原创协和小周 Gestational diabetes mellitus (GDM) is an abnormality of glucose tolerance of varying degrees that occurs or is first detected during pregnancy, and accounts for 80% to 90% of patients with gestational diabetes mellitus. Pregnant women with GDM who have poor glycemic control can have many adverse effects on themselves and their offspring, and even form a vicious cycle. Data show that the glycemic control of pregnant women with GDM is closely related to neonatal outcomes, and good glycemic control can significantly reduce adverse neonatal outcomes such as giant fetuses and larger than gestational age babies. Numerous studies at home and abroad have also shown that timely and aggressive treatment can reduce the incidence of gigantism, reduce birth injuries and cesarean deliveries, reduce the incidence of neonatal hypoglycemia, and bring the maternal and infant perinatal mortality rate of GDM close to the population average. Therefore, the significance of early diagnosis of GDM is particularly important. Diagnostic process and criteria of GDM The old diagnosis is based on the “two-step method” of the 50g GCT test: 50g GCT (glucose loading test): 50g of glucose (dissolved in 200mL water, taken within 5min) is randomly administered orally, and venous blood is drawn 1h after taking the glucose to check blood glucose. The current diagnostic process and criteria have been simplified by using the 75g OGTT test “one-step method”: the patient needs to fast for eight hours before the test, then take 75g of glucose within five minutes, and test the blood glucose for 1 hour and 2 hours respectively, and any one of the blood glucose values reaching or exceeding the following criteria can be diagnosed as GDM. 75g sugar OG TT Fasting: 5.1mmol/L 1 hour postprandial: 10.0mmol/L 2 hours postprandial: 8.5mmol/L From the above criteria, it can be seen that the diagnostic criteria for GDM are more stringent than those for T1DM and T2DM patients, because a large number of studies have shown that only by lowering the blood glucose below the above criteria can the risk of adverse complications for pregnant women and their offspring be minimized to the greatest extent possible The risk of adverse complications and birth outcomes for the pregnant woman and her offspring can only be minimized if blood glucose is lowered below these criteria. There is a physiological basis for determining the appropriate timing of screening for GDM. At the beginning of pregnancy, in order to maintain the glucose metabolic balance during pregnancy, the pancreatic β-cells of pregnant women proliferate and hypertrophy, and insulin secretion increases, compared with the non-pregnant period, insulin secretion increases 2-5 times, and the compensatory secretion of insulin after meals increases more obviously, and the insulin secretion in the first phase increases, so the period of early pregnancy is not suitable for screening GDM. By 24-28 weeks of gestation, the insulin antagonist hormone produced by the placenta The increase in insulin antagonist hormone produced by the placenta, the increase in weight and the decrease in insulin sensitivity of tissues after pregnancy lead to “physiological insulin resistance”. The peak secretion of insulin and C-peptide is delayed until 2 h after meal, and the insulin secretion in the first phase is decreased, which is reflected in the increase and delay of postprandial glucose. Abnormal screening at this stage can make timely diagnosis of GDM and facilitate clinical management. If the screening in this phase is normal, but there are high-risk factors, it should be reviewed at 32~34 weeks. It is worth noting that people with polyphagia, polyphagia, polyuria and those with positive urine glucose in early pregnancy should undergo glucose screening at the first pregnancy test to allow early diagnosis of patients with diabetes mellitus who were missed before pregnancy. People with high-risk factors Chinese, as an ethnic group of Southeast Asian descent, are also a high-risk group for GDM and should be screened for GDM promptly if they have the following conditions: 1, age >30 years, obesity; 2, PCOS before pregnancy, irregular menstruation; 3, family history of diabetes, especially first-degree relatives, maternal line; 4, positive fasting urine glucose in early pregnancy; 5, abnormal obstetric history (history of GDM, RDS, malformed baby, fetal death History of intrauterine macrosomia); 6. Suspected macrosomia and excess amniotic fluid in the current pregnancy. The selective screening protocol proposed by the ADA in 1997 suggested that pregnant women who meet the three conditions of “age <25 years; normal weight; and no family history of high risk" can be screened without ogtt, but its safety and economic implications have yet to be evaluated. < p=""> Correct diagnosis and treatment of GDM can help reduce the incidence of macrosomia, birth trauma, and cesarean delivery; and reduce the incidence of stillbirths, malformations, and other diabetes-related comorbidities. Since pregnant women with GDM have a 50% risk of developing diabetes, these potential DM patients should make early efforts to change poor lifestyle habits to prevent and delay the onset of diabetes.