76284506 Referat Jadi GDM Contoh

8/16/2019 76284506 Referat Jadi GDM Contoh

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Gestational Diabetes MellitusDisusun Guna Memenuhi Tugas dan Melengkapi Syarat Dalam Menempuh Program

Studi Profesi Dokter

Disusun Oleh :

Rainy Anjani (030.06.208)

Pembimbing :

Letkol Kes dr. akaria! "#. $G

R%MA& "AK' %"A A*GKAA* %DARA

D$K+R +"*A,A* A*AR'K"A

-AK%LA" K+D$K+RA* %*'+R"'A" R'"AK'

+R'$D+ /2 "++M+R 20// 1 /8 *$+M+R 20//


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LEMBAR PENGESAHAN

Nama : Rainy Anjani

Fakultas : Kedokteran Umum

Tingkat : Universitas Trisakti Jakarta

Bidang Pendidikan : Ilmu Kandungan dan Kebidanan

Periode Keaniteraan Klinik : !" #etember "$!! % !& November "$!!

Judul : 'iabetes (ellitus )estasional

'iajukan : !! November "$!!

Pembimbing : *etkol Kes dr+ ,akaria- #+ .)

Tela/ 'ieriksa dan 'isa/kan Tanggal (engeta/ui :

Ketua #(F Ilmu Kandungan dan Kebidanan Pembimbing

R#PAU dr+ 0sna1an Antariksa Jakarta

*etkol Kes dr+ ,akaria- #+ .) *etkol Kes dr+ ,akaria- #+ .)

2


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DAFTAR ISI

LEMBAR PENGESAHAN........................................................................................... II

JOURNAL GESTATIONAL DIABETES MELLITUS

BACKGROUND........................................................................................................1

EPIDEMIOLOGY.......................................................................................................2

CLASSIFICATION.....................................................................................................2

RISK FACTORS........................................................................................................2

PATHOPHYSIOLOGY................................................................................................ 3

SCREENING............................................................................................................5

PATHWAYS..............................................................................................................6

MANAGEMENT........................................................................................................8

LIFESTYLE..............................................................................................................9

MEDICATION.......................................................................................................... 9

PROGNOSIS..........................................................................................................10

COMPLICATIONS...................................................................................................11

REFERENCES........................................................................................................12

JURNAL DIABETES MELLITUS GESTASIONAL

KATA PENGANTAR................................................................................................... II

BAB I......................................................................................................................1

PENDAHULUAN.......................................................................................................1

BAB II..................................................................................................................... 2DIABETES MELLITUS GESTASIONAL........................................................................2

II. 1. DEFINISI......................................................................................................... 2

II. 2. EPIDEMIOLOGI................................................................................................2

II. 3. KLASIFIKASI....................................................................................................2

II. . FAKTOR RISIKO...............................................................................................3

II. !. METODE SKRINING.........................................................................................!

II. 8. MANA"EMEN................................................................................................. 10

II. 9. GAYA HIDUP................................................................................................. 10

3


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II. 1O. MEDIKASI...................................................................................................11

II. 11. PROGNOSIS................................................................................................12

II. 12. KOMPLIKASI................................................................................................13


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Gestational Diabetes Mellitus

Thomas A. Buhanan! and Anny ". #iang$

!Departments of Mediine% Obstetris and Gyneology% and Physiology and

Biophysis% and

$Department of Pre&enti&e Mediine% 'ni&ersity of Southern (alifornia )ek Shool

of Mediine% *os Angeles% (alifornia% 'SA.

Address orrespondene to: Thomas A. Buhanan% +oom ,,-$ G"% !$-- orth

State Street% *os Angeles% (alifornia /--0/1/2!3% 'SA. Phone: 42$25 $$,16,2$78a9: 42$25 $$,1$3/,7 1mail: buhanan;us.edu.

Published Marh !% $--<

Gestational diabetes 4or gestational diabetes mellitus% GDM5 is a ondition in =hih

=omen =ithout pre&iously diagnosed diabetes e9hibit high blood gluose le&els

during pregnany 4espeially during third trimester of pregnany5. Gestational

diabetes is aused =hen the body of a pregnant =oman does not serete e9essinsulin re>uired during pregnany leading to inreased blood sugar le&els. ?!@

Gestational diabetes generally has fe= symptoms and it is most ommonly

diagnosed by sreening during pregnany. Diagnosti tests detet inappropriately

high le&els of gluose in blood samples. Gestational diabetes affets 21!- of

pregnanies% depending on the population studied. ?$@

As =ith diabetes mellitus in pregnany in general% babies born to mothers =ith

gestational diabetes are typially at inreased risk of problems suh as being large

for gestational age 4=hih may lead to deli&ery ompliations5% lo= blood sugar %and aundie. Gestational diabetes is a treatable ondition and =omen =ho ha&e

ade>uate ontrol of gluose le&els an effeti&ely derease these risks.

Comen =ith gestational diabetes are at inreased risk of de&eloping type $ diabetes

mellitus 4or% &ery rarely% latent autoimmune diabetes or Type !5 after pregnany% as

=ell as ha&ing a higher inidene of pre1elampsia and aesarean setion7?2@ their

offspring are prone to de&eloping hildhood obesity% =ith type $ diabetes later in life.

