Gestational diabetes is a specific type of diabetes mellitus and a common obstetric condition. Gestational diabetes can be harmful to both mother and child and requires intensive life care and strict blood glucose control to avoid the progression of the disease.
Symptoms of gestational diabetes
Pregnant women with gestational diabetes usually have no obvious symptoms and are usually detected as hyperglycemic during pregnancy screenings. If symptoms appear, the most obvious ones are “three more and one less”, i.e. eating more, drinking more and urinating more, but losing weight, sometimes accompanied by vomiting. The vomiting reaction is different from that of pregnancy, but it is often severe and even causes electrolyte disturbance in severe cases.
In addition, another common manifestation of gestational diabetes is fatigue, which is due to the rapid breakdown of glucose in the body, which cannot be well utilized and physical energy cannot be adequately replenished. At the same time, the accelerated glucose catabolism leads to a significant increase in the level of glucose in blood and urine, which makes it easy to develop fungal infections, such as recurrent vulvovaginal pseudofilamentous yeast infections.
Diagnosis of gestational diabetes mellitus
According to the 2014 guidelines for the diagnosis and treatment of gestational diabetes mellitus, the diagnosis is as follows.
1, If the patient had diabetes before pregnancy, the diagnosis of combined diabetes mellitus can be confirmed directly.
2. Diagnosis of gestational diabetes mellitus.
(1) Fasting plasma glucose value ≥ 7.0 mmol/L.
(2) 75g oral glucose tolerance test 2 hours blood glucose ≥ 11.1mmo/L.
(3) With typical hyperglycemic symptoms or hyperglycemic crisis, along with random blood glucose ≥ 11.1mmol/L.
(4) glycated hemoglobin ≥ 6.5%.
3. Diagnosis of gestational diabetes mellitus.
(1) fasting plasma glucose value of 5.1 to <7.0 mmol/L.
(2) 75g oral glucose tolerance test for 1 hour >10.0mmo/L.
(3) 75g oral glucose tolerance test for 2 hours >8.5 to 11.1mmo/L.
The dangers of gestational diabetes
(1) hyperglycemia during pregnancy has a higher risk of pre-eclampsia and cesarean delivery, can cause abnormal embryonic development or even death, and the incidence of miscarriage is 15-30%.
2, the possibility of hypertensive disease in pregnancy is 2-4 times higher than that of non-diabetic pregnant women.
3, the incidence of excessive amniotic fluid is 10 times higher than that of non-diabetic pregnant women.
4. significantly higher incidence of huge babies, higher incidence of obstructed labor, birth canal injury, surgical delivery, and prolonged labor and postpartum hemorrhage.
5, prone to diabetic ketoacidosis and infection. If women with gestational diabetes are not managed with timely and effective treatment, they are at increased risk of developing type 2 diabetes in the future.
Gestational diabetes glycemic control goals
Blood glucose in gestational diabetes should be controlled to ≤5.3 and 6.7mmol/L before and 2h after meal respectively; nighttime blood glucose should not be less than 3.3mmol/L; preprandial and nighttime blood glucose should be controlled to 3.3 and 5.6mmol/L during pregnancy, and peak blood glucose 5.6-7.1mmol/L after meal.
Blood glucose monitoring is required during pregnancy, and pregnant women are recommended to use micro glucose meter to determine capillary whole blood glucose level by themselves. Blood glucose should be monitored seven times a day during pregnancy, including 30min before three meals, 2h after three meals and nighttime blood glucose.
How to control blood glucose during pregnancy
1.Control the intake
Sufficient energy intake should be ensured during pregnancy, but foods with low glycemic index should be preferred, and foods with high saturated fatty acid content, such as animal fats, red meat, coconut milk and full-fat dairy products, should be appropriately restricted. The diet can be rich in dietary fiber oatmeal, buckwheat noodles and other coarse grains, as well as fresh vegetables, fruits, algae food, etc..
In addition, there should be a planned increase in foods rich in vitamin B, calcium, potassium, iron, zinc and copper, such as lean meat, poultry, fish, shrimp, dairy products, fresh fruits and vegetables, etc.
2.Exercise therapy
Exercise can effectively reduce insulin resistance. It is recommended that moderate intensity exercise, such as walking, be performed after 30 min of each meal, starting from 10 min and gradually extending to 30 min, which can be interspersed with necessary intervals, and the frequency of exercise can be maintained at 3-4 times a week.
If abdominal pain, vaginal bleeding or watering, breath-holding, dizziness, severe headache, chest pain, muscle weakness, etc. occur during exercise, seek medical attention. Also, avoid exercising early in the morning before injecting insulin on an empty stomach.
3.Insulin therapy
If monitoring results show that general measures fail to control blood glucose levels, or if there are complications of excessive fetal growth, then it is necessary to use insulin therapy under the guidance of a doctor.
Prognosis of gestational diabetes
Most glucose metabolism in gestational diabetes returns to normal after delivery, but there is an increased chance of developing type 2 diabetes in the future. Therefore, if you have had diabetes during pregnancy, even if your blood sugar has returned to normal, you should pay attention to controlling your diet and exercise, otherwise you are still at risk of developing diabetes after a certain period of time.
Patients with gestational diabetes have a much higher risk of complications such as eclampsia compared to normal pregnant women, while the fetus is prone to difficult delivery. Therefore, to ensure the safety of mother and child, blood glucose needs to be controlled during pregnancy, and levels can be regulated to a certain range by controlling intake, exercise and insulin injections to avoid complications.
References
[1]Donovan, Peter J; McIntyre, H David. Drugs for gestational diabetes. Australian Prescriber. 2010, 33: 141-4.
[2]Martinez-Frias, M. L.; Frias, J. P.; Bermejo, E.; Rodriguez-Pinilla, E.; Prieto, L.; Frias, J. L. Pre-gestational maternal body mass index predicts an increased risk of congenital malformations in infants of mothers with gestational diabetes. Diabetic Medicine. 2005, 22 (6): 775-781.
[3] Yang, Hui-Xia. Guidelines for the diagnosis and treatment of combined gestational diabetes mellitus (2014)[J]. Chinese Journal of Obstetrics and Gynecology,2014, 8(8):489-498.