Gestational diabetes is not uncommon among pregnant women in Hainan. Many people like sweets, especially since Hainan is rich in fruits throughout the year, and there are many people who love to eat fruits. Many people also like to eat soup noodles and the like for breakfast, not knowing that for pregnant women with gestational diabetes, all these hobbies will cause more or less obstacles to controlling blood sugar. Zhang Xiulan, Department of Gynecology, Hainan Provincial Hospital Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance that occurs during pregnancy. It can be diagnosed by glucose tolerance test (OGTT) with oral 75g of glucose at 24 to 28 weeks of gestation or later. Gestational diabetes mellitus is a condition that needs to be managed in the obstetrics department of high-risk pathology in pregnancy because it can lead to a series of problems such as giant fetus, difficult shoulder delivery during labor, excessive amniotic fluid, immature neonatal lung development, neonatal hypoglycemia, and fetal malformation. And to manage GDM, we often say that we need five carriages in parallel. These five carriages are: dietary guidance, exercise guidance, medication, health education and self-testing. And one of them is the dietary guidance, which is the medical nutrition therapy (MNT) of GDM is a very important issue. The purpose of MNT treatment is to keep the blood glucose of pregnant women with diabetes in the normal range, to ensure a reasonable nutritional intake of the mother and fetus, and to reduce the occurrence of maternal and fetal complications. two randomized controlled trials (RCT) since 2005 provide strong evidence for the nutritional treatment and management of GDM (level I). Once diagnosed with GDM, patients are immediately instructed in medical nutrition therapy (MNT) and exercise, as well as education on how to perform glucose monitoring. After MNT and exercise instruction, monitoring fasting and 2 hours postprandial blood glucose, those who still have abnormal blood glucose should be admitted to hospital. Recommended nutritional intake (1) Total daily energy intake should be based on pre-pregnancy weight and the rate of weight gain during pregnancy, see Table 1. Table 1 Recommended daily energy intake for pregnant women (based on pre-pregnancy weight type) Energy factor Average energy Recommended weight gain during pregnancy Recommended weekly (Kcal/Kg ideal weight) (Kcal/d) (Kg) Weight gain (Kg) Low weight 33-38 2000-2300 12.5-18 0.51 (0. 14 to 0. 58) Ideal weight 30-35 1800-2100 11.5-16 0.42 (0. 35 to 0. 50) Overweight obesity 25-30 1500-1800 7-11.5 0.28 (0. 23 to 0. 33) Note: Early pregnancy Average weight gain: 0.5 to 2 Kg; middle and late pregnancy: average increase of about 200 Kcal/d on this basis. Although it is necessary to control the total daily energy intake of pregnant women with diabetes, excessive energy restriction (<1500 kcal in early pregnancy and <1800 kcal in late pregnancy) should be avoided, especially, insufficient carbohydrate intake may lead to the development of ketosis, which can have both maternal and fetal The adverse effects on both mother and fetus. < span=""> (2) The recommended carbohydrate intake should account for 00%-60% of the total energy, with no less than 150g of carbohydrate per day, which is more appropriate for maintaining normal blood glucose during pregnancy. Refined sugars such as sucrose should be avoided as much as possible. Low glycemic index foods can be preferred in the selection of equal carbohydrate foods. Monitoring the carbohydrate intake is a key strategy to achieve the blood glucose control standard. Grain and legumes are the main food, especially oatmeal, brown rice and whole wheat bread with high fiber content are recommended; fruits such as strawberry, pineapple and kiwi are better. Do not eat more: bananas, sugar cane, longan, grapes and other foods containing high sugar; green leafy vegetables are not restricted, avoid eating: table sugar, honey, chocolate, desserts and other double sugar, monosaccharide food. (3) Protein is recommended to account for 15% to 20% of total energy or 1.0 to 1.2g/kg body weight/d, which can meet the needs of maternal physiological regulation during pregnancy and fetal growth and development. Milk, dairy products, poultry eggs, fish and soy products are the best sources. (4) Fat recommended dietary fat percentage of total energy is 25% to 30%. However, animal fats, red meat, coconut milk and full-fat dairy products with high saturated fatty acid content should be appropriately limited, and the intake of saturated fatty acids should not exceed 7% of the total intake for diabetic patients. Monounsaturated fatty acid rich olive oil, camellia oil, corn oil, etc. should account for more than 1/3 of the fat energy supply. Reducing the intake of trans fatty acids can lower LDL cholesterol and increase HDL cholesterol, so pregnant women with diabetes should reduce the intake of trans fatty acids (B). (5) Dietary fiber is a polysaccharide that does not produce energy. Pectin in fruits, kelp, algae gum in nori, guanidine gum in certain legumes and konjac flour have the effect of controlling postprandial rise, improving glucose tolerance and lowering blood cholesterol. Recommended daily intake of 25g ~ 30g. Can be