V \u010cesk\u00e9 republice ro\u010dn\u011b porod\u00ed v\u00edce ne\u017e 200 diabeti\u010dek 1. typu. Z\u00e1rove\u0148 se neust\u00e1le zvy\u0161uje procento t\u011bch, je\u017e jsou l\u00e9\u010deny pro t\u011bhotensk\u00fd diabetes. A to nemluv\u00edme o \u017een\u00e1ch, kter\u00e9 maj\u00ed diabetes 2. typu. Cukrovka um\u00ed do \u017eivota t\u011bhotn\u00e9 i plodu zas\u00e1hnout radik\u00e1ln\u011b.<\/p>\n
Diabeti\u010dek 1. typu je v b\u011b\u017en\u00e9 populaci asi 0,4%. Pokud m\u00e1 diabetes 1. typu matka, stoup\u00e1 riziko pro d\u00edt\u011b cca na 2\u20133%, je-li nemocn\u00fd otec, ocit\u00e1 se d\u00edt\u011b a\u017e v 6% riziku. Jsou-li diabetiky oba rodi\u010de, stoup\u00e1 \u0161ance, \u017ee se i d\u00edt\u011b narod\u00ed stejn\u011b posti\u017een\u00e9, na 10\u201315%.<\/p>\n
Diabeti\u010dka 1. typu m\u00e1, co se t\u00fd\u010de pl\u00e1nov\u00e1n\u00ed rodiny, celkem jasno \u2013 v\u00ed, \u017ee vyrovnan\u00e1 glykemie rovn\u00e1 se v\u00fdznamn\u00e9 sn\u00ed\u017een\u00ed rizika posti\u017een\u00ed d\u00edt\u011bte, a proto je zapot\u0159eb\u00ed hl\u00eddat si hladinu krevn\u00edho cukru v ide\u00e1ln\u00edm p\u0159\u00edpad\u011b 2\u20133 m\u011bs\u00edce p\u0159ed pl\u00e1novanou graviditou.<\/p>\n
Diabetes m\u016f\u017ee b\u00fdt diagnostikov\u00e1n a\u017e b\u011bhem t\u011bhotenstv\u00ed, pak je nezbytn\u00e9 co nejd\u0159\u00edve dostat krevn\u00ed cukr do norm\u00e1lu. V\u011bt\u0161ina diabeti\u010dek nemus\u00ed m\u00edt z t\u011bhotenstv\u00ed obavy a m\u016f\u017ee se klidn\u011b p\u0159ipravovat na narozen\u00ed potomka. D\u016fle\u017eit\u00e9 je ov\u0161em na t\u011bhotenstv\u00ed se p\u0159ipravit, nejl\u00e9pe jej zkonzultovat se sv\u00fdm l\u00e9ka\u0159em.<\/p>\n
S jak\u00fdmi pot\u00ed\u017eemi by se diabeti\u010dka b\u011bhem gravidity mohla setkat?<\/p>\n
Po\u010d\u00e1tek t\u00e9m\u011b\u0159 ka\u017ed\u00e9ho t\u011bhotenstv\u00ed je prov\u00e1zen \u010dast\u00fdmi nevolnostmi a n\u011bkdy i zvracen\u00edm. T\u011blo se st\u00e1v\u00e1 citliv\u011bj\u0161\u00edm na inzulin. Z t\u011bchto d\u016fvod\u016f se \u010dast\u011bji mohou objevovat hypoglykemie. Jen v\u00fdjime\u010dn\u011b se u \u017een s diabetem 1. typu setk\u00e1v\u00e1me s tzv. autonomn\u00ed neuropati\u00ed, kter\u00e1 se v t\u011bhotenstv\u00ed projev\u00ed z\u00e1va\u017en\u00fdm a opakovan\u00fdm zvracen\u00edm.<\/p>\n
D\u011bti diabeti\u010dek m\u00edvaj\u00ed vy\u0161\u0161\u00ed porodn\u00ed v\u00e1hu. Proto b\u00fdv\u00e1 t\u011bhotenstv\u00ed ukon\u010deno c\u00edsa\u0159sk\u00fdm \u0159ezem \u010dast\u011bji ne\u017e za b\u011b\u017en\u00fdch okolnost\u00ed. Cukrovka zasahuje do v\u00fd\u0161e krevn\u00edho tlaku, mohou se p\u0159idru\u017eit pot\u00ed\u017ee s ledvinami atd. Diabetes m\u016f\u017ee komplikovat i hojen\u00ed porodn\u00edch trhlinek. T\u011bhotn\u00e1 diabeti\u010dka je ve zv\u00fd\u0161en\u00e9m riziku z\u00e1n\u011btu mo\u010dov\u00fdch cest \u010di po\u0161evn\u00edch infekc\u00ed.
