikia o ka neurological, he ʻaki ʻole i ka hoʻomohala ʻana o ka noʻonoʻo.

Eia kekahi, ʻo nā keiki i hānau ʻia me nā makuahine me ka maʻi diabetes gestational he nui ka nui o ka hānau ʻana i ka trauma hānau, ka make perinatal, nā maʻi cardiovascular, ka maʻi o ke ala o ka ʻōpū, nā maʻi ʻoluʻolu metabolic o ka calcium a me ka magnesium, a me nā pilikia neurological.

No ke aha laona e hoʻōki ai ka hilo kiʻekiʻe no ka wahine hāpai

Hoʻonui ka GDM a i ʻole ka maʻi āpau i mua i ka hiki ke hiki i ka maʻi maʻi (gestosis), hōʻike nō ia iā ia iho i nā ʻano like ʻole.

• kōkuhi o nā wahine hāpai
• nephropathy 1-3 degere,
• preeclampsia,
• eclampsia.

ʻO nā kūlana hope loa e pono ai ka hoʻokipa ma ka waihona mālama mālama kino, hōʻino, a me ka lawe mua.

ʻO ka maʻi i pale ʻia me ka maʻi hānai i alakaʻi i nā maʻi o ka ʻōnaehana genitourinary - cystitis, pyelonephritis, a me ka recurrent vulvovaginal candidiasis. Hiki i nā maʻi āpau ke alakaʻi i ka maʻi o ka pēpē a i ka wā hānau.

ʻO nā hōʻailona nui o ka maʻi maʻi gestational i ka wā hāpai

ʻAʻole haʻi ʻia nā hōʻailona o ke maʻi gestational, ulu aʻe ka maʻi i kahi palau. Lawe ʻia kekahi mau hōʻailona o ka wahine no nā loli ʻano maʻamau i ka wā hāpai:

• luhi, nāwaliwali,
• makewai
• nā hoʻomaʻa pinepine ʻana
• lawa ka nui o ka momona me ka makemake nui.

Loaʻa pinepine ka hyperglycemia i ka loaʻa ʻana o ka hoʻokaʻawale ʻana o ke kaila glucose koko. Hoʻomaopopo kēia ma kahi o ka hōʻike hou.

ʻO nā kumu no nā maʻi maʻi, nā hoʻokolohua no ka maʻi diabetes

Ua hoʻonohonoho ke Kuhina o ke ola i kahi manawa no ka hoʻāʻo ʻana i ka hoʻokaʻa kō koko koko:

Inā hele i nā mea hanana, he hoʻokolohua hoʻoliʻi glucose. Inā hōʻike ʻia nā hōʻailona o ke maʻi ma ka wā hāpai, hōʻike ʻia ka hoʻāʻo glucose.

ʻAʻole hōʻike ʻia kahi hōʻike hoʻokahi e hōʻike ana i ka hyperglycemia e hana i kahi maʻi ka maʻi. Pono ke kiaʻi ʻana ma hope o kekahi mau lā. Eia kekahi, me ka hyperglycemia hoʻolaha pinepine, ua kau ʻia ke kūkākūkā o ka endocrinologist. Hoʻoholo ke kauka i ka pono a me ka manawa o ka hoʻokaʻawale ʻaʻa glucose. ʻO ka maʻamau ka liʻiliʻi o 1 ma hope o ka maʻi ma hope o ka hyperglycemia paʻa. Hoʻomaopopo hou ka hōʻike hōʻike e hōʻoia i ka maʻi maʻi.

ʻO nā hopena hōʻike i hōʻike ʻia e pili ana i ka GDM:

• ka wikiwiki o ka wikiwiki ma mua o 5.8 mmol / l,
• hoʻokahi hola ma hope o ka hoʻokomoʻana i ka glucose - ma luna o 10 mmol / l,
• ʻelua hola ma hope, ma luna o 8 mmol / l.

ʻO ka manawa, e like me nā hōʻike ʻana, ke lawe ʻia nei nā haʻawina:

• kekipukapuka hemoglobin,
• hōʻike hoʻāʻo i ka kō
• kolamu a me ka ʻōlelo lipid,
• hōʻikeʻike koko ololi,
• coagulogram
• nā mekameka koko: progesterone, estrogen, plent lactogen, cortisol, alpha-fetoprotein,
• noiʻi ʻana i ka urine e like me Nechiporenko, Zimnitsky, ʻo Reberg hōʻike.

ʻO nā wahine hāpai a me ka maʻi diabetes pre-gestational a me ke maʻi gestational e lawe i ka ultrasound janal mai ka 2 trimester, dopplerometry o ka plasenta a me nā moku umbilical, ʻo ka CTG maʻamau.

Ka hoʻokele ʻana o nā wahine hāpai i ka maʻi diabetes a me ka mālama ʻana

ʻO ke ʻano o ka hāpai ʻana me ka maʻi maʻi maʻi e kū ana i ka pae o ke kāohi ponoʻī ʻana o ka wahine a me ke hoʻoponopono ʻana o ka hyperglycemia. ʻO ka poʻe i loaʻa i ka maʻi diabetes ma mua o ka ʻāhaʻi, pono lākou e hele ma ke kula Diabetes, nā papa kūikawā e aʻo ai iā lākou pehea e ʻai ai i kaʻai, pehea e kūʻokoʻa ai i kā lākou kaohi i ka glucose.

ʻO ke ʻano o ke ʻano o ke kuʻuna, pono nā wahine hāpai i ka nānā ʻana:

• kahi kipa i ka gynecologist i kēlā me kēia 2 hebedoma ma ka hoʻomaka ʻana o ka maʻi gestation, hebedoma - mai ka lua ʻāpana,
• ʻO nā kūkākūkā endocrinologist i hoʻokahi manawa i kēlā me kēia 2 hebedoma, me ke kūlana decompensated - hoʻokahi manawa i hoʻokahi pule,
• ka nānā ʻana o ka mea lapaʻau - ʻo kēlā me kēia trimester, a me ka ʻikeʻana o ka pathology extragenital
• ophthalmologist - hoʻokahi manawa a pau a ma hope o ka hānau keiki ʻana,
• neʻe neurologia - ʻelua mau manawa no ka ʻōpū.

Hāʻawi ʻia ʻo ia i ka hoʻolaʻa ʻana no ka nānā ʻana a me ka hoʻoponopono ʻana i ka lāʻau lapaʻau no ka wahine hāpai me ka GDM:

• Ka manawa 1 - i ka mea i hoʻomaʻamaʻa mua a i ʻole ke kaohi ʻana i nā maʻi patolo,
• 2 mau manawa - i 19-20 mau wiki e hoʻoponopono i ke ʻano, hoʻoholo i ka pono e hoʻololi i ka regimen mālama,
• 3 mau manawa - me ke ʻano type type 1 a me ke ʻano type 2 - ma 35 mau hebedoma, GDM - i nā wiki 36 e mākaukau no ka hānau keiki ʻana a koho i ke ala o ka hānau ʻana.

Ma kahi hale haukapila, ʻo ka pinepine o nā haʻawina, ka papa inoa o nā hoʻokolohua a me ka pinepine o ka hoʻopaʻa ʻana i hoʻopaʻa ʻokoʻa. Pono ka nānā ʻana i kēlā me kēia lā i kahi hōʻike mimi no ka kō, ke koko, a me ke kaomi koko.

Hoʻoholo kū hoʻokahi ka pono o nā inikini insulin. ʻAʻole kēlā me nā hihia āpau o GDM e koi i kēia ala; no kekahi, ua lawa kahi ʻano lāʻau lapaʻau.

Nā hōʻailona no ka hoʻomaka ʻana i ka ineminika i nā hōʻailona ma lalo o nā hilo koko.

• ka hookeai ana i ke koko glucose me ka papa ʻaina ma mua o 5.0 mmol / l,
• hoʻokahi hola ma hope o ka ʻai ʻana ma luna o 7.8 mmol / l,
• 2 mau hola ma hope o ka nānā ʻana, glycemia ma luna o 6.7 mmol / L.

Hoʻolohe Hoʻopili ʻia nā wahine hāpai a me nā lactating e hoʻohana i nā lāʻau lapaʻau i nāʻaila, koe wale nō ka insulin. ʻAʻole hoʻohana ʻia ka insulins lōʻihi.

ʻO ke kumu o ka mālamaʻana i ka insulin e hoʻomākaukau ai i ka hana pōkole a me ka ultrashort. Ma ke ʻano maʻi maʻi 1, he ʻola bolus maʻamau e hoʻokō ʻia. No ka maʻi maʻamau a me ke GDM, hiki nō ke hoʻohana i ka kuʻuna kuʻuna, akā me kekahi o nā hoʻoponopono pilikino e hoʻoholo ana ka endocrinologist.

I ka poʻe hāpai wahine me ka mālama hewa o ka hypoglycemia, hiki ke hoʻohana ʻia nā pā o insulin, e hoʻomaʻamaʻa i ka hoʻokele ʻana o ka hormone.

Meaʻai no ka maʻi gestational i ka wā hāpai

ʻO ka mālama ponoʻana i kahi wahine hāpai i ka GDM pono e kūlike i nā ʻōlelo aneʻaneʻi:

• ʻAi a liʻiliʻi i ka liʻiliʻi. ʻOi aku ka maikaʻi ma ka hana 3 mau kīʻaha nui a me nā kīʻī liʻiliʻi 2-3.
• ʻO ka nui o nā haʻalulu paʻakikī o kahi 40%, protein - 30-60%, momona a 30%.
• E inu i ka liʻiliʻi o 1,5 lita o ka wai.
• E hoʻonui i ka nui o ka fiber - hiki iā ia ke adsorb glucose mai ka ʻōpū a lawe aku.

He aha ka maʻi diabetes?

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ʻO kahi maʻi mellitus diabetes he maʻi endocrine me kahi mea hoʻopiʻi i hoʻopiʻi i ka wahi mua o ka hana kino o ka ʻaila. ʻO kāna hana nui o ka pathogenetic ka pololei kūʻokoʻa a me ka nele paha o ka insulin - kahi hormone ulu e nā ʻāpana kūikawā o ka pancreas.

