Diabetes gestasional: Perbedaan antara revisi
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=== Riwayat maternal ===
Usia wanita hamil di atas 40 tahun▼
▲==== Usia wanita hamil di atas 40 tahun ====
Indeks massa tubuh ≥ 30 kg/m<sup>2</sup>. gg▼
Risiko untuk terjadinya diabetes gestasional berbanding lurus dengan pertambahan usia wanita hamil. Mekanisme terjadinya hal ini belum diketahui dengan pasti, tetapi berhubungan dengan resistensi insulin tingkat tinggi, tingginya petanda inflamasi dan adipositokin dalam sirkulasi darah ibu, serta adanya peningkatan stres oksidatif.<ref name=":3">{{Cite journal|last=Li|first=Yueyi|last2=Ren|first2=Xinghua|last3=He|first3=Lilan|last4=Li|first4=Jing|last5=Zhang|first5=Shiyi|last6=Chen|first6=Weiju|date=2020-04-01|title=Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants|url=https://www.sciencedirect.com/science/article/pii/S0168822719305029|journal=Diabetes Research and Clinical Practice|language=en|volume=162|pages=108044|doi=10.1016/j.diabres.2020.108044|issn=0168-8227}}</ref><ref>{{Cite journal|last=Laine|first=Merja K.|last2=Kautiainen|first2=Hannu|last3=Gissler|first3=Mika|last4=Raina|first4=Marko|last5=Aahos|first5=Ilkka|last6=Järvinen|first6=Kajsa|last7=Pennanen|first7=Pirjo|last8=Eriksson|first8=Johan G.|date=2018|title=Gestational diabetes in primiparous women–impact of age and adiposity: a register-based cohort study|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/aogs.13271|journal=Acta Obstetricia et Gynecologica Scandinavica|language=en|volume=97|issue=2|pages=187–194|doi=10.1111/aogs.13271|issn=1600-0412}}</ref> Jika dibandingkan dengan wanita hamil usia 20-24 tahun, risiko menderita diabetes gestasional akan mengalami peningkatan sebesar 3,2 kali untuk wanita berusia ≥ 35 tahun, untuk wanita berusia ≥ 40 tahun sebesar 4,2 kali, dan untuk wanita berusia ≥ 45 tahun sebesar 4,4 kali.<ref name=":3" />
Riwayat peningkatan kadar gula darah<ref>{{Cite journal|last=Berger|first=Howard|last2=Gagnon|first2=Robert|last3=Sermer|first3=Mathew|last4=Basso|first4=Melanie|last5=Bos|first5=Hayley|last6=Brown|first6=Richard|last7=Bujold|first7=Emmanuel|last8=Cooper|first8=Stephanie|last9=Gouin|first9=Katy|date=1 Mei 2016|title=Diabetes in Pregnancy|url=https://www.researchgate.net/publication/303041059_Diabetes_in_Pregnancy|journal=Journal of Obstetrics and Gynaecology Canada|volume=38|doi=10.1016/j.jogc.2016.04.002}}</ref> atau riwayat diabetes gestasional sebelumnya.<ref>{{Cite journal|last=Zhu|first=Yeyi|last2=Zhang|first2=Cuilin|date=Januari 2016|title=Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675405/|journal=Current diabetes reports|volume=16|issue=1|pages=7|doi=10.1007/s11892-015-0699-x|issn=1534-4827|pmc=6675405|pmid=26742932}}</ref>▼
Dari penelitian yang dilakukan oleh Susan Chu di tahun 2007, didapatkan bahwa terdapat peningkatan risiko diabetes gestasional sebesar 2,14 kali untuk wanita gemuk (IMT 25-29,9 kg/m<sup>2</sup>), sebesar 3,56 untuk wanita dengan obesitas (IMT ≥ 30kg/m<sup>2</sup>), dan sebesar 8,56 untuk wanita sangat obesitas (IMT ≥ 40 kg/m<sup>2</sup>).<ref>{{Cite journal|last=Chu|first=Susan Y.|last2=Callaghan|first2=William M.|last3=Kim|first3=Shin Y.|last4=Schmid|first4=Christopher H.|last5=Lau|first5=Joseph|last6=England|first6=Lucinda J.|last7=Dietz|first7=Patricia M.|date=2007-08-01|title=Maternal Obesity and Risk of Gestational Diabetes Mellitus|url=https://doi.org/10.2337/dc06-2559a|journal=Diabetes Care|volume=30|issue=8|pages=2070–2076|doi=10.2337/dc06-2559a|issn=0149-5992}}</ref>