Most patients are treated only =ith diet modifiation and moderate e9erise but some

take anti1diabeti drugs% inluding insulin.?2@

http://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Hyperglycemiahttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Screening_(medicine)http://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-emedicine-1http://en.wikipedia.org/wiki/Diabetes_mellitus_in_pregnancyhttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Jaundicehttp://en.wikipedia.org/wiki/Glycemic_controlhttp://en.wikipedia.org/wiki/Type_2_diabetes_mellitushttp://en.wikipedia.org/wiki/Type_2_diabetes_mellitushttp://en.wikipedia.org/wiki/Latent_autoimmune_diabeteshttp://en.wikipedia.org/wiki/Diabetes_mellitus_type_1http://en.wikipedia.org/wiki/Pre-eclampsiahttp://en.wikipedia.org/wiki/Caesarean_sectionhttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ap01-2http://en.wikipedia.org/wiki/Childhood_obesityhttp://en.wikipedia.org/wiki/Childhood_obesityhttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Anti-diabetic_drugshttp://en.wikipedia.org/wiki/Anti-diabetic_drugshttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ap01-2http://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Hyperglycemiahttp://en.wikipedia.org/wiki/Pregnancyhttp://en.wikipedia.org/wiki/Symptomshttp://en.wikipedia.org/wiki/Screening_(medicine)http://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-emedicine-1http://en.wikipedia.org/wiki/Diabetes_mellitus_in_pregnancyhttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Macrosomiahttp://en.wikipedia.org/wiki/Hypoglycemiahttp://en.wikipedia.org/wiki/Jaundicehttp://en.wikipedia.org/wiki/Glycemic_controlhttp://en.wikipedia.org/wiki/Type_2_diabetes_mellitushttp://en.wikipedia.org/wiki/Type_2_diabetes_mellitushttp://en.wikipedia.org/wiki/Latent_autoimmune_diabeteshttp://en.wikipedia.org/wiki/Diabetes_mellitus_type_1http://en.wikipedia.org/wiki/Pre-eclampsiahttp://en.wikipedia.org/wiki/Caesarean_sectionhttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ap01-2http://en.wikipedia.org/wiki/Childhood_obesityhttp://en.wikipedia.org/wiki/Type_2_diabeteshttp://en.wikipedia.org/wiki/Anti-diabetic_drugshttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ap01-2


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+#ideioloy

Gestational diabetes affets 21!- of pregnanies% depending on the population

studied.?$@

4lassi5iation

Gestational diabetes is formally defined as any degree of gluose intolerane =ith

onset or first reognition during pregnany. This definition akno=ledges the

possibility that patients may ha&e pre&iously undiagnosed diabetes mellitus% or may

ha&e de&eloped diabetes oinidentally =ith pregnany. Chether symptoms subside

after pregnany is also irrele&ant to the diagnosis. ?6@?uired

Risk -ators

(lassial risk fators for de&eloping gestational diabetes are the follo=ing:?0@?/@

A pre&ious diagnosis of gestational diabetes or prediabetes% impaired gluose

tolerane% or impaired fasting glyaemia

A family history re&ealing a first degree relati&e =ith type $ diabetes

Maternal age 1 a =omans risk fator inreases as she gets older 4espeially

for =omen o&er 2< years of age5

http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-emedicine-1http://en.wikipedia.org/wiki/Glucose_intolerancehttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-definition-3http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-definition-3http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ADA2004-4http://en.wikipedia.org/wiki/Priscilla_White_(physician)http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-PWhite-5http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-OBSTETRICS-6http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ACHOISreview-7http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-obesity-8http://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Family_history_(medicine)http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-emedicine-1http://en.wikipedia.org/wiki/Glucose_intolerancehttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-definition-3http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ADA2004-4http://en.wikipedia.org/wiki/Priscilla_White_(physician)http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-PWhite-5http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-OBSTETRICS-6http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-ACHOISreview-7http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-obesity-8http://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Family_history_(medicine)http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2


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thni bakground 4those =ith higher risk fators inlude Afrian1

Amerians% Afro1(aribbeans% ati&e Amerians% "ispanis% Paifi Eslanders% and

people originating from South Asia5

Being o&er=eight% obese or se&erely obese inreases the risk by a fator $.!%2., and 0.,% respeti&ely.

A pre&ious pregnany =hih resulted in a hild =ith a high birth =eight 4H/-th

entile% or H6--- g 40 lbs !$.0 oI55

En addition to this% statistis sho= a double risk of GDM in smokers. Polyysti

o&arian syndrome is also a risk fator% although rele&ant e&idene remains

ontro&ersial. Some studies ha&e looked at more ontro&ersial potential risk fators%

suh as short stature. ?0@?!-@?!!@?!$@

About 6-1,- of =omen =ith GDM ha&e no demonstrable risk fator7 for this reason

many ad&oate to sreen all =omen. Typially =omen =ith gestational diabetes

e9hibit no symptoms 4another reason for uni&ersal sreening5% but some =omen may

demonstrate inreased thirst%

inreased urination% fatigue% nausea and &omiting% bladder infetion% and blurred

&ision.?!2@

at7o#7ysioloy

ffet of insulin on gluose uptake and metabolism. Ensulin binds to its reeptor

4!5 on the ell membrane =hih in turn starts many protein ati&ation asades

4$5. These inlude: transloation of Glut16 transporter to the plasma

membrane and influ9 of gluose 425% glyogen synthesis 465% glyolysis 4


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The preise mehanisms underlying gestational diabetes remain unkno=n. The

hallmark of GDM is inreased insulin resistane. Pregnany hormones and other

fators are thought to interfere =ith the ation of insulin as it binds to the insulin

reeptor . The interferene probably ours at the le&el of the ell signaling path=ay

behind the insulin reeptor. Sine insulin promotes the entry of gluose into most

ells% insulin resistane pre&ents gluose from entering the ells properly. As a result%

gluose remains in the bloodstream% =here gluose le&els rise. More insulin is

needed to o&erome this resistane7 about !.