\nPro plod pak m\u016f\u017ee cukrovka znamenat vy\u0161\u0161\u00ed riziko vrozen\u00fdch v\u00fdvojov\u00fdch vad, je\u017e postihuj\u00ed srdce, kostn\u00ed apar\u00e1t, nervov\u00fd syst\u00e9m i vnit\u0159n\u00ed org\u00e1ny plodu. Nedostate\u010dn\u011b kontrolovan\u00fd diabetes matky m\u016f\u017ee souviset s poporodn\u00edmi komplikacemi u d\u00edt\u011bte (nap\u0159\u00edklad n\u00edzk\u00fdm krevn\u00ed cukrem nebo n\u00edzk\u00fdmi hodnotami v\u00e1pn\u00edku a ho\u0159\u010d\u00edku v krvi). Novorozenci diabeti\u010dek m\u00edvaj\u00ed del\u0161\u00ed novorozeneckou \u017eloutenku. Proto mus\u00ed b\u00fdt t\u011bhotenstv\u00ed diabeti\u010dek sledov\u00e1no \u010dast\u011bji a d\u016fkladn\u011bji, p\u0159edev\u0161\u00edm ultrazvukem a dal\u0161\u00edmi metodami.<\/p>\n
Jak co nejv\u00edce p\u0159edej\u00edt mo\u017en\u00fdm komplikac\u00edm?<\/p>\n
Pokud se c\u00edt\u00edte na po\u010det\u00ed d\u00edt\u011bte a v\u00e1\u0161 zdravotn\u00ed stav ani l\u00e9ka\u0159 tomu nebr\u00e1n\u00ed, m\u011bla byste ze v\u0161eho nejd\u0159\u00edve srovnat svou hladinu krevn\u00edho cukru. Proto je dobr\u00e9 pl\u00e1novat t\u011bhotenstv\u00ed s v\u011bt\u0161\u00edm \u010dasov\u00fdm p\u0159edstihem a kontrolovat onemocn\u011bn\u00ed s v\u011bt\u0161\u00ed intenzitou. L\u00e9ka\u0159i doporu\u010duj\u00ed \u010dast\u011bj\u0161\u00ed monitoring glykemie, nejl\u00e9pe p\u0159ed ka\u017ed\u00fdm j\u00eddlem (hladina glykemie by se m\u011bla pohybovat nala\u010dno do 5 mmol\/l a glykemie po j\u00eddle do 7,5 mmol\/l; hladina „dlouh\u00e9ho cukru“ \u2013 glykovan\u00e9ho hemoglobinu \u2013 by m\u011bla b\u00fdt v rozmez\u00ed 40\u201350 mmol\/mol). Neda\u0159\u00ed-li se kompenzace diabetu dos\u00e1hnout b\u011b\u017enou inzulinovou l\u00e9\u010dbou a spr\u00e1vnou \u017eivotospr\u00e1vou, doporu\u010duje se p\u0159echod na inzulinovou pumpu, d\u00edky n\u00ed\u017e m\u016f\u017eete dos\u00e1hnout stabilizace.<\/p>\n
Samoz\u0159ejmost\u00ed je vy\u0161et\u0159en\u00ed o\u010dn\u00edho pozad\u00ed, funkce ledvin, \u0161t\u00edtn\u00e9 \u017el\u00e1zy ad.<\/p>\n
P\u0159esto\u017ee se t\u011bhotenstv\u00ed vyv\u00edj\u00ed podle pl\u00e1nu, m\u016f\u017ee se st\u00e1t, \u017ee v\u00e1s p\u0159ijmou do porodnice p\u00e1r dn\u00ed p\u0159ed term\u00ednem porodu. A to i za situace, kdy je v\u0161e v po\u0159\u00e1dku. T\u011bhotenstv\u00ed by nem\u011blo trvat d\u00e9le ne\u017e 39 t\u00fddn\u016f. Jestli\u017ee se porod nerozb\u00edh\u00e1 spont\u00e1nn\u011b, l\u00e9ka\u0159i jej vyvolaj\u00ed pomoc\u00ed l\u00e9k\u016f.<\/p>\n
B\u011bhem porodu nesm\u00edte j\u00edst, ale budete dost\u00e1vat infuzi gluk\u00f3zy a inzulin, aby se udr\u017eela hladina glykemie.<\/p>\n
Po porodu se v\u0161e vrac\u00ed k norm\u00e1lu. Spot\u0159eba inzulinu kles\u00e1 na p\u016fvodn\u00ed d\u00e1vku.<\/p>\n
