Today, let’s get to know “gestational diabetes”.
1. What is gestational diabetes mellitus?
Gestational diabetes is an increase in blood glucose caused by abnormal glucose metabolism that occurs during pregnancy or is first detected during pregnancy.
Among the patients with diabetes found during pregnancy, 90% of them have glucose metabolism disorders due to pregnancy, and about 8% of them have type 2 diabetes that was only discovered during pregnancy, which is a pre-pregnancy diagnosis. The term gestational diabetes is generally used to refer to diabetes that occurs as a result of pregnancy.
2. What are the metabolic changes that occur in the fetus during gestational diabetes?
Fluctuating hyperglycemia in the mother and fetus can cause hyperinsulinemia in the fetus. With hyperinsulinemia, the fetus will store too many nutrients, resulting in a “giant baby”. ［A giant baby is a newborn weighing ≥4000 grams at birth.]
In addition, excess glucose is converted to fat, and the conversion process generates energy consumption, which leads to an increase in fetal oxygen consumption, and can easily cause fetal hypoxia.
In 5-10% of newborns born to diabetic mothers, erythrocytosis (erythrocyte pressure >65%) occurs, resulting in increased intravascular viscosity, poor circulation, and hyperbilirubinemia in the newborn.
3. How is gestational diabetes diagnosed?
All pregnant women need to be screened for gestational diabetes. The decision of when to screen is based on an assessment of risk factors. Pregnant women without high risk factors are usually screened at 24 to 28 weeks of gestation.
4. What are the possible adverse effects of gestational diabetes on the mother?
In addition to disorders of glucose metabolism, gestational diabetes is likely to cause the following problems for the mother.
1, hypertension and pre-eclampsia
2. increased chance of cesarean section
3. Postpartum diabetes: Patients with gestational diabetes are prone to develop gestational diabetes again when they become pregnant again. The likelihood of developing type 2 diabetes is also greater with increasing age.
5. What are the possible adverse effects of gestational diabetes on the fetus?
If the mother’s gestational diabetes is poorly controlled or left unattended, it may have adverse effects on the fetus.
1. Huge babies: Newborns weighing ≥ 4000 grams at birth are called huge babies. Fluctuating hyperglycemia in the mother and fetus can cause hyperinsulinemia in the fetus. Under the effect of hyperinsulinemia, the fetus will have excessive storage of nutrients, resulting in a “giant baby”.
2, shoulder birth injury: huge babies are prone to birth injury during natural delivery
3.Increased chance of cesarean section: oversized fetus is the main reason
4.Premature birth
5.Neonatal hypoglycemia: hypoglycemia occurs after leaving the mother’s body due to the effect of high insulin
6.Respiratory distress after birth
7.Likely to develop obesity and type 2 diabetes during later growth
6.How to treat after diagnosis of gestational diabetes?
Medical nutrition therapy (diet therapy)
The goal of dietary therapy is to meet the energy needs of the pregnant woman and the fetus while strictly limiting the intake of carbohydrates, maintaining blood glucose in the normal range, and not to develop starvation ketosis. Avoid single large intakes of diets with a high proportion of simple carbohydrates.
Total daily calories during pregnancy: about 1700-2200 kcal (varies according to the height and basic weight of pregnant women), of which 45%-55% are carbohydrates, 20%-25% are proteins, and 25%-30% are fats.
It is recommended to divide the diet into 6 meals per day, including 3 main meals and 3 intermittent meals, which has the advantage of controlling the amount of energy intake at any given time in the blood flow. The diet should include complex carbohydrates and fiber, such as whole grain bread, coarse grains, etc.
Nutritional therapy should be monitored by a professional dietitian. Restricting energy intake by about 30% in obese women (body mass index > 30 kg/m2) can significantly improve hyperglycemia and high triglycerides.
(1) Mild exercise therapy
Regular and appropriate exercise can maintain health during pregnancy and after delivery. Exercise can help glucose to be better utilized and bring down blood sugar. Exercise can also increase the sensitivity of tissues to insulin and reduce insulin resistance.
You can take your doctor’s advice and choose gentler exercises according to your situation. Walking, housework, gardening, swimming, etc. are all options during pregnancy. The premise is to ensure the safety of exercise.
(2) Insulin therapy
In gestational diabetes, insulin therapy is required when diet and proper exercise are not able to control blood sugar. The appropriate insulin preparation is selected according to the patient’s blood glucose profile. The effectiveness and safety of insulin have made it the standard treatment for diabetes during pregnancy.
The goal of insulin therapy during pregnancy is to bring the patient’s blood glucose profile as close as possible to that of a non-diabetic pregnant woman. Postprandial glucose control in healthy pregnant women is in a relatively narrow range (3.9-6.7 mmol/L), and the ability to achieve the desired results requires the cooperation of both the pregnant woman and her physician.
In China, insulin during pregnancy is currently based on genetically synthesized human insulin, and according to the patient’s glycemic profile, regular insulin, intermediate-acting insulin, or direct application of premixed insulin regimens are chosen. In recent years, insulin analogues have also become widely used in general diabetic patients. Clinical studies on the use of lysergic insulin, menthol insulin, and detergent insulin in pregnant women in foreign countries have shown that these analogues are safe and effective for use during pregnancy. Clinical studies of glargine insulin in pregnant women are less frequent, considering its long-acting characteristics, which may aggravate maternal hypoglycemia.
(3) Other drug treatments
Although it is unknown whether there are long-term side effects, the oral drugs gliphenylurea and metformin are beginning to be used abroad for the treatment of gestational diabetes. Although both drugs can pass through the placenta, current clinical trials have shown that these drugs are effective when applied during pregnancy and have no adverse effects on the fetus.
7.Does diabetes disappear after delivery?
In most patients, gestational diabetes disappears after delivery of the fetus. However, about one-third of patients with gestational diabetes will remain diabetic or have abnormal glucose tolerance after delivery.
To determine if diabetes is still present after delivery, an oral glucose tolerance test is needed to reassess 6-12 weeks after delivery.
Gestational diabetes is a high risk factor for type 2 diabetes, and even if blood glucose returns to normal after delivery, it is still recommended that women with gestational diabetes have their blood glucose tested at least once every three years.