Diabetes gestasional: Perbedaan antara revisi
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== Definisi ==
Diabetes gestasional adalah intoleransi glukosa yang didiagnosis pertama kali dalam masa kehamilan setelah usia 24 minggu dan berakhir setelah proses persalinan.
Diabetes yang telah terdiagnosis sebelum masa kehamilan tidak termasuk ke dalam kriteria diabetes gestasional. Seorang wanita yang telah menderita diabetes sebelum hamil termasuk ke dalam kelompok diabetes dalam kehamilan atau ''diabetes in pregnancy'' (DIP).
Kriteria diabetes gestasional sebagai peningkatan kadar gula darah selama masa kehamilan memiliki keterbatasan karena sebagian besar kondisi ini sebenarnya telah terjadi sebelum masa kehamilan, tetapi tidak ada skrining yang dilakukan pada wanita usia reproduktif yang tidak sedang hamil. Untuk ibu hamil yang dicurigai telah menderita diabetes yang tidak terdiagnosis, dilakukan pemeriksaan lagi setelah proses persalinan.▼
▲Kriteria diabetes gestasional sebagai peningkatan kadar gula darah selama masa kehamilan memiliki keterbatasan karena sebagian besar kondisi ini sebenarnya telah terjadi sebelum masa kehamilan, tetapi tidak ada skrining yang dilakukan pada wanita usia reproduktif yang tidak sedang hamil. Untuk ibu hamil yang dicurigai telah menderita diabetes yang tidak terdiagnosis, dilakukan pemeriksaan lagi setelah proses persalinan.<ref name=":2">{{Cite journal|date=Maret 2010|title=International Association of Diabetes and Pregnancy Study Groups Recommendations on the Diagnosis and Classification of Hyperglycemia in Pregnancy|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827530/|journal=Diabetes Care|volume=33|issue=3|pages=676–682|doi=10.2337/dc09-1848|issn=0149-5992|pmc=2827530|pmid=20190296}}</ref>
Oleh karena itu pada tahun 2015, [[Federasi Obstetri dan Ginekologi Internasional]] atau International Federation of Gynaecology and Obstetrics (FIGO), membuat kriteria kadar gula darah untuk membedakan diagnosis antara diabetes gestasional dengan diabetes dalam kehamilan. Hal ini menyebabkan penggunaan kriteria gula darah diabetes melitus tipe 1 atau tipe 2 yang dahulu dipakai untuk mendiagnosis diabetes gestasional, tidak lagi digunakan.
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== Faktor risiko ==
Faktor risiko yang meningkatkan kemungkinan seorang wanita hamil menderita diabetes gestasional adalah:
Etnis. Etnis tertentu yang memiliki kemungkinan lebih besar untuk menderita diabetes gestasional adalah [[Asia]],<ref>{{Cite journal|last=Lee|first=Kai Wei|last2=Ching|first2=Siew Mooi|last3=Ramachandran|first3=Vasudevan|last4=Yee|first4=Anne|last5=Hoo|first5=Fan Kee|last6=Chia|first6=Yook Chin|last7=Wan Sulaiman|first7=Wan Aliaa|last8=Suppiah|first8=Subapriya|last9=Mohamed|first9=Mohd Hazmi|date=14 Desember 2018|title=Prevalence and risk factors of gestational diabetes mellitus in Asia: a systematic review and meta-analysis|url=https://doi.org/10.1186/s12884-018-2131-4|journal=BMC Pregnancy and Childbirth|volume=18|issue=1|pages=494|doi=10.1186/s12884-018-2131-4|issn=1471-2393|pmc=PMC6295048|pmid=30547769}}</ref><ref>{{Cite journal|last=Kunasegaran|first=Thubasni|last2=Balasubramaniam|first2=Vinod R. M. T.