Gestasyonel Diyabetes Mellitus
Özet
Gestasyonel diyabetes mellitus (GDM), gebelikte ilk kez ortaya çıkan kan şekeri yüksekliği olup en yaygın metabolik bozukluktur. İleri anne yaşı, obezite ve aile öyküsü gibi risk faktörleri içeren gebelerde ilk trimesterde, diğer tüm gebelerde ise 24-28. haftalarda 75 gr tek aşamalı veya 50/100 gr iki aşamalı OGTT ile taranması önerilir. GDM; preeklampsi, makrozomi ve yenidoğan hipoglisemisi gibi ciddi komplikasyon risklerini artırır. Tedavide öncelik diyet ve egzersiz gibi yaşam tarzı değişiklikleridir; bu yöntemlerle hastaların %80-90'ında başarı sağlanır. Kan şekerinin regüle edilemediği veya fetal gelişimin olumsuz etkilendiği durumlarda, plasentayı geçmediği için ilk tercih olarak insülin tedavisine, alternatif olarak da metformin veya glubirid gibi oral ajanlara başvurulur. Takiplerde fetal iyilik testleri uygulanmalı ve doğum zamanlaması hastanın regülasyon durumuna göre 39-40. haftalar arasında planlanmalıdır. Doğum sonrasında GDM tedavisi sonlandırılsa da hastaların ilerleyen dönemlerde tip 2 DM riski yüksek olduğundan postpartum 6-12. haftalarda, birinci ve üçüncü yıllarda taramalara devam edilmelidir.
Gestational diabetes mellitus (GDM) is the most common metabolic disorder characterized by glucose intolerance first recognized during pregnancy. Screening is recommended in the first trimester for pregnant women with risk factors such as advanced maternal age, obesity, and family history, and at 24-28 weeks for all other pregnancies using a 75 g one-step or 50/100 g two-step OGTT. GDM increases the risk of severe complications, including preeclampsia, fetal macrosomia, and neonatal hypoglycemia. Management primarily relies on lifestyle modifications like diet and exercise, which successfully achieve glycemic control in 80-90% of patients. If target blood glucose levels cannot be maintained or adverse fetal growth is detected, insulin therapy is initiated as the gold standard because it does not cross the placenta, while oral agents like metformin or glyburide serve as alternatives. Fetal well-being monitoring is essential, and delivery induction should be planned between 39-40 weeks based on maternal glycemic control. Although treatment is discontinued postpartum due to the rapid decline of placental hormones, patients retain a high long-term risk for type 2 DM, necessitating follow-up screenings with a 75 g OGTT at 6-12 weeks, the first year, and the third year postpartum.
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