Ngati pali vuto la insulin mthupi, matenda a shuga amapezeka.
M'mbuyomu, pomwe mahomoni awa sanagwiritse ntchito ngati mankhwala, azimayi omwe anali ndi matenda amtunduwu analibe mwayi wobereka. 5% yokha mwaiwo ndi omwe amatha kukhala ndi pakati, ndipo kufa kwa fetal kunali pafupifupi 60%!
Masiku ano, matenda ashuga mwa amayi apakati asiya kukhala owopsa, popeza chithandizo cha insulin chimalola amayi ambiri kubereka ndi kubereka popanda zovuta.
Amabala
Vuto la kubereka lomwe limapangidwa ndi matenda a shuga mellitus (DM) limakhala likuwunikidwa nthawi zonse ndi ma endocrinologists ndi maopaleshoni, chifukwa limalumikizidwa ndi zovuta pafupipafupi mu nthawi ya perinatal ndikuwopseza thanzi la mayi ndi mwana wamtsogolo.
Malinga ndi ziwerengero, m'dziko lathu la mtundu 1 ndi matenda ashuga 2 amawapeza mu 1-2% azimayi omwe ali pantchito. Kuphatikiza apo, pregestational (1% ya milandu) ndi matenda osokoneza bongo (kapena GDM) amadziwika.
Chachilendo cha matenda omalizirawo ndikuti zimangokhala mu nthawi ya perinatal. GDM imasokoneza mpaka 14% ya mimba (mchitidwe wapadziko lonse). Ku Russia, matenda amtunduwu amapezeka mu 1-5% ya odwala.
Matenda a amayi oyembekezera, omwe nthawi zambiri amatchedwa GDM, amapezeka mwa azimayi onenepa kwambiri omwe ali ndi matenda osakwanira (achibale omwe ali ndi matenda ashuga). Zokhudza matenda a shuga omwe azimayi amabereka akangobadwa nawo, izi zimachitika kawirikawiri ndipo zimakhala zosavuta 1% yovomerezeka.
Zifukwa za maonekedwe
Cholinga chachikulu ndikulemera thupi komanso chiyambi cha kusintha kwa mahomoni m'thupi.
Maselo a minofu amachedwa kutaya insulin (amakhala olimba).
Zotsatira zake, mahomoni opezekanso salinso okwanira kusunga kuchuluka kwa shuga m'magazi: ngakhale insulin ikupitilizidwa kupanga, singathe kukwaniritsa ntchito zake.
Mimba ndi shuga omwe alipo
Amayi ayenera kudziwa kuti panthawi yomwe ali ndi pakati amapezeka kuti amamwa mankhwala ochepetsa shuga. Odwala onse ndi mankhwala a insulin.
Monga lamulo, mu trimester yoyamba, kufunikira kwake kumachepetsedwa. Lachiwiri - limachulukitsa nthawi 2, ndipo lachitatu - limatsikanso. Pakadali pano, muyenera kutsatira zakudya mosamalitsa. Ndiosafunika kugwiritsa ntchito mitundu yonse ya zotsekemera.
Kwa odwala matenda ashuga, ndipofunika kudya zakudya zama protein. Ndikofunika kuti musamadye zakudya zamafuta ambiri: masoseji ndi mafuta anyama, mkaka wa kalori wambiri. Kuchepetsa chakudya chamagulu ochulukirapo m'zakudya za amayi omwe ali ndi pakati kungachepetse chiopsezo chokhala ndi mwana wosabadwa.
Kuti muchepetse kuchuluka kwa glycemic nthawi yam'mawa, tikulimbikitsidwa kudya zakudya zochepa. Ndikofunikira kuyang'anira kuwerengera magazi nthawi zonse. Ngakhale hyperglycemia yofatsa panthawi yoyembekezera sitiwonedwa ngati yowopsa, imapewedwa bwino.
Mwa amayi apakati omwe ali ndi matenda amtundu woyamba, hypoglycemia imatha kuchitika. Pankhaniyi, ndikofunikira kuwonedwa pafupipafupi ndi endocrinologist ndi gynecologist.
Kodi matendawa amakhudza bwanji kubereka kwa mwana wosabadwayo?