|last3=Arasoo|first3=Valliammai Jayanthi Thirunavuk|last4=Palanisamy|first4=Uma Devi|last5=Ramadas|first5=Amutha|date=Februari 2021|title=Gestational Diabetes Mellitus in Southeast Asia: A Scoping Review|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908368/|journal=International Journal of Environmental Research and Public Health|volume=18|issue=3|pages=1272|doi=10.3390/ijerph18031272|issn=1661-7827|pmc=7908368|pmid=33572656}}</ref> [[subbenua India]] ([[India]], [[Pakistan]], [[Bangladesh]], [[Nepal]], [[Sri Lanka]], [[Bhutan]], dan [[Maladewa]]),<ref>{{Cite journal|last=Jenum|first=Anne K.|last2=Mørkrid|first2=Kjersti|last3=Sletner|first3=Line|last4=Vange|first4=Siri|last5=Torper|first5=Johan L.|last6=Nakstad|first6=Britt|last7=Voldner|first7=Nanna|last8=Rognerud-Jensen|first8=Odd H.|last9=Berntsen|first9=Sveinung|date=1 Februari 2012|title=Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study|url=https://eje.bioscientifica.com/view/journals/eje/166/2/317.xml|journal=European Journal of Endocrinology|language=|volume=166|issue=2|pages=317–324|doi=10.1530/EJE-11-0866|issn=0804-4643}}</ref><ref>{{Cite journal|last=Mukerji|first=G.|last2=Chiu|first2=M.|last3=Shah|first3=B. R.|date=2012-08-01|title=Impact of gestational diabetes on the risk of diabetes following pregnancy among Chinese and South Asian women|url=https://doi.org/10.1007/s00125-012-2549-6|journal=Diabetologia|language=en|volume=55|issue=8|pages=2148–2153|doi=10.1007/s00125-012-2549-6|issn=1432-0428}}</ref> [[Orang Kepulauan Selat Torres|penduduk asli Kepulauan Selat Torres]],<ref>{{Cite journal|last=Wood|first=Anna|last2=MacKay|first2=Diana|last3=Fitzsimmons|first3=Dana|last4=Derkenne|first4=Ruth|last5=Kirkham|first5=Renae|last6=Boyle|first6=Jacqueline A.|last7=Connors|first7=Christine|last8=Whitbread|first8=Cherie|last9=Welsh|first9=Alison|date=2020-2|title=Primary Health Care for Aboriginal Australian Women in Remote Communities after a Pregnancy with Hyperglycaemia|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7037226/|journal=International Journal of Environmental Research and Public Health|volume=17|issue=3|pages=720|doi=10.3390/ijerph17030720|issn=1661-7827|pmc=7037226|pmid=31979123}}</ref><ref>{{Cite journal|last=Hare|first=Matthew J. L.|last2=Barzi|first2=Federica|last3=Boyle|first3=Jacqueline A.|last4=Guthridge|first4=Steven|last5=Dyck|first5=Roland F.|last6=Barr|first6=Elizabeth L. M.|last7=Singh|first7=Gurmeet|last8=Falhammar|first8=Henrik|last9=Webster|first9=Vanya|date=2020-08-01|title=Diabetes during pregnancy and birthweight trends among Aboriginal and non-Aboriginal people in the Northern Territory of Australia over 30 years|url=https://www.thelancet.com/journals/lanwpc/article/PIIS2666-6065(20)30005-5/abstract|journal=The Lancet Regional Health – Western Pacific|language=English|volume=1|doi=10.1016/j.lanwpc.2020.100005|issn=2666-6065}}</ref> [[penduduk Pasifik]],<ref>{{Cite