Gestational diabetes mellitus is a common comorbidity during pregnancy, referring to abnormal glucose metabolism during pregnancy or with underlying hypoglycemic tolerance, and diabetes mellitus that appears or is detected only during pregnancy, with an incidence of 1%-5% in China and a significant increasing trend in recent years.
I. High-risk factors for the occurrence of gestational diabetes
Current studies have shown that age, race, obesity, family history of diabetes and poor reproductive history are the main factors affecting the development of gestational diabetes.
1. Advanced pregnancy is currently recognized as the main risk factor for gestational diabetes mellitus. The risk of gestational diabetes in pregnant women aged 40 years and older is eight times higher than that of pregnant women aged 20 to 30 years. In addition maternal age factor in addition to affecting the occurrence of diabetes, the older the age, the smaller the gestational week of pregnant women diagnosed with gestational diabetes.
2, race: similar to the relationship between type 2 diabetes and race in adults, gestational diabetes has a clear geographical and racial correlation. Our country has a higher incidence of gestational diabetes than compared to European ethnic groups. Race factors in addition to genetic factors, can not except the role of economic and cultural, dietary habits and other factors in it.
3, obesity: is an important risk factor for the occurrence of hypoglycemic tolerance and diabetes. The risk of gestational diabetes in pregnant women with BMI ≥ 20.9 is twice that of those with BMI ≤ 19.1.
4. Family history of diabetes and poor obstetric history: family history of diabetes is a risk factor for gestational diabetes, and the risk of gestational diabetes in those with a family history of diabetes is 1.55 times higher than that in those without a family history of diabetes, and 2.89 times higher in those with a family history of diabetes in first-degree relatives.
Second, the adverse effects of gestational diabetes on mother and child
GDM can cause adverse pregnancy outcomes such as gestational hypertension, excessive amniotic fluid, postpartum hemorrhage, preterm delivery, giant babies and stillbirths, the extent of which depends on the condition of diabetes and glycemic control.
Risks to pregnant women
1. Increased rate of spontaneous abortion, especially when blood sugar is high in early pregnancy.
2. Hypertensive disease in pregnancy: Pregnant women with diabetes are prone to combined hypertension and pre-eclampsia, especially in those with long duration of diabetes combined with microangiopathy, or diabetes combined with nephropathy.
3, preterm delivery: the occurrence of preterm delivery in pregnant women with gestational diabetes is significantly higher than in normal pregnant women, excessive amniotic fluid is one of the reasons, while the proportion of preterm delivery of medical origin is also higher.
4, Infection: Pregnant women with diabetes combined with pregnancy have reduced resistance and are prone to the risk of infection, especially asymptomatic bacteriuria and urinary tract infections such as pyelonephritis.
5, excessive amniotic fluid: the proportion of pregnant women with unsatisfactory blood sugar control with excessive amniotic fluid is up to 17%, mainly related to fetal malformation, increased placental area, osmotic diuresis caused by fetal hyperglycemia, and giant babies.
6, various complications during labor: including prolonged labor, weak contractions, postpartum hemorrhage, etc.
Risks to the fetus (newborn)
While the blood sugar of pregnant women increases, the excess sugar can easily reach the fetus through the placenta, causing the fetus to develop hyperglycemia. Once the fetus’ blood sugar is elevated, its pancreas will secrete more insulin to metabolize the excess glucose. The excess blood sugar and insulin in the fetus’ blood will cause it to produce more fat and protein and increase its weight to become a giant baby. The main effects of gestational diabetes on the fetus are as follows:
1, can make the fetal mortality rate increase: research has concluded that the increase in fetal mortality is mainly related to the increase in blood sugar levels of pregnant women. If gestational diabetes patients can strictly control blood sugar and strengthen the monitoring of the fetus in the late pregnancy, it can reduce the fetal mortality.
2, can form a huge fetus: gestational diabetes mostly occurs in the middle and late stages of pregnancy, when the fetal organs have been formed, so the main impact on the fetus is that it can lead to excessive development, thus forming a huge fetus.
3, can lead to fetal malformations: gestational diabetes patients are prone to fetal malformations of the nervous system and cardiovascular system, such as spina bifida, hydrocephalus, congenital anal atresia, etc.
4, can lead to neonatal jaundice: the occurrence of diabetes in pregnant women can lead to fetal hypoxia in utero and increase the erythropoietin in the fetus, causing erythrocytosis. Newborns with erythropoiesis are prone to neonatal jaundice because of the destruction of a large number of red blood cells in their bodies.
5, can lead to neonatal respiratory distress syndrome: infants born to patients with gestational diabetes are six times more likely to suffer from neonatal respiratory distress syndrome than infants born to non-diabetic pregnant women. The occurrence of this syndrome is closely related to the failure of gestational diabetes patients to control blood sugar well, resulting in fetal hyperglycemia.
6, can lead to neonatal hypoglycemia: fetuses conceived by patients with gestational diabetes are prone to the formation of hyperinsulinemia, a condition that can cause hypoglycemia in newborns.
Long-term effects on mother and child
The long-term effects of gestational diabetes on pregnant women include: about 50%-70% of pregnant women convert to type 2 diabetes, and the risk of gestational diabetes in pregnant women with gestational diabetes in another pregnancy is about 60%. The long-term effects on the newborn include obesity and a tendency to develop diabetes, as well as neuropsychiatric developmental problems.
Therefore, early glycemic control is beneficial for maternal and infant outcomes. Pregnant women with high-risk factors should be screened as early as possible, and through dietary guidance, weight management and exercise during pregnancy, blood glucose control should be stabilized throughout pregnancy to reduce the occurrence of maternal and infant complications.