I. What is gestational diabetes?
Gestational diabetes occurs during pregnancy when there is no diabetes before pregnancy.
Why do pregnant women get gestational diabetes?
After pregnancy, the body undergoes great changes, such as changes in hormones and cytokines, as well as changes in sugar and lipid metabolism. These changes can lead to increased insulin resistance in the pregnant woman’s body, and consequently, blood sugar cannot be used properly, resulting in a continuous increase in blood sugar levels, which eventually leads to the development of gestational diabetes.
What tests should be done to confirm the presence of gestational diabetes?
After 24 weeks of gestation, 75g oral glucose test (75g OGTT) should be performed: Firstly, fasting blood glucose should be measured in the morning of the test day (no later than 9:00 a.m.), and then 75g of glucose (50% glucose solution 20ml X 7½ sticks, dissolved in 150ml warm water) should be taken orally and finished within 5 minutes. Test the blood sugar 1 hour and 2 hours after taking glucose (timing from the first sip of glucose solution). Diagnostic criteria of gestational diabetes: the diagnostic threshold of fasting, 1h and 2h blood glucose are 5.1, 10.0 and 8.5mmol/L respectively. Any 1 of the 3 blood glucose monitoring results reaching or exceeding the above criteria can be diagnosed as gestational diabetes.
Matters to note when doing glucose test (OGTT)
1. Definition of fasting glucose: fasting for 8 to 12 hours. In other words, you should not eat anything except water for at least 8 to 12 hours.
2.Pregnant women need to fast, smoke and sit still during the test. Avoid excessive activities that may cause the blood glucose level to drop and affect the accuracy of the test results.
V. Hazards of gestational diabetes
1.Harm to pregnant women.
(1) Hypertensive disorders during pregnancy.
(2) Excessive amniotic fluid.
(3) Premature delivery.
(4) infection.
(5) l ketoacidosis.
2. The effects of gestational diabetes on the fetus.
(1) Fetal malformation
The effects of elevated blood glucose on the fetus are different in different stages of pregnancy. The incidence of serious malformations is 7-10 times that of normal pregnancy. Because of the high blood sugar of pregnant women, the extra glucose enters the fetus through the placenta, making the fetus overdeveloped and the birth weight ≥ 4000g.
(2) Neonatal hypoglycemia
After birth, separated from the maternal source of blood sugar, the newborn is prone to hypoglycemia.
(3) Respiratory distress syndrome
Excessive fetal insulin affects the development of fetal lungs. If the baby is born prematurely, it is more prone to respiratory distress, i.e. dyspnea, which worsens progressively.
(4) Neonatal jaundice
Babies delivered by mothers with gestational diabetes are prone to neonatal jaundice, which gradually worsens because the newborn’s liver does not function well and cannot clear bilirubin in a timely manner.
3. Long-term effects of gestational diabetes mellitus
If a pregnant woman with gestational diabetes has poor blood sugar control during pregnancy, her next generation has a high risk of developing obesity and type 2 diabetes in childhood and adulthood, and the age of onset of type 2 diabetes in adulthood is early. One third of pregnant women with gestational diabetes become type 2 diabetic as they get older.
Dietary treatment of gestational diabetes
A rationalized diet is the key to dietary treatment. Dietitians calculate the actual energy needs of individuals based on parameters such as height and weight of pregnant women and personalize the diet for patients. Most patients can achieve blood glucose control through diet control alone.
The principles of medical nutrition therapy for patients with gestational diabetes are as follows.
1.Control of total energy and establishment of a reasonable diet structure.
2.Balanced nutrition and reasonable control of the ratio of carbohydrate, protein and fat.
3, small and frequent meals.
4, high-fiber diet.
5, light diet, low fat and less oil.
6, reasonable control of maternal and fetal weight gain.
