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Titolo:
Management of insulin treatment in type 1 diabetes mellitus in prospect for and during pregnancy: Means and objectives.
Autore:
Renard, E; Raingeard, I; Boulot, P; Bringer, J;
Indirizzi:
Hop Lapeyronie, Serv Malad Endocriniennes, F-34295 Montpellier 5, France Hop Lapeyronie Montpellier France 5 ennes, F-34295 Montpellier 5, France Hop Arnaud Villeneuve, Serv Gynecol Obstet, F-34295 Montpellier, France Hop Arnaud Villeneuve Montpellier France F-34295 295 Montpellier, France
Titolo Testata:
DIABETES & METABOLISM
fascicolo: 4, volume: 27, anno: 2001,
parte:, 2
pagine: S61 - S66
SICI:
1262-3636(200109)27:4<S61:MOITIT>2.0.ZU;2-#
Fonte:
ISI
Lingua:
FRE
Soggetto:
SPONTANEOUS-ABORTION; CONGENITAL-MALFORMATIONS; FETAL GROWTH; WOMEN; MOTHERS; INFANTS; CONCEPTION; ANOMALIES; RISK; CARE;
Keywords:
type 1 diabetes; diabetic pregnancy; insulin; diabetic education;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
41
Recensione:
Indirizzi per estratti:
Indirizzo: Renard, E Hop Lapeyronie, Serv Malad Endocriniennes, F-34295 Montpellier 5, France Hop Lapeyronie Montpellier France 5 4295 Montpellier 5, France
Citazione:
E. Renard et al., "Management of insulin treatment in type 1 diabetes mellitus in prospect for and during pregnancy: Means and objectives.", DIABETE MET, 27(4), 2001, pp. S61-S66

Abstract

Clinical data in the 1980s showed a close relationship between the conceptional glycated hemoglobin and the occurrence of spontaneous early abortionsand fetal malformations. Blood glucose level during pregnancy was similarly correlated with the risk of fetal macrosomia, due to significant links between birthweight. fetal hyperinsulinemia and mean maternal blood glucose. Tight blood glucose control from conception to term was shown to be able tolower the risk of fetal malformations and perinatal mortality to that of the offspring of a non diabetic mother. Prerequisites include: 1) contraception until tight blood glucose control, 2) close partnership between diabetologist and obstetrician, 3) assessment of diabetic complications. Seldom, coronary heart disease or advanced nephropathy contraindicate pregnancy. Uncontrolled proliferative or pre-proliferative retinopathy, or macular edema,are temporary contraindications to pregnancy. Laser plotocoagulation must then be performed before tightening blood glucose control. A complete review of diabetes management is associated with therapeutic intensification. Blood glucose objectives allow as limits: 70 to 100 mg/dl before meals, up to140 mg/dl one hour and 120 mg/dl two hours after meals. HbA1c allowing conception is close to 7%. Blood glucose monitoring requires 6-7 measurements per day. The most efficient insulin regimens include 3 to 4 shots per day. The distribution between regular and NPH or lente insulins is adapted individually. Lispro insulin, now appearing as safe, may be used to improve post-meal blood glucose control. Insulin pumps may be useful in case of late-night poor control or frequent hypoglycemic events. Patient acceptance of this option is unavoidable to obtain a benefit. Preconceptional insulin therapy must be maintained until pregnancy term. Follow-up must be intensified after twenty fourth week. Labor and delivery, cesarean section, fetal maturation by corticosteroids and use of IV betamimetic drugs require continuous IV insulin delivery. The continuation of intensive insulin management in post-partum is encouraged.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 04/12/20 alle ore 19:13:43