Kwa mkazi, kubereka mwana si mayeso osavuta, chifukwa pa nthawi imeneyi thupi lake limagwira ntchito mopitilira muyeso. Chifukwa chake, munthawi ngati izi, zovuta zamatumbo zambiri nthawi zambiri zimawonekera, mwachitsanzo, shuga ya amayi apakati. Koma kodi shuga ya gestational ndi chiyani ndipo ingakhudze bwanji thanzi la mayi ndi mwana wosabadwayo.
Matendawa amapezeka pamene kuchuluka kwa shuga m'magazi kumakhala kwakukulu pamimba. Nthawi zambiri matendawa amazimiririka mwana akangobadwa. Komabe, mtundu uwu wa matenda ashuga ndiwowopsa kwa azimayi, chifukwa maphunzirowa angatengedwe ngati chiwopsezo cha matenda a mtundu 2 mtsogolo.
Gellational matenda a shuga amachitika mu 1-14% ya akazi. Matendawa amatha kuoneka mosiyanasiyana. Mu trimester yoyamba, matenda a shuga amapezeka mu 2.1% ya odwala, chachiwiri - mu 5.6%, ndipo chachitatu - mu 3.1%
Zomwe zimayambitsa ndi zizindikiro
Mwambiri, mtundu uliwonse wa matenda ashuga ndi matenda a endocrine pomwe kulephera mu chakudya cha carbohydrate. Potengera maziko awa, pali inshuwaransi kapena insulin yokwanira, yomwe imayenera kupangidwa ndi kapamba.
Cholinga cha kuperewera kwa timadzi timeneti timatha kukhala osiyana. Mwachitsanzo, kusagwira bwino ntchito pakusintha kwa proinsulin kukhala timadzi wogwira, kuchepa kwa chiwerengero cha ma cell a beta mu kapamba, kusowa kwa kuzindikira kwa insulin ndi maselo, ndi zina zambiri.
Zotsatira za insulin pa kagayidwe kazakudya zimatsimikiziridwa ndi kukhalapo kwa enieni a glycoprotein receptors mu minofu yotengera timadzi. Akamakonzedwa, mayendedwe a shuga m'magazi amawonjezeka ndipo misempha ya magazi imachepa.
Kuphatikiza apo, insulin imayerekezera kugwiritsidwa ntchito kwa shuga ndi momwe imapangidwira monga glycogen mu minofu, makamaka minofu yamanja ndi chiwindi. Ndikofunikira kudziwa kuti kutulutsidwa kwa glucose kuchokera ku glycogen kumachitikanso mothandizidwa ndi insulin.
Homoni ina imakhudza kagayidwe kazakudya ndi mafuta. Imakhala ndi anabolic, imalepheretsa lipolysis, kuyambitsa biosynthesis ya DNA ndi RNA m'maselo omwe amadalira insulin.
Matenda a shuga akachitika, zomwe zimayambitsa zimaphatikizapo zinthu zingapo. Chofunika kwambiri pamenepa ndi kugwirira ntchito kwakanthawi pakati pa kuchepetsa mphamvu ya insulini ndi mphamvu ya hyperglycemic yomwe imapangidwa ndi mahomoni ena.
Kukaniza kwa insulin, kupita patsogolo pang'onopang'ono, kumapangitsa kuchepa kwa insulin kwambiri. Zomwe zimatithandizanso zimapangitsa izi:
- kunenepa kwambiri kumene kumapitilira 20% kapena kuposerapo, kupezeka ngakhale asanakhale ndi pakati;
- shuga wokwezeka wamwazi, womwe umatsimikiziridwa ndi zotsatira za kusanthula kwamkodzo;
- kubadwa m'mbuyomu kwa mwana wolemera kilogalamu 4;
- dziko (matenda a shuga ogwidwa nthawi zambiri amapezeka ku Asia, Hispanics, Blacks and Native Americaans);
- kubadwa kwa mwana wakufa kale;
- kulephera kwa shuga;
- kukhalapo kwa matenda a m'mimba;
- polyhydramnios yodziwika ndi madzi ochulukirapo amniotic;
- cholowa;
- zovuta za endocrine zomwe zimachitika nthawi yapitayi yapakati.
Pakati pa nthawi yayitali, kusokonezeka kwa endocrine kumachitika chifukwa cha kusintha kwa thupi, chifukwa kale gawo loyambirira la gestation, kagayidwe kamapangidwanso. Zotsatira zake, ndikusowa pang'ono kwa shuga mu mwana wosabadwayo, thupi limayamba kugwiritsa ntchito malo osungirako, kulandira mphamvu kuchokera ku lipids.