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"reenin

$--, C"O Diabetes riteria?!3@

4ondition2 7our luose

mmolFl4mgFdl5

-astin luose

mmolFl4mgFdl5

*oral K3.0 4K!6-5 K,.! 4K!!-5

'#aired 5astin

lyaeiaK3.0 4K!6-5 L ,.!4L!!-5 K3.-4K!$,5

'#aired luose

toleraneL3.0 4L!6-5 K3.- 4K!$,5

Diabetes ellitus L!!.! 4L$--5 L3.- 4L!$,5

A number of sreening and diagnosti tests ha&e been used to look for high le&els

of gluose in plasma or serum in defined irumstanes. One method is a step=ise

approah =here a suspiious result on a sreening test is follo=ed by diagnosti

test. Alternati&ely% a more in&ol&ed diagnosti test an be used diretly at the first

antenatal &isit in high1risk patients 4for e9ample in those =ith polyysti o&arian

syndrome or aanthosis nigrians5.?!,@

Tests for gestational diabetes

http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-who2006-16http://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Polycystic_ovarian_syndromehttp://en.wikipedia.org/wiki/Polycystic_ovarian_syndromehttp://en.wikipedia.org/wiki/Acanthosis_nigricanshttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-controversies-15http://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-who2006-16http://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Impaired_fasting_glycaemiahttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Impaired_glucose_tolerancehttp://en.wikipedia.org/wiki/Diabetes_mellitushttp://en.wikipedia.org/wiki/Glucosehttp://en.wikipedia.org/wiki/Blood_plasmahttp://en.wikipedia.org/wiki/Blood_serumhttp://en.wikipedia.org/wiki/Polycystic_ovarian_syndromehttp://en.wikipedia.org/wiki/Polycystic_ovarian_syndromehttp://en.wikipedia.org/wiki/Acanthosis_nigricanshttp://en.wikipedia.org/wiki/Gestational_diabetes#cite_note-controversies-15


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on1hallenge blood gluose tests

8asting gluose test

$1hour postprandial 4after a meal5 gluose test

+andom gluose test

Sreening gluose hallenge test

Oral gluose tolerane test 4OGTT5

on1hallenge blood gluose tests in&ol&e measuring gluose le&els in blood

samples =ithout hallenging the subet =ith gluose solutions. A blood gluose le&el

is determined =hen fasting% $ hours after a meal% or simply at any random time. Enontrast% hallenge tests in&ol&e drinking a gluose solution and measuring gluose

onentration thereafter in the blood7 in diabetes% they tend to remain high. The

gluose solution has a &ery s=eet taste =hih some =omen find unpleasant7

sometimes% therefore% artifiial fla&ours are added. Some =omen may e9periene

nausea during the test% and more so =ith higher gluose le&els.?!0@?!/@

at7ays

There are different opinions about optimal sreening and diagnosti measures% inpart due to differenes in population risks% ost1effeti&eness onsiderations% and

lak of an e&idene base to support large national sreening programs. The most

elaborate regime entails a random blood gluose test during a booking &isit% a

sreening gluose hallenge test around $6N$0 =eeks gestation% follo=ed by an

OGTT if the tests are outside normal limits. Ef there is a high suspiion% =omen may

be tested earlier.?


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Chen a plasma gluose le&el is found to be higher than !$, mgFdl 43.- mmolFl5 after

fasting% or o&er $-- mgFdl 4!!.! mmolFl5 on any oasion% and if this is onfirmed on a

subse>uent day% the diagnosis of GDM is made% and no further testing is re>uired.

These tests are typially performed at the first antenatal &isit. They are patient1

friendly and ine9pensi&e% but ha&e a lo=er test performane ompared to the other tests% =ith moderate sensiti&ity% lo= speifiity and high false positi&e rates. ?


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! hour blood gluose le&el L!0- mgFdl 4!- mmolF*5

$ hour blood gluose le&el L!uired t=o &alues reahing or

e9eeding the &alue to be positi&e. ?22@ Subse>uent information led to alterations in

OSulli&ans riteria. Chen methods for blood gluose determination hanged from

the use of =hole blood to &enous plasma samples% the riteria for GDM =ere also

hanged.

'rinary Gluose Testing

Comen =ith GDM may ha&e high gluose le&els in their urine 4gluosuria5.

Although dipstik testing is =idely pratied% it performs poorly% and disontinuing

routine dipstik testing has not been sho=n to ause underdiagnosis =here uni&ersal

sreening is performed. Enreasedglomerular filtration rates during pregnany

ontribute to some


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Ef a diabeti diet or G.E. Diet% e9erise% and oral mediation are inade>uate to ontrol

gluose le&els% insulin therapy may beome neessary.

The de&elopment of marosomia an be e&aluated during pregnany by

using sonography. Comen =ho use insulin% =ith a history of stillbirth% or =ith

hypertension are managed like =omen =ith o&ert diabetes. ?!2@

Li5estyle

(ounselling before pregnany 4for e9ample% about pre&enti&e foli aid supplements5and multidisiplinary management are important for good pregnany outomes. Most

=omen an manage their GDM =ith dietary hanges and e9erise. Self monitoring of

blood gluose le&els an guide therapy. Some =omen =ill need antidiabeti drugs%

most ommonly insulin therapy.?6-@

Any diet needs to pro&ide suffiient alories for pregnany% typially $%--- 1 $%


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+esearh suggests a possible benefit of breastfeeding to redue the risk of diabetes

and related risks for both mother and hild.?66@

Mediation

Ef monitoring re&eals failing ontrol of gluose le&els =ith these measures% or if there

is e&idene of ompliations like e9essi&e fetal gro=th% treatment =ith insulin might

beome neessary. The most ommon therapeuti regime in&ol&es premeal fast1

ating insulin to blunt sharp gluose rises after meals. (are needs to be taken to

a&oid lo= blood sugar le&els 4hypoglyemia5 due to e9essi&e insulin inetions.