Matenda a shuga amachulukitsa mimba. Chowopsa chake ndi chakuti glycemia imatha kuyambitsa: kumayambiriro - kusokonezeka kwa mwana wosabadwa komanso kuchotsa mimba mwachangu, komanso kumapeto - polyhydramnios, komwe ndi kowopsa poyambiranso kubadwa msanga.
Mzimayi amakumana ndi matenda ashuga ngati izi zingachitike;
- Mphamvu ya mavuto a impso ndi retina;
- mtima ischemia;
- kukula kwa gestosis (toxicosis) ndi zovuta zina za pakati.
Ana obadwa kwa amayi oterowo nthawi zambiri amakhala ndi kulemera kwakukulu: 4.5 kg. Izi zikuchitika chifukwa cha kuchuluka kwa shuga kwa amayi mu chikhodzodzo kenako kulowa m'magazi a mwana.
Nthawi yomweyo, zikondamoyo za mwana wosabadwayo zimapanga insulin komanso zimapangitsa kukula kwa mwana.
Nthawi yapakati, shuga imawoneka mosiyanasiyana:
- pathology attenuation imadziwika ndi 1 trimester: Magazi a shuga amachepetsa. Pofuna kupewa hypoglycemia pakadali pano, mlingo wa insulin umachepetsedwa ndi wachitatu;
- kuyambira sabata la 13 la kubereka, matenda a shuga amayambanso. Hypoglycemia ndiyotheka, motero, mlingo wa insulin ukuwonjezeka;
- pakatha masabata 32 mpaka pakubadwa, pali kusintha pakadutsa matenda ashuga, glycemia ikhoza kuchitika, ndipo mlingo wa insulin umachulukanso ndi wachitatu;
- atangobereka, shuga m'magazi amayamba kuchepa, kenako amakula, mpaka amazindikira pofika masiku 10.
Pokhudzana ndi zovuta zovuta za matenda ashuga, mkazi amagonekedwa kuchipatala.
Zizindikiro
Matenda a shuga amawoneka ngati akhazikitsidwa ngati, malinga ndi zotsatira za kuyesedwa kwa labotale, phindu la shuga m'magazi (pamimba yopanda kanthu) ndi 7 mmol / l (kuchokera pamtsempha) kapena kupitirira 6.1 mmol / l (kuchokera pachala).
Ngati matenda a shuga akukayikira, kuyesedwa kwa glucose kumayikidwa.
Chizindikiro china chofunikira cha matenda a shuga ndi shuga mumkodzo, koma pokhapokha ndi hypoglycemia. Matenda a shuga amasokoneza kagayidwe kazakudya ndi mafuta m'thupi, zomwe zimadzetsa ketonemia. Ngati kuchuluka kwa shuga ndi kokhazikika komanso koyenera, zimaganiziridwa kuti shuga imalipidwa.
Zovuta zotheka
Nthawi ya perinatal motsutsana ndi maziko a shuga imakhudzana ndi zovuta zingapo.
Ambiri odziwika - kuchotsa mimbayo (15-30% ya milandu) pakatha masabata 20-27.
Mankhwala ochedwa poyizoni amapezekanso, ogwirizana ndi matenda a impso a wodwalayo (6%), matenda amkodzo thirakiti (16%), polyhydramnios (22-30%) ndi zina. Nthawi zambiri gestosis imayamba (35-70% ya akazi).
Ngati kulephera kwa impso kumawonjezeredwa ku matenda awa, mwayi wa kubereka umachulukira kwambiri (20-45% ya milandu). Mu theka la azimayi omwe amatha kubereka polyhydramnios ndi zotheka.
Mimba imaphatikizidwa ngati:
- pali microangiopathy;
- Chithandizo cha insulin sichimapereka zotsatira;
- maanja onse ali ndi matenda ashuga;
- kuphatikiza kwa matenda ashuga ndi chifuwa chachikulu;
- m'mbuyomu, akazi adabereka mobwerezabwereza;
- shuga imaphatikizidwa ndi mkangano wa Rhesus mwa mayi ndi mwana.
Ndi matenda ashuga operewera, kutenga pakati komanso kubereka mwana kumachitika mosatekeseka. Ngati matendawa samasowa, funso limadzuka pokhudzana ndi kubereka msanga kapena gawo la cesarean.
