1. What is gestational diabetes (GDM)?
(1) GDM refers to the occurrence or occurrence of glucose tolerance abnormality during pregnancy, but the blood sugar does not reach the level of dominant diabetes, accounting for 83.6% of hyperglycemia during pregnancy. Diagnostic criteria are: 75g glucose tolerance test (OGTT) is performed at any time during pregnancy, fasting blood glucose ≥5.1mmol/l, OGTT 1h blood glucose ≥10.0mmol/L, OGTT 2h blood glucose ≥8.5mmol/L. GDM is diagnosed if any point of blood sugar meets the above criteria.
2. What are the metabolic changes of the maternal body during pregnancy?
(1) Reduced renal glucose threshold and fasting hypoglycemia cause hyper-nonesterified fatty acidemia: ① Reduced renal glucose threshold: Some hormones produced by the placenta reduce the renal tubules' reabsorption of sugar, coupled with the increase in blood volume during pregnancy, the glomerular filtration rate increases, and the renal glucose threshold decreases, which can lead to diabetes. ② Fasting blood sugar decreases: Fasting blood sugar levels in the early stage of pregnancy are reduced by about 10%, reaching the lowest level at 12 weeks of pregnancy, and maintaining this level until delivery. The main reasons are: in addition to their own needs, pregnant women also need to supply the energy required for fetal growth; the fetus itself does not have the liver enzyme system activity required to promote the effect of glucose , and cannot use fat and protein as energy, and the energy required must all come from glucose in the mother's blood; the renal blood flow and glomerular filtration rate during pregnancy increase, but the reabsorption of sugar by renal tubular cannot increase accordingly, resulting in an increase in sugar excretion in some pregnant women from urine; on an empty stomach, pregnant women's ability to remove glucose is stronger than that during non-pregnancy. ③High non-esterified fatty acidemia: Fasting blood sugar is reduced, making it easy to cause hypoglycemia. The accelerated fatty acids in the blood increase and produce ketone .
(2) Anti-insulin factors cause insulin resistance: During pregnancy, hormones that antagonize insulin include cortisol , placental prolactin, progesterone, estrogen and placental insulinase. In addition to cortisol, other hormones and enzymes are mainly secreted by the placenta during pregnancy. Among them, cortisol, placental prolactin, progesterone and estrogen mainly increase gluconeogenesis and inhibit the use of glucose in surrounding tissues. Placental insulin enzyme is a protease that can degrade insulin into amino acid and peptides and lose activity.
(3) Obesity and insufficient islet β-cell function lead to abnormal sugar metabolism during gestation.
3. Who are the people at high risk of gestational diabetes ?
① The body is overweight or obese, and the body mass index is above 26kg/m2 before pregnancy. ②Pregnant women are older than 30 years old, especially those over 35 years old. ③ Have a family history of diabetes, especially those with diabetes among first-degree relatives (including parents and siblings). ④ Routine urine tests during pregnancy often show positive urine sugar on the fasting. ⑤ Long-term repeated vulvovaginal candidiasis. ⑥ There have been unexplained spontaneous miscarriage , premature birth, stillbirth, neonatal death and deformity, huge children, ; ⑦ I have given birth to a fetus weighing more than 4kg. ⑧ Has gestational diabetes . ⑨ During pregnancy, it was found that the fetus was larger than the actual gestational week or that had too much amniotic fluid . ⑩ Pregnancy of more than 2 times; ⑾ Primary hypertension, polycystic ovary syndrome (PCOS), etc.
4. When will diabetes screening be performed during pregnancy?
All pregnant women advocate blood sugar test in the early stages of pregnancy . GDM screening is usually performed at 24-28 weeks of gestation. It is recommended to perform in patients who are overweight or obese and have other risk factors for diabetes including a history of GDM. For areas with backward resources, there is no condition for all pregnant women to undergo OGTT tests at 24 to 28 weeks. FPG is considered first. FPG <> 5 and hyperglycemia on pregnant women? ①Hyperglycemia can cause abnormal embryo development and even death, with the incidence of miscarriage reaching 15% to 30%. ②The possibility of hypertension during pregnancy is 2 to 4 times higher than that of non-diabetic pregnant women. ③ Pregnant women who fail to control their blood sugar are prone to infection. Infection can also aggravate diabetic metabolic disorders and even induce acute complications such as ketoacidosis .④The incidence of excessive amniotic fluid is 10 times higher than that of non-diabetic pregnant women. ⑤The incidence of huge children has increased significantly, resulting in increased risk of labor, birth canal damage, and surgery. ⑥ It is prone to diabetic ketoacidosis . Due to complex metabolic changes during pregnancy. In addition, hyperglycemia and insulin are relatively or absolutely insufficient, fat decomposition is accelerated, serum ketone bodies are sharply increased, further developing into metabolic acidosis. ⑦ When pregnant women with GDM are pregnant again, the recurrence rate of diabetes is as high as 33% to 69%. The probability of long-term diabetes increases, and 17% to 63% will develop into 2 diabetes . 6. What are the effects of hyperglycemia on the fetus? ①The incidence of huge fetus is as high as 25%~42%. The reason is that pregnant women have high blood sugar
7. What are the effects of diabetes or hyperglycemia on newborns?
① The incidence of respiratory distress syndrome in neonatal babies is increased. ② Neonatal hypoglycemia : After the newborn leaves the maternal hyperglycemia environment, hyperinsulinemia still exists. If glucose is not supplemented in time, hypoglycemia is prone to occur, and in severe cases endangeres the life of the newborn.
The next section will continue to explain the precautions during the treatment of gestational diabetes, so stay tuned.
The Endocrinology and Metabolism Department of Qujing First Hospital has experts and specialists coming to the clinic all day from Monday to Sunday. If you need it, you can go to the endocrinology clinic area on the second floor of the outpatient clinic for consultation.
Correspondent: Wang Hanmin