Ensulin therapy an be normal or &ery tight7 more inetions an result in better

ontrol but re>uires more effort% and there is no onsensus that it has large benefits.?0@?!,@?6ually effeti&e as insulin.?uired less insulin% and they

gained less =eight. Cith no long1term studies into hildren of =omen treated =ith the

drug% here remains a possibility of long1term ompliations from metformin

therapy% although follo=1up at the age of !0 months of hildren born to =omen

=ith polyysti o&arian syndrome and treated =ith metformin re&ealed no

de&elopmental abnormalities.?2@?63@?60@?6/@?ronosis

Gestational diabetes generally resol&es one the baby is born. Based on different

studies% the hanes of de&eloping GDM in a seond pregnany are bet=een 2- and

06% depending on ethni bakground. A seond pregnany =ithin ! year of the

pre&ious pregnany has a high rate of reurrene.?


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treatment% had antibodies assoiated =ith diabetes 4suh as antibodies

against glutamate dearbo9ylase% islet ell antibodies andFor insulinoma antigen1$5%

=omen =ith more than t=o pre&ious pregnanies% and =omen =ho =ere obese 4in

order of importane5. Comen re>uiring insulin to manage gestational diabetes ha&e

a


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fators 4suh as obesity5. *abelling a =oman as ha&ing GDM may in it self inrease

the risk of ha&ing a aesarean setion.?,6@?,


17/49

6+ /ite P+ Pregnan4y 4omli4ating diabetes+ Am J (ed !9C 5: 6$+ P(I'

!:

"$5$6+ P(I' !59!65&6

!$+ 0ngland *J- *evine RJ- ian 3- et al+ )lu4ose toleran4e and risk o? gestational

diabetes mellitus in nulliarous 1omen 1/o smoke during regnan4y+ Am J

0idemiol "$$9C !6$=!">: !"$


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!5+ 2'e?inition and 'iagnosis o? 'iabetes (ellitus and Intermediate

Eyergly4emia2 =d?>+ orld Eealt/ .rgani@ation+ 111+1/o+int+ "$$6+ Retrieved

"$!!$""$+

!&+ #ievenier J*- Jenkins 'J- Josse R)- ;uksan ;+ 'ilution o? t/e 5

!!!6

""+ (ires )J- illiams F*- Earer ;+ #4reening ra4ti4es ?or gestational diabetesmellitus in UK obstetri4 units+ 'iabet (ed!C !6=">: !8&9!+ P(I' !$""8$5

"8+ 3anadian 'iabetes Asso4iation 3lini4al Pra4ti4e )uidelines 0Hert

3ommittee+ 3anadian 'iabetes Asso4iation "$$8 3lini4al Pra4ti4e )uidelines ?or t/e

Prevention and (anagement o? 'iabetes in 3anada+ 3an J 'iabetes "$$8C "5 =#ul

">: !%!9$+

"9+ )abbe #)- )raves 3R+ (anagement o? diabetes mellitus 4omli4ating

regnan4y+ .bstet )yne4ol "$$8C !$"=9>: &

"$$&>+ 2#4reening ?or gestational diabetes mellitus: a systemati4 revie1 ?or t/e U+#+

Preventive #ervi4es Task For4e2+Ann+ Intern+ (ed+ !9& =!$>: 566%

5


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"5+ #a4ks 'A- 3/en - oldeTsadik )- Bu4/anan TA+ Fasting lasma glu4ose

test at t/e ?irst renatal visit as a s4reen ?or gestational diabetes+ .bstet

)yne4ol "$$8C !$!=6>: !!5"$8+P(I' !"5&+ 2/at I need to kno1 about )estational

'iabetes2+ National 'iabetes In?ormation 3learing/ouse+ National 'iabetes

In?ormation 3learing/ouse+ Retrieved "$$6!!"5+

8$+ )lu4ose toleran4e test+ (edlinePlus- November &- "$$6+

8!+ 3arenter (- 3oustan 'R+ 3riteria ?or s4reening tests ?or gestational

diabetes+ Am J .bstet )yne4ol !&"C !99=5>: 56&58+P(I' &8$5!!

8"+ (ello )- 0lena P- .gnibene A- 3ioni R- Tondi F- Pe@@ati P- Pratesi (-

#4arselli )- (esseri )+ *a4k o? 4on4ordan4e bet1een t/e 5:

!65&9+ P(I' !6&58"<

88+ 2)estational 'iabetes2+ 'iabetes (ellitus Pregnan4y )estational 'iabetes+

Armenian (edi4al Net1ork+ "$$6+ Retrieved "$$6!!"5+

89+ R/ode (A- #/airo E- Jones . 8rd+ Indi4ated vs+ routine renatal urine

4/emi4al reagent stri testing+ J Rerod (ed "$$5C: "&http://www.ncbi.nlm.nih.gov/pubmed/12798525http://www.ncbi.nlm.nih.gov/pubmed/17506370http://www.ncbi.nlm.nih.gov/pubmed/17506370http://diabetes.niddk.nih.gov/dm/pubs/gestational/http://diabetes.niddk.nih.gov/dm/pubs/gestational/http://diabetes.niddk.nih.gov/dm/pubs/gestational/http://www.nlm.nih.gov/medlineplus/ency/article/003466.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.ncbi.nlm.nih.gov/pubmed/83071919http://www.ncbi.nlm.nih.gov/pubmed/16873295http://www.ncbi.nlm.nih.gov/pubmed/16873295http://www.health.am/pregnancy/gestational-diabetes/http://www.ncbi.nlm.nih.gov/pubmed/17465289http://www.ncbi.nlm.nih.gov/pubmed/16266604http://www.ncbi.nlm.nih.gov/pubmed/16856816http://www.ncbi.nlm.nih.gov/pubmed/15951574http://www.ncbi.nlm.nih.gov/pubmed/15951574http://www.ncbi.nlm.nih.gov/pubmed/12798525http://www.ncbi.nlm.nih.gov/pubmed/17506370http://diabetes.niddk.nih.gov/dm/pubs/gestational/http://diabetes.niddk.nih.gov/dm/pubs/gestational/http://www.nlm.nih.gov/medlineplus/ency/article/003466.htmhttp://en.wikipedia.org/wiki/MedlinePlushttp://www.ncbi.nlm.nih.gov/pubmed/83071919http://www.ncbi.nlm.nih.gov/pubmed/16873295http://www.health.am/pregnancy/gestational-diabetes/http://www.ncbi.nlm.nih.gov/pubmed/17465289http://www.ncbi.nlm.nih.gov/pubmed/16266604http://www.ncbi.nlm.nih.gov/pubmed/16856816http://www.ncbi.nlm.nih.gov/pubmed/15951574