Jako t\u011bhotn\u00e1 diabeti\u010dka byste m\u011bla doch\u00e1zet do specializovan\u00e9 t\u011bhotensk\u00e9 poradny. V Praze jsou tyto poradny na Gynekologicko-porodnick\u00e9 klinice 1. LF UK a VFN, ve FN Motol a v \u00daPMD v Podol\u00ed, ale najdete je i v dal\u0161\u00edch m\u011bstech. Kompletn\u00ed seznam diabetologick\u00fdch t\u011bhotensk\u00fdch poraden je uveden nap\u0159\u00edklad na internetov\u00fdch str\u00e1nk\u00e1ch: www.tehotenskacukrovka.cz\/ seznam-dia-poraden-pro-tehotne Obrovsk\u00fd d\u00edl pr\u00e1ce \u010dek\u00e1 p\u0159edev\u0161\u00edm v\u00e1s, proto byste se na sv\u00e9 t\u011bhotenstv\u00ed m\u011bla \u2013 zejm\u00e9na po metabolick\u00e9 str\u00e1nce \u2013 p\u0159ipravit co nejl\u00e9pe. St\u00e1le plat\u00ed jedna \u00fam\u011bra: \u010d\u00edm d\u0159\u00edve se pro t\u011bhotenstv\u00ed rozhodnete, t\u00edm l\u00e9pe \u2013 jak pro v\u00e1s, tak pro va\u0161e miminko!<\/p>\n
Kdy t\u011bhotenstv\u00ed nen\u00ed doporu\u010deno?<\/p>\n
Existuje n\u011bkolik d\u016fvod\u016f, kv\u016fli kter\u00fdm by diabeti\u010dka nem\u011bla riskovat \u2013 jak \u017eivot sv\u016fj, tak i d\u00edt\u011bte. Pat\u0159\u00ed mezi n\u011b nap\u0159\u00edklad z\u00e1va\u017en\u00e9 posti\u017een\u00ed funkc\u00ed ledvin, arteri\u00e1ln\u00ed hypertenze l\u00e9\u010den\u00e1 v\u00edce ne\u017e 3 druhy l\u00e9k\u016f, ji\u017e vznikl\u00e9 posti\u017een\u00ed s\u00edtnice nebo posti\u017een\u00ed velk\u00fdch c\u00e9v, nap\u0159\u00edklad stav po infarktu myokardu.<\/p>\n
Co se t\u00fd\u010de „dlouh\u00e9ho cukru“, nen\u00ed t\u011bhotenstv\u00ed doporu\u010deno p\u0159i hodnot\u00e1ch HbA1C nad 75\u201380 mmol\/mol. P\u0159i takov\u00e9to hladin\u011b je vy\u0161\u0161\u00ed riziko vzniku v\u00fdvojov\u00e9 vady u d\u00edt\u011bte. Pokud se rozhodnete pro pokra\u010dov\u00e1n\u00ed gravidity, je k odhalen\u00ed mo\u017en\u00e9 v\u00fdvojov\u00e9 vady prov\u00e1d\u011bno speci\u00e1ln\u00ed krevn\u00ed a ultrazvukov\u00e9 vy\u0161et\u0159en\u00ed.<\/p>\n","protected":false},"excerpt":{"rendered":"
V \u010cesk\u00e9 republice ro\u010dn\u011b porod\u00ed v\u00edce ne\u017e 200 diabeti\u010dek 1. typu. Z\u00e1rove\u0148 se neust\u00e1le zvy\u0161uje procento t\u011bch, je\u017e jsou l\u00e9\u010deny pro t\u011bhotensk\u00fd diabetes. A to […]<\/a><\/p>\n<\/div>","protected":false},"author":1,"featured_media":14132,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11],"tags":[],"class_list":["post-15495","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-zdravi"],"_links":{"self":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15495","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=15495"}],"version-history":[{"count":0,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/posts\/15495\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=\/wp\/v2\/media\/14132"}],"wp:attachment":[{"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=15495"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=15495"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.invarena.cz\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=15495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}