59 21 ỄIăTHỄOă NGăTRONGăTHAIăK nhăngh a I áiătháoăđ ngăthaiăk ălƠăcóăr iălo nădungăn păđ nh năl năđ uătrongăkhiămangăthai II ngăm iăxu tăhi năho căđ căghiă SƠngăl c Y uăt ănguyăc Giaăđìnhăcóăng áiătháoăđ iăđáiătháoăđ ngă ăthaiăk ătr ng c Ti năc năsinh to (> 4000 g) Ti năc năthaiăl uă(đ căbi tă ă3ăthángăcu i);ăSinhăconăd ăt t Cóăă≥ăă3ăl năs yăthaiăliênăti p iăt ng- th iăđi măth căhi n D Ngayăl năkhámăthaiăđ uătiênăc năx pălo iănguyăc Thaiăph ăkhôngăcóăy uăt ănguyăc ;ăn uăcóăb tăth ngăđ ngăhuy tălúcăđóiă(≥ă92ă mg/dl ) ph i t măsoátăb ngănghi măphápădungăn păglucoseăđ ngău ngă(OGTT)ă lúc thai 24-28ătu n T Thaiă ph ă cóă y uă t ă nguyă c ă nênă đ că t mă soátă b ngă nghi mă phápă dungă n pă glucoseăđ ngău ngă(OGTT)ătrongă3ăthángăđ uăthaiăk ;ăngayăl năkhámăđ u Có th ăl păl iă ă24-28ătu năn uătr căđóăbìnhăth ng Xét ỉghi m sàỉg ệ Ế: Testădungăn păglucoseăđ ngău ngă(OGTT) BV Th căhi nă8ăgi ăsauă năvƠăch ăđ ă năcarbohydrateăbìnhăth ngătrongăbaăngƠyătr că oăglucoseămáuălúcăđói.ă Pha 75g glucose 200ml n c,ău ngătrongă3-5ăphútă(khôngăhútăthu c,ă n,ă hayău ngăn căng tătrongăkhiălƠmăxétănghi m) oăglucoseămáuăsauă1ăvƠă2ăgi K tăqu ăbìnhăth ng:ăGlucose máu: Lúcăđói:ăăă≤ă92ămgă/dlă(5.1ămmolă/L) Sauă1ăgi :ă≤ă180ămgă/dlă(10ămmolă/L) Sauă2ăgi :ă≤ă153ămgă/dl (8.5 mmol /L) * T ăthaiăk ăđ căch năđoánăn uăcóăhai k tăqu ăb ngăhayăh năgi iăh nătrên *K tălu nălƠăr iălo nădungăn păđ h năgi iăh nătrên B ỉh ối ỉ T D ngătrongăthaiăk ăn uăcóăm tăk tăqu ăb ngăhayă PháẾ đ u tọ s ỉ ịh ỆhỊa - 2012 60 III Ch năđoán:ă(ch ăy uăd aăvƠoăc nălơmăsƠng) Lâm sàng Béo phì (BMI > 27 kg/m2) nănhi u,ău ngănhi u,ălênăcơnănhi uă(ă>ă20ăkg) Thaiăto,ăđaă i,ăd ă i,ăthaiăl u C nălơmăsƠng ngăhuy tălúcăđóiăă≥ă126ămg/dlă(7ămmol/ăL);ăho că ngăhuy tăb tăk ă≥ă200ămg/dlă(11.1ămmol/ăL);ăho c Testădungăn păglucoseăđ ngău ngă(OGTT):ăă(+) IV i uătr Nguyêỉ t Ế: tu ăthu căvƠoăđ ătr ngăthƠnhăc aăthai M cătiêuăđi uătr 1.Thaiăch aăđ ătr D Gi ăm căđ ngăhuy t:ă Lúcăđói:ăăăăăăă90ă- 95 mg/dl (5 - 5,5 mmol/l) 1ăgi ăsauă n:ă 150 mg/dl: Insulinătruy năTM BV TÀI LI UăTHAMăKH O T D H uăs n NgƠyăth ă2ăh uăs n,ăđoăđ ngăhuy tătr că năvƠă2ăgi ăsauă n.ă C năđi uătr ă T ăn u:ă Hătr că nă>ă110ămgă/dlă(ă6,1 mmol /L) Hă2ăgi ăsauă nă>ă200ămgă/dlă(ă11,1 mmol /L) Th căhi năOGTTă tu nă6-12ăsauăsinhă(t iăchuyênăkhoaăn iăti t) Nuôiăconăb ngăs aăm Ng aăthaiătíchăc c:ăBCS,ăDCTC,ăviênăthu căk tăh păhƠmăl ngăth p Brody SC, Harris R, Lohr K Screening for gestational diabetes: a summary of the evidence for the U.S Preventive Services Task Force Obstet Gynecol 2003;101(2):380ậ392 Tuffnell DJ, West J, Walkinshaw SA Treatments for gestational diabetes and impaired glucose tolerance in pregnancy Cochrane Database Syst Rev 2003;(3):CD003395 Crowther CA, Hiller JE, Moss JR, McPhee AJ, Jeffries WS, Robinson JS, for the