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8&+ #ermer (- Naylor 3'- )are 'J et al+ Ima4t o? in4reasing 4arbo/ydrate

intoleran4e on maternal?etal out4omes in 8685 1omen 1it/out gestational diabetes+

T/e Toronto TriEosital )estational 'iabetes Proje4t+ Am J .bstet )yne4ol !: !96: !""85+

96+ alkins/a1 #A+ ;ery tig/t versus tig/t 4ontrol ?or diabetes in regnan4y=ITE'RAN>+ 3o4/rane 'atabase #yst Rev "$$5C=">: 3'$$$""6+ P(I'

!56866"8

95+ Kremer 3J- 'u?? P+ )lyburide ?or t/e treatment o? gestational diabetes+ Am J

.bstet )yne4ol "$$9C !$=: !98&+ P(I' !:!!89&+ P(I' !!$86!!&

http://www.ncbi.nlm.nih.gov/pubmed/7631672http://www.ncbi.nlm.nih.gov/pubmed/12917965http://www.ncbi.nlm.nih.gov/pubmed/12917965http://www.ncbi.nlm.nih.gov/pubmed/18007138http://health.yahoo.net/news/s/hsn/healthtipyourdietsroleingestationaldiabeteshttp://www.ncbi.nlm.nih.gov/pubmed/18001611http://www.ncbi.nlm.nih.gov/pubmed/18001611http://www.ncbi.nlm.nih.gov/pubmed/8166187http://www.ncbi.nlm.nih.gov/pubmed/16192255http://www.ncbi.nlm.nih.gov/pubmed/17636623http://www.ncbi.nlm.nih.gov/pubmed/17636623http://www.ncbi.nlm.nih.gov/pubmed/17636623http://www.ncbi.nlm.nih.gov/pubmed/15167862http://www.ncbi.nlm.nih.gov/pubmed/11036118http://www.ncbi.nlm.nih.gov/pubmed/7631672http://www.ncbi.nlm.nih.gov/pubmed/12917965http://www.ncbi.nlm.nih.gov/pubmed/18007138http://health.yahoo.net/news/s/hsn/healthtipyourdietsroleingestationaldiabeteshttp://www.ncbi.nlm.nih.gov/pubmed/18001611http://www.ncbi.nlm.nih.gov/pubmed/18001611http://www.ncbi.nlm.nih.gov/pubmed/8166187http://www.ncbi.nlm.nih.gov/pubmed/16192255http://www.ncbi.nlm.nih.gov/pubmed/17636623http://www.ncbi.nlm.nih.gov/pubmed/17636623http://www.ncbi.nlm.nih.gov/pubmed/15167862http://www.ncbi.nlm.nih.gov/pubmed/11036118


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9+ #immons '- alters BN- Ro1an JA- (4Intyre E'+ (et?ormin t/eray and

diabetes in regnan4y+ (ed J Aust "$$9C !&$=>: 96"9+ P(I' !:"$$8!

: 6$5!"+ P(I' !6

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22/49

'iabetes (ellitus and T/eir .??sring+ 3lin .bstet )yne4ol "$$5C : 5"

+ P(I' !5&"89$

6!+ Perrin (3- Terry (B- Klein/aus K- et al+ )estational diabetes and t/e risk o?

breast 4an4er among 1omen in t/e Jerusalem Perinatal #tudy+ Breast 3an4er Res

Treat "$$5 M0ub+ P(I' !5956: "589+ P(I'

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mal?ormations in in?ants o? mot/ers 1it/ gestational diabetes+ 'iabet

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23/49

6+ #avona;entura 3- )att (+ 0mbryonal risks in gestational diabetes

mellitus+ 0arly Eum 'ev "$$9C 5=!>: : "85+e!%

+doi:!$+!$!67j+ajog+"$$&+$6+$"&+ P(I' !&6595


24/49

Rainy Anjani (030.06.208)

Pembimbing :

Letkol Kes dr. akaria! "#. $G

R%MA& "AK' %"A A*GKAA* %DARA

D$K+R +"*A,A* A*AR'K"A

-AK%LA" K+D$K+RA* %*'+R"'A" R'"AK'

+R'$D+ /2 "++M+R 20// 1 /8 *$+M+R 20//


25/49

21


26/49

KATA PENGANTAR

Puji syukur enulis anjatkan keada Tu/an Dang (a/a 0sa yang tela/ memberikan

berka/ dan ra/matNya se/ingga enulis daat menyelesaikan re?erat mengenai Q)estational

'iabetes (ellitus guna memenu/i sala/ satu ersyaratan dalam menemu/ Keaniteraan

Klinik Bagian Imu Kandungan dan Kebidanan Fakultas Kedokteran Universitas Trisakti di

R#PAU dr+ 0sna1an Antariksa Jakarta eriode !" setember % !& November "$!!+

'isaming itu- makala/ ini ditunjukan untuk menamba/ engeta/uan bagi yang

memba4anya+

Pada kesematan ini enulis ingin menyamaikan u4aan terima kasi/ yang sebesar %

besarnya keada i/ak yang tela/ membantu dalam menyelesaikan makala/ ini- yaitu:

