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Dennoch bestehen bei Frauen mit konzeptionell manifestem Diabetes nach wie vor h\u00f6here Komplikationsraten und eine h\u00f6here perinatale Morbidit\u00e4t und Mortalit\u00e4t. Eine fehlende oder zumindest unzureichende Schwangerschaftsplanung und pr\u00e4konzeptionelle Betreuung mit Optimierung der Stoffwechsellage vor Konzeption ist daf\u00fcr verantwortlich. Alle Frauen mit Diabetes sollen im Selbstmanagement der Insulintherapie mit Anpassungen der Insulindosis geschult sein und eine stabile Stoffwechsellage vor Schwangerschaftsbeginn aufweisen. Eine Schilddr\u00fcsendysfunktion, Hypertonie oder diabetische Komplikationen vor der Konzeption sollten ausgeschlossen bzw. ad\u00e4quat behandelt sein, um das Risiko einer m\u00f6glichen Progression der Komplikationen und Begleiterkrankungen sowie insgesamt m\u00fctterliche und fetale Risiken zu minimieren. Ein Ziel der m\u00fctterlichen Stoffwechselkontrolle ist das Erreichen von Normoglyk\u00e4mie und normalen HbA<jats:sub>1c<\/jats:sub>-Werten, falls dies ohne Risiko f\u00fcr Hypoglyk\u00e4mien m\u00f6glich ist, da eine schlechte Blutzuckereinstellung mit diabetischer Embryopathie und diabetischer Fetopathie assoziiert ist. Das Hypoglyk\u00e4mierisiko ist speziell bei Typ\u00a01\u00a0Diabetes mellitus in der Fr\u00fchschwangerschaft deutlich erh\u00f6ht, nimmt aber mit den hormonellen Ver\u00e4nderungen und der Zunahme der Insulinresistenz im Schwangerschaftsverlauf deutlich ab. Eine weltweit steigende Adipositaspr\u00e4valenz f\u00fchrt zus\u00e4tzlich zu einem Anstieg von M\u00fcttern mit Typ\u00a02\u00a0Diabetes. Dieser Trend ist auch bei Frauen mit Typ\u00a01\u00a0Diabetes zu beobachten und aggraviert die Metabolik und die perinatalen Ergebnisse. Eine funktionelle, intensivierte Insulintherapie mit multiplen t\u00e4glichen Insulininjektionen oder eine Insulinpumpentherapie tragen neben dem vermehrten Einsatz des kontinuierlichen Glukosemonitorings zum Erreichen einer guten m\u00fctterlichen Stoffwechselkontrolle vor und w\u00e4hrend der Schwangerschaft bei. Orale Antidiabetika (Metformin) k\u00f6nnen vor allem bei Typ\u00a02\u00a0Diabetes und Adipositas helfen die Insulinsensitivit\u00e4t zu verbessern und dadurch den Insulinbedarf zu vermindern, sollten jedoch aufgrund der Plazentag\u00e4ngigkeit und ungewissen Langzeitergebnissen bei den Nachkommen mit Bedacht (shared decision making) verordnet werden. Aufgrund des erh\u00f6hten Pr\u00e4eklampsierisikos bei Frauen mit Diabetes in der Schwangerschaft ist hier ein fr\u00fches Screening zu empfehlen. Regelm\u00e4\u00dfige und engmaschige geburtshilfliche Kontrollen in einem spezialisierten Zentrum und bei spezialisierten Fach\u00e4rzt:innen sowie interdisziplin\u00e4re Zusammenarbeit werden empfohlen um eine gute Stoffwechseleinstellung und gesunde Entwicklung des Kindes zu sichern.<\/jats:p>","DOI":"10.1007\/s00508-023-02188-2","type":"journal-article","created":{"date-parts":[[2023,4,26]],"date-time":"2023-04-26T23:03:25Z","timestamp":1682550205000},"page":"129-136","update-policy":"http:\/\/dx.doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Gravidit\u00e4t bei vorbestehendem Diabetes (Update 2023)","Clinical practice recommendations for diabetes in pregnancy (Update 2023)"],"prefix":"10.1007","volume":"135","author":[{"given":"Alexandra","family":"Kautzky-Willer","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne","family":"Winhofer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raimund","family":"Weitgasser","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monika","family":"Lechleitner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Harreiter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,20]]},"reference":[{"issue":"5","key":"2188_CR1","doi-asserted-by":"publisher","first-page":"1060","DOI":"10.2337\/dc08-9020","volume":"31","author":"JL Kitzmiller","year":"2008","unstructured":"Kitzmiller\u00a0JL, Block\u00a0JM, Brown\u00a0FM, et\u00a0al. 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