There are two types of diabetes during pregnancy. One type is when the pregnant mother had diabetes before she was pregnant with the baby or when the abnormal blood sugar is clear at the initial obstetric examination, which we call combined diabetes. The other type is diabetes that develops after pregnancy when the glucose metabolism was normal before the pregnancy, called gestational diabetes mellitus (GDM). GDM is detected by OGTT, which accounts for about 90% of pregnant mothers with diabetes, and we often refer to this group of pregnant mothers as “sugar mothers”. In 2015, the prevalence of GDM in Beijing was as high as 19.2%. So the following is written for sugar moms! I. Why is GDM easy to occur after pregnancy? In the middle and late pregnancy, the anti-insulin substances in pregnant mothers’ bodies increase, such as placental lactogen, tumor necrosis factor, estrogen, progesterone, etc., which make pregnant mothers less sensitive to insulin, so the insulin demand increases accordingly After a pregnant mother with impaired insulin secretion ingests a certain amount of glucose, the blood glucose concentration will rise sharply. And it cannot be restored to normal level in a short time like normal people. Many pregnant mothers have uncontrolled diet and wrong diet structure. Second, what are the manifestations of gestational diabetes? Typical manifestations are polydipsia, polyphagia, polyuria and recurrent vulvar and vaginal fungal infections. Pregnant mothers weighing >90kg, with excessive amniotic fluid in this pregnancy or a fetal baby significantly larger than the actual gestational week, should highly suspect the possibility of GDM. But the reality is that most sugar mothers do not show it obviously! What are the risks of GDM to pregnant mothers and fetal babies? Sugar mothers: during pregnancy: gestational hypertension disease, excessive amniotic fluid, ketoacidosis. During labor: difficult labor, birth canal injury, increased chance of surgical delivery. In the distant future: obesity, high blood pressure, hypertension, type 2 diabetes and cardiovascular disease risks are greatly increased. Fetal baby: during fetal period: giant baby, fetal growth restriction, fetal malformation, increased probability of preterm birth; after birth: higher risk of whistling distress syndrome, hypoglycemia, erythrocytosis, hyperbilirubinemia, etc.; in the distant future: increased risk of obesity, diabetes, hypertension, cardiovascular disease, etc. What is the ideal range of blood sugar control for sugar mothers? Glucose control standard during pregnancy Fasting and half an hour before meals: 3.3~5.3mmol/L 2 hours after meals and at night: 4.4~6.7mmol/L Note: This must be based on the pregnant mother’s lack of obvious hunger, normal blood sugar in exchange for hunger will make both mother and baby very dangerous! V. How can sugar mothers control their blood sugar? Preferred program: Individualized medical nutrition therapy (MNT) (jointly developed by obstetrician and nutritionist), many sugar mothers can control their blood glucose within satisfactory range through reasonable diet and proper exercise! Supplementary program: If the blood sugar control still does not reach the standard after 1 to 2 weeks of reasonable diet + appropriate exercise, insulin should be preferred for blood sugar control while continuing medical nutrition therapy (the program needs to be modified appropriately). At present, China has not officially approved any oral hypoglycemic drugs for the treatment of hyperglycemia during pregnancy, so sugar mothers should not blindly use the drugs. When it is really necessary to use oral hypoglycemic drugs, they should be guided by doctors and used with caution. Let’s discuss in detail the specific practice of reasonable diet and proper exercise! The objectives of individualized medical nutrition therapy (MNT) are 1) to maintain the reasonable weight gain of pregnant mothers; 2) to ensure the nutritional needs of pregnant mothers and the growth and development of fetal babies; 3) to keep the blood glucose stable and free from hypoglycemia, hyperglycemia and ketosis; 4) to cooperate with clinical treatment to prevent and treat various complications of diabetes. VII. Pregnancy weight gain recommendations for different pre-pregnancy BMI Pregnancy weight gain recommendations for twin pregnancies: Normal pre-pregnancy weight (16.7-24.3kg) Overweight pre-pregnancy (13.9-22.5kg) Obese pre-pregnancy (11.3-18.9kg) Note: Body mass index BMI = weight (kg)/height (m) 2 VIII. The pre-pregnancy body mass index (BMI) determines the total daily intake of Energy BMI < 18.5: 35 ~ 40 kcal/kg. day BMI 18.5 ~ 24.9: 30 ~ 35 kcal/kg. day BMI 25 ~ 27.9: 25 ~ 30 kcal/kg. day BMI ≧ 28: 70% of pre-pregnancy, a minimum of 1600 ~ 1800 kcal/day The proportion of energy intake per day: Carbohydrate: 50% ~ 60% Protein: 12 ~ 20% Fat: 35% to 40% Note: specific data individual differences, should be developed by a doctor or dietitian! Nine, a reasonable diet recommended consumption: 1, staple food: coarse and fine, three meals must be eaten, seven minutes full can be, not less than three two / day. Because of the starch content of sweet potatoes, potatoes and other vegetables, classified as staple foods, about two to three such foods = half two staple foods. 2, vegetables: 1-1.5 kg / day breakfast 3 two noon "3-2-1 principle": 3 two leafy vegetables, 2 two melon vegetables, 1 two mushrooms and algae dinner content can refer to lunch 3, protein: 1 ~ 3 two lean meat / day recommended ranking: rabbit > fish and shrimp > skinless chicken, duck and goose > beef and lamb > pork > ribs > ham boiled egg 1 / day or egg whites 2 skim / low-fat milk 1 cup or soy milk a cup or yogurt a small cup tofu 1 ~ 2 two / day (not fried tofu bubbles) 4, fruit: four two / day, about the size of a fist 5, condiments: oil 25g (such as eating a small handful of nuts to go a spoonful of oil) salt < 6g (fried vegetables last salt, forbidden salted vegetables, pickled products) 10, three meals three points to eat (eat less and more meals) can reduce the risk of hypoglycemia and ketosis! Meal energy ratio 08:00 breakfast 10~15% 10:00 plus point 5~10% 12:00 lunch 20~30% 15:00 plus point 5~10% 18:00 dinner 20~30% 21:00 late point 5~10