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ʻO ke kumu o ke kūʻole i ka insulin e paha:

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• ka emi ʻana o ka helu o cells-cells of islets of Langerhans in the pancreas, responsible for the secretion insulin,
• kue i ke kaʻina o ka hoʻohuli ʻana i ka proinsulin kaila i ka hāmeʻe ikaika ʻana i ke ʻano o ka hormone,
• ke kāpili ʻana o ka molina insulin abnormal me ke ʻano amino acid hoʻololi a hoʻemi ʻia ka hana,
• ka loli i ka ʻike ʻana o nā ʻāpana o nā cellular i ka insulin,
• mahuahua ka hana o nā hormones, ka mea i kū i ka hopena o ka insulin,
• keʻano o ka nui o ka glucose i hāʻawi ʻia i ka pae o ka hormone i hana ʻia e ka pancreas.

ʻO ka hopena o ka insulin i ka pākuʻiʻana o ka protein, ma muli o ke kaheʻana o nā mea hoʻonā glycoprotein kiko i nā umauma i hilinaʻi ʻia i insulin. ʻO kā lākou hana a me ka hoʻololi i ka hoʻolālā kino e alakaʻi i ka hoʻonui i ka hoʻoliʻi glucose i loko o nā pū me ka hoʻohaʻahaʻa i ke kō o ke koko a me nā wahi intercellular. Eia nō hoʻi, ma lalo o ka hana o ka insulin, e hoʻoulu ʻia ka lua o ka glucose me ka hoʻokuʻu o ka ikehu (ke kaʻina o ka glycolysis) a me kona hōʻiliʻili ʻana i nā ʻili i loko o ke ʻano o ka glycogen. ʻO ka depot nui nui i kēia hihia nā mea momona a me nā huila. ʻO ka hoʻokuʻu mai o ka glucose mai ka glycogen e hele mai ana ma lalo o ka hopena o ka insulin.

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Hoʻopilikia kēia hormon i ka momona a me ka metabolism protein. Loaʻa ia i kahi hopena anabolic, e kāohi ana i ka wāwahi ʻia o nā momona (lipolysis) a hoʻoulu i ka biosynthesis o RNA a me DNA i loko o nā cell e hilinaʻi i nā insulin. No laila, me kahi hoʻohaʻahaʻa haʻahaʻa o ka insulin, kahi hoʻololi i kāna hana a i ʻole ka hoʻēmi ʻana i ka ʻike kiko, ʻike ʻia nā mea hoʻokalakupua a multifaceted. Akā aia nā hōʻailona nui o ka maʻi maʻi i ka hoʻololi ʻana i ka hoʻoliʻiliʻi o ka hoʻoliʻiliʻi. I ka manawa like, loaʻa ka nui o ka neʻe o ka pae i ka nui o ke koena i loko o ke koko a me ke ʻano o kahi kiʻekiʻe loa i kona kaila ʻana ma hope o ka ʻai ʻana a me ka hānai ʻana i ke kō.

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ʻO ka mellitus maʻi diabetes uncompensated e alakaʻi i nā maʻi vascular a me ka trophic i nā koena āpau. I kēia hihia, ʻoi aku nā ʻāpana kūʻokoʻa o ka insulin (nā keiki, ka lolo, ka naʻau). Hoʻololi ka helu o nā mea huna olakino maoli, ka mea i hāʻawi ʻia i ka hoʻomohala ʻana o ka ʻōpū o ka pūpū, waha ʻeha a me nā ʻiwi. ʻO ke keʻakeʻa o ka ʻili a me nā membrane mucous i emi, i ka hana o nā kumu kūloko o ke pale ʻana i ka pale ʻana i ka maʻi. A ʻo kahi hopena, me ka diabetes mellitus, ʻo ke ʻano o ka nānā ʻana o nā maʻi o ka maʻi me nā maʻi a me ka hoʻoweliweli o ka ʻili a me ka ʻōnaehana genitourinary, nā hoʻomaʻamaʻa purulent a me nā hana hoʻoponopono hou i pākuʻi a nui aʻe.

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Nā maʻi maʻi

Aia kahi ʻano like ʻole o ka maʻi maʻi. ʻOkoʻa lākou i kēlā me kēia i loko o ka etiology, nā papa hana pathogenetic o ka hemahema o ka insulin a me ke ʻano o ke papa.

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• type 1 diabetes mellitus me ka ikehu ole o ka insulin (pono i ke ʻano incinsable insulin), i kumu o ka make ʻana o nā mea e ili ai ka Langerhans,
• type 2 diabetes mellitus, hōʻailona ʻia e ka pale kino insulin resistant a me ka huna ʻana i ka mea huna insulin.
• maʻi mellitus maʻi gestational, me ka hyperglycemia i ʻike mua i ka wā o ka hapai a hiki i ka nalo ʻana ma hope o ka hānau ʻana,
• nā ʻano maʻi ʻē aʻe ma muli o nā hui endocrine i hui pū ʻia (endocrinopathies) a i ʻole pancreatic dysfunction me nā maʻi, nā inu ʻona, nā hopena o nā lāʻau lapaʻau, pancreatitis, nā kūlana autoimmune a i nā maʻi ʻano hoʻoholo.

Pono nā wahine hāpai i ka ma waena o ke maʻi maʻi gestational a me ka decompensation o ka maʻi ma mua o mua (pre-gestational).

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Nā hiʻohiʻona o ka maʻi maʻi gestational

ʻO nā pathogenesis o ka hoʻomohalaʻana o ka maʻi diabetes i nā wahine hāpai i loaʻa i kekahi mau māhele. ʻO ka hana nui e hana ʻia e ka pale ʻana ma waena o ka hopena hypoglycemic insulin a me ka hopena hyperglycemic o kahi pūʻulu o nā hormone ʻē aʻe. Ke hoʻonui haʻahaʻa ʻana i ka pale ʻana o ka insulin i nā ʻili e hoʻonui i ke kiʻi o ka insular insufficiency. A ʻo ka hana ʻole, ʻoi aku ka nui o ka paona me ka hoʻonui ʻana o ka mahele o ka pā adipose a me ka hoʻonui pinepine ʻia ʻana i ka nui o nā calorie o nā meaʻai e lilo i mea hoʻonāukiuki.

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ʻO ka palena no ka pilikia o endocrine i ka wā hāpai ka hoʻololi a me ka hoʻololi ʻana i ka metabolic physiological. Aia ma nā hoʻomaka mua o ka wā kahi o ka gestation, ua hoʻonohonoho houʻia ka hana metabolism. Ma muli o kēia, ma ka hōʻailona liʻiliʻi o ka hōʻemi o ka hoʻokaʻaʻana o ka glucose i ka fetus, hiki ke hoʻololi koke i ka ʻōnaehana kalakika nui o ka nui kalepa i kahi lipid kūloko. Ua kapa ʻia kēia ʻano pale palekana i ka wā o ka pōloli wikiwiki. Hāʻawi ia i kahi halihali ka neʻe o ka glucose i ka pā o ka fetoplacental i ka wā a pau i ka mālama ʻia o ka glycogen a me ka substrate no ka glucogenesis i loko o ka puʻuwai o ka makuahine.

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I ka hoʻomaka ʻana o ka hāpai ʻana, lawa ka nui o ka metabolic hou i ka momona o ka pono o ke keiki e ulu ana. Ma hope aʻe, i mea e lanakila ai i ka kū i ka insulin, hypertrophy o β-cells of islets of islet of Lagnergans a me ka hoʻonui ʻana i kā lākou hana hana. Hoʻonui ʻia ka nui o ka nui o ka insulin i hoʻoulu ʻia e ka wikiwiki o kona luku ʻia, ma muli o ka hoʻonui ʻia o ka hana a me ka hana ʻana o ka insulinase plenta. Akā i loko o ka lua o ka wā hapalua o ka hāpai ʻana, e hoʻomaka ka placenta ʻoki e hoʻokō i kahi hana endocrine, hiki i ka hopena metabolism.

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ʻO nā antagonist o ka insulin he steroid plenta-synthesized a me nā testosterone e like me nā hormone (progesterone a me plact lactogen), nā estrogens a me cortisol i hūnā ʻia e nā kumuwaiwai adrenal a ka makuahine. Manaʻo ʻia he mau maʻi paha lākou, me ka mana nui loa e lilo i ka hormone fetoplacental. Hoʻomaka lākou ʻike e hoʻonui i ka 16-18 mau pule gestation. A maʻamau ma ka 20 mau hebedoma wahine wahine hūnā me ka maʻi hoke o ka insular i ʻike i ka hōʻailona mua ʻana o ka lāʻau maʻi gestational. I ka hapanui pinepine, ʻike ʻia ka maʻi ma 24-28 mau pule, a ʻo ka wahine hoʻi ʻaʻole i hana i nā hoʻopiʻi maʻamau.

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ʻO kekahi manawa, ʻike ʻia kahi hoʻololi o ka hoʻohaʻahaʻa glucose, kahi i manaʻo ʻia he prediabetes. I kēia hihia, hōʻike wale ʻia ka nele o ka insulin me ka nui o ka nui o ka nui o nā hāmeʻe mai ka meaʻai a me kekahi mau mea hoʻonāukiuki ʻē aʻe.

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Wahi a ka ʻikepili i kēia manawa, ʻaʻole i hele pū ʻia ka maʻi diabetes o nā wahine hāpai i ka make o nā pihi pancreatic a i ʻole ka hoʻololi ʻana i ka mololi insulin. ʻO ia ke kumu i hoʻohuli ʻia ai nā maʻi endocrine e hele mai nei i loko o nā wahine a ua hoʻokipa pinepine lākou lākou iho ma hope o ka wā hānau.

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He aha ke ʻano maʻi maʻi gestational no kahi keiki?