M'masiku oyambilira a mimba, kukonzanso kofanana kwa metabolic kumakwaniritsa mphamvu zonse za mwana wosabadwayo. Koma mtsogolomo, kuti tithane ndi insulin kukokana, hypertrophy ya maselo a pancreatic beta amayamba, omwe amakhalanso otanganidwa kwambiri.
Kupanga kwa mahomoni kumalipiriridwa ndi kuwonongeka kwake kothamanga. Komabe, kale mu nyengo yachiwiri ya mimba, placenta imagwira ntchito ya endocrine, yomwe nthawi zambiri imakhudza kagayidwe kazachilengedwe.
Ma estrogens opangidwa ndi placenta, ma steroid onga, mahomoni a steroid ndi cortisol amakhala odana ndi insulin. Zotsatira zake, kale sabata 20, zizindikiro zoyambirira za matenda amiseche zimachitika.
Komabe, nthawi zina, mzimayi amawulula kusintha kochepa kwa shuga, izi zimatchedwa pre-gestationalabetes mellitus. Pankhaniyi, kuchepa kwa insulin kumadziwika kokha ndi kuvutitsidwa kwa zakudya zamatumbo komanso kupezeka kwa zinthu zina zoyambitsa.
Ndizofunikira kudziwa kuti matenda ashuga panthawi yomwe ali ndi pakati samayendera limodzi ndi kufa kwa maselo a beta kapena kusintha kwa molekyulu ya mahomoni. Chifukwa chake, mawonekedwe amtunduwu wa endocrine amawonedwa kuti ndi osinthika, zomwe zikutanthauza kuti pamene kubereka kumachitika, amalipidwa ndi iwo eni.
Zizindikiro za matenda amiseche zimakhala zocheperako, motero azimayi nthawi zambiri amawauza kuti ndi apathupi omwe amakhala ndi pakati. Mawonetsero akulu omwe amapezeka nthawi iyi ndizizindikiro zamtundu uliwonse wa kusokonezeka kwa carbohydrate metabolism:
- ludzu
- dysuria;
- Khungu;
- kuchepa thupi kwambiri komanso zinthu zina.
Popeza Zizindikiro za matenda amishuga gestational sizodziwika, kuyesedwa kwa Laborate ndiye maziko othandizira matendawa. Komanso, mkazi nthawi zambiri amamuika mtundu wa ultrasound, womwe mutha kudziwa kuchuluka kwa kusakhazikika ndikuwonetsa matenda a mwana wosabadwayo.
Mwazi wamagazi mwa amayi apakati komanso kuzindikira kwa matendawa
Kodi ndi shuga wanji wamwazi wovomerezeka panthawi yapakati? Kuthamanga kwa glucose sayenera kupitirira 5.1 mmol / L, mutatha kadzutsa chizindikirocho chimatha kufika pa 6.7 mmol / L.
Ndipo ayenera kukhala ndi maperesenti angati a glycated hemoglobin? Chizindikiro cha chizindikirochi chikufika pa 5.8%.
Koma momwe mungazindikire izi? Kuti mudziwe ngati kuchuluka kwa shuga sikupitirira panthawi ya kubereka, kuwunika kwapadera kumachitika, kuphatikiza kuyesa kwamkodzo komanso kuyesa magazi kwa shuga, acetone, kuyesa kwa glucose komanso kudziwa kuchuluka kwa hemoglobin ya glycated.
Komanso, kuwunika kwa matenda a shuga gestational kumachitika pambuyo pa mayeso wamba, monga biochemistry yamagazi ndi OAC. Malinga ndi zomwe zikuwonetsa, chikhalidwe cha mkodzo wa bacteriological, kuyesa kwa mkodzo malinga ndi Nechiporenko kungathe kuyikidwa. Komanso pitani pothandizidwa ndi madokotala, endocrinologist, akatswiri a zamankhwala ndi opaleshoni ya maso.
Chizindikiro choyamba cha matenda a shuga nthawi yapakati ndi glycemia wokwera (kuyambira 5.1 mmol / l). Ngati miyezo ya shuga ya magazi idutsa, ndiye kuti njira zakuya zakuya zimagwiritsidwa ntchito pothandiza kuzindikira matenda ashuga panthawi ya bere.
