Deutsche medizinische Wochenschrift
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The quality of metabolic control at the beginning of pregnancy already determines the course and outcome of pregnanies with type 1 and type 2 diabetes mellitus. The preconceptional counseling and support provided by experienced teams is more important than modern technical equipment with insulin pumps and sensors for continuous glucose measurement. The incidence of congenital malformations is significantly reduced by a periconceptional HbA1c level < 6.5 % and folic acid supplementation started preconceptionally. ⋯ For the diagnosis of asymptomatic gestational diabetes mellitus, all women in Germany with 24 + 0 to 27 + 6 weeks of pregnancy are offered a two-stage screening. Structured follow-up care is required after gestational diabetes mellitus, because these women have an increased risk of developing type 2 diabetes mellitus and cardiovascular complications. Pregnant women with COVID-19 and hyperglycemia have an increased risk of a severe course of the infection, which is further increased by obesity - they are an important target group for vaccination with an mRNA vaccine.
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The COVID-19 pandemic has put triage on the political agenda. Disabled people feared being disadvantaged in the allocation of scarce intensive care resources. The German Federal Constitutional Court has agreed with them and obliged the legislature to regulate the triage. However, the new paragraph 5c of the Infection Protection Act (IfSG) raises more questions than it answers.
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Tachycardiomyopathy (TMP) is the development of heart failure due to a cardiac arrhythmia - triggered by rapid and/or irregular ventricular actions. TMP is in principle a (at least partially) reversible disease, so that control of the arrhythmia is of central importance. This article provides an overview of the causes, diagnosis and therapy.
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Polycystic ovary syndrome (PCOS) is diagnosed according to the Rotterdam criteria, where two of the following three criteria must be met: Anovulation, hyperandrogenism, and characteristic morphology by sonography. Women diagnosed with PCOS are at higher risk for diabetes and impaired glucose tolerance. ⋯ Some women benefit from metformin, which needs to be clarified by off-label use. For fertility, mild stimulation is possible in women with unovulatory cycles, whereas women with PCOS need to be monitored more closely for the development of gestational diabetes, preeclampsia or hypertension during pregnancy.