▲==== Riwayat peningkatan kadar gula darah<ref>{{Cite journal|last=Berger|first=Howard|last2=Gagnon|first2=Robert|last3=Sermer|first3=Mathew|last4=Basso|first4=Melanie|last5=Bos|first5=Hayley|last6=Brown|first6=Richard|last7=Bujold|first7=Emmanuel|last8=Cooper|first8=Stephanie|last9=Gouin|first9=Katy|date=1 Mei 2016|title=Diabetes in Pregnancy|url=https://www.researchgate.net/publication/303041059_Diabetes_in_Pregnancy|journal=Journal of Obstetrics and Gynaecology Canada|volume=38|doi=10.1016/j.jogc.2016.04.002}}</ref> atau riwayat diabetes gestasional sebelumnya.<ref>{{Cite journal|last=Zhu|first=Yeyi|last2=Zhang|first2=Cuilin|date=Januari 2016|title=Prevalence of Gestational Diabetes and Risk of Progression to Type 2 Diabetes: a Global Perspective|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6675405/|journal=Current diabetes reports|volume=16|issue=1|pages=7|doi=10.1007/s11892-015-0699-x|issn=1534-4827|pmc=6675405|pmid=26742932}}</ref> ====
Riwayat keluarga dengan diabetes melitus.<ref>{{Cite journal|last=Nankervis|first=Alison|last2=Price|first2=Sarah|last3=Conn|first3=Jennifer|date=Juli 2018|title=Gestational diabetes mellitus: A pragmatic approach to diagnosis and management|url=https://www1.racgp.org.au/ajgp/2018/july/gestational-diabetes-mellitus|journal=Australian Journal of General Practitioner|volume=47|issue=7|doi=10.31128/AJGP-01-18-4479|issn=2208-7958}}</ref>▼
▲==== Riwayat keluarga dengan diabetes melitus.<ref>{{Cite journal|last=Nankervis|first=Alison|last2=Price|first2=Sarah|last3=Conn|first3=Jennifer|date=Juli 2018|title=Gestational diabetes mellitus: A pragmatic approach to diagnosis and management|url=https://www1.racgp.org.au/ajgp/2018/july/gestational-diabetes-mellitus|journal=Australian Journal of General Practitioner|volume=47|issue=7|doi=10.31128/AJGP-01-18-4479|issn=2208-7958}}</ref> ====
Riwayat persalinan dengan [[bayi besar untuk masa kehamilan]].▼
[[Sindrom ovarium polikistik|Sindrom polikistik ovarium]]▼
Riwayat bayi mati dalam masa perinatal▼
▲==== Riwayat bayi mati dalam masa perinatal ====
Pengobatan dengan kortikosteroid dan [[antipsikotik]].▼
Kehamilan kembar.<ref>{{Cite journal|last=Hiersch|first=Liran|last2=Berger|first2=Howard|last3=Okby|first3=Rania|last4=Ray|first4=Joel G.|last5=Geary|first5=Michael|last6=Mcdonald|first6=Sarah D.|last7=Murry-Davis|first7=Beth|last8=Riddell|first8=Catherine|last9=Halperin|first9=Ilana|date=September 2018|title=Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies|url=https://obgyn.utoronto.ca/sites/default/files/incidence_and_risk_factors_for_gestational_diabetes_mellitus_in_twin_versus_singleton_pregnancies.pdf|journal=Archives of Gynecology and Obstetrics|volume=298|issue=3|pages=579–587|doi=10.1007/s00404-018-4847-9|issn=1432-0711|pmid=29971559}}</ref>▼