journal|last=Sugiyama|first=Mindy|last2=Cash|first2=Haley|last3=Roseveare|first3=Christine|last4=Reklai|first4=Rumi|last5=Basilius|first5=Kliu|last6=Madraisau|first6=Sherilynn|date=2017-10-01|title=Assessment of Gestational Diabetes and Associated Risk Factors and Outcomes in the Pacific Island Nation of Palau|url=https://www.researchgate.net/publication/318716567_Assessment_of_Gestational_Diabetes_and_Associated_Risk_Factors_and_Outcomes_in_the_Pacific_Island_Nation_of_Palau|journal=Maternal and Child Health Journal|volume=21|doi=10.1007/s10995-017-2313-0}}</ref><ref>{{Cite journal|last=Williams|first=Andrew D|last2=Grantz|first2=Katherine L|last3=Zhang|first3=Cuilin|last4=Nobles|first4=Carrie|last5=Sherman|first5=Seth|last6=Mendola|first6=Pauline|date=2019-02-01|title=Ambient Volatile Organic Compounds and Racial/Ethnic Disparities in Gestational Diabetes Mellitus: Are Asian/Pacific Islander Women at Greater Risk?|url=https://doi.org/10.1093/aje/kwy256|journal=American Journal of Epidemiology|volume=188|issue=2|pages=389–397|doi=10.1093/aje/kwy256|issn=0002-9262}}</ref> [[Suku Māori]],<ref>{{Cite web|title=Gestational-diabetes-in-New-Zealand-ethnic-groups|url=https://www.oatext.com/Gestational-diabetes-in-New-Zealand-ethnic-groups.php|website=www.oatext.com|language=en|access-date=2022-02-11}}</ref><ref>{{Cite journal|last=Reid|first=Jennifer|last2=Anderson|first2=Anneka|last3=Cormack|first3=Donna|last4=Reid|first4=Papaarangi|last5=Harwood|first5=Matire|date=2018-12-05|title=The experience of gestational diabetes for indigenous Māori women living in rural New Zealand: qualitative research informing the development of decolonising interventions|url=https://doi.org/10.1186/s12884-018-2103-8|journal=BMC Pregnancy and Childbirth|volume=18|issue=1|pages=478|doi=10.1186/s12884-018-2103-8|issn=1471-2393}}</ref> [[Timur Tengah]],<ref>{{Cite journal|last=Al-Rifai|first=Rami H.|last2=Abdo|first2=Noor Motea|last3=Paulo|first3=Marília Silva|last4=Saha|first4=Sumanta|last5=Ahmed|first5=Luai A.|date=2021|title=Prevalence of Gestational Diabetes Mellitus in the Middle East and North Africa, 2000–2019: A Systematic Review, Meta-Analysis, and Meta-Regression|url=https://www.frontiersin.org/article/10.3389/fendo.2021.668447|journal=Frontiers in Endocrinology|volume=12|doi=10.3389/fendo.2021.668447/full#h6|issn=1664-2392}}</ref> [[Hispanik dan Latino Amerika|hispanik]],<ref>{{Cite web|last=Huston|first=Kim|date=2019-09-24|title=Latina women are at greater risk for gestational diabetes {{!}} Norton Children's Louisville, Ky.|url=https://nortonchildrens.com/news/latina-gestational-diabetes/|website=Norton Children's|language=en|access-date=2022-02-11}}</ref><ref>{{Cite journal|last=Fujimoto|first=Wilfred|last2=Samoa|first2=Raynald|last3=Wotring|first3=Amy|date=2013-03-22|title=Gestational diabetes in high-risk populations|url=https://go.gale.com/ps/i.do?p=AONE&sw=w&issn=08918929&v=2.1&it=r&id=GALE%7CA331004127&sid=googleScholar&linkaccess=abs|journal=Clinical Diabetes|language=English|volume=31|issue=2|pages=90–95}}</ref> dan [[orang kulit berwarna]] dari [[Afrika]].<ref>{{Cite web|title=Incidence of gestational diabetes in Australia, Risk factors|url=https://www.aihw.gov.au/reports/diabetes/incidence-of-gestational-diabetes-in-australia/contents/risk-factors|website=Australian Institute of Health and Welfare|language=en-AU|access-date=2022-02-11}}</ref><ref>{{Cite web|last=CDC|date=2022-02-03|title=Diabetes Risk Factors|url=https://www.cdc.gov/diabetes/basics/risk-factors.html|website=Centers for Disease Control and Prevention|language=en-us|access-date=2022-02-11}}</ref>
