Gestational diabetes threatens the safety of every advanced mother. Why do you say advanced maternal age? This is because it mostly occurs in mothers of advanced age (greater than 35 years). It not only threatens the safety of the mother, but the fetus also has high risks, such as fetal malformation, miscarriage, macrosomia, etc.
Gestational diabetes should be strictly controlled in every way. So how can we stay away from it?
As the saying goes, “Know yourself and know your enemy and you will be in a hundred battles”. Only by understanding it can you overcome it. Below, we take a moment to explain the relevant issues for you.
If a relative or friend around you is not aware of the danger, you can explain it to her.
First, let’s look at what is gestational diabetes?
Diabetes in pregnancy includes both pre-pregnancy diabetes and diabetes onset or first discovered after pregnancy. The latter is also known as gestational diabetes (GMD).
There are several key features of gestational diabetes:
1. More than 80% of gestational diabetes mellitus is gestational diabetes;
2. With the progress of pregnancy, the blood sugar level of pregnant women in the first and second trimesters gradually decreases, and the sensitivity of pregnant women to insulin decreases in the second and third trimesters. At this time, if the compensatory secretion of insulin is insufficient, GDM is prone to occur. ;
3. The clinical manifestations are not typical, and the glucose tolerance test (OGTT) is the main diagnostic method;
4. The principle of treatment is to actively control the blood sugar of pregnant women and prevent the occurrence of maternal and child complications.
Let’s take a look at the specific dangers of gestational diabetes:
1. High blood sugar can cause abnormal embryonic development or even death, prone to fetal malformation, miscarriage, and premature birth;
2. Increases the likelihood of gestational hypertension by 2-4 times. It is clinically found that these two conditions almost always occur in pairs;
3. Infection. Not only during pregnancy, but all diabetic patients have weakened immunity and are at high risk of infection;
4. The incidence of polyhydramnios increased 10 times. Therefore, such mothers usually have a large abdominal circumference;
5. Due to the increase in the incidence of macrosomia, the incidence of dystocia, cesarean section, and postpartum hemorrhage increases. When implementing labor analgesia, we are also very worried about the problem of childbirth safety and the problem of anterotomy;
6. prone to diabetic ketoacidosis and other complications of diabetes;
7. When pregnant again, the recurrence rate is as high as 33-69%.
The shocking figures make us have to pay attention to this problem!
What other hazards are there for newborns?
Because of their large body weight, the relatively immature lungs cannot meet the “enormous” body oxygen consumption; in addition, these children are prone to respiratory distress due to excessive obesity. In addition, the incidence of neonatal hypoglycemia is relatively high. Recent international studies have shown that children have relatively high rates of obesity, high blood pressure and diabetes in adulthood.
So, what type of pregnant woman is suspected of having gestational diabetes?
1. Maternal factors: age>=35 years old, obesity, impaired glucose tolerance, polycystic ovary syndrome;
2. Family history: family history of diabetes;
3. History of pregnancy and childbirth: unexplained stillbirth, stillbirth, History of miscarriage, macrosomia, fetal malformation and polyhydramnios, history of GDM. Special reminder, GDM is not a lifelong disease, the key depends on how you treat it;
4. Factors of this pregnancy: the occurrence of fetal larger than gestational age, polyhydramnios, and repeated vulvovaginal candidiasis during pregnancy.
If you find that pregnant women have the above factors, you should be suspicious!
How is it diagnosed?
Although this part is very professional, it is also necessary to introduce:
1. Glucose tolerance test. Normal people’s blood sugar will temporarily rise after eating sugar, and it will rise to the highest peak after 0.5–1 hour, but not more than 8.9mmol/l, and return to the fasting level after 2 hours. Diabetic patients and those with abnormal glucose tolerance do not follow this rule, resulting in elevated blood sugar levels and rhythm disorders;
2. Fasting and 1 and 2 hours postprandial blood glucose values were: 5.1, 10.0, 8.5mmo/l;
3. GDM is diagnosed at any point when the blood sugar level reaches or exceeds the above standard;
What should I pay attention to when I go to the hospital for examination during pregnancy?
Normal physical activity and diet for the first three days. Fast for at least 8 hours after dinner the previous day, but do not fast too much to prevent hypoglycemia.
Assuming a person is diabetic, how do you know if you can get pregnant?
1. Diabetes patients should determine the severity of diabetes during pregnancy. Once untreated severe diabetes is pregnant, the risk to mother and child is high, and contraception should be avoided;
2. Those with mild organic lesions and good blood sugar control can continue pregnancy under active treatment and strict monitoring;
3. From before pregnancy, the blood sugar level should be strictly controlled with the assistance of a physician. Make sure your blood sugar is in the normal range before conception, during pregnancy, and during labor.
Should I choose a vaginal or cesarean delivery?
In general, this is not subjective. If you need a cesarean section, you can’t give birth naturally.
First of all, we need to emphasize that diabetes is not an indication for a cesarean section!
Indications for elective cesarean section:
1. Diabetes mellitus with vascular disease and other obstetric indications, such as suspected fetal macrosomia, poor placental function, abnormal fetal position and other obstetric indications;
2. For patients with poor blood sugar control during pregnancy, large fetuses or a history of stillbirth or stillbirth in the past, the indications for cesarean section should be appropriately relaxed. That said, cesarean delivery should be performed in these cases.
Once a cesarean section is selected, these details need attention:
1. Discontinue predinner zinc insulin on the day before surgery, and discontinue subcutaneous insulin on the day of surgery. Hypoglycemia events are more worthy of our attention! Insulin was discontinued for this purpose;
2. Monitor blood glucose and urine ketones in the morning of surgery, reassess risks and make emergency plans;
3. Infusion should be 3-4g glucose + 1U insulin, and intravenous infusion at the rate of 2-3U per hour;
4. Measure blood sugar every 1-2 hours, try to control intraoperative blood sugar 6.67-10.0mmol/l;
5. Check blood sugar every 2-4 hours after surgery until diet resumes.
About which anesthesia method is best to implement, it mainly depends on the strength of the anesthesiology department of the hospital where you are located, which includes both hardware and software. Intraoperative safety requires not only strong anesthesiology and obstetrics, but also the close cooperation and good preparation of various departments.
Finally, let’s emphasize one more point: No matter what condition a child was born with, it should be considered a high-risk child! Especially for those who are not satisfied with pre-pregnancy blood sugar control, the focus should be on preventing neonatal hypoglycemia, and glucose solution should be instilled regularly while breastfeeding. As a mother or family member, you must listen to advice and don’t go your own way!
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