!+ Kolonel Kes 'r+ Benny T+- #+.T- selaku Keala R#PAU dr+ 0sna1an Antariksa

Jakarta

"+ *etkol Kes 'r+ ,akaria- #+.)- selaku ketua #(F Ilmu Kandungan dan Kebidanan

R#PAU dr+ 0sna1an Antariksa Jakarta+

8+ Kolonel Kes 'r+ Frits (+R+- #+.)- selaku embimbing Keaniteraan Klinik Ilmu

Kandungan dan Kebidanan R#PAU dr+ 0sna1an Antariksa Jakarta+

9+ Ibu % ibu bidan selaku era1at Bagian Ilmu Kandungan dan Kebidanan R#PAU dr+

0sna1an Antariksa Jakarta+


27/49

BAB I

PENDAHULUAN

)estational diabetes =diabetes melitus gestasional atau- )'(> adala/ suatu kondisi di

mana 1anita yang tana sebelumnya didiagnosis diabetes menunjukkan eningkatan kadar

glukosa dara/ selama ke/amilan =terutama selama trimester ketiga ke/amilan>+ )estational

diabetes ini disebabkan ketika tubu/ seorang 1anita /amil tidak mengeluarkan insulin yang

dibutu/kan selama ke/amilan se/ingga terjadi eningkatan kadar gula dara/+ M!

)estational diabetes umumnya memiliki beberaa gejala dan /al ini aling sering

didiagnosis dengan skrining selama masa ke/amilan+ )estational diabetes memengaru/i 8

!$S dari ke/amilan- tergantung ada oulasi yang diteliti+ M"

#eerti gestational diabetes mellitus ada umumnya- bayi yang la/ir dari ibu dengan diabetes

gestasional biasanya memunyai eningkatan risiko masala/ seerti bayi besar untuk usia

ke/amilan =yang daat menyebabkan komlikasi kela/iran>- gula dara/

renda/ =/ioglikema>- dan enyakit kuning + )estational diabetes adala/ suatu kondisi yang

daat diobati dan 1anita yang tela/ mengontrol kadar gulanya se4ara e?ekti? daat

menurunkan risiko ini+

anita dengan diabetes gestasional memunyai eningkatan risiko diabetes melitus

tie " =atau- sangat jarang- diabetes autoimun laten atau Tie !> setela/ ke/amilan- serta

memiliki insiden yang lebi/ tinggi reeklamsia dan kela/iran dengan oerasi 4aesar +

#edangkan keturunan mereka rentan untuk ertumbu/an obesitas- dan atau dengan diabetes

tie " di kemudian /ari+ Kebanyakan asien diobati /anya dengan modi?ikasi diet dan ola/

raga tetai beberaa mengambil obat antidiabetes- termasuk insulin+ M8

1

http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus&usg=ALkJrhhliCX40G799q0s26r4ZwDO0a3c9Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pregnancy&usg=ALkJrhhyvBiR59fiZypMwB3_6JYtmzPftQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Symptoms&usg=ALkJrhgDpiDGgSjBjb22m7-o9zbSGpme6ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Symptoms&usg=ALkJrhgDpiDGgSjBjb22m7-o9zbSGpme6ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Screening_(medicine)&usg=ALkJrhiuSIBlja2H0K7frKQtu6ia7S3W1Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-emedicine-1http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus_in_pregnancy&usg=ALkJrhgpULKxtlTkrhuOwdrewRKq7w621ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Macrosomia&usg=ALkJrhjegEsPU5pDAURRrbjPkL7vD7TH5ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Macrosomia&usg=ALkJrhjegEsPU5pDAURRrbjPkL7vD7TH5ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hypoglycemia&usg=ALkJrhjl0qOO3yY8ZO2Teg8lMMChNpbRNAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hypoglycemia&usg=ALkJrhjl0qOO3yY8ZO2Teg8lMMChNpbRNAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hypoglycemia&usg=ALkJrhjl0qOO3yY8ZO2Teg8lMMChNpbRNAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Jaundice&usg=ALkJrhhSnJML5n48srUKRbouRYo-QJOSJAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Jaundice&usg=ALkJrhhSnJML5n48srUKRbouRYo-QJOSJAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Type_2_diabetes_mellitus&usg=ALkJrhhRFyOuG-2hvosUuc4lt3pDRRS4Vwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Type_2_diabetes_mellitus&usg=ALkJrhhRFyOuG-2hvosUuc4lt3pDRRS4Vwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Latent_autoimmune_diabetes&usg=ALkJrhj7wjIXO2HQC7e_M0EIdpLo6D2UoQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus_type_1&usg=ALkJrhg64IBI4kH9HdONIQ_wQ9-xJ1zShghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pre-eclampsia&usg=ALkJrhj1b_bE-nYz_EqOgwkKlFguq2v8wAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Caesarean_section&usg=ALkJrhjqYXUootKDHHlHjYHz6rvCyqkluAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Caesarean_section&usg=ALkJrhjqYXUootKDHHlHjYHz6rvCyqkluAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Caesarean_section&usg=ALkJrhjqYXUootKDHHlHjYHz6rvCyqkluAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Childhood_obesity&usg=ALkJrhgqi8hzA1uqh_64b1Cbnid1Zue07Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Type_2_diabetes&usg=ALkJrhixzoJU5AP3jZkQaGf5k_DZD5US8whttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Type_2_diabetes&usg=ALkJrhixzoJU5AP3jZkQaGf5k_DZD5US8whttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Anti-diabetic_drugs&usg=ALkJrhghkSo7NbimY2Q-P8G0_H1YeJ-aqAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Anti-diabetic_drugs&usg=ALkJrhghkSo7NbimY2Q-P8G0_H1YeJ-aqAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Insulin&usg=ALkJrhiZhgm7MvznGV4We6qqFhjXOeTsOAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Insulin&usg=ALkJrhiZhgm7MvznGV4We6qqFhjXOeTsOAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Insulin&usg=ALkJrhiZhgm7MvznGV4We6qqFhjXOeTsOAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ap01-2http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus&usg=ALkJrhhliCX40G799q0s26r4ZwDO0a3c9Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pregnancy&usg=ALkJrhhyvBiR59fiZypMwB3_6JYtmzPftQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Symptoms&usg=ALkJrhgDpiDGgSjBjb22m7-o9zbSGpme6ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3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BAB II

DIABETES MELLITUS GESTASIONAL

II. 1 DEFINISI

)estational diabetes =diabetes melitus gestasional atau- )'(> adala/ suatu kondisi di mana

1anita yang tana sebelumnya didiagnosis diabetes menunjukkan eningkatan kadar glukosa

dara/ selama ke/amilan =terutama selama trimester ketiga ke/amilan>+ )estational diabetesini disebabkan ketika tubu/ seorang 1anita /amil tidak mengeluarkan insulin yang

dibutu/kan selama ke/amilan se/ingga terjadi eningkatan kadar gula dara/+ M!