Ke ʻike ʻia ka maʻi hānai gestational i loko o kahi wahine hāpai, e kū mau ana nā nīnau: he aha ka hopena o ke keiki i ke keiki a inā paha he mea maoli paha ke ʻano. ʻOiaʻiʻo, ʻaʻole pinepine kēia maʻi i kahi hoʻoweliweli koke i ka ola o ka makuahine ʻāpono a ʻaʻole loa e loli iki ʻo ia i kona nohona maikaʻi. Akā pono koʻikoʻi ka mālama ʻana e pale i nā hoʻopiʻi o perinatal a me nā pilikia o ka hāpai ʻana.

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ʻO ka Diabetes mellitus e alakaʻi i kahi kolohe o ka microcirculation i loko o nā lau o ka makuahine. Hoʻokomo ka spasm o nā moku liʻiliʻi e ka pōʻino o ka endothelium i loko o lākou, ka hoʻōla o ka lipid peroxidation, a hoʻokauʻē i ka DIC maʻi. Hoʻopili kēia mau mea i ka nele o ka fetoplacental maʻi me ka hypoxia fetal.

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ʻO ka hoʻopili nui o ka glucose i ke keiki ke ʻano ʻole he pōʻino ʻole ia. Ma hope o nā mea a pau, ʻaʻole i hua ʻia kāna pancreas i ka nui o ka hormone pono, a ʻaʻole i komo ka insulin maternal i ka lāʻau fetoplacental. A hiki i kahi pae glucose kūpono ʻole e alakaʻi i ka discirculatory a me ka metabolabous maʻi ʻana. Hiki i ke hyperlipidemia lua ke kumu o nā loli o ka hana a me ka hana ʻana i nā membranes, e hoʻomaʻamaʻa i ka hypoxia o nā kīpopuna.

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Hoʻokumu ka Hyperglycemia i kahi keiki hypertrophy o ka pancreatic β-cells a me ko lākou mau hala mua o ka hele. I ka hopena, hiki i kahi keiki hou ke loaʻa aku nā maʻi a me nā hoʻoweliweli i ka nui o ke ola ʻana. Inā ʻaʻole e hoʻoponopono ʻia ka maʻi maʻi gestational a ʻoi aku i loko o ka hapakolu o ka hapai o ka hapai, hoʻomohala ʻo ka pūpū macrosomia (ka nui o ke kaumaha o ke kino) me ka momona o kahi maʻi, splenitis a me ka hepatomegaly. Eia kekahi, immaturity o ke ka hanu, ka cardiovascular a me nā ʻōnaehana digestive e ʻike pinepine ʻia i ka hānau ʻana. Ua pili kēia mau mea a pau i ka fetopathy maʻi.

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ʻO nā mea hoʻonā nui o ka maʻi maʻi gestational ka:

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• hypoxia fetal me ka hoʻokuʻu ʻana i ka ulu intrauterine,
• haunaele
• make mua o ka huaiki,
• make hala nui keiki i waena o nā keiki i hānau i nā wahine me ke maʻi maʻi maʻi.
• macrosomia, e alakaʻi ana i kahi papa paʻakikī o ka hānau keiki ʻana a hoʻonui i ka hōʻeha o ka hōʻeha o ka hānau ʻana i ke keiki (collarbone fracture, Erb paralysis, phrenic paralysis, trauma to skull and cervical spine) a me ka poino i ka hānau hānau ʻo ka makuahine.
• preeclampsia, preeclampsia a me ka eclampsia i kahi wahine hāpai,
• pinepine ka hoʻomaʻamaʻa ʻana i nā maʻi ʻeha i ka wā hāpai,
• nā ʻōpū keu o nā membrane mucous (me ka genital).

Kuhi kekahi mau kauka i nā hoʻopiʻi o ka maʻi gestational me ka hoʻohaʻahaʻa kuʻeʻe i ka wā mua. Akā ʻo ke kumu nui o ka kuhi hewa ʻana o ka papa ʻaina o ka mua e pili ana i ka maʻi maʻamau.

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Nā ʻlelo a me nā Diagnosis

Loaʻa i nā wahine hāpai i ka maʻi maʻi maʻi hoʻopiʻi e pili ana i ka maʻi. ʻO nā maʻi maʻamau ka maʻi maʻamau, a noʻonoʻo nā wahine iā lākou i kahi hōʻike physiological o ka 2 a me ka 3 trimesters. ʻO ka Dysuria, makewai, ka ʻāʻī o nā leʻaleʻa, ʻaʻole lawa ka nui o ke kaumaha e hiki ke loaʻa wale me ka maʻi maʻi gestational No laila, ʻo ka mea nui i ke kauʻana o kēia maʻi kahi hōʻike ma nā lāʻau lapaʻau. A kōkua i ka ultrasound kikoʻī e hoʻopili i ka hōʻeha o ka insentence o ka placental a maopopo i nā hōʻailona o ka pathology development fetal.

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ʻO kahi noiʻi screening e hoʻoholo i ke kiʻekiʻe o ka glucose i ke koko o kahi wahine hāpai i ka ʻōpū ʻole. Hoʻopili ʻia ia ma ka manawa maʻamau mai ka 20 o ka wiki o gestation. I ka loaʻa ʻana o nā māka paepae o ka glycemia, ʻike kahi hōʻike e hoʻoholo ai i ka pale ʻana i ka glucose. A i nā wahine hāpai mai kahi pūʻulu koʻikoʻi kiʻekiʻe no ka hoʻomohala ʻana i ka maʻi gestational, pono ia e hana i kēlā hoʻokolohua ma ka hōʻike mua ʻana i ka hoʻokipa ʻana a hoʻoiho hou ʻia no kahi manawa o 24-28 mau pule, ʻoiai me ka hoʻoluʻu ʻaʻai maʻamau.

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ʻO Glycemia mai 7 mmol / L ma kahi ʻōpū ʻole i loko o ke koko capillary a i ʻole mai ka 6 mmol / L ma kahi ʻōpū ʻole i loko o ka maʻi venous e hōʻike mau ʻia i nā ʻōkuhi āpau no ka maʻi gestational. ʻO kahi hōʻailona nō hoʻi o ka maʻi ka ʻike i ka hyperglycemia ma luna o 11.1 mmol / L me ke ana ʻana me ka helu ʻana i ka lā.

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Ke hana nei i kahi hoʻokolohua hoʻokaʻina glucose (glucose hoʻokipa hoʻāʻo) e pono i ka mālama pono ʻana i nā kūlana. I loko o 3 mau lā, pono ka wahine ma muli o kāna kīʻama a me nā hana kino, me ka ʻole o nā mea i kauoha ʻia no ka maʻi maʻi. ʻAi i ka pāʻina ma ka pō o ke hōʻike e loaʻa i ka 30-50 g o nā kaʻe. Hoʻopili ʻia ke nānā ʻana ma kahi ʻōpū ʻole, ma hope o ka hola 12-14 o ka hookeai. I ka wā o ka hoʻāʻo, ka hake ʻana, ka lawe ʻana i nā lāʻau lapaʻau, ka hoʻoikaika kino (me ka piʻi ʻana o nā ala), ua kāpae ʻia ka meaʻai a me ka mea inu.

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ʻO ka hōʻike mua ka wikiwiki ke koko. Ma hope o kēia, ua hāʻawi ʻia ka wahine hāpai i ka wai o ka momona glucose hou (75 g o ka maloʻo no ka 300 ml o ka wai). E loiloi i nā kikoʻī o glycemia a maopopo i kāna mau kihi huna, ʻoi aku ka mau i hoʻohuli ʻia i kēlā me kēia 30 minuke. Akā pinepine ka mea i hoʻoholo ai ka pae glucose koko, 2 mau hola ma hope o ka lawe ʻana i ka hopena o ka hōʻike.

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ʻO ka maʻamau, 2 mau hola ma hope o ka ukana o ke kō, ʻo ka glycemia ʻaʻole pono eʻoi aku ma mua o 7.8 mmol / L. Hōʻike ʻia ka emi ʻana o ke ahonui i nā helu o 7.8-10.9 mmol / L. Hōʻike ʻia kahi maʻi maʻi gestational ma kahi o 11.0 mmol / L.

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ʻAʻole hiki ke hoʻomohala ʻia ka hopena o ka maʻi mestitus maʻi gestational me ka hoʻoholo ʻana o ka glucose i loko o ka urine (glucosuria) a i ʻole ka nui o nā kiʻekiʻe glucose i nā mika glucose koko home me nā ʻāpana hoʻāʻo. Nā hoʻokolohua koko hoʻoliʻi kūlike e hiki ke hōʻoia a haʻalele paha i kēia maʻi.

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ʻO ka algorithm Screening a Diagnostics no GSD

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Inine hoʻōla

Mālilo ponoʻī pilikino i ke kiʻekiʻe o ka glucose i ke koko venous peripheral e hoʻohana ana i nā glucometer. Hāpai ka wahine hāpai i ka nānā 'ana ma luna o ia me ka ʻōpū ʻole a me 1-2 mau hola ma hope o ka ʻai ʻana, ka kākau ʻana i nā kaʻuʻina a me ke kō ʻana o ka ʻai o ka meaʻai i loko o kahi diary kūikawā.

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Inā ʻaʻole kahi alakaʻi hypocaloric me ka maʻi gestational i ke ʻano o ka glycemia, ua hoʻoholo ke kauka i ka koho ʻana i ka maʻi insulin. I ka manawa like, ua kuhikuhi ʻia nā insulins o ka hana pōkole a me ka ultrashort i loko o ka hoʻoponopono o ka nui o nā injections, me ka lawe ʻana i nā kikoʻī o caloric o kēlā me kēia ʻaina a me ka pae o ka glucose.I kekahi manawa he insulins me kahi manawa maʻamau o ka hana e hoʻohana mau ʻia. I kēlā me kēia manawa, hoʻoponopono ke kauka i ka regimen mālama, me ka mālama ʻana i ka ʻike o ka mālama ponoʻī ʻana, nā kaila o ka pēpē a me ka hōʻailona ultrasound o ka maʻi fetopathy maʻi.

