Gestational diabetes is a kind of diabetes that occurs in pregnant women. It is caused by abnormal glucose metabolism in women during pregnancy.
In 2022, the guidelines for diagnosis and treatment of gestational hyperglycemia were issued, and gestational hyperglycemia was divided into pre pregnancy diabetes combined with pregnancy, pre diabetes and pregnancy diabetes.
Gestational diabetes includes type A1 and A2, among which the ideal person of blood glucose control can be defined as type A1 GDM through nutrition management and exercise guidance; Additional hypoglycemic drugs are required to define individuals with ideal blood glucose control as type A2 GDM.
1、 Symptoms and harms of diabetes in pregnancy
Most patients with diabetes in pregnancy will not have obvious symptoms, it is difficult for pregnant women to recognize themselves, and fasting blood glucose may be within the normal range.
However, gestational diabetes is prone to bring a series of complications, such as excessive amniotic fluid, abnormal embryonic development, abortion, pregnancy induced hypertension and early pregnancy, ketoacidosis, dystocia and birth canal damage caused by giant fetus, prolonged operation, postpartum hemorrhage, increased risk of diabetes in the second pregnancy, prolonged hospital stay, hyperglycemia, etc., and giant fetus, dystocia of fetal shoulder, fetal growth restriction, abortion and premature delivery, fetal malformation, neonatal respiratory distress syndrome, neonatal hypoglycemia, etc.
Most patients will recover from abnormal glucose metabolism after childbirth, and their blood sugar will naturally return to normal. However, some patients may develop type 2 diabetes and have a high recurrence rate if they become pregnant again.
2、 Diagnosis of diabetes in pregnancy
1. 75gOGTT was performed at 24-28 weeks of pregnancy as a diagnostic method of diabetes in pregnancy.
Specifically, the blood glucose thresholds for fasting and 1 hour and 2 hours after oral glucose intake are 5.1, 10.0, and 8.5 mmol/L, respectively. Diagnosis is made when the blood glucose level reaches or exceeds the above criteria at any time point.
It is best to draw fasting blood before 9am during OGTT examination, as a later time may affect the test results.
2. Pregnant women with high risk factors of diabetes should strengthen health education and lifestyle management. High risk factors include obesity, especially severe obesity, first-degree relatives with type 2 diabetes, history of coronary heart disease, chronic hypertension, high density lipoprotein (1 mmol/L and or triacylglycerol) 2.8 mmol/L, history of pregnancy diabetes or macrosomia delivery, history of polycystic ovary syndrome, repeated positive fasting urine sugar in early pregnancy, age>45 years old.
3、 Blood glucose control objectives and monitoring of gestational diabetes
The blood glucose control objectives of gestational diabetes are pre meal and fasting blood glucose<5.3mmol/L, blood glucose<7.8mmol/L at 1h after meal or blood glucose<6.7mmoL at 2h after meal, and avoid nocturnal blood sperm<3.3mmol/L.
After diagnosis, pregnant women with gestational diabetes use a micro blood glucose meter to conduct self blood glucose monitoring and record fasting and postprandial blood glucose. If the blood glucose is well controlled, the monitoring frequency can be appropriately adjusted; A1 type GDM monitors fasting and postprandial blood glucose levels at least once a week, while A2 type GDM monitors postprandial and postprandial blood glucose levels at least every 2-3 days. If insulin is used, nighttime blood glucose levels should be measured during the early stages of bedtime insulin use, when hypoglycemia occurs at night, or when increasing bedtime insulin dosage but fasting blood glucose levels are still poorly controlled.
At the same time, the occurrence of hypoglycemia should be avoided. Glycated hemoglobin should be controlled below 6%, and attention should be paid to monitoring urine ketones. If urine ketones are positive, medical attention should be sought in a timely manner.
4、 Treatment of diabetes in pregnancy
1. Adjust diet: under the condition of ensuring the energy supply of the puerpera and fetus, control the blood sugar within an ideal range through reasonable diet; You can consult a professional nutritionist to develop a diet that suits the patient's condition based on their weight, pregnancy time, blood sugar level, and other factors. Pregnant women with diabetes should keep a light diet and form a regular eating habit. They can eat less and eat more meals. In diet, it is important to maintain a balanced nutrition, eat more low calorie, high fiber foods, and ensure adequate intake of carbohydrates. It is recommended to consume a variety of vegetables rich in vitamins.
2. Proper exercise: exercise therapy plays an important auxiliary role in the treatment of gestational diabetes. It is recommended that pregnant women take aerobic exercise, upper limb exercise and walking, such as walking for 10 to 15 minutes after meals. It can start from 10 minutes and gradually extend to 30 minutes. Suggest exercising 3-4 times a week;
3. Drug treatment
Most pregnant women with diabetes in pregnancy can reach the blood sugar standard through diet control and proper exercise intervention. If they cannot reach the standard, pregnant women with diabetes in pregnancy should first recommend insulin to control blood sugar.
The commonly used insulin analogues are: winter insulin and detemir insulin injection. For both fasting and postprandial blood glucose elevation, it is recommended to continue subcutaneous injection of short acting/fast acting insulin before meals, as well as mid acting/long-acting insulin analogs or insulin pumps before bedtime.