== Patofisiologi ==
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== Diagnosis ==
Pendekatan diagnosis diabetes gestasional yang banyak dilakukan dan dinilai efektif adalah melalui skrining faktor risiko. Selain itu ada juga yang menggunakan sistem skoring berdasarkan usia kehamilan, [[indeks massa tubuh]], riwayat keluarga dengan diabetes melitus, riwayat diabetes gestasional pada kehamilan sebelumnya, [[glikosuria]], dan usia wanita hamil seperti yang dilakukan di Kanada,<ref>{{Cite journal|last=Naylor|first=C. David|last2=Sermer|first2=Mathew|last3=Chen|first3=Erluo|last4=Farine|first4=Dan|date=
Pada tahun 2010, International Association of Diabetes and Pregnancy Study Groups (IADPSG) merekomendasikan skrining pada semua wanita hamil dengan metode satu langkah menggunakan [[tes toleransi glukosa oral]] 75 gram atau 75 gram ''oral glucose tolerance test'' (OGTT 75-g). Dengan rekomendasi yang didukung oleh [[Organisasi Kesehatan Dunia|WHO]], [[Federasi Diabetes Internasional]] atau International Diabetes Federation (IDF), dan [[Asosiasi Diabetes Amerika]] atau American Diabetes Association (ADA) ini,<ref>{{Cite journal|last=Colagiuri|first=Stephen|last2=Falavigna|first2=Maicon|last3=Agarwal|first3=Mukesh|last4=Boulvain|first4=Michel|last5=Coetzee|first5=Edward|last6=Hod|first6=Moshe|last7=Meltzer|first7=Sara|last8=Metzger|first8=Boyd|last9=Omori|first9=Yasue|date=1 Maret 2014
FIGO membagi skrining diabetes gestasional berdasarkan ketersediaan pemeriksaan ke dalam tiga kriteria yaitu:<ref name=":1" />
{| class="wikitable"
|+
! rowspan="2" |Ketersediaan sarana
! colspan="2" |Strategi
|-
|Waktu pemeriksaan
|Alat diagnostik
|-
| rowspan="2" |Sarana pemeriksaan lengkap
|Trimester pertama
|Gula darah puasa, gula darah sewaktu, atau pemeriksaan [[Hemoglobin terglikasi|HbA1c]]
|-
|Kehamilan usia 24-28 minggu
|Jika skrining pertama negatif, lakukan tes toleransi glukosa oral 75 gram 2 jam setelah makan
|-
|Sarana pemeriksaan lengkap dan terdapat [[Kelompok etnik|etnis]] dengan risiko tinggi<sup>a</sup>
|Trimester pertama
|Tes toleransi glukosa oral 75 gram 2 jam setelah makan
|-
|
|Kehamilan usia 24-28 minggu
|Jika skrining pertama negatif, lakukan tes toleransi glukosa oral 75 gram 2 jam setelah makan
|-
|Sarana standar
|Kehamilan usia 24-28 minggu
|Tes toleransi glukosa oral 75 gram 2 jam setelah makan
|}