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Hāpai ʻia nā inikini o ka insulin e nā syringes subcutaneously kūikawā. ʻO ka hapa pinepine, ʻaʻole pono ka wahine i waho o ka kōkua o waho no kēia, ʻo ka hoʻomaʻamaʻa ʻia e kekahi endocrinologist a i ʻole nā ​​limahana kula maʻi. Ināʻoi aku ka nui o nā lā i kēlā me kēia lā o ka insulin i nā 100 o nā ʻāpana, hiki iā ia ke hoʻoholo e hoʻokomo i kahi pamu insulin subcutaneous. Ua pāpā ʻia ka hoʻohana ʻana o nā lāʻau hypoglycemic waha i ka wā hāpai.

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ʻO kahi lāʻau lapaʻau kokoke, hiki i nā lāʻau lapaʻau ke hoʻohana i ka hoʻomaikaʻi ʻana i ka microcirculation a me ka mālama ʻana i ka maʻi o plasenta, Hofitol, nā huaora.

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ʻO kaʻai no ke maʻi maʻi gestational

I ka wā hāpai, ʻo kaʻai ʻana i kaʻai ʻana ke kumu nui o ka mālama ʻana i ka maʻi diabetes a me ka hoʻomanawanui i ka hoʻohaʻahaʻa glucose. Hoʻomaopopo kēia i ke kaumaha o ke kino a me ka hana kino o ka wahine. Hoʻokomo ʻia nā hōʻike aʻoaʻo i ka hoʻoponopono ʻana i ka meaʻai, ka hoʻolālā ʻana o ka meaʻai a me kāna ʻike calorie. ʻO ka papa inoa o ka wahine hāpai me ka maʻi hānai gestational, pono, e hōʻoia i ka hāʻawi ʻana i nā mea momona pono a me nā momona, a ua hāʻawi i ka normalization o ka gastrointestinal tract. Ma waena o 3 mau papa ʻaina nui e pono ai e hoʻonohonoho i nā mea kīʻaha, a ʻo ka ʻike nui loa o ka calorie e lilo i ka hapalua mua o ka lā. Akā ʻo ka meaʻimi hope loa ma mua o ka hiamoe ʻana o ka pō e hoʻokomo pū me nā huina i ka nui 15-30 g.

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He aha kaʻu e ʻai ai me ka maʻi maʻi maʻi? He haʻahaʻa nā momona hānai a nā iwi, nā ʻiʻo a me ka iʻa, nā mea momona momona (ka lau, nā ʻōpala a nā mea kanu), nā mea kanu, ka waiū haʻahaʻa a me nā huahana waiū-hua, hua manu, ʻaila aila, huaʻai. I mea e ʻike ai i ke ʻano o nā huaʻai i hoʻokomo ʻia i loko o ka papaʻai, pono ʻoe e loiloi i ka piʻi o kaʻohi o nā kūlaʻi koko i ka manawa ma hope o ko lākou komo ʻana. ʻAi ʻia nā ʻāpala, nā ʻāpala, nā pomegerane, nā hua ʻai koholā, nā ʻoniʻoni. Hoʻomaopopo ʻia ka hoʻopau ʻana i nā paina hou i nā mea liʻiliʻi a i ʻole wai pāpaʻa me ka loaʻa ʻole o ke kō. Akā ʻoi aku ka maikaʻi ma ka haʻalele ʻana i ka maiʻa a me nā ʻoloka mai ka papaʻaina, ʻike lākou i nā kaikena digestible a komo i ka wikiwiki o ka ulu wikiwiki o ka glycemia.

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Hoʻouna a me ka prognosis

ʻO ka hānau ʻana i ka maʻi gestational ke kūlohelohe a i ʻole ma ka pauku caesarean. Hoʻokumu nā Tactics i ke kaumaha i manaʻoʻia o ka pūpū, nā mea hoʻohālike o ka pelvis o ka makuahine, ka pae o ka uku o ka maʻi.

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Me nā hānau kūʻokoʻa, ka mālama ʻia nā pae o ka glucose i kēlā me kēia 2 mau hola, a me kahi ʻano o ka hypoglycemic a me ka hypoglycemic kūlana, i kēlā me kēia hola. Inā he wahine kekahi ma ka therapy insulin i ka wā hāpai, mālama ʻia ka lāʻau lapaʻau me kahi infusomat i ka wā hānau. Inā lawa ka mālama ʻana i nā meaʻaiʻai, ua hoʻoholo ʻia ka hoʻoholo e hoʻohana i ka insulin e like me ke pae o ka glycemia. Me ka māhele caesarean, pono ka nānā ʻana o ka glycemic ma mua o ka hoʻouka ʻana, ma mua o ka wehe ʻana i ke keiki, ma hope o ka wehe ʻana i ka plasenta, a ma kēlā me kēia mau hola 2.

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Me ka ʻike koke ʻana i ka maʻi maʻi gestational a me ka loaʻa o ka uku paʻa no ka maʻi ma ka wā hāpai, ʻike ʻia ka hoʻomaikaʻi ʻia no ka makuahine a me ke keiki. Eia nō naʻe, he pilikia nā pēpē hou no ka make pēpē a koi pono i ka mālama pono ʻana e ka neonatologist a me ka lāʻau lapaʻau. Akā no kahi wahine, hiki i nā hopena o ka maʻi hānai hāpai i nā makahiki he nui ma hope o ka hoʻopiʻi ʻana i ke ʻano o ka maʻi type 2 a i ʻole nā ​​prediabetes.

Pehea e kū ai ka maʻi maʻi gestational?

ʻAʻohe manaʻo maopopo ʻole e pili ana i ke kumu e ulu ai ka maʻi diabetes i ka manawa o ka hānau ʻana i kahi keiki. Ke manaʻoʻiʻo nei ka hana nui i kēia hana e ka hoʻopili hou ʻia o ke kino o ka wahine, pili me ka pono e mālama i ke ola a me ka hoʻomohala ʻana o ka pūpū.

Diabetest gestational i ke wā hapai e pono ai i kahi meaʻai paʻa.

Hānau ʻia ke pēpē me ka pleka i kēia manawa. Hoʻokumu kēia kino i nā hormone e hoʻolaha i ka ulu a me ka hoʻomohala ʻana o ka pūpū, me ka pale ʻia hoʻi i ka hana o ka insulin i ka makuahine e kali ana. ʻO ka hopena, ʻaʻole pau nā haki a pau i hāʻawi ʻia me ka meaʻai i wāwahi ʻia. ʻAʻole hiki i ka pancreas ke hana i ka nui o ka insulin. Ke alakaʻi nei kēia i ka hoʻolālāʻana o ka hyperglycemia, keʻano o ka maʻi maʻi.

Hoʻoholo ʻia nā pilikia o GDM e nā mea:

• hoonui nui ke kino
• loaʻa ka paona i ka wā gestation, ma mua o nā mea maʻamau
• ʻoi aku i mua o 25 makahiki
• ka heleʻana o GDM i ka wā hānau mua,
• maʻi hānai i nā hoahānau pili kokoke.

Hoʻoholo ka hopena o ka ulu ʻana o ka insulin i nā hopena wale nō. Aia kekahi mau mea ʻē aʻe i pili i ka hoʻomakaʻana o GDM.

Pehea ka maʻi maʻi gestational

ʻAʻole ʻokoʻa nā hōʻailona o ka GDM mai ka hōʻike ʻana i ka maʻi mellitus o ka maʻi mellitus o ka ʻano mua a ʻelua paha. Hiki iā ʻoe ke kānalua i ka hele ʻana o kēia ʻano ma o nā hōʻailona aʻe:

• loaʻa kālā wikiwiki no ka kumu ʻike ʻole ʻole,
• mau ka makewai mau
• ua hoʻonui ʻia urine output
• hoʻemi i ka momona
• ka hoʻomohala ʻana o ka maikaʻi.

Ke hele mai nei kēia mau hōʻailona, ​​pono e hoʻopili ʻia kahi wahine hāpai i kāna kauka i ka hiki.

ʻO ka hoʻomohala ʻana o ka maʻi hānai i nā wahine hāpai

Pono nā wahine i ka wā o ka hānau ʻana i kahi keiki e hoʻomaʻamaʻa pinepine, ʻo ia hoʻi e hoʻoholo ai i ka pae o ka glucose koko. Nui nā mea nui o nā hopena o kēia noiʻi no ka manawa o 24-28 pule. No ka poʻe maʻi i loaʻa ka predisposition i ka hoʻomohala o GDM, kuhikuhi nā kauka i nā kiʻekiʻe o ka nui o nā kō kōnohi koko.

Lawe ʻia ke koko ma kahi ʻōpū ʻole, a ma hope iho ua hāʻawi ʻia ka wahine i kahi aniani o ka wai kukui. ʻO ka lua kaʻi e lawe ai i ke koko ma hope o ka hola. Inā loaʻa i ke kiʻekiʻe o ka glucose koko ma kēia mau ho'āʻo ʻelua ma mua o nā waiwai i ʻae ʻia, ua hōʻike ka mea maʻi i ka maʻi gestational.

Nā hopena hiki paha o GDM

Ke hoʻomaopopo nei i kēia ʻano, pono ia e hana i nā hana e pili ana i ka hoʻouku ʻana iā hyperglycemia ma ka hiki koke. Inā ʻaʻole, hiki i ka diabetes maʻi ʻole ke hāpai i ka hopena.

1. ʻO ka hānau ʻana o kahi keiki me ke kaumaha o ke kino ma mua o 4 kg he macrosomia. Ma muli o kēia, ʻoi aku ka paʻakikī o ka hānau keiki, aia kahi pilikia nui o ka hōʻeha, ʻo ia ka mea e koi ai i ka ʻāpana cesarean.
2. ʻO ka hoʻomaka ʻana o ka hana, hoʻomohala ʻana i nā maʻi pehu o ka hanu i kahi keiki e pili ana i ka lawa ʻole o ka hoʻomohala ʻana o ka ʻōnaehana hanu ma ka prima manawa.
3. Hypoglycemia ma hope o ka hānau ʻana i kahi pēpē.
4. Hoʻonui ka hoʻololiʻana i ka preeclampsia a me nā hoʻopiʻi'ē aʻe i nā wahine i ka wā hāpai. Ua hoʻolōʻihi ʻia kēia mau kūlana i kahi kuʻi.

