妊娠期和妊娠期糖尿病合并囊性纤维化的孕妇。

IF 4.2 Q1 ENDOCRINOLOGY & METABOLISM
Rachael Oxman , Andrea H. Roe , Jagdeesh Ullal , Melissa S. Putman
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引用次数: 7

摘要

随着囊性纤维化跨膜调节因子(CFTR)调节剂疗法的使用寿命更长,健康质量提高,患有囊性纤维化(CF)的女性越来越多地追求怀孕。患有CF的孕妇的母体风险在很大程度上取决于女性的基线肺和胰腺功能,大多数CF妊娠将以活产成功结束。糖尿病,无论是妊娠期还是先前存在的囊性纤维化相关糖尿病(CFRD),在CF女性中非常普遍,在最近的CF中心报告中,影响了18%至62%的妊娠。除了CFRD的发病率随着年龄的增长而增加外,妊娠期糖尿病在患有CF的妇女中也更常见,因为与没有CF的孕妇相比,患有CF的孕妇胰岛素分泌较低,胰岛素抵抗较高,肝葡萄糖生成增加。妊娠期糖尿病对孕产妇和胎儿健康有重要影响。在没有CF的女性中,血糖控制与胎儿畸形、新生儿围产期死亡率、剖宫产和新生儿重症监护需求的风险直接相关。对患有CF的女性进行的小型研究表明,与没有糖尿病的孕妇相比,患有糖尿病的孕妇早产的风险增加,胎龄降低,胎儿出生体重降低。应就糖尿病风险向准备怀孕的CF妇女提供咨询,如果在过去六个月内尚未完成,则应通过口服葡萄糖耐量测试(OGTT)进行CFRD的常规筛查。妊娠前慢性疲劳综合征患者的血糖控制应在受孕前进行优化。胰岛素是通过每日多次注射或胰岛素泵治疗CF孕妇糖尿病的首选药物,连续血糖监测仪(CGM)可用于降低低血糖风险。CF妇女在怀孕期间面临着许多影响糖尿病护理的独特挑战,并将受益于包括营养和内分泌在内的多学科护理团队的支持,以确保健康怀孕。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

Gestational and pregestational diabetes in pregnant women with cystic fibrosis

As cystic fibrosis transmembrane regulator (CFTR) modulator therapies offer greater longevity and improved health quality, women living with cystic fibrosis (CF) are increasingly pursuing pregnancy. Maternal risks for pregnant women with CF largely depend on a woman’s baseline pulmonary and pancreatic function, and the majority of CF pregnancies will successfully end in live births.

Diabetes, either gestational or pre-existing cystic fibrosis-related diabetes (CFRD), is highly prevalent in women with CF, affecting 18 to 62% of pregnancies in recent CF center reports. In addition to the rising incidence of CFRD with age, gestational diabetes is also more common in women with CF due to lower insulin secretion, higher insulin resistance, and increased hepatic glucose production as compared to pregnant women without CF. Diabetes occurring during pregnancy has important implications for maternal and fetal health. It is well established in women without CF that glycemic control is directly associated with risks of fetal malformation, neonatal-perinatal mortality, cesarean delivery and need for neonatal intensive care. Small studies in women with CF suggest that pregnancies affected by diabetes have an increased risk of preterm delivery, lower gestational age, and lower fetal birth weight compared to those without diabetes.

Women with CF preparing for pregnancy should be counseled on the risks of diabetes and should undergo routine screening for CFRD with oral glucose tolerance testing (OGTT) if not already completed in the past six months. Glycemic control in those with pre-gestational CFRD should be optimized prior to conception. Insulin is preferred for the management of diabetes in pregnant women with CF via multiple daily injections or insulin pump therapy, and continuous glucose monitors (CGM) can be useful in mitigating hypoglycemia risks. Women with CF face many unique challenges impacting diabetes care during pregnancy and would benefit from support by a multidisciplinary care team, including nutrition and endocrinology, to ensure healthy pregnancies.

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来源期刊
CiteScore
6.10
自引率
0.00%
发文量
24
审稿时长
16 weeks
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