II. 2. EPIDEMIOLOGI

)estational diabetes memengaru/i 8!$S dari ke/amilan- tergantung ada oulasi yang

diteliti+ M"

II. 3 KLASIFIKASI

)estational diabetes se4ara resmi dide?inisikan sebagai 2setia tingkat intoleransi

glukosa dengan onset atau diakui ertama kali selama ke/amilan2+ 'e?inisi ini menyatakan

kemungkinan ba/1a asien mungkin tela/ terdiagnosis diabetes mellitus sebelumnya+ M9 M dan diabetes yang ada

sebelum ke/amilan =diabetes regestational>+ Kedua kelomok ini kemudian dibagi lagi

sesuai dengan risiko yang terkait dan manajemennya+ M6M5

2

http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus&usg=ALkJrhhliCX40G799q0s26r4ZwDO0a3c9Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pregnancy&usg=ALkJrhhyvBiR59fiZypMwB3_6JYtmzPftQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-emedicine-1http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-emedicine-1http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Glucose_intolerance&usg=ALkJrhjc_FbfYU4GjkHqE-WdkxZL2ocW7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Glucose_intolerance&usg=ALkJrhjc_FbfYU4GjkHqE-WdkxZL2ocW7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Glucose_intolerance&usg=ALkJrhjc_FbfYU4GjkHqE-WdkxZL2ocW7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-definition-3http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-definition-3http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ADA2004-4http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Priscilla_White_(physician)&usg=ALkJrhhi9eLXHUMurCTjOkDF-PXsmDOMtAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Priscilla_White_(physician)&usg=ALkJrhhi9eLXHUMurCTjOkDF-PXsmDOMtAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-PWhite-5http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-OBSTETRICS-6http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus&usg=ALkJrhhliCX40G799q0s26r4ZwDO0a3c9Qhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hyperglycemia&usg=ALkJrhhQvwNDqbKD-hqhLdDj7EguS54Swghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pregnancy&usg=ALkJrhhyvBiR59fiZypMwB3_6JYtmzPftQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-emedicine-1http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Glucose_intolerance&usg=ALkJrhjc_FbfYU4GjkHqE-WdkxZL2ocW7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Glucose_intolerance&usg=ALkJrhjc_FbfYU4GjkHqE-WdkxZL2ocW7ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-definition-3http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ADA2004-4http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Priscilla_White_(physician)&usg=ALkJrhhi9eLXHUMurCTjOkDF-PXsmDOMtAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-PWhite-5http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-OBSTETRICS-6


29/49

Ada " subtie diabetes gestasional:

Tie A!: tes toleransi glukosa oral yang abnormal =TT).> tetai kadar glukosa dara/

uasa dan " jam setela/ makan normal- modi?ikasi diet memadai untuk mengontrol

kadar glukosa+

Tie A": TT). yang abnormal ditamba/ ole/ kadar glukosa dara/ uasa dan 7 atau "

jam sesuda/ makan abnormalC memerlukan terai tamba/an dengan insulin atau obat

lain+

II. 4. FAKTOR RISIKO

Faktor risiko klasik untuk gestational diabetes adala/ sebagai berikut: M& M

#ebelumnya didiagnosis gestational diabetes atau radiabetes- toleransi glukosa

terganggu- atau gula dara/ uasa terganggu

(emunyai ri1ayat keluarga dengan diabetes tie "

Usia ibu- ?aktor risiko meningkat ada 1anita usia tua =terutama bagi 1anita di atas

8< ta/un>

*atar belakang etnis =mereka yang memiliki ?aktor risiko tinggi termasuk A?rika

Amerika- A?roKaribia- enduduk asli Amerika- Eisanik - Keulauan Pasi?ik - dan orang

orang yang berasal dari Asia #elatan>

Kelebi/an berat badan - obesitas atau sangat gemuk meningkatkan risiko

Ri1ayat ke/amilan sebelumnya erna/ mela/irkan seorang anak dengan berat

kela/iran yang tinggi = 9$$$ g>

#elain itu- statistik menunjukkan risiko ganda )'( ada erokok + #indrom ovarium

olikistik juga meruakan ?aktor risiko- 1alauun bukti yang relevan masi/ kontroversial+

Beberaa enelitian tela/ meli/at adanya ?aktor risiko otensial yang lebi/ kontroversial-

seerti era1akan endek + M&M!$M!!M!"

