United Nations Diabetes Day | How much do you know about gestational diabetes?

Gestational diabetes mellitus (GDM) is a common complication of pregnancy, which seriously affects the short-term and long-term health of mothers and their offspring. Therefore, pregnant women must undergo diabetes screening during obstetric health check-ups. In recent years, with the continuous improvement of living standards, the incidence of GDM is gradually increasing.

Question 1: What is gestational diabetes?

GDM refers to normal glucose metabolism before pregnancy, but different degrees of impaired glucose tolerance and elevated fasting blood sugar are first found during pregnancy. The diagnostic criteria for GDM have been continuously improved with the deepening of clinical research, but there is still a lack of unified GDM screening and diagnostic criteria internationally. At present, my country recommends that pregnant women undergo an oral glucose tolerance test (OGTT) at 24 to 28 weeks of pregnancy: first measure fasting blood sugar, then drink 300 ml of glucose solution (containing 75 g glucose) within 5 minutes, and measure blood sugar levels 1 hour and 2 hours after drinking; fasting blood sugar and 1 hour and 2 hours after taking sugar should be lower than 5.1 mmol/L, 10.0 mmol/L, and 8.5 mmol/L, respectively. If any of the above blood sugar levels reaches or exceeds the above standards, GDM can be diagnosed.

Question 2: What are the dangers of gestational diabetes?

If GDM is not controlled, it will not only have a serious impact on the offspring, but also pose a huge threat to pregnant women. For the fetus, if the mother is in a high blood sugar environment for a long time during pregnancy, there may be risks such as neonatal hypoglycemia, neonatal respiratory distress syndrome, hyperbilirubinemia, polycythemia, and obesity during growth and development; for pregnant women, GDM is prone to cause a variety of adverse pregnancy outcomes, including miscarriage, premature birth, dystocia, preeclampsia, premature rupture of membranes and ketoacidosis, etc., and in the later stage, it also greatly increases the risk of type 2 diabetes and cardiovascular disease after pregnancy.

Question 3: What are the risk factors and pathogenesis of gestational diabetes?

Global GDM shows that high-risk factors for GDM include family history of diabetes, adverse reproductive history, advanced age (over 35 years old), obesity, polycystic ovary syndrome, HBV infection, etc. At present, there is no consensus on the pathogenesis of GDM. Overall, the occurrence and development of gestational diabetes is multifaceted and is affected by genetics, endocrine, age, weight, lifestyle, etc. Most people believe that GDM is mainly related to hormonal changes in the mother during pregnancy, because the placenta secretes a variety of hormones during pregnancy, which reduces the sensitivity of maternal cells to insulin, thereby leading to increased blood sugar levels.

Question 4: How to prevent and treat gestational diabetes?

Once GDM is diagnosed, lifestyle intervention is the first choice, including medical nutrition therapy and exercise. Reasonable diet and exercise intervention should be carried out before, during and after pregnancy. Reasonable diet is the key to controlling blood sugar. By rationally matching nutrients, increasing dietary fiber and appropriate protein intake, and controlling carbohydrate intake, it helps to maintain blood sugar stability. Appropriate exercise is also necessary. Pregnant women can choose low-intensity exercises such as walking, swimming, and prenatal yoga, 3 to 5 times a week, 30 minutes each time, which helps to improve insulin sensitivity and improve blood sugar control. If the patient's blood sugar still cannot reach the standard after lifestyle intervention, timely drug treatment is required. Multiple guidelines point out that insulin is the first choice for the treatment of GDM. Since insulin is a large molecular protein, it cannot pass through the placenta in pregnant women, so it will not affect the blood sugar level of the fetus, nor will it cause abnormal insulin secretion in postpartum GDM patients. Currently commonly used insulin preparations include ultra-short-acting, short-acting, intermediate-acting, long-acting and premixed insulin.

In short, GDM is a common complication of pregnancy, and its long-term impact on pregnant women and offspring cannot be ignored. Therefore, GDM patients should receive timely intervention and treatment, which will help control the progression of the disease and significantly improve the quality of life.

(Text by Liu Haiting and Wang Junnan from Beijing University of Chinese Medicine Dongzhimen Hospital)