<sup>a: Wanita Asia memiliki risiko tinggi mengalami hiperglikemia dengan insiden tertinggi pada kelompok wanita usia muda.<ref>{{Cite journal|last=Qiao|first=Qing|last2=Hu|first2=Gang|last3=Tuomilehto|first3=Jaako|last4=Nakagami|first4=Tomoko|last5=Balkau|first5=Beverley|last6=Borch-Johnsen|first6=Knut|last7=Ramachandran|first7=Ambady|last8=Mohan|first8=Viswanathan|last9=Iyer|first9=S|date=1 Juli 2003|title=Age- and sex-specific prevalence of diabetes and impaired glucose regulation in 11 Asian Cohorts|url=https://www.researchgate.net/publication/10744080_Age-_and_sex-specific_prevalence_of_diabetes_and_impaired_glucose_regulation_in_11_Asian_Cohorts|journal=Diabetes care|volume=26|pages=1770–80}}</ref> Pada populasi Asia, gula darah puasa dan HbA1C sensitifitasnya lebih rendah dibandingkan pemeriksaan tes toleransi glukosa oral 2 jam setelah makan.<ref>{{Cite journal|last=Ramachandran|first=Ambady|last2=Snehalatha|first2=Chamukuttan|last3=Shetty|first3=Ananth Samith|last4=Nanditha|first4=Arun|date=15 juni 2012|title=Trends in prevalence of diabetes in Asian countries|url=https://www.wjgnet.com/1948-9358/full/v3/i6/110.htm|journal=World Journal of Diabetes|language=|volume=3|issue=6|pages=110–117|doi=10.4239/wjd.v3.i6.110}}</ref> Dalam satu penelitian di Cina, partisipan tanpa diabetes terbukti memiliki peningkatan kadar gula darah dengan tes toleransi glukosa oral 2 jam setelah makan.<ref>{{Cite journal|last=Yang|first=Wenying|last2=Lu|first2=Juming|last3=Weng|first3=Jianping|last4=Jia|first4=Weiping|last5=Ji|first5=Linong|last6=Xiao|first6=Jianzhong|last7=Shan|first7=Zhongyan|last8=Liu|first8=Jie|last9=Tian|first9=Haoming|date=25 Maret 2010|title=Prevalence of Diabetes among Men and Women in China|url=https://doi.org/10.1056/NEJMoa0908292|journal=New England Journal of Medicine|volume=362|issue=12|pages=1090–1101|doi=10.1056/NEJMoa0908292|issn=0028-4793|pmid=20335585}}</ref></sup>
Recommendations for early testing for GDM for women with high
risk(s).
Women, not known to have pre-existing glucose abnormalities, but at high risk of
GDM (vide infra) should have a 75 g OGTT at the first opportunity after conception,
with venous plasma samples taken fasting, one hour and two hours. Women at high
risk but with a normal OGTT at booking should have a repeat OGTT at the usual time
of 24-28 weeks gestation.3 However an OGTT should be performed at any earlier
time during pregnancy if clinically indicated.
High risk factors for GDM
Previous GDM
Previously elevated blood glucose level
Ethnicity: Asian, Indian, Aboriginal, Pacific Islander, Maori, Middle Eastern, non-
white African
Maternal age ≥40 years
Family history DM (1st degree relative with diabetes or a sister with GDM)
Obesity, especially if BMI > 35 kg/m2
Previous macrosomia (baby with birth weight > 4500 g or > 90th centile)
Polycystic ovarian syndrome
Medications: corticosteroids, antipsychotics
=== Kriteria diagnosis ===
{| class="wikitable"
|+Perbedaan kriteria diagnosis diabetes dalam kehamilan dengan diabetes gestasional<ref name=":1" />
!
!Diabetes dalam kehamilan
!Diabetes gestasional
|-
|[[Gula darah|Gula darah puasa]]
|≥ 7 [[Mol|mmol]]/[[liter]] (126 [[Gram|mg]]/dl)
|5,1-6,9 mmol/liter (95-125 gr/dl)
|-
|1 jam setelah pemberian 75 [[gram]] [[glukosa]]
|
|≥ 10 mmol/liter (180 mg/dl)
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|8,5-11 mmol/liter (153-199 mg/dl)
|-
|[[Gula darah|Gula darah sewaktu]]
|≥ 11,1 mmol/liter (200 mg/dl) disertai gejala diabetes
|
| |||