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糖尿病控制好，一样可以顺利怀孕

发布日期：2024-08-27 19:13:41编辑：秩名


糖尿病患者有遗传风险，但门诊上经常会遇到糖尿病患者前来咨询如何才能降低遗传风险的问题。事实上，有研究显示，中国的糖尿病发病率现在已高达11.6%，其中不乏很多育龄人群。每对育龄的夫妻，都渴望有个健康的宝宝，但是对于糖尿病患者来讲，能否怀孕却是需要慎重考虑的问题。糖尿病对胎儿的影响有：羊水过多症导致胎死宫内、巨大儿、未成熟儿、畸形儿，新生儿的低血糖、低血钙等，还有流产、早产、新生儿死亡、畸形儿等。
 
但这并不代表糖尿病人不能生育一个健康的宝宝。研究表明，如果糖尿病患者有医生指导的话，他们生出有出生缺陷宝宝的概率就会大幅降低。 
 
糖尿病患者可以结婚生育。虽然糖尿病可能影响子代，但是很难肯定子代中哪些孩子会得病。如果父母双方都有糖尿病，其子女患糖尿病的危险性就会相对增大。避免两个糖尿病患者结婚，可减少子代患糖尿病的危险。
 
1型糖尿病父母都可遗传，遗传性父亲比母亲强。1型糖尿病患者血液中可以检测到胰岛细胞抗体、胰岛素自身抗体以及谷氨酸脱羧酶抗体；患者的兄弟姐妹中这些抗体的阳性率也比无1型糖尿病的兄弟姐妹高，而且这些抗体阳性的同胞更容易患1型糖尿病，抗体滴度越高，患1型糖尿病的可能性就越大。因此，我们也许可以利用这些抗体预测患1型糖尿病的风险。 
 
2型糖尿病是一种多基因遗传的疾病，而且往往与肥胖、血脂紊乱、高血压、冠心病、脑血管病伴随存在。母亲在2型糖尿病遗传中的作用超过父亲。2型糖尿病女性特别是肥胖者，可伴有多囊卵巢综合征，不易怀孕。
 
糖尿病女性在决定怀孕前3个月，应尽可能使血糖、血压、体重控制在正常范围内并检查并发症，了解自己的病情，知道如何保护自己和胎儿。正在用口服降糖药的女性应在医生的指导下改用胰岛素治疗。相对来说，如果准爸爸患有糖尿病，问题就简单许多，他们只需将血糖控制达标即可，尚未有研究表明男方口服降糖药会对胎儿有影响。
 
患有糖尿病的育龄女性决心要一个小孩，建议在怀孕前先使用避孕工具避孕3个月，严格控制代谢紊乱，使血糖保持正常或接近正常，然后再考虑妊娠，妊娠后2～10周尽可能控制血糖，有助于减少畸胎可能。但是如果是已合并糖尿病心血管病变及糖尿病肾病、增殖性视网膜病变或玻璃体出血时，奉劝患者应尽量避孕，怀孕者应终止妊娠，同时绝育。
 
糖尿病女性孕前应该做好充分准备，全面体检，重点检查血糖（24小时）、糖化血红蛋白、血脂、尿蛋白、尿常规(酮体、糖、感染)、血压、眼底、神经系统及心电图。孕前应掌握血糖监测，注意妊娠期的饮食调整和运动，对胰岛素注射、低血糖的识别和处理等糖尿病有关知识技能和妊娠相关知识。
 
女性糖尿病患者如血糖得到很好控制并且无严重的心、脑、肾、眼及其他严重并发症，可以怀孕。理想的血糖控制包括24小时血糖正常化，血糖无异常波动，糖化血红蛋白在4.0%～6.0%之间。糖尿病背景型视网膜病变妊娠时会加重，所以怀孕前应该进行眼底检查和适当治疗，多数糖尿病患者产后视网膜病变可以恢复到产前水平。糖尿病肾脏病变在怀孕前要进行适当治疗。怀孕前尿蛋白应小于1克／日，血浆蛋白、血压均应达到正常。
 
血糖控制不良不仅对孕妇有害，且可以导致胎儿畸形、死胎。妊娠可使增殖期视网膜病变加重，严重时可能导致视网膜脱离和失明。糖尿病肾脏病变严重，尿蛋白l克／日以上，肌酐清除率70毫升／分以下，或合并严重高血压的女性妊娠，容易出现胎儿宫内发育迟缓，胎儿宫内窘迫，孕妇容易合并子痫，因此有上述情况时不宜妊娠。
 

若可以怀孕的话，准妈妈应做到如下几点。

 
如果患者在服用磺酰脲类药物，必须停药：这种药有可能使婴儿产生先天缺陷，可换用胰岛素。另外若在服用其他药物，则应在医生指导下用药，对胎儿有损害的药物应停用或换用。
 
怀孕前要进行一次全面的检查：包括各项生化指标、血压、心电图、腹部B超及心脏彩超、眼科检查，评价患者有无高血压、心脏病、肾病、神经疾病和眼科疾病的迹象。如果有这些疾病的某种迹象，应在患者考虑怀孕之前进行治疗。 
 
良好的饮食习惯：根据医师指导根据患者的体重、怀孕期间体重的增加和血糖目标值制定一份饮食计划，尽量少食多餐、控制糖及脂肪类饮食，以保持血糖水平稳定。
 
运动：在备孕期间坚持体育活动是十分重要的。这不仅有助于更好地控制血糖水平，而且也有助于应付生产时的体力需求和生完小孩以后的身体恢复，运动后适当增加饮食量或减少胰岛素用量，以往有高血压病、妊娠高血压、心脑血管并发症、增殖性视网膜病变、糖尿病肾病、体位性低血压等则不能行运动治疗。
 
事实上，糖尿病女性患者想要一个健康的宝宝，做到这些还远远不够，她们的整个妊娠期都要提高警惕。婴儿的主要器官都是在孕期前8周形成的。此时许多患者甚至还不知道她们已经怀孕了。如果在此期间患者的血糖水平没有控制好，就会严重影响到胎儿。
 
妊娠后糖尿病患者则必须对医生表明病史，并在医生的指导下排查及用药，因为孕期的一个不小心，很可能使之前的努力都前功尽弃。
 

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