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Svangerskapsdiabetes og diabetes i svangerskap

Sist oppdatert: Sist revidert:
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Definisjon:
Diabetes i svangerskapet: kjent eller nydiagnostisert diabetes type 1- eller 2 hos gravide. Svangerskapsdiabetes: diabetes oppstått i svangerskapet, normaliseres vanligvis etter fødsel, men videre økt risiko for DT2. 
Forekomst:
Svangerskapsdiabetes, DT1 og DT2 diagnostisert hos hhv 6%, 0,5% og 0,2% av gravide i 2021. 
Symptomer:
Vanligvis symptomfri. 
Funn:
Vanligvis ingen diabetesrelaterte kliniske funn ved svangerskapsdiabetes.
Diagnostikk:
HbA1c hos risikogrupper ved første svangerskapskontroll for å avdekke hyperglykemi, DT1 eller DT2. Peroral glukosebelastning i uke 24-28 hos risikogrupper for å avdekke svangerskapsdiabetes.
Behandling:
Oppfølging og behandling i spesialisthelsetjenesten ved diabetes type 1 og 2. Kosttiltak, fysisk aktivitet og egenmåling av glukose ved svangerskapsdiabetes. Insulin eller metformin om behandlingsmål ikke nås ved livsstilsintervensjon.
  1. Helsedirektoratet. Nasjonal faglig retningslinje for svangerskapsdiabetes. Oslo 2018. Sist faglig oppdatert 26.02.2020. Siden besøkt 02.11.2022 helsedirektoratet.no  
  2. Folkehelseinstituttet, Medisinsk fødselsregister. Diabetes hos mor. Folkehelseinstituttet 2021. Siden besøkt 24.10.2022 statistikkbank.fhi.no  
  3. Behboudi-Gandevani S, Parajuli R, Vaismoradi M. A Systematic Review of the Prevalence of Gestational Diabetes in Norway. Int J Environ Res Public Health. 2021 Feb 3;18(4):1423. PMID: 33546492 PubMed  
  4. Folkehelseinstituttet, Mors kroppsmasseindeks før svangerskapet. Medisinsk fødselsregister. Folkehelseinstituttet 2021. Siden besøkt 24.10.2022 statistikkbank.fhi.no  
  5. Plows JF, Stanley JL, Baker PN et al. The Pathophysiology of Gestational Diabetes Mellitus. Int J Mol Sci. 2018 Oct 26;19(11):3342. dPMID: 30373146 PubMed  
  6. Chawla A, Amundsen ÅL, Hanssen KF, Iversen PO. Svangerskapsdiabetes hos kvinner fra Sør-Asia. Tidsskr Nor Lægeforen 2006; 126: 1041-3. PubMed  
  7. Glukosebelastning – analysering på pasientnært instrument Oral glukosetoleransetest (OGTT). NOKLUS 2021. Siden lest 13.10.22. cms.legehandboka.no  
  8. Helsedirektoratet. Nasjonal faglig retningslinje for svangerskapsomsorgen. Oslo, 2018 www.helsedirektoratet.no  
  9. Magnussen EB. et al. Adipositas i svangerskap og fødsel. Norsk gynekologisk forening Veileder i fødselshjelp (2020). ePub. ISBN 978-82-692382-0-4. [hentet 03. juni 2022]. www.legeforeningen.no  
  10. Middleton P, Crowther CA, Simmonds L. Different intensities of glycaemic control for pregnant women with pre-existing diabetes. Cochrane Database Syst Rev 2012 Aug 15; 8: CD008540. Cochrane (DOI)  
  11. Hartling L, Dryden DM, Guthrie A, et al. Benefits and harms of treating gestational diabetes mellitus: a systematic review and meta-analysis for the U.S. Preventive Services Task Force and the National Institutes of Health Office of Medical Applications of Research. . Ann Intern Med 2013 May 28 . doi:10.7326/0003-4819-159-2-201307160-00661 DOI  
  12. Garrison A. Screening, Diagnosis, and Management of Gestational Diabetes Mellitus. Am Fam Phys 2015; 91: 460-7. pmid:25884746 PubMed  
  13. Martis R, Crowther CA, Shepherd E, Alsweiler J, Downie MR, Brown J. Treatments for women with gestational diabetes mellitus: an overview of Cochrane systematic reviews. Cochrane Database of Systematic Reviews 2018, Issue 8. Art. No.: CD012327. DOI: 10.1002/14651858.CD012327.pub2 DOI  
  14. Poolsup N, Suksomboon N,Amin M. Effect of treatment of gestational diabetes mellitus: a systematic review and meta-analysis. PLoS One. 2014;9(3):e92485. PMID: 24658089. PubMed  
  15. Alwan N, Tuffnell DJ, West J. Treatments for gestational diabetes. Cochrane Database of Systematic Reviews 2009, Issue 3. Art. No.: CD003395. DOI: 10.1002/14651858.CD003395.pub2. DOI  
  16. Socialstyrelsen. Nationella riktlinjer för diabetesvård – Stöd för styrning och ledning. 2018. (Hämtad 2018-09-27) www.socialstyrelsen.se  
  17. Rowan JA, Rush EC, Plank LD, et al. Metformin in gestational diabetes: the offspring follow-up (MiG TOFU): body composition and metabolic outcomes at 7–9 years of age. BMJ Open Diabetes Res Care 2018; 6: e000456. pmid:29682291 PubMed  
  18. Landi SN, Radke S, Engel SM et al. Association of Long-term Child Growth and Developmental Outcomes With Metformin vs Insulin Treatment for Gestational Diabetes. JAMA Pediatr 2018. PMID: 30508164 PubMed  
  19. Sénat M-V, Affres H, Letourneau A, et al. Effect of Glyburide vs Subcutaneous Insulin on Perinatal Complications Among Women With Gestational Diabetes A Randomized Clinical Trial. JAMA 2018; 319: 1773-80. pmid:29715355 PubMed  
