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既有糖尿病的妊娠建議

Preconceptional Counseling of Overt Diabetes Mellitus

摘要


現代人隨著飲食習慣的改變以及高齡懷孕,受孕前既有糖尿病婦女的比例也是逐年增加。糖尿病影響範圍甚巨,包含視網膜、內分泌、腎臟及心血管系統等等。而生育年紀的女性是國家及社會重要的支柱,在這群既有糖尿病妊娠的婦女當中,亟需要婦產科醫師、內分泌科醫師及營養師共同照護攜手合作,以減少併發症和減少社會健康成本的支出。因此,透過統整文獻,將既有糖尿病妊娠相關的治療、監測以及如何於門診追蹤整理成文章供臨床醫師參考。

並列摘要


Nowadays, due to changes in the dieting habits and elder pregnancy age, the prevalence of pre-existing diabetes mellitus before conception increased over the years. Diabetes has wide influence on different systems which includes ophthalmology, endocrinology, nephrology and cardiovascular system. Child-bearing age women are important support of the society. Therefore, it is essential to make women with preexisting diabetes mellitus to be followed up regularly with gynecologists, endocrinologists and nutritionists during their pregnancy in order to minimize the possible complication and health care cost of the society. In this article, we presented the full-spectrum caring of women with preconception diabetes and summarized an algorithm that could aid clinicians to apply the caring into practice.

參考文獻


Correa A, Bardenheier B, Elixhauser A, et al: Trends in prevalence of diabetes among delivery hospitalizations, United States, 1993-2009. Matern Child Health J 2015;19:635-42.
Bowyer L: The Confidential Enquiry into Maternal and Child Health (CEMACH). Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer 2003–2005. The Seventh Report of the Confidential Enquiries into Maternal Deaths in the UKGwynethLewis ISBN: 978-0-9533536-8-2London: CEMACH, 2007. Obstetric Medicine. 2008;1(1):54
Balsells M, García-Patterson A, Gich I, et al: Maternal and fetal outcome in women with type 2 versus type 1 diabetes mellitus: a systematic review and metaanalysis. J Clin Endocrinol Metab 2009;94:4284-91.
Ray J: Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. Qjm 2001;94:435-44.
Macintosh MCM, Fleming KM, Bailey JA, et al: Perinatal mortality and congenital anomalies in babies of women with type 1 or type 2 diabetes in England, Wales, and Northern Ireland: population based study. BMJ 2006;333:177.

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