Ndizachilendo kuti ngati hemoglobin ya glycated ichulukitsidwa, ndiye kuti izi zikutanthauza kuti kuchuluka kwa glucose kuchuluka sikunachitike munthawi yomweyo. Chifukwa chake, hyperglycemia imawonetsedwa nthawi ndi nthawi m'masiku 90 apitawa.
Koma shuga wowoneka mkodzo amatha kupezeka pokhapokha magazi a glucose akuchokera 8 mmol / l. Chizindikiro ichi chimatchedwa cholumikizira impso.
Komabe, matupi a ketone mumkodzo amatha kupezeka mosaganizira shuga. Ngakhale kukhalapo kwa acetone mu mkodzo sikuti kukuwonetsa mwachindunji kuti mzimayi wapezeka ndi matenda akutali. Kupatula apo, ma ketoni amatha kupezeka ndi:
- toxicosis;
- kusadya bwino;
- kuperewera kwa zakudya m'thupi;
- SARS ndi matenda ena limodzi ndi kutentha;
- preeclampia ndi edema.
Ponena za mbiri ya glycemic, tanthauzo la kafukufukuyu ndikuwayeza shuga mumagazi oposa maola 24 nthawi zosiyanasiyana, musanadye komanso mutadya. Cholinga ndikudziwa nsonga zamatumbo a glycemia, omwe angathandize pochiza matenda a hyperglycemia.
Kodi kuyeserera kwa glucose ndi chiyani? Njira iyi imakuthandizani kuti mupeze zolakwika zobisika zamatenda a carbohydrate. Ndikofunika kukumbukira kuti kukonzekera molakwika phunziroli kungakhudze zotsatira zake. Chifukwa chake, madzulo muyenera kudya moyenera, kupatula kupanikizika kwamalingaliro ndi thupi.
Kuti mupeze matenda a shuga, muyenera kufunsa katswiri wazachipatala yemwe adzayang'ane ngongoleyo.
Inde, ndi zovuta za endocrine, mavuto monga matenda ashuga retinopathy nthawi zambiri amabuka.
Kodi chiwopsezo cha matenda ndichani kwa mwana?
Amayi onse oyembekezera omwe ali ndi shuga yayikulu amadzifunsa kuti: Kodi chiwopsezo cha matenda ashuga kwa mwana ndi chiani? Nthawi zambiri matendawa sakhala pachiwopsezo ku thanzi la mayi, ndipo zomwe zimachitika sizimakhudzanso thanzi lake. Koma kuwunika kwa madotolo amati pakapanda chithandizo, ntchito nthawi zambiri imachitika ndi zovuta komanso zovuta zina.
Mwa amayi apakati omwe ali ndi vuto la gestational shuga, kukoka kwa michere kumachitika. Ndi kuphipha kwa zombo zazing'ono, endothelium imawonongeka, lipid peroxidation imayendetsedwa, ndipo DIC imayamba. Izi zimayambitsa zovuta monga kukula kwa kusakwanira kwa placental ndi pambuyo pake fetal hypoxia.
Mavuto oyipa a shuga kwa mwana amakhalanso pakukula kwa shuga kwa mwana wosabadwayo. Kupatula apo, kapamba wake satha kupanga insulin yokwanira, ndipo mahomoni opangidwa m'thupi la mayi sangadutse chotchinga cha fetoplacental.
Mwazi wamagazi osagwiritsika ntchito umapangitsa kuti michere ya metabolic ndi discirculatory ithe. Ndipo yachiwiri hyperglycemia imayambitsa kusintha kwa magwiridwe antchito, komanso imapangitsanso hypoxia ya fetal minofu.
Komanso kuchuluka kwa shuga kwa ana kumayambitsa matenda oopsa a cell ya beta. Zotsatira zake, mwana akabadwa, amatha kudwala matenda obwera chifukwa cha carbohydrate metabolism ndi zophophonya zomwe zimawopseza moyo wakhanda.
Ngati gestational shuga mellitus siichitira wachitatu trimester wa mimba, mwana wosabadwayo amakula ndi macrosomia ndi dysplastic kunenepa ndi hepato- ndi splenomegaly. Ngakhale atabadwa, ana ena amakhala ndi kusakhazikika kwa ziwalo zosiyanasiyana.
Zotsatira zake zazikuluzikulu za matenda ashuga gestational ndi:
- fetal ikutha;
- fetal hypoxia ndi intrauterine kukula retardation;
- chiopsezo chachikulu cha kufa ali wakhanda;
- kubadwa msanga;
- pafupipafupi matenda a kwamikodzo thirakiti;
- preeclampsia, eclampsia, ndi preeclampsia mwa akazi;
- macrosomia ndi kuwonongeka kwa ngalande yakubadwa;
- zotupa za m'mimba.