Hoʻokumu ʻia ka maʻi ʻaʻai o ka maʻi gestational ma ke ʻano he loiloi o ke kō koko koko a ma hope o ka ʻai ʻana.

Hiki ke pale ʻia nā hoʻopiʻi i ʻōlelo ʻia ma muli o nā ʻōlelo a ke kauka hele mai.

Hana no ka maʻi maʻi maʻi gestational

Ke hoʻoponopono nei i ka hyperglycemia i kahi wahine hāpai i hoʻomaka me nā lāʻau lapaʻau ʻole:

• kākaʻai
• hoʻoikaika kino
• kaohi koko koko.

ʻO kaʻaiʻai Diet ke kumu nui i ka mālama ʻana i ka maʻi gestational. Ke kumu:

1. ʻO ka wehe loa mai ka papaʻaina o nā mea ʻawaʻawa maʻalahi - kaomi, ke kō, ka wai, ka meli, nā mea i wae ʻia.
2. Ka hōʻole ʻia o nā mea momona, me nā huahana e pili ana i ka fructose, ʻo ka pāpā ʻia ʻana i ka wā hāpai a me ka lactation.
3. ʻOi aku ka nui o nā wahine momona ma kā lākou komo ʻana i nā momona, hōʻole loa i nā meaʻai i hoʻouka ʻia, mayonnaise, a me nā sausage.
4. Palapala kaiʻaiila - e kuhi ʻia e ʻai i ka meaʻai i nā wahi liʻiliʻi mai 4 a 6 mau manawa i ka lā. ʻAʻole ʻae ʻia ka hakakā.

ʻAe ʻia ka hana pilikino i kēlā mau maʻi ʻaʻole i loaʻa nā contraindications. ʻO ka hoʻohiolo maʻamau i nā pae koko koko, lawa ka hele ʻana i ka lewa wai i kēlā me kēia lā no 30 mau minuke, e hana i ka hale kalila wai. Hoʻowai ʻia nā hoʻomaʻamaʻa ʻana e hoʻonui ai i ke koko, no ka mea hiki iā lākou ke hōʻeha i ka hypertonicity o ka ʻōpū.

Me kēia, ua ʻōlelo ʻia e mālama i kahi diary i kēlā me kēia lā, kahi e kuhikuhi ai ʻoe:

1. Hālau ke koko aʻai ma mua o ka papaʻaina, hoʻokahi hola ma hope o ka papa no ka lā. Pono nō hoʻi e kākau inoa i kēia wehewehe ma mua o ka hele ʻana i ka moena.
2. ʻAi nā meaʻai a me nā meaʻai.
3. I ka mua o nā kaha hōʻike hoʻokolohua - ka pae o ka ketones ketone i hoʻoholo ʻia i ke kakahiaka.
4. ʻO ke kahe koko i ke kakahiaka a me ke ahiahi - ʻaʻole pono kēia hōʻailona o ka hoʻonui ʻana o 130/80 mm RT. ʻAniā.
5. ʻO ka hana uila a ka pūpū.
6. Ke kino wahine o ka wahine.

ʻO ka mālama ʻana i kēia diary he mea ia e kōkua i ke nānā ʻana i nā ʻōpiopio kūpono loa i ke kūlana olakino ma mua o ka hoʻomaka ʻana o nā hōʻailona. He pono pono no ia i ke kauka ke hoʻoponopono pono i ka papa o ka hāpai ʻana.

Ma ka hihia pono ʻole o ka lāʻau lapaʻau ʻole, pono e kapa ʻia kekahi wahine no ka kūkā ʻana me ka endocrinologist. Inā hoʻomau ka pae kiʻekiʻe o ke koko, ua hōʻike ʻia nā hoʻomākaukau no ka insulin. ʻO kahi koho kūpono o ka lāʻau lapaʻau e palekana no nā wahine. ʻAʻole ke hele i ka insulin i ka plasenta, no laila ʻaʻole ia e hoʻopōʻino i ka wahine maʻi.

Hoʻouna ma GDM

Ma hope o ka ʻike ʻana i ka maʻi mellitus maʻi gestational, ua koho kēlā me kēia wahine i ke ʻano kūpono o ka hoʻokau ʻana. Hoʻolahalaha ʻia ka hōʻike hōʻike hope ʻia ma mua o 38 mau hebedoma, e like me kona mau hopena, ke hoʻoholo nei ke kauka i ka hiki i ka wā hānau.

Me ka GDM, ʻaʻole pono e hoʻolōʻihi i ka wā hoʻomaha a ʻoi aku ma mua o 40 mau pule. Hoʻonui nui ʻia kēia i ka hoʻopiʻi o ka hoʻopiʻi ʻana no ke keiki, ʻoiai i kēia manawa ka hoʻokaʻawale nā ​​papahele plasenta, a hiki i kona hakahaka i ka wā hānau. No kēia kumu, ʻo ka manawa mai ka 38 i ka 40 mau pule ka mea i makemake ʻia ʻo ka manawa maikaʻi loa ia no ka lawe.

Nā manaʻo ma hope o ka lawe ʻana

Ma hope o ka hānau ʻana, pono nā wahine me GDM:

1. Inā hana ʻia ka lāʻau lapaʻau, hoʻopau ia.
2. ʻO kahi mahina ʻē aʻe a me ka hapa e hahai ai i kahi meaʻai.
3. Nānā i nā pae glucose koko no nā lā ʻekolu ma hope o ka hānau ʻana.
4. I ka manawa o 6-12 mau pule ma hope o ka hānau keiki - kūkākūkā me ka endocrinologist, hana i kahi hana hou aku e loiloi ai i ka ʻaina metabolism.

ʻO nā wahine i hōʻike ʻia i ka maʻi diabetes mellitus e pono e hana i ka wā e hoʻolālā ana i nā hāpai ʻana ma hope e hoʻemi i ka hopena o ka ulu hou ʻana o kēia ʻano pathological.

I mea e pale ai i nā hopena hopena o GDM, pono kiaʻi pinepine ka wahine i nā pae koko koko.

ʻO nā keiki i hānau ʻia a mau makuahine me GDM e ulu a paʻa i nā maʻi diabetes type 2. No laila, i ka wā nui o ke ola e pono lākou e ʻai i ka papaʻaina me kahi hoʻohaʻahaʻa haʻahaʻa haʻahaʻa, nānā ʻia e ka endocrinologist.

ʻO ka paleʻana i ka maʻi hānai ma nā wahine hāpai

ʻIke i ka ʻike o nā mea e hoʻopili ana i ka hoʻomohala ʻana i ka hemahema o ka insulin, hiki iā ʻoe ke hōʻemi i ka hopena o kēia ʻano pathological.

I mea e pale ai i ka hoʻomohala ʻana o GDM, makemake ʻia nā wāhine āpau i ka wā hānau o ke keiki e nānā i nā hana pale.

1. ʻO ka papaʻaina e hoʻokaʻawale aʻe i nā hā aʻe o ka momona, kāohi ʻia i ke ʻano o nā momona, ka paʻakai.
2. ʻO ka normization o ke kaumaha o ke kino - ua aʻo ʻia e hana i kēia ma mua o ka wā hapai.
3. Hoʻopaʻa pinepine ʻia ka hele kino, hele wāwae i ka lewa hou.
4. Inā loaʻa iā ʻoe ka ʻohana me ka maʻi diabetes, pākahi i ka makahiki hoʻokahi ka wikiwiki o ka hoʻokeo koko a ma hope o ka ʻai ʻana.

ʻO kahi maʻi gestational diabetes mellitus kahi maʻi e hiki ke hoʻomohala wale i ka manawa o ka gestation. He koʻikoʻi ka Hyperglycemia no ka hoʻoulu ʻana i nā hoʻopiʻi he nui no ka makuahine a me ka maʻi hānau. No laila, he mea nui e hana i nā hana e pili ana i ka hoʻokaʻawale i nā pae glucose koko. Inā he maikaʻi ʻole kaʻai a me nā ʻano lāʻau ʻē aʻe, hōʻike ʻia ka hoʻohana ʻana i ka insulin e like me ka nui o ka ʻai i kālai ʻia.

He aha nā hopena maʻi maʻi gestational i ka wā hāpai? Hoʻololi i ka GDM a me ka mālama ʻana.

I ka wā e hāpai ʻia ai, e ulu ʻino paha nā maʻi maʻi a i ʻole nā ​​hōʻailona paha o nā pilikia i ʻike ʻole ʻia ma mua. Hiki i ka maʻi diabetes ke lilo i pilikia.

Wahi a ka helu honua World Health Organization, "diabetes gestational" he diabetes mellitus i ʻike ʻia i ka wā o ka hapai, me ka hoʻokaʻawale ʻana i nā glucose glucose (maikaʻi ʻole e ʻike ʻia e ke kino), i ʻike ʻia i kēia wā. ʻO kona kumu ke hoʻemi ʻana o ka ʻike ʻole o nā ʻoli i ko lākou iho i ka insulin (kūʻē i ka insulin), ka mea i hui pū ʻia me ka ʻike kiʻekiʻe o nā ʻōpū o ka hapai i ke koko. Ma hope o ka hānau ʻana, ʻike pinepine ka nui o ke kō koko koko i ke ʻano maʻamau. Eia nō naʻe, ʻaʻole hiki ke hoʻoholo ʻia ka hopena o ka ulu ʻana o ka maʻi type a me ka type 2 i ka wā hāpai. Hoʻopā i nā maʻi o kēia mau maʻi ma hope o ka hānau ʻana.

Ke hoʻoili nei i nā ʻike mai nā noiʻi he nui, ua hoʻopau nā kauka ma mua o ka 50% o nā wahine hāpai i ka maʻi maʻi gestational ma hope e hoʻomohala i ka maʻi mellitus maoli ma hope o ke ola.

He aha nā hopena pilikia no ka hoʻomohala ʻana i ka GDM?

