With the opening of the "three-child" policy, many mothers' three-child plans have also been put on the agenda. But as pregnant mothers get older, this matter needs to be vigilant. That's high blood sugar during pregnancy.
What is hyperglycemia during pregnancy?
Gestational hyperglycemia includes gestational diabetes mellitus, gestational overt diabetes, and preconception diabetes. Gestational diabetes mellitus (GDM): GDM refers to abnormal glucose metabolism that occurs during pregnancy, but blood glucose does not reach the level of dominant diabetes. Overt diabetes mellitus during pregnancy refers to diabetes mellitus during pregnancy, which is detected during pregnancy and meets the diagnostic criteria for diabetes in non-pregnant people. Pre-pregnancy diabetes refers to mothers who have been diagnosed with diabetes before they become pregnant.
Diagnostic criteria for gestational diabetes mellitus: 75 g of oral glucose tolerance test (OGTT), 5.1 mmol/L≤ fasting blood glucose, OGTT 1h blood glucose ≥ 10.0 mmol/L, 8.5 mmol/L≤ OGTT 2h blood glucose at any time of pregnancy, any 1 point of blood glucose meets the above criteria to diagnose GDM.
Which moms need to focus on screening for high blood sugar during pregnancy?
How is screening done?
If the expectant mother has a history of gestational diabetes, a history of delivery of a huge baby, obesity, polycystic ovary syndrome (PCOS), a family history of diabetes in first-degree relatives, a positive fasting glucose in early pregnancy, a history of multiple spontaneous abortions without obvious causes, a history of fetal malformations and stillbirths, and a history of delivery of neonatal respiratory distress syndrome, it is necessary to focus on screening for hyperglycemia during pregnancy.
If the blood glucose at the first obstetric check-up is normal, blood glucose should still be checked regularly and OGTT should be performed as early as possible if necessary. If blood glucose persists, or if there are people who are not at high risk, a 75 g glucose tolerance test must be performed at 24 to 28 weeks' gestation. Diabetic patients should go to the endocrinologist for pre-pregnancy consultation and evaluation before pregnancy, adjust drugs and do a good job of pre-pregnancy comprehensive management.
Gestational glycemia
What should it be controlled?
Blood glucose targets during pregnancy: fasting blood glucose, postprandial 1h blood glucose, postprandial 2h blood glucose.
How to manage hyperglycemia during pregnancy?
The use and adjustment of hypoglycemic drugs should be consulted with an endocrinologist, in addition to which expectant mothers should do the following.
(1) Diet and exercise. It is recommended to consult a dietitian to develop an individualized diet and exercise plan. Whenever possible, choose foods with low glycemic index. A small number of multiple meals should be implemented, divided into 5 to 6 meals per day, and 1/3 to 1/2 of staple foods to add meals is helpful for the control of blood glucose after meals. Encourage appropriate exercise during pregnancy, including aerobic and resistance exercise. The duration of each exercise is less than 45 min.
(2) Blood glucose monitoring. Women with gestational diabetes whose glycemic control is stable or who do not require insulin therapy are measured at least once a week at 4 a.m. (on an empty stomach and 2 h after three meals) blood glucose. Other patients increase the number of measurements as appropriate. Ambulatory glucose monitoring is indicated in patients with poor blood glucose.
(3) Weight management. Obesity before pregnancy and excessive weight gain during pregnancy are both risk factors for hyperglycemia during pregnancy. A pregnancy weight gain plan needs to be made from the first trimester (table below).
Source: Guangzhou University of Chinese Medicine Shenzhen Hospital (Futian)