Obstetrische aspecten van
preexisterende Diabetes Mellitus
Preexisterende diabetes
Definitie
Type I diabetes Geen productie van insuline
Auto-immuun ziekte
Destructie van bètacellen in de pancreas
Ontstaan op jongere leeftijd (<35ste levensjaar)
Behandeling: Insuline
Type II diabetes Onvoldoende productie van insuline
Ontstaan op oudere leeftijd (35ste – 40ste levensjaar)
Risicofactor: Overgewicht
Behandeling: Orale medicatie ( Insulinegevoeligheid verhogen) en/of insuline
Diabetes Mellitus
= Ziekte die het hele lichaam aantast
Ziekte in kleine zichtbare bloedvaten Alle bloedvaten in het lichaam zijn aangetast
Hoe ernstiger vasculaire aantasting hoe groter het risico op verwikkelingen
Ernst van maternale ziekte afhankelijk van:
Glycemieregeling
Duur van de diabetes
Acute glycemieschommelingen ( Ketoacidose en hypoglycemisch coma)
, Maternale morbiditeit
Diabetes Retinopathie
= Aantasting van de bloedvaten van het netvlies veroorzaakt door diabetes ( Leidend tot
blindheid)
Zwangerschap – Diabetes Retinopathie ( Voor zwangerschap – einde zwangerschap)
Geen retinopathie Wel retinopathie (tot 33%)
Background retinopathie Proliferatieve retinopathie (10% - 65%)
Proliferatieve retinopathie Toename proliferaties (14% - 100%)
Behandeling
ACE inhibitoren (ook bij normale bloeddruk)
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