• ʻO ka momona, luhi
• Nā pilina maʻi ma ka ʻohana koke
• ʻO ka wahine hāpai i ka 30 makahiki
• Ho‘opilikia ‘ia nā pākuhi kūpilikiʻi:
• ʻO ka keiki ma mua ua hānau ʻia ma ke kaupaona ʻana ma mua o 4000 mau grama
• ʻO GDM i kahi wā hāpai
• Ka maʻi kaumaha (ka hala a me ka wā hemahema)
• Polyhydramnios
• Kaui
• Malformations i nā keiki o mua

He aha ka maʻi maʻi kino maʻi gestational?

Hoʻoulu ʻia nā maʻi diabetes gestational i nā kūlana kulekele ma waena o 16 a 32 mau wiki o ka wā o ka hōʻeha. ʻO nā kipi o ka pau aʻe o ka haʻalohiko, ʻike ʻia i ka wā ma mua, ma ke ʻano he kānāwai, e ʻōlelo i ka maʻi ma mua o ka goutational pre-gestational ("pre-pregnant").

ʻO kaʻoiaʻiʻo, ʻoi aku ka maikaʻi o ka aʻo ʻana e pili ana i nā maʻi maʻi ma mua o ka hānau ʻana, a laila hiki ke ʻāpono ʻia no lākou. No kēia kumu, uaʻike ʻo nā kauka i ka hoʻolālā ʻana i ka hāpai ʻana. I ka ʻōlelo o ka hoʻomākaukau no ka hāpai ʻana, e hele nō ka wahine i nā hoʻokolohua maʻamau, me ka ʻike ʻana o ka maʻi maʻi. Inā ʻike ʻia nā kueʻe o nā puhalaka o nā kaʻe, hiki ke kau ke kauka i ka mālama ʻana, hāʻawi i nā ʻōlelo ʻana, a hoʻomau mau ʻia ka hapai i ka wā e hiki mai ana, a hānau mai ke pēpē.

ʻO ke kumu nui no ka mālama ʻana i kahi wāʻeha i paʻakikī e ka maʻi maʻi (ʻelua gestational a me nā ʻano like ʻole) e mālama ana i ka pae o ka glucose o ke koko i loko o ka maʻamau maʻamau (3.5-5.5 mmol / L). A i ʻole, he pilikia paʻakikī ka makuahine a me ka pēpē.

He aha ka mea e hoʻoweliweli ai i ka makuahine? ʻO ka hānau keiki Preterm a me nā hoʻohālikelike hiki ke loaʻa. Hōʻalo ka pilikia o ka hoʻomohala ʻana i ka maʻi gestosis (me ka maʻi maʻamau a hoʻomohala pinepine ʻia - a hiki i 30 mau pule), hydramnion, a no laila ke kīpopopopopopopopopopopau i ka maʻi a me ka pōpilikia fetal. ʻOi paha ka hoʻomohala ʻana o ka maʻi ketoacidosis maʻi (kahi kūlana i loaʻa ka nui o ka glucose a me ka ʻike ʻana o nā kino ketone i loko o ke koko), ʻo nā maʻi ʻōpiopio, kahi i hoʻopaʻa ʻia 2 mau manawa pinepine a hoʻomau i ka loaʻa ʻana o ka maʻi hānau a me ka hānau mua. Hiki nō hoʻi i ka holomua o ka microangiopathies me kahi hopena o ka ʻike maka ʻole, ke kumu o ka huehue, kahe koko ʻole ma o nā moku o ka plasenta a me nā mea'ē aʻe. Hiki i ka wahine ke hana i kahi nāwaliwali i ka hana, ʻo ia hoʻi, i hoʻohui pū ʻia me ka pelvis e ʻoi aku ana a me kahi pāloi nui, e hoʻokaʻawale i ka hāʻawi ʻana i ka pauku caesarean. I nā wahine me nā maʻi maʻi, nā maʻi hōʻeha i nā wā postpartum i mea maʻamau.

Nā pilikia no ke pēpē

ʻO nā hiʻohiʻona o ka metabolism i loko o ka māmā a me ke keiki ka like, e loaʻa i ka pēpē i ka glucose mai ka makuahine, akā ʻaʻole ia e loaʻa i ka insulin.Pēlā, ʻo ka hyperglycemia (ka nui o ka glucose), ka mea ma ka trimester mua, i ka wā i loaʻa ʻole ai ka pūpū me kāna insulin ponoʻī, hoʻonāukiuki i ka hoʻomohala ʻana o nā ʻano like ʻole o ka fetal. . ^ E Ha yM. Ma hope o 12 mau hebedoma, i ka wā e hoʻomohala ai ke kino o ka pēpē e hiki mai ana i ka insulin, e ulu ka hyperinsulinemia, e hoʻoweliweli ana i ka hoʻomohala ʻana o ka asphyxia a me nā hōʻeha i ka hānau ʻana, ʻeha o ka hanu (ʻōpū o nā ʻōpū hanu) a me nā kūlana hypoglycemic o ka wahine hou.

Aia anei kahi ala e pale ai i kēia mau pilikia? Ka. ^ Na ʻO ka mea nui ka ʻike o ka pilikia a me kona hoʻoponopono kūpono ʻana.

Diagnosis o GDM i ka wā hāpai

ʻO ka mea mua i ka maʻi o ka maʻi gestational kahi loiloi o ka hopena o ka hopena o kona hoʻomohala ʻana. Ke hoʻopaʻa inoa nei i ka wahine no ka hoʻopaʻa inoa ʻana i loko o kahi haukapila antenatal, loiloi ʻia nā helu he nui, no ka laʻana, e like me ke ʻano a me ke koʻikoʻi o ka wahine hāpai, ka mōʻaukala obstetric (ʻo ka manawa o ka maʻi gestational diabetes ma mua o nā wā hāpai ʻana, ka hānau ʻana o nā keiki ma ke kaupaona ʻana ma mua o 4 kg, mauʻano a me kekahi). nā hoahānau) a pēlā aku. Aia ka papa ʻala ma lalo nei

E nānā kāua i ka pāpaʻi "ʻO ka hānau ʻana o ke keiki ke kau nei ma mua o 4 kg". ʻAʻole ia he lono o ia ka mea i komo i ka loiloi ʻana o ka hoʻohālikelike ʻana o ka maʻi gestational. ʻO ka hānau ʻana o kēlā pēpē e hōʻike paha i ka hoʻomohala ʻana i ka maʻi diabetes maoli maoli a me ka maʻi maʻi gestational i ka wā e hiki mai ana. No laila, i ka wā o hope o ka ulu ʻana, pono e hoʻolālā a nānā mau i ka pae o ke kō i loko o ke koko.

I ka hoʻoholo ʻana i ka pilikia o ka hoʻomohala ʻana i ke maʻi maʻi, koho ke kauka i kahi ʻano hana hoʻokele.

ʻO ka hana ʻelua he ʻatikala koko e hoʻoholo i ka pae o ke kō, e pono e hana i nā manawa he nui i ka wā hāpai. Inā ma kahi o ka manawa hoʻokahi iʻoi aku ka nui o ka glucose i ka 5 mmol / l, ua ʻike ʻia kahi hōʻike hou, ʻo ia hoʻi kahi hōʻike hoʻoliʻi glucose.

I ka manawa e manaʻo ʻia ai ka maikaʻi? Ke hoʻokō nei i kahi hōʻike me kahi ukana o 50 g o ka glucose, nānā ka nui o ka glycemia ma kahi ʻōpū ʻole a ma hope o ka 1 hola. Inā ʻoi aku ka wikiwiki o ka glucose i ka 5.3 mmol / L, a ma hope o ka hola 1 ke kiʻekiʻe aku nei ka waiwai ma mua o 7.8 mmol / L, a laila hiki ke kuhikuhi ʻia kahi hōʻike me 100 g o glucose.

Hōʻike ka maʻi mellitus maʻi mestitus inā he wikiwiki ka wikiwiki o ka glucose ma mua o 5.3 mmol / l, ma hope o ka hola 1 - ma luna o 10.0 mmol / l, ma hope o 2 mau hola - ma luna o 8.6 mmol / l, ma hope o 3 mau hola - ma luna o 7.8 mmol / l. Mea koʻikoʻi: kahi hoʻonui i hoʻokahi wale o nā hōʻailona e hāʻawi i kahi maʻi i kahi maʻi. I kēia hihia, pono e hoʻihoʻi hou ka ho'āʻo ma hope o 2 mau pule. No laila, ʻo ka hoʻonui ʻana o 2 a i ʻole mau hōʻailona e hōʻike ana i ka maʻi maʻi.

Ka Kūlana hoʻokolohua:

1. 3 mau lā ma mua o ka hoʻokolohua, ua noho ka wahine hāpai i kāna hana maʻamau a pili pono i kāna hana kino maʻamau
2. Hana ʻia ka hoʻokolohua ma ke kakahiaka ma ka ʻōpū ʻole (ma hope o ka pōkole pōkole no 8 mau hola).
3. Ma hope o ka lawe ʻana i ka hoʻokahe koko ma kahi ʻōpū ʻole, pono e inu ka mea maʻi i kahi hopena glucose, e like me ka 75 o ka glucose o ka maloʻo maloʻo i hoʻoneʻe ʻia i 250-300 ml wai o nā wai, no 5 mau minuke. Kālua a ʻelua koko koko e hoʻoholo ai i ke kō o ke koko ma mua o 2 mau hola ma hope o ka hoʻoheheʻe i ka glucose.

Nā waiwai koʻikoʻi glycemia:

1. hookeai kūlohelohe - 3.3-5.5 mmol / l,
2. glycemia ma mua o ka ʻai (basal) 3.6-6.7 mmol / l,
3. glycemia 2 mau hola ma hope o ka ʻai ʻana i ka 5.0-7.8 mmol / l,
4. glycemia ma mua o ka hiamoe e 4.5-5.8 mmol / l,
5. glycemia ma 3.00 5.0-5.5 mmol / L.

