Gestational diabetes is defined as diabetes that is detected or occurs during pregnancy. Most people with gestational diabetes recover after delivery, but have an increased chance of developing diabetes in the future.
Diabetes affects pregnant women in the following ways.
1. Spontaneous abortion. If the pregnancy has diabetes before pregnancy and blood sugar is not controlled normally, it can make the embryo malformation, death, miscarriage.
2, hypertension disease. For normal pregnant women 3-5 times, once it occurs, the mother and child complications, poor prognosis.
3.Infection. Diabetic patients with reduced resistance, easy to combine bacterial or fungal infections, the chance of pyelonephritis is 5 times higher than normal.
4. Excessive amniotic fluid. It is related to fetal hyperglycemia and is prone to premature rupture of membranes, preterm labor and postpartum hemorrhage.
5.Giant fetus. The incidence is 25-40%. It may lead to obstructed labor and birth injury.
6.Ketoacidosis. If it occurs, it will easily lead to maternal and fetal death.
The effect of diabetes on the perinatal baby.
1, maternal hyperglycemia itself can reduce the placenta to the fetal blood oxygen supply, resulting in fetal hypoxia, and in serious cases, fetal death occurs in the uterus.
2, fetal malformation. The fetal malformation is significantly higher when the gestation is combined with dominant diabetes, reaching 4-12.9%, which is about 7-10 times of normal pregnancy. The most common malformations are cardiovascular and neurological malformations.
3, newborns are prone to respiratory distress syndrome, hypoglycemia, low calcium, low magnesium and heart disease.
Pregnant women with gestational diabetes usually have no conscious symptoms and may have normal fasting glucose. To avoid underdiagnosis, the International Conference on Gestational Diabetes recommends that all pregnant women should have a 50-glucose screening test and then a 75-glucose tolerance test (OGTT) for abnormalities in order to diagnose gestational diabetes patients early.
Glucose screening test: Dissolve 50 g of glucose in 200 ml of water during 24-28 weeks of pregnancy, drink it in 5 minutes, and draw venous blood to check blood glucose in 1 hour, blood glucose value ≥7.2 mmol/L is considered abnormal for glucose screening, and further OGTT should be performed.
Glucose tolerance test: check fasting blood sugar after 8-14 hours of fasting, then dissolve 75 grams of glucose in 400 ml of water, finish it within 5 minutes, and draw venous blood for blood sugar check in 1 or 2 hours from the time of starting to take sugar water, and the results are fasting blood sugar lower than 5. 1mmol/L, 1 hour after meal lower than 10.0mmol/L, 2 hours after meal blood sugar lower than 8.5mmol/L as Normal. If more than one of the three results is abnormal, gestational diabetes can be diagnosed.
Women with overt diabetes mellitus should have a comprehensive physical examination before pregnancy, and should consult with endocrinologists and obstetricians to see if they can get pregnant and choose the timing of pregnancy.
Treatment of gestational diabetes
1. Diet control
80% of gestational diabetes patients can maintain normal blood glucose by diet control only. The main food should be small and multiple meals, divided into 5-6 meals per day, and the amount of breakfast should be small.
2.Insulin therapy
Pregnant women with gestational diabetes need to monitor blood sugar regularly, and if blood sugar is still not normal after strict dietary control, insulin treatment should be added in time.
3.Monitoring of pregnant women
In addition to general prenatal checkups, pregnant women need to have renal function monitoring, fundus examination, blood pressure monitoring and ultrasound to observe changes in the height of the uterine fundus to detect huge fetus or excessive amniotic fluid in time.
4.Fetal monitoring
Ultrasound examination should be performed during 18-20 weeks of pregnancy to check the gestational age and exclude fatal fetal malformation. Ultrasound should also be performed to detect congenital heart disease in time. Placental function measurement, fetal heart monitoring, and umbilical artery flow measurement should also be performed. Amniocentesis should be performed to understand the maturity of fetal lung and to promote fetal lung maturation.
If the glucose control is good and there is no comorbidity, and the fetus is normal in utero, the pregnancy can be terminated near the expected date of delivery; if the glucose control has been unsatisfactory and combined with hypertension, vascular disease and placental dysfunction, the pregnancy should be terminated in time. In general, the cesarean delivery rate of pregnant women with diabetes is more than 50%.
6. Neonatal treatment
All newborns should be treated as preterm babies, pay attention to warmth and oxygen, feed sugar water early, breastfeed early, monitor blood sugar changes, and check whether the newborns have any deformities.
7.Postpartum follow-up
Therefore, fasting glucose should be checked within 1 week after delivery to determine whether insulin treatment is needed, and OGTT should be rechecked every 2 months after delivery.