  20. Balsells M, García-Patterson A, Solà I, et al. Glibenclamide, metfomin, and insulin for the treatment of gestational diabetes: a systematic review and meta-analysis. BMJ 2015; 350: h102. doi:10.1136/bmj.h102 DOI  
  21. Tieu J, Shepherd E, Middleton P, Crowther CA. Dietary advice interventions in pregnancy for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews 2017, Issue 1. Art. No.: CD006674. DOI: 10.1002/14651858.CD006674.pub3. Accessed 03 November 2022. The Cochrane Library  
  22. Shepherd E, Gomersall JC, Tieu J, Han S, Crowther CA, Middleton P. Combined diet and exercise interventions for preventing gestational diabetes mellitus. Cochrane Database of Systematic Reviews 2017, Issue 11. Art. No.: CD010443. DOI: 10.1002/14651858.CD010443.pub3. Accessed 03 November 2022. The Cochrane Library  
  23. Vounzoulaki E, Khunti K, Abner SC, et al. Progression to type 2 diabetes in women with a known history of gestational diabetes: systematic review and meta-analysis. BMJ 2020; 369: m1361. www.bmj.com  
  24. Koivusalo S, Rönö K, Klemetti M, et al. Gestational diabetes mellitus can be prevented by lifestyle intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL): A randomized controlled trial. Diabetes Care 2015. PMID: 26223239 PubMed  
  25. Claesson R, Ignell C, Shaat N, et al. HbA1c as a predictor of diabetes after gestational diabetes mellitus. Prim Care Diabetes 2017; 11(1): 46-51. pmid:27692850 PubMed  
  26. Köhler M, Ziegler AG, Beyerlein A. Development of a simple tool to predict the risk of postpartum diabetes in women with gestational diabetes mellitus. Acta Diabetologica 2015. doi:10.1007/s00592-015-0814-0 DOI  
  27. Ignell C, Ekelund M, Anderberg E, et al. Model for individual prediction of diabetes up to 5 years after gestational diabetes mellitus. Springerplus 2016; 5: 318. pmid:27065426 PubMed  
  28. Persson M, Norman M, Hanson U. Obstetric and perinatal outcomes in type 1 diabetic pregnancies: A large, population-based study. Diabetes Care 2009; 32(11): 2005-9. pmid:19675195 PubMed  
  29. Farrar D, Simmonds M, Bryant M et al. Treatments for gestational diabetes: a systematic review and meta.analysis. BMJ Open 2017; 7: e015557. pmid:28647726 PubMed  
  30. Feghali MN, Scifres CM. Novel therapies for diabetes mellitus in pregnancy. BMJ 2018; 362: k2034. pmid:30012851 PubMed  
  31. Billionet C, Mitanchez D, Weill A et al. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60: 636-44. pmid:28197657 PubMed  
  32. Lai FY, Johnson JA, Dover D, Kaul P. Outcomes of singleton and twin pregnancies complicated by pre-existing diabetes and gestational diabetes: A population-based study in Alberta, Canada, 2005-11. J Diabetes 2016; 8: 45-55. pmid:25496644 PubMed  
  33. Retnakaran R, Shah BR. Glucose screening in pregnancy and future risk of cardiovascular disease in women: a retrospective, population-based cohort study. Lancet Diabet Endocrinol 2019; 7: 378-84. pmid:30928459 PubMed  
  34. Yang J, Qian F, Chavarro JE, et al. Modifiable risk factors and long term risk of type 2 diabetes among individuals with a history of gestational diabetes mellitus: prospective cohort study. BMJ 2022; 378: 070312. pmid:36130782 PubMed  
  35. Persson M, Shah PS, Rusconi F et al. Association of Maternal Diabetes With Neonatal Outcomes of Very Preterm and Very Low-Birth-Weight Infants: An International Cohort Study. JAMA Pediatr 2018; 172: 867-75. pmid:29971428 PubMed  
  36. Xie W, Wang Y, Xiao S, et al. Association of gestational diabetes mellitus with overall and type specific cardiovascular and cerebrovascular diseases: systematic review and meta-analysis. BMJ 2022; 378: e070244. pmid:36130740 PubMed  
  37. Wang Y-X, Mitsunami M, Manson JE, et al. Association of gestational diabetes with subsequent long-term risk of mortality. JAMA Intern Med 2023. pmid:37695588 PubMed  
  38. Eidem I, Vangen S, Hanssen KF, et al. Perinatal and infant mortality in term and preterm births among women with type 1 diabetes. Diabetologia 2011; 54: 2771-8. www.ncbi.nlm.nih.gov  
  39. Eletri L, Mitanchez D. How Do the Different Types of Maternal Diabetes during Pregnancy Influence Offspring Outcomes? Nutrients. 2022 Sep 19;14(18):3870. PMID: 36145247 PubMed  
  • Silje Folven Barlindhaug, spesialist allmennmedisin, redaktør NEL

Tidligere fagmedarbeidere

  • Kerstin Berntorp, docent och överläkare, Endokrinologiska kliniken, Skånes universitetssjukhus (Medibas)
  • Per Bergsjø, professor emeritus, dr. med., Universitetet i Bergen. Spesialist i kvinnesykdommer og fødselshjelp, forsker ved Nasjonalt folkehelseinstitutt, Oslo