Inā maʻamau nā hopena o ke aʻo ʻana, a laila e hoʻi hou ka hōʻike ʻana i ka 24-28 mau pule o ka hāpai ʻana, i ka wā e loli ai ka ʻano o ka hormonal. I nā manawa mua, ʻaʻole ʻike pinepine ʻia ka GDM, a me ka maʻi ma hope o nā hebedoma 28 mau i ka pale ʻole i ka hoʻomohala ʻana o nā hoʻopiʻi ma ka pūpū.

Eia naʻe, ʻaʻole i hoʻokō ka wahine hāpai i nā kō koko kiʻekiʻe. I kekahi manawa hōʻike i kahi hōʻike koko "hōʻike" hypoglycemia - kahi hoʻokahe koko haʻahaʻa. ʻO ka manawa pinepine, ulu ka hypoglycemia i ka wā hoʻomaha. Ma ka manawa hāpai, piʻi ka honu e nā cell, a no laila, ʻaʻole ʻae ʻia ka lōʻihi o ka wā hoʻomaha ma waena o nā pāʻina, a ʻaʻohe kumu e "noho iho" ma kahi meaʻai e ʻai ana i ka paona. Eia kekahi, i kekahi mau loiloi hiki iā ʻoe ke ʻike i nā waiwai palena palena e hōʻike mau ana i ka kiʻekiʻe o ka hoʻomohala ʻana i ka maʻi, no laila e pono e nānā pono i nā helu koko, pili i nā ʻōlelo a ke kauka a hahai i kahi papa i kuhikuhi ʻia e ka loea.

He mau huaʻōlelo e pili ana i ka mālama ʻana i ka maʻi diabetes gestational

ʻO ka wahine hāpai i ka maʻi maʻi lā, e ʻike i ke ʻano o ke kāohi pono ʻole o ka glycemia. I 70% o nā hihia, ua hoʻoponopono ʻia nā maʻi maʻi gestational e ka meaʻai. ʻOiaʻiʻo, ke kū nei ka hana ʻana o ka insulin, ʻaʻohe mea pono e hoʻohana ʻia no ka lāʻau lapaʻau.

ʻO nā mea koʻikoʻi o ka meaʻai no GDM:

1. Pono e hoʻokaʻawale ka meaʻai o kēlā me kēia lā ma waena o nā koena, ka momona a me nā protein -35-40%, 35-40% a me 20-25%.
2. Pono ka haʻahaʻa o nā calorie i nā kau momona momona 25 kcal no 1 kg o ka paona a 30 paha - 35 kcal no 1 kg me ka paona maʻamau. Hāʻawi ʻia nā wahine ma luna o nā wahine i ke kau ʻana i ka pehea e hōʻemi ai a hoʻoponopono ʻole paha. Pono e hoʻemi i ka hana kal calorie me ka mālama koʻikoʻi, me ka ʻole o nā hana paʻakikī.
3. ʻO nā haʻalulu'ōmaʻomaʻo maʻalahi, ʻo ia hoʻi, kahi kīmaʻi, ke haʻalele ʻia mai ka papa inoa o kēlā me kēia lā.
   Pono ke wahine ola i ke kani ʻana inā makemake ʻo ia i nā sweets? "Pono ke aloha no nā lole momona" e makaʻala inā he mau loli i nā loiloi. Akā i kekahi hihia, pono ʻoe e hoʻopili i nā ʻōlelo ʻaʻai meaʻai a mai hoʻopale i nā mea momona a i ʻole kekahi mea ʻē aʻe. Pono e hoʻomanaʻo e makemake ʻoe e ʻai i ka "mea momona" ʻoi aʻe ka makemake o ka makemake wale e ʻoliʻoli wale. No laila, ʻo ka "momona" hiki ke hoʻololi ʻia i nā hua.
4. E hōʻemi i ka nui o ka momona i hoʻopau ʻia e ka waiwai i ka ʻai me ka momona (nā huaʻai a me nā mea kanu) a me ka protein i 1,5 g / kg.

Ma kahi o nā hanana hiki ʻole ke hoʻoponopono pono i ka pae o ka glycemia me ka mea ʻai hoʻokahi, pono ke alualu i ka insulin, kahi i helu ʻia a me ʻili ʻia (hoʻoponopono ʻia) e ka kauka kauka.

Ua kapa ʻia nā maʻi maʻi gestational no ka mea he manifests (manifests) i ka wā hāpai. ʻO kekahi hiʻohiʻona o kāna mau hiʻohiʻona e nalowale ma hope o ka hānau keiki ʻana. Eia naʻe, inā he wahine i loaʻa ka maʻi gestational i ka wā hāpai, hiki i ka uluʻana ke ulu aʻe i ka piʻi maoli e 3-6 manawa. No laila, he mea nui e nānā i ka wahine ma hope o ka hānau keiki. 6 mau pule ma hope o ka hānau ʻana, koi ʻia kahi noiʻi o ke ʻano o ka puhiha o nā puhaka o ka ʻai. Inā ʻike ʻole ʻia ka hoʻololi, koho ʻia ka hoʻokele i hoʻokahi manawa i kēlā me kēia 3 mau makahiki, a inā hoʻi me ka hoʻomanawanui i ka hoʻohaʻahaʻa glucose - ʻo ka hoʻopuka ʻana i nā papa aʻoaʻo a me ka nānā aku hoʻokahi makahiki i ka makahiki.

I kēia hihia, pono nā pāpā a pau ma hope.

He aha ka maʻi maʻi maʻi gestational?

ʻO ka pilikia o ka maʻi e pālua. ʻO ka mea mua, pono e hoʻomanaʻo i ka hopena e pili ana i ka hopena o ke kino o ka mea maʻi. ʻO kahi mea koʻikoʻi ʻoi aku ka hopena ma luna o ka wahine hānau. Ma muli o ke maʻi maʻi o ka wahine hāpai wahine hiki ke hana i ka gestosis (ʻoi ʻia ka toxicosis), preeclampsia syndrome (ke koko kiʻekiʻe a me ka hana renal impaired). Inā ʻaʻole, ʻaʻole kahi hakahaka gestational i kahi hoʻoweliweli koʻikoʻi i ka makuahine. ʻO nā kumu o nā honi gula i ka wā hāpai a ʻoi aku ka nui o ka maʻi o ka maʻi diabetes, a he manawa pōkole loa ka wā hapalua i ka wā e hiki ʻole ai i ka hoʻopiʻi ka hoʻopiʻi ʻana i ke ola. Akā inā ʻaʻole ʻoe e hoʻopili i ka mālama ʻana i ka maʻi gestational, a laila lawe ia i kēlā me ka pilikia e like me ka degeneration i loko o ka maʻi maʻamau holoʻokoʻa 2 mau ʻano. A ʻo kēia hoʻi ka maʻi e hopohopo nei i kekahi kanaka i kona ola a pau, mai kahi maʻalahi ʻole ke kāpae ʻia mai.

Nā hopena no ke keiki

Akā ʻo ka hopena koʻikoʻi ka hopena ma ka fetus. ʻO ka ʻoiaʻiʻo ke kolo ka manu i ka leʻe ma o ka paepae placental. I ka hoʻomaka ʻana o ka wā hāpai, ʻaʻole i kūkulu ʻia ka pūpū me kāna iho pancreas. No laila, hana i nā kōʻai paʻila pancreatic o ka makuahine i ka pālua lua, e hana ana i ka insulin no lākou iho a me ke keiki. Ka lōʻihi o ka manawa, ua loli ke kūlana, no ka mea i ka hopena o ka hapai ʻana, hoʻomaka ka hana a nā keiki ponoʻī o ka insulin hana. Eia nō naʻe, inā nui ka nui o ka glucose i ke koko o ka pēpē, a laila hana lākou me overvoltage. I ka hopena, hiki i ka pēpē hou ke hoʻomohala aku i ka piha ʻana i ka pancreatic a me ka maʻi diabetes type 1.

ʻO ka glucose hoʻonā i hāʻawi ʻia i ka ʻōpū ke hiki i nā hopena maikaʻi ʻole. Hoʻololi ʻia ka nui o ia mau kalo i ka pā adipose, a hoʻomaka ka nui o ke keiki i ke maʻamau. Hiki iā ia ke hoʻonui nui i kekahi mau wahi o ke kino, aʻo nā mea ʻē aʻe e noho maʻamau. A hoʻoweliweli kēia i ka makuahine me kahi hānau paʻakikī, a ʻo ke keiki me ka hōʻeha hānau. ʻO ka hōʻeha koʻikoʻi loa i ka ʻūhā a me nā spine. I kekahi manawa ʻaʻole hiki i kahi wahine hāpai ke hānau pēpē i kāna pēpē ponoʻī pono'ī, a loaʻa iā ia kahi hapa cesarean. Kēia mau hiʻona holomua i ka hoʻomohala ʻana o ka pūpū me kāna hypoxia, hana liʻiliʻi o ka cardiovascular, digestive system, a me ka ʻike ʻole ʻana o ka surfactant (kahi mea mālama i ke ʻōnaehana hanu) hiki pū kekahi. Pēlā, ʻoi aku ka nui o ka make ma waena o nā pēpē i hānau ʻia i nā makuahine me ka maʻi gestational.

Eia kekahi, no kahi keiki hou, ʻo kahi hapai i kaupaona ʻia e GDM e piha me:

• ka pale ʻole ʻana i ka māhele o ke kino,
• ka ʻōpū ʻana o nā kiko,
• jaundice
• hypoglycemia.

ʻO ka hoʻomohala ʻana o ka maʻi hānai i nā wahine hāpai

ʻO nā hōʻailona o ka maʻi maʻi gestational e pili ana i nā loli o ka hormonal i ke kino e hoʻomaka ka ʻike koke ʻole ma hope o ka hoʻomaka ʻana o ka hāpai ʻana, akā mai ka 20 mau pule. ʻOiaʻiʻo, inā ua hūnā ka wahine hūnā i ka maʻi mellitus ma mua o ka hoʻolilo ʻana, a laila hiki ʻole i kēia ke hoʻopilikia i ka hoʻomohala ʻana o ka pūpū.