Wanita hamil dengan [[penyakit autoimun]] yang menerima terapi [[kortikosteroid]] memiliki risiko yang lebih besar untuk menderita diabetes gestasional.<ref>{{Cite journal|last=Bandoli|first=Gretchen|last2=Palmsten|first2=Kristin|last3=Forbess Smith|first3=Chelsey J.|last4=Chambers|first4=Christina D|date=Agustus 2017|title=A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604866/|journal=Rheumatic diseases clinics of North America|volume=43|issue=3|pages=489–502|doi=10.1016/j.rdc.2017.04.013|issn=0889-857X|pmc=5604866|pmid=28711148}}</ref> Pemberian [[glukokortikoid]] sistemik akan meningkatkan [[resistensi insulin]] dengan cara mengurangi [[ekspresi gen]] untuk transpor glukosa<ref>{{Cite journal|last=Weinstein|first=Steven P|last2=Paquin|first2=Tania|last3=Pritsker|first3=Alla|last4=Haber|first4=Richard S|date=1995-04-01|title=Glucocorticoid-Induced Insulin Resistance: Dexamethasone Inhibits the Activation of Glucose Transport in Rat Skeletal Muscle by Both Insulin- and Non-Insulin-Related Stimuli|url=https://doi.org/10.2337/diab.44.4.441|journal=Diabetes|volume=44|issue=4|pages=441–445|doi=10.2337/diab.44.4.441|issn=0012-1797}}</ref><ref>{{Cite journal|last=Leguisamo|first=Natalia M.|last2=Lehnen|first2=Alexandre M.|last3=Machado|first3=Ubiratan F.|last4=Okamoto|first4=Maristela M.|last5=Markoski|first5=Melissa M.|last6=Pinto|first6=Graziela H.|last7=Schaan|first7=Beatriz D.|date=2012-08-16|title=GLUT4 content decreases along with insulin resistance and high levels of inflammatory markers in rats with metabolic syndrome|url=https://doi.org/10.1186/1475-2840-11-100|journal=Cardiovascular Diabetology|volume=11|issue=1|pages=100|doi=10.1186/1475-2840-11-100|issn=1475-2840|pmc=PMC3439702|pmid=22897936}}</ref> dan mengurangi migrasi sel serta menurunkan level [[glikogen sintase]].<ref>{{Cite journal|last=Lee|first=Chang-Hoon|last2=Kim|first2=Jimin|last3=Jang|first3=Eun Jin|last4=Lee|first4=Joon-Ho|last5=Kim|first5=Yun Jung|last6=Choi|first6=Seongmi|last7=Kim|first7=Deog Kyeom|last8=Yim|first8=Jae-Joon|last9=Yoon|first9=Ho Il|date=2016-05|title=Inhaled Corticosteroids Use Is Not Associated With an Increased Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus: Two Nested Case-Control Studies|url=https://journals.lww.com/md-journal/fulltext/2016/05310/inhaled_corticosteroids_use_is_not_associated_with.7.aspx|journal=Medicine|language=en-US|volume=95|issue=22|pages=e3627|doi=10.1097/MD.0000000000003627|issn=0025-7974}}</ref><ref>{{Cite journal|last=Ruzzin|first=Jérôme|last2=Wagman|first2=A.S.|last3=Jensen|first3=Jørgen|date=2005-11-01|title=Glucocorticoid-induced insulin resistance in skeletal muscles: Defects in insulin signalling and the effects of a selective glycogen synthase kinase-3 inhibitor|url=https://www.researchgate.net/publication/7681747_Glucocorticoid-induced_insulin_resistance_in_skeletal_muscles_Defects_in_insulin_signalling_and_the_effects_of_a_selective_glycogen_synthase_kinase-3_inhibitor|journal=Diabetologia|volume=48|pages=2119–30|doi=10.1007/s00125-005-1886-0}}</ref>
==== Pengobatan dengan antipsikotik ====
