Diabete gestazionale
Il diabete gestazionale è un’ alterazione del metabolismo del glucosio che viene diagnosticato la prima volta durante la gravidanza, una forma di diabete che solitamente si risolve completamente con il parto.
Questo innalzamento della glicemia è dovuto a ormoni che vengono prodotti dalla placenta ed è importante individuare tutte le cause. Gli attuali programmi di screening prevedono una curva da carico di glucosio alla 24a-28a settimana di gestazione. Questa curva può essere anticipata alla 16a settimana nelle donne ad alto rischio.
DIAGNOSI
Si fa diagnosi di diabete gestazionale quando in almeno in un punto della curva si raggiunge o si superano i valori soglia della glicemia che sono di:
- 92 mg/dl sul basale
- 180 mg/dl dopo 1H
- 153 mg/dl dopo 2H
Se il diabete gestazionale non è ben controllato il feto potrebbe crescere eccessivamente e questo potrebbe portare un ricorso eccessivo al parto cesareo con complicazioni alla nascita potenzialmente gravi. Durante la gravidanza oltre all’autocontrollo domiciliare della glicemia che viene effettuato più volte al giorno è necessario effettuare esami di laboratorio e frequenti controlli ecografici per valutare la crescita fetale, soprattutto la crescita della circonferenza addominale. Solo in circa il 20% dei casi deve fare ricorso ad una terapia insulinica nel restante 80% è sufficiente mantenere un certo stile di vita.
FATTORI DI RISCHIO
- età indice massa corporea (IMC) pregravidico
- diabete gestazionale in una gravidanza precedente
- Obesità o sovrappeso
- donne con tolleranza alterata del glucosio prima della gravidanza
- aver avuto un neonato di peso superiore a 4.500 g (macrosomia fetale)
- presenza di diabete nei familiari (parenti di I grado)
- donne di determinate aree al alta prevalenza di diabete come ad esempio:
l’Asia meridionale in particolare l’India, il Pakistan e Bangladesh, i Caraibi( popolazioni africana) Medio Oriente in particolare l’Arabia Saudita, Emirati Arabi, Iraq, Giordania, Siria, Oman, Qatar, Kuwait, Libano e l’Egitto, sono tutte delle zone in cui c’è un’alta prevalenza di diabete gestazionale.
COMPLICANZE
- macrosomia: un’ eccessiva crescita fetale con aumento tipico del pannicolo adiposo del tronco e delle spalle, evento che predispone al momento del parto a una difficoltà alla fuoriuscita delle spalle.
- polidramnios: eccessiva quantità di liquido amniotico con conseguente sovradistensione dell’utero e maggior rischio di rottura prematura della membrana.
- maturazione polmonare ritardata o insufficiente rischio di morte endouterina del feto durante le ultime 8-4 settimane di gravidanza.
- rischio di sviluppare la gestosi gravidica, una malattia che si manifesta con la comparsa pressione alta, edema (gonfiore) e presenza di proteine nelle urine che se trascurata può avere gravi ripercussioni sulla madre e sul feto.
RISCHI PER IL NEONATO
- distocia della spalla
- ipoglicemia alla nascita
- obesità infantile
RISCHI PER LA MADRE
- aborto spontaneo e parto prematuro
- preeclampsia ed eclampsia (ipertensione e danno renale che impongono l’interruzione della gravidanza)
- taglio cesareo
COME SI CURA
I cardini della terapia del GDM sono la:
- terapia dietetica
- terapia insulinica
LA DIETA
Attraverso al dieta 3 donne su 4 riescono a controllare il GDM.
- La dieta serve a controllare l’innalzamento della glicemia dopo i pasti
- su indicazione del dietista vengono ridotti gli zuccheri a rapido assorbimento, controllati ma non aboliti gli amidi (pane e pasta)
- vengono aumentate le fibre (verdura) e, a volte, aumentato il frazionamento dei pasti nel corso della giornata.
PESO
Un altro fattore da tenere sotto controllo è il peso. E’ ideale nel corso della gravidanza che il peso non aumenti più di 7-10 kg.
ECOGRAFIA
Il ginecologo seguirà il decorso del diabete controllando che il bambino non diventi macrosomico, per questo motivo misurerà con particolare attenzione alcuni parametri del feto.
ATTIVITA’ FISICA
Un’attività fisica costante (passeggiare, nuotare) esercita un effetto favorevole sul controllo della glicemia, pertanto è altamente consigliata.
CONTROLLO DELLA GLICEMIA
Alle donne con diabete gestazionale viene insegnato l’autocontrollo della glicemia. che deve essere fatto più volte al giorno, in particolare prima dei tre pasti (colazione, pranzo e cena) e un’ora dopo i pasti. Il diabete è ben controllato quando parte dei valori riscontrati prima dei pasti è inferiore a 95 mg/ dl e la maggior parte dei valori riscontrati a un’ora dai pasti è inferiore a 140 mg/dl.
E’ opportuno annotare i valori della glicemia su un taccuino e valori del diabete e portarli alle visite di controllo.
TERAPIA INSULINICA
In una donna su quattro, tuttavia, dieta e attività fisica non sono sufficienti a mantenere sotto controllo la glicemia. In tal caso bisogna ricorrere alla terapia più logica e naturale:l’insulina
L’insulina somministrata dall’esterno si affianca a quella prodotta dal pancreas della madre. L’ assunzione di insulina va fatta con serenità in quanto non significa assolutamente che la donna sia destinata ad andare incontro a maggiori problemi e l’utilizzo non significa che il diabete sia peggiorato.
L’insulina iniettata e quello della madre non raggiungono il bambino (che produce la sua insulina)
Non si può fare utilizzo di ipoglicemizzanti orali in gravidanza a causa dei possibili effetti teratogeni.
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