Hoʻokahi wale nō ala e ʻike ai i ka hele ʻana o ka maʻi gestational - he hōʻike koko no ke kō. ʻOiaʻiʻo, i ka wā hāpai, hiki pinepine ʻole nā ​​hōʻailona o ka maʻi maʻi i ka neʻe ʻana, no ka mea, ua liʻiliʻi wale nō e hoʻonui i ke kō o ke koko. A inā loaʻa ka hōʻailona (no ka laʻana, make wai, nā urination pinepine, ka ʻeha, ka hōʻeha ʻeha o ke kino, nui ka makemake), a laila hoʻāliʻi ʻia lākou i ke ʻano o ke ʻano o ka maʻi o ka maʻi, kaʻai ʻana o ka meaʻai, nā loli o ka hormon, ke kaumaha, a me nā mea ʻē aʻe.

No ka ʻike i ka maʻi latine i loko o nā wahine hāpai, pono nā hōʻike o ke koko no ke kō. ʻO nā hoʻokolohua koko no ke kōhi i ka wā hāpai a hana pinepine ʻia ʻekolu mau manawa. ʻO ka manawa mua - i ka wā e kākau inoa ai, ka lua - i ka lua o ka trimester (i ka he 24-28 pule), ʻo ke kolu - ka manawa koke ma mua o ka hānau ʻana. Inā loaʻa nā hōʻailona o ka hōʻike mua ma waho o ka maʻamau maʻamau, ua hana ʻia kahi hōʻike ʻelua.

Lawe ʻia ke koko ma kahi ʻōpū ʻole i ke kakahiaka. Ma mua o ka hōʻike hoʻokolohua, pono ia e pale i ka hoʻoikaika kino, ka lawe ʻana i nā lāʻau lapaʻau.

Kālila ʻia ke koko no ka hapanui i ka wā hāpai a lawe ʻia mai kahi vein, ʻoiai nā hopena i loaʻa i ka wā o ka mālamaʻana i ka manamana lima ʻaʻole uninformative.

ʻO ka waiwai o ke aniani o ka hānai no nā wahine hāpai i ka liʻiliʻi ma 5.1 mmol / l. Me nā hōʻailona o ka 5.1-7.0 mmol / l, ua hōʻike ʻo GDM. Me kahi hōkū ʻē aʻe mai ka maʻamau (ʻoi aku ma mua o 7.0 mmol / l), ke kumu ke kānalua nei i kahi maʻi (i.e., hōʻike ʻia no ka manawa mua) ka maʻi maʻamau hakahaka 2.

Eia kekahi, hoʻokō ʻia ka hoʻokolohua hoʻokaʻae glucose. Me kēia hoʻokolohua, hāʻawi ka mea maʻi i kahi aniani o ka glucose (maʻa mau he 75 g o ka glucose i 300 g o ka wai) ma ka ʻōpū ʻole a hana ʻia kahi ʻano koko ma hope o nā hola 2. Ua hana pū ka mea maʻi i ka meaʻai, inu, a me ka hoʻomaʻamaʻa. Hōʻike ʻia ʻo GDM ma nā kumukūʻai ma luna o 8.5 mmol / L.

ʻO nā maʻi maʻi ʻē aʻe:

• glycated hemoglobin analahi,
• no ka kolamu
• ke kō i ka paʻakai
• hōʻikeʻike koko ololi,
• noiʻi ʻana i ka urine e like me Nechiporenko,
• ka loiloi o ka pae o nā hormone wahine.

ʻO ka ultrasound a me ka CT o ka pūpū, hiki ke hoʻokō i ka plas dopplerography.

Meaʻai no ka maʻi maʻi maʻi gestational

Eia nō naʻe, hele wale lākou i ka insulin inā inā he ʻano hana o ka ʻai, ka ʻai, ʻaʻole maikaʻi. E like me nā ʻano maʻi ʻē aʻe, ʻo ka pahuhopu o ke kīʻai no GDM ka mea nui e hoʻohaʻahaʻa i ka glucose koko. ʻAi ʻia nā mea momona a “ʻoluʻolu” wale nō, me ka hāʻawi ʻana i nā kao nā kaima, no ka mea he nui ka nui o ka ketoacidosis, ka mea hiki ke hoʻoliʻawe i ka hoʻokaʻawale ʻai kalima. ʻAʻole pono e poina i ka ulu ʻana o ka wā liʻiliʻi me ke ʻano maʻamau, a no ia mea pono ke loaʻa i nā mea pono a pau. No laila, pono ke kūlike i kaʻai.

ʻO ka haki, nā kō, nā mea ʻono, nā mea kuʻai momona, nā wai momona me kahi kōniha gula piha, nā hua momona, nā huahana i loaʻa nā momona saturated - ʻo ka margarine a me nā kīʻaha i hoʻomākaukau ʻia ma luna, ʻo nā mea momona (e like me ke kofe a me nā tiʻa me ka kō) ka mea i pāpā ʻia. Pono ka pasta, ʻuala (ʻoi ʻia hoʻi). Mai kaʻai a me ka moa ka mea e koho ai e koho i nā ʻano momona haʻahaʻa (veal, turkey). Hoʻomaopopo ʻia e hoʻonui i ka komo ʻana i nā meaʻai i momona i ka momona, ai nā mea kanu ʻole.

ʻO ka huina o ka caloric intake i kēlā me kēia lā ʻaʻole pono e hoʻonui i ka 1800 kcal. ʻO ka pae maikaʻi loa o nā kaū, nā momona a me nā protein he 45%, 30% a me 25%. Pono ʻoe e inu i ka liʻiliʻi - ma ka liʻiliʻi o 1,5 lita i kēlā me kēia lā.

He mea nui hoʻi ka meaʻai. Pono e loaʻa pinepine a ma ka liʻiliʻi (3 mau kīʻai nui a me nā kīnē he 2-3), mai overeat.

I ka hihia o ka hypoglycemia (no ka mea e hoʻomaʻamaʻa ana i ka inika insulin), ua makemake ʻia e loaʻa i kahi huahana momona, no ka laʻana, he ʻelea a i ʻole kahi wai o ka wai wai, e kōkua i ka hoʻihoʻi i ke kō i ke kō ma ka maʻamau.

Kaohi o ka Kauka

Lawe ʻia ka mālama ʻia ʻana o ka maʻi diabetes gestational ma ka home. Eia nō naʻe, ke hana ʻia nei ke kahua hoʻokipa hoʻokūkū no ka hoʻokolokolo - i ka trimester mua, ma 19-20 a me 35-36 mau pule. I kēia hihia, ua hoʻoholo ʻia ke kūlana o ka makuahine a me kāna wahine hānau.

Pono ka mea maʻi e hāʻawi i ka manawa i ka maʻamau e hoʻoholo ai i nā kiko o nā kino ketone. ʻO ka loaʻa ʻana o nā kino ketone e pili ana i kahi decompensation o ka maʻi.

ʻO ka wā maʻi me ka maʻi maʻi e nānā pono ʻia e ke kauka. No kēia kumu, pono ia e kipa i kahi gynecologist a me endocrinologist i hoʻokahi manawa i ʻelua pule a hoʻokahi i hoʻokahi pule me ka hoʻēmi ʻana i ka maʻi diabetes.

Ke kiaʻi

Pono e hoʻomanaʻo ʻia o ka hoʻohana ʻana o ka insulin e hoʻokomo pono i ka mālama pono ʻana e ka mea maʻi. ʻO ia, pono kahi wahine hāpai i ka mālama ʻana i ka neʻe o ka glucose i ke koko i ka lā. Hoʻomaopopo ʻia e hana i kēia ma kahi o 7 mau manawa o ka lā (hoʻokahi hola a me hoʻokahi hola ma hope o ka ʻaina kakahiaka, ʻaina awakea a me ka pāʻina a ma mua o ka wā hiamoe). Inā ʻaʻole, aia kahi kūlana kiʻekiʻe o nā kūlana hypoglycemic. Inā ʻai ka mea maʻi ma ka meaʻai, a laila helu ʻia ka glucose i ka ʻōpū ʻole i ke kakahiaka a i hoʻokahi hola ma hope o ka ʻai ʻana.

Eia kekahi, pono e mālama mau i ke kahe koko, ke kaumaha o ke kino.

Hoʻomaʻamaʻa kūlohelohe

Hiki i kahi mea maʻi me ka maʻi maʻi gestational ke kuhikuhi i nā hana olakino e kōkua i ka wela o ka glucose a me ka hoʻemi ʻana i ke kaumaha o ke kino. Eia nō naʻe, pono e noʻonoʻo ʻia ka ʻae ʻana ʻaʻole ke ʻae i kekahi hāmeʻa traumatic, no ka mea hiki ke kūpono i ka pēpē. ʻAʻole ʻōlelo ʻia nā hana ʻōpū.

Inā hāʻawi ʻia ka mālama kūpono, a laila maʻamau ke hopena maikaʻi ʻole. Hoʻohana maikaʻi ka hānau ʻana o ke keiki ma ka maʻi diabetes, akā ʻaʻole i hoʻokō ʻia nā ʻano hoʻopiʻi like ʻole. Inā pono, kahi hānau mua, cesarean ʻāpana.

Hoʻomaʻomaʻo ka hapanui o nā maʻi i ka maʻi ʻole me ka hopena a haʻalele i ka maʻi maʻi koke ma hope o ke ʻano o ka hāpai ʻana. Eia nō naʻe, ʻo GDM kahi pōpō kani e hōʻike ana i kahi kiʻekiʻe (ma mua o 50%) o ka hoʻomohala ʻana o ke ʻano type type 2 i ka wā e hiki mai ana (ma mua o 15 mau makahiki).Kūpono maoli nō kēia no kēlā mau makuahine e mālama pono i ko lākou paona liʻiliʻi a loaʻa nā paona keu. Eia nō naʻe, i kekahi manawa ʻo GDM ma hope o ka hānau keiki ʻana holoʻokoʻa piha o ka maʻi diabetes. Hana ʻia kēia ma 10% o nā maʻi. Nui ka ʻike i ka loli o ka maʻi gestational i loko o nā maʻi type 1. Inā he hanana hou ka wā hānau, a laila me ka hopena kiʻekiʻe e loaʻa ka hōʻemi o GDM.