Ndi matenda a shuga m'modzi mwa makolo, chiopsezo chotengera matenda amenewa mu ana ndi 2-6%, onse - mpaka 20%. Mavuto onsewa amachititsa kuti kubereka kubereka kwabwinobwino. Nthawi yotsatila nthawi zambiri imakhudzana ndi matenda opatsirana.
Mfundo zachithandizo
Ndikofunika kwambiri kukumbukira kuti mayi yemwe ali ndi matenda ashuga ayenera kuwonana ndi dokotala asanatenge pathupi. Matendawa ayenera kulipiriridwa mokwanira chifukwa chodziwa bwino za insulin.
Chakudya cha wodwalayo chimagwirizana kwambiri ndi endocrinologist ndipo amakhala ndi zakudya zochepa, zamafuta.
Kuchuluka kwa zakudya zamapuloteni kuyenera kuchulukitsidwa pang'ono. Onetsetsani kuti mumamwa mavitamini A, C, D, B, kukonzekera kwa ayodini ndi folic acid.
Ndikofunikira kuyang'anira kuchuluka kwa chakudya cham'mimba ndikuphatikiza bwino zakudya ndi kukonzekera kwa insulin. Maswiti osiyanasiyana, semolina ndi phala la mpunga, msuzi wa mphesa suyenera kuperekedwa kuchakudya. Penyani kulemera kwanu! Pa nthawi yonse yobereka, mkazi sayenera kupitilira ma kilogalamu 10-11.
Zovomerezeka ndi Zoletsedwa za Matenda A shuga
Ngati zakudya zalephera, wodwalayo amamuika ku insulin. Mlingo wa jakisoni ndi chiwerengero chawo chimatsimikiziridwa ndikuwongoleredwa ndi adokotala. Mu matenda a shuga, chithandizo chofatsa chimasonyezedwa mwa mawonekedwe azitsamba. Amayi oyembekezera amalimbikitsidwa kuchita masewera olimbitsa thupi mwanjira yoyenda.
Zonsezi zimagwiritsidwa ntchito kwa amayi omwe ali ndi matenda ashuga a mtundu woyamba. Matenda a 2 a shuga komanso matenda ashuga okalamba sakhala wamba pakati pa azimayi ogwira ntchito.
Kuwongolera mimba
Kuti mukhalebe ndi pakati, ndikofunikira kulipira kwathunthu shuga.
Popeza kufunikira kwa insulin nthawi zosiyanasiyana zaubongo ndizosiyana, mayi woyembekezera ayenera kuchipatala katatu:
- itatha yoyamba kufunsa chithandizo chamankhwala;
- kachiwiri pa sabata 20-24. Pakadali pano, kufunika kwa insulini kumasintha mosalekeza;
- ndipo pa masabata 32 mpaka 36, pamene toxosis ya mochedwa imakonda kujowina, zomwe zimawopsa kwambiri pakukula kwa mwana wosabadwayo. Kugonekedwa pachipatala pankhaniyi kumatha kutha ndi gawo la caesarean.
Mimba imatheka ngati mwana wosabadwayo amakula bwinobwino popanda mavuto.
Madokotala ambiri amawona kuti kubereka kwakwanthawi kwakadutsa milungu 35- 38. Njira yakuperekera ndi munthu payekha. Chigawo cha ku Kaisareya cha odwala matenda ashuga amapezeka 50% ya milandu. Nthawi yomweyo, mankhwala a insulin sasiya.
Ana obadwa kwa amayi oterewa amawonedwa asanabadwe. Afunika chisamaliro chapadera. Mu maola oyamba amoyo wamwana, chidwi chonse cha madokotala chimangoyang'ana kupewa ndi kupewa glycemia, acidosis, ndi matenda opatsirana ndi kachilombo.
Makanema okhudzana nawo
Za momwe mimba ndi kubereka zimayendera ndi matenda a shuga, mu kanema:
Mimba ndi mayeso ofunikira kwambiri kwa mayi yemwe ali ndi matenda ashuga. Mutha kuwerengera kuti zinthu ziziwayendera bwino mwakuyang'ana mosamalitsa malangizo onse a endocrinologist.
