1. Diabetes Diabetes is a metabolic defect caused by the disorder of glucose metabolism. The main hazards of hyperglycemia during pregnancy are poor perinatal maternal and infant clinical outcomes and increased mortality, including maternal development of type 2 diabetes, abnormal intrauterine growth, neonatal malformations, and macrosomia comorbidities and risk of trauma) and increased risk of neonatal hypoglycemia. Patients with diabetes should go to a specialist clinic for pre-pregnancy diabetes assessment before preparing for pregnancy, and determine whether they are suitable for pregnancy according to the condition.
【Diagnostic Criteria】 (1) Diagnosis of diabetes before pregnancy, diabetes diagnostic criteria: diabetes symptoms + plasma glucose level at any time ≥ 11.1mmol/L (200mg/dl) or fasting plasma glucose (FPG) level ≥ In the 7.0mmol/(126mg/dl) or 75g oral glucose tolerance test, the blood glucose level 2 hours after the test meal is greater than or equal to 11.1mmol/L (200mg/dl). (2) The following criteria are used for the diagnosis of gestational diabetes mellitus: All pregnant women should have their blood glucose measured at 24-28 weeks of gestation. If any of the following three time points of the 75g oral glucose tolerance test is higher than the following criteria, the diagnosis can be made: fasting blood glucose ≥5.3mmol/L (95mg/dl); 1 hour postprandial blood glucose ≥10.0mmol/L (180mg/dl); 2 hours postprandial blood glucose ≥8.0mmol/L (155mg/dl). (3) Grading of gestational diabetes: Grade A: diabetes that occurs or is discovered during pregnancy. Grade B: Overt diabetes, onset after the age of 20, and the course of the disease is less than 10 years. Grade C: The age of onset is 10 to 19 years old, or the disease duration is 10 to 19 years. Class D: Onset before the age of 10, or disease duration ≥ 20 years, or combined with simple retinopathy. Class F: Diabetic nephropathy. Grade R: Proliferative retinopathy or vitreous hemorrhage in the fundus. Class H: coronary atherosclerotic heart disease. Grade T: There is a history of kidney transplantation.
[Risk classification] (1) D, F, R, H, and T diabetic patients are not suitable for pregnancy. If they are already pregnant, they should terminate the pregnancy as soon as possible, otherwise there is a greater risk to the mother and child. , the risk is category X. (2) For patients with grade A, B, and C diabetes mellitus, under close monitoring and active treatment, the blood sugar can be controlled in a good and stable state to continue pregnancy, and the risk is C. [Pre-pregnancy eugenics guidance and advice] (1) Women with diabetes should plan pregnancy and take contraceptive measures until their diabetes is not satisfactorily controlled. Pregnant women with unsatisfactory blood sugar control in diabetic patients are prone to fetal malformations, stillbirths, and miscarriages. Women with gestational diabetes should be informed of the importance of intensive glycemic control during pregnancy and the possible risks of hyperglycemia to the mother and child. (2) Before planning pregnancy, the history of diabetes and its related medical history should be reviewed carefully. (3) Evaluation of suitability for pregnancy by a diabetes physician and an obstetrician and gynecologist. (4) If you plan to become pregnant, the following preparations should be made before conception: ①Comprehensive examination. ② Stop taking oral hypoglycemic drugs and use insulin to control blood sugar. ③ Strictly control blood sugar and strengthen blood sugar monitoring. ④Strictly control blood pressure below 130/80mmHg. ⑤ Stop statins and fibrate lipid-lowering drugs. ⑥ Strengthen diabetes education. ⑦ Quit smoking.