Komanso, zovuta za matenda ashuga nthawi yapakati zimaphatikizira kuchotsa mimbayo komwe kumachitika koyambirira. Komabe, nthawi zambiri zomwe zimayambitsa kusokonezeka kwamagona zimagwiritsidwa ntchito pakuwonekera kwa matenda ashuga, omwe sanawapeze munthawi yake.
Ngakhale pakalibe chithandizo cha kusokonezeka kwa endocrine pa nthawi yoyembekezera, matenda osokoneza bongo omwe abereka pambuyo pobadwa kwa mwana amatha kukhala shuga.
Matendawa amafunika chithandizo chotalikilapo, ndipo mwina kwa nthawi yayitali.
Kuchiza ndi kubereka
Ngati mayi woyembekezera ali ndi matenda ashuga, chithandizo chimachitika limodzi ndi endocrinologist ndi gynecologist. Pankhaniyi, wodwalayo azitha kudziyimira pawokha pakatha kudya glycemia ndikatha kudya.
Pofuna kuti kubereka mwana ndi matenda osokoneza bongo azichita bwino, wodwalayo amapatsidwa zakudya zapadera. Ikawonedwa, ndikofunikira kudya zakudya m'magawo ang'onoang'ono, osadya zakudya zamafuta ndi yokazinga, komanso osamadya zakudya zopanda pake, kuphatikizapo zakudya zomwe zimapezeka pompopompo. Mukanyamula mwana, zinthu zomwe zimachulukitsa chitetezo chokwanira ndikuziziritsa thupi ndi mavitamini, mchere ndi fiber (zipatso, mbewu zonse, mbewu zosiyanasiyana, masamba) ndizothandiza.
Koma ngati zotsatira zotsatila kudya sizinali zofunika pakulimbana ndi matenda a hyperglycemia, ndiye kuti wodwalayo adalandira mankhwala a insulin. Insulin ya GDM imagwiritsidwa ntchito mopitilira muyeso komanso mwachidule.
Ndikofunikira kubaya insulin mobwerezabwereza, chifukwa cha caloric kudya ndi glycemia. Mlingo ndi malangizo a momwe mungabayitsire mankhwalawa ayenera kufotokozedwa ndi endocrinologist.
Ndikofunika kukumbukira kuti amayi oyembekezera omwe ali ndi matenda ashuga saloledwa kumwa mapiritsi ochepetsa shuga. Nthawi zina chithandizo chothandizira chitha kuchitika, chomwe:
- mavitamini;
- ma microcirculation zowonjezera;
- Chophytol;
- mankhwala omwe amalepheretsa kukula kwa placental insufficiency.
Malinga ndi ziwonetsero, matenda a shuga oyembekezera atabereka mu 80% ya milandu imachoka paokha ndipo mkazi akatuluka m'chipatala cha amayi oyembekezera, mkhalidwe wake umayamba pang'onopang'ono. Koma machitidwe a mwana amatha kukhala ovuta.
Chifukwa chake, nthawi zambiri mwana wakhanda amakhala ndi kulemera kwambiri. Chifukwa chake, nthawi zambiri, vutoli limathetsedwa ndi gawo la cesarean, chifukwa ngati mayi akabereka mwana payekha, mapewa ake amatha kuvulala.
Kubadwa kwa mwana ku matenda a shuga mellitus pankhani yothandizira matendawa panthawi yoyembekezera komanso kuyang'aniridwa kwachipatala konse kumayenda bwino. Koma nthawi zambiri kuchuluka kwa shuga mwa akhanda sikubwinobwino. Kuti izi zitheke, ndikokwanira kumuyamwa kapena zosakaniza zapadera.
Kupewera kwa matenda osokoneza bongo a m'mimba ndi kutsata mfundo za chakudya chopatsa thanzi, kuchita masewera olimbitsa thupi nthawi zonse ndi octopus komanso matenda a kugona ndi kupumula. Komanso, omwe kale anali ndi vuto la matenda ashuga m'mimba yapitayi amafunika nthawi yambiri yowunika kuchuluka kwa shuga m'magazi, kutsatira zakudya zamafuta ochepa ndikukonzekera zonse zomwe zimachitika mtsogolo.
Zambiri zokhudzana ndi matenda a shuga gestational zimaperekedwa mu kanema munkhaniyi.
