Today, I’d like to tell you the story of Xiao Zhang, a gestational diabetic patient who has now given birth to a healthy baby.
On Friday afternoon, Zhang’s mother came to the endocrine 2 ward on the 26th floor of DMD 2. She said that Zhang was crying at home, and I said what happened? I said, “I thought the delivery went well and the baby is fine. Zhang’s mother said, “Yes, the blood glucose was fine in the first few days after the baby was born, but now, two weeks after the birth, the blood glucose is high again, and Zhang told her mother at home that she would have diabetes for the rest of her life, so she cried because she was very sad. I said, “Auntie, don’t worry, let’s see what’s going on – the story has to start from 3 months ago, about 3 months ago, our obstetrician and gynecologist said that a good friend of hers was 7 months pregnant and her blood sugar was high, in fact, when she was 3 months pregnant, she found that her blood sugar was high, but she didn’t take it seriously at all. control a little. She is Xiao Zhang.
When she was admitted to the hospital, she had a fasting blood sugar of 13 mmol/L, which is a very high blood sugar even for non-pregnant people. Although she didn’t take gestational diabetes seriously before, she had a characteristic that she was particularly optimistic, unlike other pregnant women who were anxious every day and worried about their children, and she was always smiling and happy every time she visited the hospital. Since she was hospitalized, she has been very compliant after diabetes education, and has changed her habit of eating a lot of fruits and dried fruits, taking enough nutrition to ensure the growth and development of the fetus while controlling her calories. Her blood glucose had been completely reduced to the standard range of gestational diabetes by the time she was discharged. When she was leaving, she said, “Doctor, some gestational diabetics may not be able to lower their blood glucose to normal after having a baby, and then they will become real diabetics. I said, “If you control it well, you can stay away from diabetes, but you must not.
Later, I learned that she had a daughter and her blood sugar was normal, so I was really happy for her.
Why did Zhang’s mother say that she cried because her blood sugar rose again 2 weeks after delivery?
I said, “Auntie, aren’t all blood sugars good after having a baby?”
She said, “Yes, it’s only this week that it’s high, the first week after birth, the blood sugar is fine.”
I asked, “Then how about eating during this period?”
She said, “I’m eating the essentials to make sure the baby is breastfeeding.” “You’re not taking any other supplements, are you?” Zhang’s mother said, “No, I don’t take any health supplements, but I eat gum every day.”
”How long have you been taking it?”
”1 week, I think.”
”The gum is boiled with sugar during the production process, so this week’s blood sugar is higher than last week’s when I didn’t eat gum.
It dawned on Xiao Zhang’s mom!
Later, Xiao Zhang gave me feedback that after stopping the gum, her blood sugar really dropped to normal.
I told Zhang to wait until the baby was 1.5 to 2 months old and then go to the hospital for a glucose tolerance test to see if her blood sugar was really normal.
What does gestational diabetes mean? What does it mean to have diabetes in combination with pregnancy?
In late 2013, the latest U.S. guidelines recommended that pregnant women without prior diabetes should be fully screened for diabetes with fasting glucose (FPG), HbA1c, or random glucose at their first maternity visit. The diagnosis of overt diabetes is confirmed if FPG >7.0 mmol/L, random glucose >11.1 mmol/L, or HbA1c >6.5%; note that this refers to intravenous glucose. Overt diabetes mellitus is diabetes mellitus, or diabetes mellitus that was not detected before the pregnancy, and is called diabetes mellitus combined with pregnancy. In patients with overt diabetes, it is also necessary to confirm this by retesting at a later date in the absence of symptoms of hyperglycemia.
The guidelines emphasize that women without prior overt diabetes or gestational diabetes at 24 weeks of gestation need to be screened for gestational diabetes using the IADPSG criteria using the one-step method of a 75 g oral glucose tolerance test at least 8 hours after fasting at 24-28 weeks of gestation. Gestational diabetes is diagnosed if the fasting venous glucose is 5.1-6.9 mmol/L, the 1-hour glucose is >10 mmol/L, and the 2-hour glucose value is >8.5 mmol/L after sugar administration. The diagnosis of overt diabetes is confirmed if the glucose level is >11,1 mmol/L 2 hours after sugar administration.
