What to do with gestational diabetes

Gestational diabetes is a disease that is more common in women during pregnancy. This disease can have serious consequences for the health of pregnant women and the normal development of the baby, and will pose a great threat to human health. Therefore, if you have diabetes during pregnancy, or are prone to diabetes, you must take certain measures to prevent or treat gestational diabetes.

1. Treatment of pregnant women with abnormal glucose metabolism

(1) Satisfactory standard for blood sugar control during pregnancy: Pregnant women have no obvious hunger, and fasting blood sugar is controlled at 3.3-5.6 mmol/L; 30 minutes before meal: 3.3-5.8 mmol/L; 2 hours after meal: 4.4-6.7 mmol/L; at night: 4.4-6.7 mmol/L.

(2) Dietary treatment Dietary control is very important. The ideal dietary control goal is to ensure and provide the calorie and nutritional needs during pregnancy, avoid postprandial hyperglycemia or hunger ketosis, and ensure the normal growth and development of the fetus.

(3) Drug treatment: For diabetes that cannot be controlled by dietary therapy, insulin is the main treatment drug.

(4) Treatment of diabetic ketoacidosis during pregnancy: While monitoring blood gas, blood glucose, and electrolytes and providing appropriate treatment, it is recommended to use a small dose of regular insulin 0.1U/(kg·h) by intravenous drip. Monitor blood sugar every 1 to 2 hours. If blood sugar is >13.9mmol/L, insulin should be added to 0.9% sodium chloride injection and dripped intravenously. If blood sugar is ≤13.9mmol/L, insulin should be added to 5% glucose sodium chloride injection and dripped intravenously. After ketone bodies turn negative, it can be changed to subcutaneous injection.

2. Maternal and Child Care during Pregnancy

Check once a week until the 10th week of pregnancy. The second trimester of pregnancy should be checked every two weeks. Generally, the insulin requirement begins to increase at 20 weeks of pregnancy and needs to be adjusted in time. Renal function and glycosylated hemoglobin levels were measured monthly, and fundus examinations were performed. After 32 weeks of pregnancy, check-ups should be done weekly. Pay attention to blood pressure, edema, and urine protein. Pay attention to monitoring of fetal development, fetal maturity, fetal-placental function, etc., and hospitalize early if necessary.

3. Timing of delivery

In principle, the termination of pregnancy should be postponed as much as possible. If blood sugar is well controlled, there are no complications in late pregnancy, and the fetus is in good intrauterine condition, termination of pregnancy should be delayed until 38 to 39 weeks of pregnancy. If blood sugar control is unsatisfactory, accompanied by vascular disease, severe preeclampsia, severe infection, fetal growth restriction, or fetal distress, amniotic fluid should be drawn early and dexamethasone should be injected to promote fetal lung maturity. The pregnancy should be terminated immediately after the fetal lungs mature.

4. Delivery method

Cesarean section should be performed for pregnancy complicated by diabetes, macrosomia, placental dysfunction, abnormal fetal position or other obstetric indications. For pregnant women with diabetes duration of more than 10 years, accompanied by retinopathy and renal damage, severe preeclampsia, and a history of stillbirth, the indications for cesarean section should be relaxed.