selected in the diet rich in dietary fiber oatmeal, buckwheat noodles and other coarse grains, as well as fresh vegetables, fruits, algae food. (6) supplementation of vitamins and minerals during pregnancy on the need for iron, folic acid, vitamin D doubled, calcium, phosphorus, thiamine, vitamin B6 increased by 33 to 50%, zinc, riboflavin increased by 20 to 25%, vitamin A, B12, C and energy, selenium, potassium, biotin, niacin increased by about 18%. Therefore, it is recommended that foods rich in vitamin B6, calcium, potassium, iron, zinc, and copper (such as lean meat, poultry, fish, shrimp and dairy products, fresh fruits and vegetables) be increased systematically during pregnancy. (7) Use of non-nutritive sweeteners: The ADA recommends that only FDA-approved non-nutritive sweeteners can be used by pregnant women and is moderately recommended, with very limited relevant research available (level of evidence: expert consensus). The five FDA-approved non-nutritive sweeteners are: potassium acetyl sulfamate, aspartame, neotame, edible saccharin and sucralose. Reasonable arrangement of meals Small and frequent meals and regular and quantitative meals are very important for blood sugar control. We found that many pregnant women have irregular life and cannot eat at a fixed time, which is a very troublesome problem. We should find ways to overcome it. The energy of breakfast, lunch and dinner should be controlled at 10-15%, 30% and 30%, and the energy of extra snack or fruit can be 5-10%. , which helps prevent excessive hunger before meals. Some pregnant women with more severe diabetes may require insulin therapy. The process of nutritional therapy is closely coordinated with insulin application. The type and dose of insulin to be applied, as well as the number of injections, should be adjusted only on the basis of a largely fixed diet. Those who apply insulin therapy need to pay attention to the prevention of hypoglycemia by adding appropriate meals before meals. Meal planning must be individualized, and reasonable meal arrangements and corresponding nutrition education should be carried out according to cultural background, lifestyle, economic conditions and education level. Diabetes diet education is a very important aspect and a difficult one in prenatal counseling and prenatal testing for high-risk pregnant women. I have met many pregnant women is very difficult to control the diet, especially some young people, just out of the door of the hospital, go to eat hot pot, spicy oil and spicy oil before good, control blood sugar to meet the standard is very difficult. Therefore, diet education is also a difficult point, which takes a lot of time and energy from doctors. This area also needs the cooperation of pregnant women, self-learning, self-control, and joint achievement of the standard. The risk of early miscarriage and fetal malformations is significantly increased in pregnant women with diabetes, and ideal glycemic control before and after pregnancy can significantly reduce this risk. the risk of type 1 or type 2 diabetes is comparable, but the degree of risk is difficult to quantify. relatively few preconception consultations are performed for type 2 diabetes. Spontaneous abortions and fetal malformations are less frequent when GhbAlc% is slightly higher before and during early pregnancy, and spontaneous abortions and fetal malformations are significantly higher with poor glycemic control. Diabetic patients who plan to get pregnant should try to control their blood glucose with GHbAlc%<6.5% (<7% if insulin is applied). GH-bAlc%<6.5% corresponding capillary blood glucose is probably <6.5mmol/L before meal and <8.5mmol>8% after meal is not recommended to get pregnant until blood glucose control is close to normal. Pregnant women’s blood glucose monitoring 1. Blood glucose monitoring method using micro glucose meter to determine capillary whole blood glucose level. Four times a day including fasting and 2h after three meals unprotected blood glucose monitoring; for those with poor or unstable blood glucose control and those who apply insulin therapy during pregnancy, seven times a day blood glucose monitoring before three meals, 2h after three meals and night time blood glucose; stable blood glucose control should be monitored by blood glucose profile test at least once a week, and the amount of insulin should be adjusted timely according to the results of blood glucose monitoring. It is not advocated to use continuous blood glucose detector as the means of clinical routine monitoring of blood glucose. 2. The goal of blood glucose control during pregnancy: fasting/preprandial blood glucose <5.3mmol/L (95mg/dl); 2 hours postprandial blood glucose <6.7mmol/L (120mg/dl); nighttime blood glucose not less than 3.3mmol/L (60mg/dl); glycated hemoglobin preferably <5.5% during pregnancy. In patients with pre-pregnancy type 1< span="">diabetes, blood glucose control should not be too strict in early pregnancy to prevent hypoglycemia. 3. HbAlc measurement: It reflects the average blood glucose level in the 2-3 months before blood sampling and can be used as a good indicator of long-term control of diabetes mellitus for the initial evaluation of CDM, and is recommended to be checked every 1 to 2 months during insulin therapy.