Diabetes that occurs or is detected during pregnancy is called gestational diabetes mellitus (GDM). Risk factors for gestational diabetes include family history of diabetes, age >30 years, pre-pregnancy obesity, excess amniotic fluid, large fetus, gestational hypertension syndrome, and excessive weight gain during pregnancy. The incidence of gestational diabetes as well as impaired glucose tolerance in pregnancy (GIGT) is increasing as diabetes becomes younger and pregnant women are getting older.
1. Effects of gestational diabetes on pregnant women and fetuses
(1) Effects on pregnant women
1, spontaneous abortion rate increases: spontaneous abortion rate increases up to 15%-30%.
2, the incidence of gestational hypertension syndrome increased.
3, decreased resistance: easy to combine bacterial or fungal urinary tract infections, easy to cause pyelonephritis, serious cases caused by infectious shock, and diabetes mellitus once the complication of infection easily lead to insulin resistance, quickly cause ketoacidosis.
4, surgical delivery and birth injuries increase.
(2)Effects on fetus
1, perinatal children are prone to intrauterine hypoxia: perinatal children with gestational diabetes are prone to intrauterine hypoxia, resulting in increased mortality, and the mortality rate can be 30% to 90% when ketoacidosis is complicating.
2, increased risk of malformed fetus: the incidence of 6%-15%.
3. Increased incidence of giant fetus: gestational diabetes can be accompanied by accelerated or delayed fetal growth.
4, increased neonatal comorbidities, increased mortality: neonatal comorbidities include neonatal hyperbilirubinemia, neonatal respiratory distress syndrome, neonatal hypoglycemia, neonatal hypocalcemia, hypomagnesemia and neonatal heart disease. In addition, it can also lead to neonatal mental retardation and mental abnormalities.
2.Dietary treatment of gestational diabetes
Dietary control is the basis of diabetes treatment, especially in gestational diabetes. Patients with poor dietary control should be considered for insulin treatment. For those with impaired glucose tolerance during pregnancy, the main purpose of blood sugar control can be achieved through dietary control. Overweight and obese women with gestational diabetes should reduce energy intake, self-monitor blood glucose and urinary ketones, and increase moderate exercise.
(1) Dietary requirements.
1. Adjust energy intake to reasonable requirements: energy requirements are calculated according to standard weight, generally supplying 30~40kcal/d per kilogram of body weight, plus the energy required for fetal growth and development at different stages of pregnancy. Early pregnancy generally does not need to increase energy, mid and late pregnancy then increase the energy of 200kcal per day, obese pregnant women should not excessively control the diet, underweight pregnant women can correspondingly intake slightly higher energy, but need to maintain the necessary weight growth, but also need to adjust the energy of the diet at any time according to the situation of blood sugar.
2, the appropriate ratio of the three capacity nutrients: appropriate control of carbohydrate intake, increase the amount of protein, accounting for about 80-100g of total energy per day; reduce the intake of fat, accounting for 25%-30% of total energy, about 50-70g per day.
3, strictly limit the intake of refined sugar (single and double sugar): choose multi-saccharides such as rice, flour, coarse grains and their products, etc. Different food sources of carbohydrates and mixed diets have different effects on blood sugar, that is, the glycemic index (GI) is different, dietary fiber, especially soluble dietary fiber can reduce the food GI value. Buckwheat, black rice, rye, barley, whole wheat and its products, cherries, plums, peaches, grapefruit and apples, which contain high soluble dietary fiber have low GI value, while white rice, glutinous rice, refined white flour products, tangerine, kiwi, grapes, pineapple and melon have relatively high GI value, especially glutinous rice, de-glutenized white wheat bread, white wheat buns, rice porridge, ripe bananas and watermelon have high GI value, which is not good for blood sugar control. It is not good for blood sugar control. Roots and tubers have a high GI value and should be chosen carefully.
4. Use low-fat lean foods: such as fish, lean pork, beef, chicken, rabbit and soybeans, low-fat milk as the source of high-quality protein, reduce the intake of animal fat, and use vegetable oil for cooking.
5, supply sufficient vitamins, minerals: vitamin B1, vitamin B2 and niacin have an important role in sugar metabolism, trace elements of zinc, chromium, magnesium is a variety of enzymes in the body, of which zinc is involved in protein synthesis, chromium is insulin factor, can improve the sensitivity of tissue to insulin, promote sugar metabolism and protein synthesis. Animal food is rich in vitamins and trace elements, especially oysters and other seafood high in zinc, egg yolk, yeast rich in chromium.
6, increase the intake of dietary fiber: dietary fiber can reduce the glycemic index of food, has a hypoglycemic effect, especially soluble fiber pectin, prolong the time of food emptying in the gastrointestinal tract, reduce hunger, but also delay the absorption of glucose, reduce postprandial blood sugar. Therefore, pregnant women with gestational diabetes should choose more coarse grains as the main food, and eat more fresh vegetables and moderate amounts of fruit.
(2) Precautions.
1, balanced diet: including cereals, vegetables and fruits, meat and milk and beans and other kinds of food.
2. Restrict mono- and dietary sugar: avoid sweet foods and sweet fruits, and occasionally use sugar substitutes.
3, choose foods with low glycemic index: coarse grains, such as red rice, buckwheat, rye, oats, whole grain beans and vegetables.
4.Eat a light diet with less salt: no fatty meat and animal skin, and less frying, braising and other cooking methods that use a lot of oil.
5, regular meals: at least three meals a day, breakfast, lunch and dinner and breakfast, lunch and dinner extra.