3

http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-obesity-8http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_glucose_tolerance&usg=ALkJrhiDLMQvzza8Q04ZhIhwupLCCR6Wtwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_glucose_tolerance&usg=ALkJrhiDLMQvzza8Q04ZhIhwupLCCR6Wtwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_fasting_glycaemia&usg=ALkJrhgxQsq67v3ijESvTRnRUfjjg-HNVghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Family_history_(medicine)&usg=ALkJrhjFpg1dvEKPUunskeU5Pxk9KdnxBwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2&usg=ALkJrhgILZ7W3c8cGO3YPJ2HMnFOGPUBKAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/African-Americans&usg=ALkJrhhDEn9l4-T4NhAibqq4QXKrhIMAJghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/African-Americans&usg=ALkJrhhDEn9l4-T4NhAibqq4QXKrhIMAJghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Afro-Caribbeans&usg=ALkJrhhqRBYRa5dPeLyt469eEplhEIPX6ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Indigenous_peoples_of_the_Americas&usg=ALkJrhjepT8znrFK9NetZix2xDDNp1GOKwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hispanics&usg=ALkJrhjRbkq3suzeHMbUhykdm0pbWYKjaQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hispanics&usg=ALkJrhjRbkq3suzeHMbUhykdm0pbWYKjaQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pacific_Islanders&usg=ALkJrhj7tjmFt8cyowr9_wEGPTMFnPS02ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/South_Asia&usg=ALkJrhhSCkr-oKf0IvtIW4xkZsiy0WENYwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Overweight&usg=ALkJrhhLFjC2TXsWzafrZHsIqvonosKDAQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Obesity&usg=ALkJrhgkqKVz6VJmVYDgTv9KARMkpZhQNQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Smoking&usg=ALkJrhg1k5ro7IJFHpOklyWOhJDpgm284ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Polycystic_ovarian_syndrome&usg=ALkJrhiHViP5A0qBuM63clxfP3_m6RpNbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Polycystic_ovarian_syndrome&usg=ALkJrhiHViP5A0qBuM63clxfP3_m6RpNbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Short_stature&usg=ALkJrhhjGPzfSw3iURJzyj0NszWNxFm0uQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-smoking-9http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-controversial-10http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-short-11http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-obesity-8http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_glucose_tolerance&usg=ALkJrhiDLMQvzza8Q04ZhIhwupLCCR6Wtwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_glucose_tolerance&usg=ALkJrhiDLMQvzza8Q04ZhIhwupLCCR6Wtwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Impaired_fasting_glycaemia&usg=ALkJrhgxQsq67v3ijESvTRnRUfjjg-HNVghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Family_history_(medicine)&usg=ALkJrhjFpg1dvEKPUunskeU5Pxk9KdnxBwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2&usg=ALkJrhgILZ7W3c8cGO3YPJ2HMnFOGPUBKAhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/African-Americans&usg=ALkJrhhDEn9l4-T4NhAibqq4QXKrhIMAJghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/African-Americans&usg=ALkJrhhDEn9l4-T4NhAibqq4QXKrhIMAJghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Afro-Caribbeans&usg=ALkJrhhqRBYRa5dPeLyt469eEplhEIPX6ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Indigenous_peoples_of_the_Americas&usg=ALkJrhjepT8znrFK9NetZix2xDDNp1GOKwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Hispanics&usg=ALkJrhjRbkq3suzeHMbUhykdm0pbWYKjaQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Pacific_Islanders&usg=ALkJrhj7tjmFt8cyowr9_wEGPTMFnPS02ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/South_Asia&usg=ALkJrhhSCkr-oKf0IvtIW4xkZsiy0WENYwhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Overweight&usg=ALkJrhhLFjC2TXsWzafrZHsIqvonosKDAQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Obesity&usg=ALkJrhgkqKVz6VJmVYDgTv9KARMkpZhQNQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Smoking&usg=ALkJrhg1k5ro7IJFHpOklyWOhJDpgm284ghttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Polycystic_ovarian_syndrome&usg=ALkJrhiHViP5A0qBuM63clxfP3_m6RpNbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Polycystic_ovarian_syndrome&usg=ALkJrhiHViP5A0qBuM63clxfP3_m6RpNbQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Short_stature&usg=ALkJrhhjGPzfSw3iURJzyj0NszWNxFm0uQhttp://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-ACHOISreview-7http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-smoking-9http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-controversial-10http://translate.googleusercontent.com/translate_c?hl=id&prev=/search%3Fq%3Dwikipedia%2Bindonesia%2Bdiabetes%2Bgestasional%26hl%3Did%26prmd%3Dimvns&rurl=translate.google.co.id&sl=en&twu=1&u=http://en.wikipedia.org/wiki/Gestational_diabetes&usg=ALkJrhhHrEJkVs-3e44XgYv3XJt0G86FPw#cite_note-short-11


30/49

Namun sekitar 9$6$S 1anita dengan )'( tidak memiliki ?aktor risiko- karena

alasan ini banyak endaat untuk menskrining semua 1anita+ Biasanya 1anita dengan

diabetes gestasional tidak menunjukkan gejala 7asimtomatik se/ingga dijadikan alasan lain

untuk skrining universal- tetai beberaa 1anita mungkin menunjukkan eningkatan /aus -

eningkatan buang air ke4il- kelela/an- mual dan munta/- in?eksi kandung kemi/-

dan engli/atan kabur + M!8

II. 5. PATOFISIOLOGI

0?ek insulin ada utake glukosa dan metabolisme+

=!> Insulin berikatan dengan resetor ada membran sel yang ada ak/irnya mulai

mengaktivasi kaskade rotein =">+ Ini termasuk: translokasi )*UT9 transorter ke membran

lasma dan masuknya glukosa =8>- sintesis glikogen =9>-glikolisis = dan sintesis asam

lemak =6>+

(ekanisme yang mendasari gestational diabetes samai saat ini teta tidak

diketa/ui+ 3iri )'( adala/ meningkatnya resistensi insulin+ Eormon ke/amilan dan ?aktor

?aktor lain diangga insulin ole/ resetor insulin se/ingga teriikat ada resetor insulin+

Karena ?ungsi insulin mendorong masuknya glukosa ke dalam sel- dan damak dari resetor

insulin sala/ mengenali /ormon ke/amilan- terjadila/ resistensi insulin yang berdamak

ada tidak masuknya glukosa ke dalam selsel+ Akibatnya- glukosa teta berada dalam aliran

dara/- se/ingga kadar glukosa dara/ menjadi meningkat+ #e/ingga lebi/ banyak insulin

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76284506 Referat Jadi GDM Contoh