The prevalence of gestational diabetes in the United States ranges from 1% to 25%, and women with gestational diabetes are not only at increased risk for pregnancy complications, but up to 60% of women with gestational diabetes will develop type 2 diabetes 5 to 15 years after delivery. Early diagnosis of gestational diabetes and good glycemic control can significantly reduce the risk of pregnancy complications. Therefore, the screening and treatment of GDM is of great importance. The U.S. Preventive Medicine Task Force aimed to review and evaluate the available clinical trial evidence to determine the risks and benefits of screening for GDM at two time points: before or after 24 weeks of gestation. The overall evidence suggests that screening and treatment of GDM after 24 weeks of gestation (usually 24-28 weeks) significantly reduces the risk of preeclampsia, macrosomia, and obstructed shoulder birth with minimal risk to mother and baby.
In addition, overweight or obese women should lose weight before pregnancy; women with gestational diabetes diagnosed during pregnancy should have active lifestyle interventions (medical nutrition and moderate exercise, etc.), and medication should be used when lifestyle interventions are not sufficient to control blood glucose; for patients diagnosed with gestational diabetes, such as the woman mentioned here, an oral glucose tolerance test should be performed 6 to 8 weeks after the birth of the child to rule out the presence of diabetes or prediabetes. For patients diagnosed with gestational diabetes, such as the one mentioned here, an oral glucose tolerance test should be performed 6-8 weeks after the birth of the child to rule out the presence of diabetes or prediabetes and to monitor the onset of diabetes regularly.
What are the risks of gestational diabetes to both mother and baby?
(1) High blood sugar can cause abnormal development or even death of the embryo, and the incidence of miscarriage is 15% to 30%.
(2) The possibility of gestational hypertensive disease is 2 to 4 times higher than that of non-diabetic pregnant women, and the complication of GDM with gestational hypertensive disease may be related to the presence of severe insulin resistance and hyperinsulinemia.
(3) Infection is a major complication of diabetes. Pregnant women who fail to control their blood sugar well are prone to infections, which can also aggravate the metabolic disorders of diabetes and even induce acute complications such as ketoacidosis.
(4) The incidence of excessive amniotic fluid is 10 times higher than that of non-diabetic pregnant women. The reason for this may be related to fetal hyperglycemia, hyperosmolar diuresis resulting in increased fetal urine excretion.
(5) The incidence of large babies is significantly higher, and the chance of obstructed labor, birth canal injury and surgical delivery is increased.
(6) Diabetic ketoacidosis is likely to occur. Due to the complex metabolic changes during pregnancy, coupled with hyperglycemia and relative or absolute insulin deficiency, the metabolic disorder further develops into accelerated lipolysis, a sharp increase in serum ketone bodies, and further develops into metabolic acidosis.
(7) GDM pregnant women again when pregnant, the recurrence rate is as high as 33% to 69%. The chance of developing diabetes in the long term increases, and 17% to 63% will develop into type 2 diabetes.
2, the impact on the fetus (1) the incidence of huge fetus up to 25% ~ 42%. The reason for this is the high blood sugar of the pregnant woman, the fetus is in the environment of hyperinsulinemia caused by maternal hyperglycemia for a long time. The promotion of protein and fat synthesis and inhibition of lipolysis lead to excessive trunk development.
(2) The incidence of fetal growth restriction (FGR) is 21%. Hyperglycemia in early gestation has an inhibitory effect on embryonic development, leading to a lag in embryonic development in early pregnancy.
(3) Prone to miscarriage and preterm delivery. The incidence of preterm birth is 10%-25%.
(4) The rate of fetal malformation is higher than that of non-diabetic pregnant women, and the incidence of serious malformation is 7 to 10 times that of normal pregnancy, which is closely related to the high blood sugar level in the first few weeks after conception, and is an important cause of perinatal death.
3. Effects on newborns (1) Increased incidence of neonatal respiratory distress syndrome.
(2) Neonatal hypoglycemia After the neonate leaves the maternal hyperglycemic environment, hyperinsulinemia still exists, and if the sugar is not replenished in time, hypoglycemia is likely to occur and endanger the life of the neonate in serious cases.