Australian Carbohydrate Intolerance Study in Pregnant Women (ACHOIS) Trial Group Effect of treatment of gestational diabetes mellitus on pregnancy outcomes N Engl J Med 2005;352(24):2477ậ2486 US Preventive Services Task Force Screening for gestational diabetes Topic page Rockville, Md: Agency for Healthcare Research and Quality 2008 http://www.ahrq.gov/clinic/uspstf/uspsgdm.htm Accessed January 5, 2009 Metzger BE, Lowe LP, Dyer AR, for the HAPO Study Cooperative Research Group Hyperglycemia and adverse pregnancy outcomes N Engl J Med 2008;358(19):1991ậ2002 American College of Obstetricians and Gynecologists Committee on Practice BulletinsậObstretrics ACOG Practice Bulletin Clinical management guidelines for obstetrician-gynecologists Number 30, September 2001 (replaces Technical Bulletin Number 200, December 1994) Gestational diabetes Obstet Gynecol 2001;98(3):525ậ538 Naylor CD, Sermer M, Chen E, Farine D Selective screening for gestational diabetes mellitus Toronto Trihospital Gestational Diabetes Project Investigators N Engl J Med 1997;337(22):1591ậ1596 B ỉh ối ỉ T D PháẾ đ u tọ s ỉ ịh ỆhỊa - 2012 63 Cosson E, Benchimol M, Carbillon L, et al Universal rather than selective screening for gestational diabetes mellitus may improve fetal outcomes Diabetes Metab 2006;32(2):140ậ146 Metzger BE, Coustan DR Summary and recommendations of the Fourth International Workshop-Conference on Gestational Diabetes Mellitus The Organizing Committee Diabetes Care 1998;21(suppl 2):B161ậB167 10 Metzger BE, Buchanan TA, Coustan DR, et al Summary and recommendations of the Fifth International Workshop-Conference on Gestational Diabetes Mellitus [published correction appears in Diabetes Care 2007;30(12):3154] Diabetes Care 2007;30(suppl 2):S251ậS260 11 American Diabetes Association Gestational diabetes mellitus Diabetes Care 2004;27(suppl 1):S88ậS90 12 Agarwal MM, Dhatt GS, Punnose J, Zayed R Gestational diabetes: fasting and postprandial glucose as first prenatal screening tests in a high-risk population J Reprod Med 2007;52(4):299ậ305 13 Buhling KJ, Elsner E, Wolf C, et al No influence of high- and low-carbohydrate diet on the oral glucose tolerance test in pregnancy Clin Biochem 2004;37(4):323ậ327 14 Hollander MH, Paarlberg KM, Huisjes AJ Gestational diabetes: a review of the current literature and guidelines Obstet Gynecol Surv 2007;62(2):125ậ136 15 Carpenter MW, Coustan DR Criteria for screening tests for gestational diabetes Am J Obstet Gynecol 1982;144(7):768ậ773 16 Alberti KG, Zimmet PZ Definition, diagnosis and classification of diabetes mellitus and its complications Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation Diabet Med 1998;15(7):539ậ553 17 Up to Date 2012 BV T D B ỉh ối ỉ T D PháẾ đ u tọ s ỉ ịh ỆhỊa - 2012