Dari penelitian yang dilakukan oleh Suat Kucukgoncu pada tahun 2019, penggunaan obat [[antipsikotik]] akan meningkatkan risiko diabetes gestasional hingga 1,6 kali lipat dibandingkan wanita hamil kontrol.<ref>{{Cite journal|last=Kucukgoncu|first=Suat|last2=Guloksuz|first2=Sinan|last3=Celik|first3=Kubra|last4=Bahtiyar|first4=Mert Ozan|last5=Luykx|first5=Jurjen J|last6=Rutten|first6=Bart P F|last7=Tek|first7=Cenk|date=2020-02-26|title=Antipsychotic Exposure in Pregnancy and the Risk of Gestational Diabetes: A Systematic Review and Meta-analysis|url=https://doi.org/10.1093/schbul/sbz058|journal=Schizophrenia Bulletin|volume=46|issue=2|pages=311–318|doi=10.1093/schbul/sbz058|issn=0586-7614}}</ref> Mekanisme terjadinya diabetes gestasional terjadi akibat peningkatan berat badan. Antipsikotik meningkatkan nafsu makan dengan cara menghambat reseptor [[dopamin]].<ref name=":4">{{Cite journal|last=Holt|first=Richard I. G.|date=2019|title=Association Between Antipsychotic Medication Use and Diabetes|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718373/|journal=Current Diabetes Reports|volume=19|issue=10|pages=96|doi=10.1007/s11892-019-1220-8|issn=1534-4827|pmc=6718373|pmid=31478094}}</ref><ref name=":5">{{Cite web|last=Chhim|first=Theary|last2=Chase|first2=Phil|date=2012|title=Antipsychotic-Induced Diabetes Mellitus|url=https://www.uspharmacist.com/article/antipsychotic-induced-diabetes-mellitus|website=www.uspharmacist.com|language=|access-date=11 Februari 2022|last3=Neumiller|first3=Joshua J.}}</ref>
Penumpukan jaringan lemak akan menyebabkan lipolisis yang tidak terkontrol sehingga [[asam lemak]] dalam darah akan meningkat. Peningkatan ini akan merangsang terjadinya glukoneogenesis dan resistensi insulin di hati dan otot akibat penumpukan diasilgliserol atau [[digliserida]].<ref name=":4" />
Antipsikotik juga memiliki efek toksik terhadap sel beta pankreas sehingga sekresinya akan menurun.<ref name=":4" /><ref name=":5" />
==== Kehamilan kembar. ====
▲Kejadian diabetes gestasional dapat dipicu oleh kehamilan kembar. Kehamilan kembar akan menyebabkan peningkatan berat badan dan penurunan kadar PAPPA (sejenis [[metaloprotease]]) yang berfungsi untuk mengatur [[faktor pertumbuhan mirip insulin]] atau ''insulin-like growth factor'' (IGF). Kadar PAPPA yang rendah akan menyebabkan gangguan [[proteolisis]] [[Adipositas|jaringan adiposa]] sehingga terjadi penumpukan lemak. Gangguan metabolisme jaringan lemak ini akan meningkatkan resistensi insulin dan gangguan toleransi glukosa.<ref>{{Cite journal|last=Hiersch|first=Liran|last2=Berger|first2=Howard|last3=Okby|first3=Rania|last4=Ray|first4=Joel G.|last5=Geary|first5=Michael|last6=Mcdonald|first6=Sarah D.|last7=Murry-Davis|first7=Beth|last8=Riddell|first8=Catherine|last9=Halperin|first9=Ilana|date=September 2018|title=Incidence and risk factors for gestational diabetes mellitus in twin versus singleton pregnancies|url=https://obgyn.utoronto.ca/sites/default/files/incidence_and_risk_factors_for_gestational_diabetes_mellitus_in_twin_versus_singleton_pregnancies.pdf|journal=Archives of Gynecology and Obstetrics|volume=298|issue=3|pages=579–587|doi=10.1007/s00404-018-4847-9|issn=1432-0711|pmid=29971559}}</ref><ref>{{Cite journal|last=Buerger|first=Olga|last2=Elger|first2=Tania|last3=Varthaliti|first3=Antonia|last4=Syngelaki|first4=Argyro|last5=Wright|first5=Alan|last6=Nicolaides|first6=Kypros H.|date=2021-01|title=First-Trimester Screening for Gestational Diabetes Mellitus in Twin Pregnancies|url=https://www.mdpi.com/2077-0383/10/17/3814|journal=Journal of Clinical Medicine|language=en|volume=10|issue=17|pages=3814|doi=10.3390/jcm10173814}}</ref>
== Patofisiologi ==
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