Seven, pregnant women with diabetes should pay attention to the rules of food consumption
1.Foods that can be eaten without restriction
(1) Vegetables can be eaten freely, except for those containing starch. (Starchy vegetables include: potatoes, pumpkins, sweet potatoes, etc.) These foods have fish contain a lot of carbohydrates, the amount of consumption needs to be controlled.)
(2) Purified water, mineral water, unsweetened chrysanthemum tea, unsweetened barley tea.
(3) condiments: mint, vinegar, soy sauce, pepper, etc. (all condiments except sweet sauce can be consumed). Ketchup can be consumed at most 2 spoons per day.
2.Foods that need to be consumed in controlled amounts
(1) Rice and its substitutes: rice, white noodles, rice crackers.
(2) Fiber can slow down the rate of glucose absorption into the blood, which can help control blood sugar, so you can choose rice substitutes containing fiber to help better control blood sugar, such as: coarse grains, whole wheat bread, whole wheat cookies, etc.
(3) Starchy foods: potatoes, sweet potatoes, pumpkin, carrots, lotus root, water chestnuts, etc.
(4) Legumes: red beans, green beans, etc.
(5) Fruits: The consumption of fruits needs to be controlled. Durian, lychee, bananas, etc. because they contain more sugar or fat, try not to eat.
(6) Dairy: skim or low-fat milk, sugar-free yogurt.
3.Reduce fat intake
(1) Minimize cooking with cooking oil, mayonnaise, salad dressing.
(2) reduce the consumption of nuts such as cashews, peanuts, etc.
(3) Do not ingest cream, coconut milk and food made from coconut milk.
(4) Do not ingest fried and greasy foods such as fried spring rolls, French fries, cream cakes, etc.
4.Avoid high sugar food
(1) jams, honey, syrup, chocolate sauce.
(2) all kinds of drinks, flavored milk such as chocolate milk, strawberry milk, fruit juice, sweet wine, etc.
(3) Sweets and snacks: cakes, chocolates, sweet cookies, jellies, ice creams, candies, etc.
(4) Canned fruits, dried fruits.
VIII. Exercise therapy for gestational diabetes
Exercise can make glucose enter muscle and fat tissue, increase insulin response, enhance intracellular glucose metabolism, and help control blood sugar. In the absence of obstetric or medical contraindications, patients should engage in moderate activity. The principle of exercise is preferable to not cause fetal distress or uterine contractions. Keep the heart rate within 120 beats/min during exercise and prohibit vigorous activity. If you talk freely and breathe smoothly during exercise, that is, the amount of exercise is appropriate; if you struggle to talk, wheeze or cough during exercise, you need to reduce the amount of exercise or stop exercising; if you feel too tired, weak, dizzy or particularly hot during exercise, you should stop exercising immediately.
Walking is currently recommended and acceptable to pregnant women as the most common and safest method during pregnancy, with a daily exercise duration of 20 minutes of walking.
IX. Pharmacological treatment of gestational diabetes
When the fasting blood glucose is >5.8mmol/L, or the blood glucose is not satisfactorily controlled after 1~2 weeks of diet therapy, and the urinary ketone body persistently appears or cannot be controlled by combined exercise therapy, additional medication is needed to control the blood glucose. Insulin is the most commonly used medication during pregnancy.
X. Self-monitoring of blood glucose
Self-monitoring can not only effectively control blood glucose but also prevent hypoglycemia, which is an important monitoring method in the treatment of gestational diabetes. It is recommended to use the seven-point method at the beginning (0.5 hours before three meals, two hours after three meals and seven times at night before bedtime). The ideal blood glucose control level is 3.3~5.6mmol/L for fasting, 4.4~7.8mmol/L for 1h after meal and 4.4~6.7mmol/L for 2h after meal. The frequency of monitoring can be reduced to 4 times a day when the blood glucose reaches the standard and is stable.
Note: When dizziness and dizziness occur, hypoglycemia should be considered, and blood glucose should be measured immediately and treated early.