What is the cause of gestational diabetes? what to do?
2022-03-26
Pregnant mothers go to the hospital for their sixth prenatal visit before 28 weeks of pregnancy. One of the main inspection items of this prenatal checkup is the glucose tolerance test, which mainly checks whether the pregnant woman has gestational diabetes. What exactly is the cause of gestational diabetes? What is its criterion? What to do if you are diagnosed with gestational diabetes mellitus? Let's take a look at it next.
Causes of gestational diabetes mellitus
Gestational diabetes is a general term for abnormal glucose tolerance, abnormal fasting blood glucose and diabetes that are found or developed during pregnancy. Current research shows that age, obesity, ethnicity, adverse reproductive history and family history of diabetes are the main factors affecting gestational diabetes.
Reason 1: Age factor. Advanced pregnancy is currently recognized as a major risk factor for gestational diabetes. The risk of gestational diabetes in women aged 40 and older was 8.2 times that of women aged 20 to 30. In addition to age factors that affect the onset of diabetes, the older the woman, the smaller the gestational age at which a pregnant woman is diagnosed with gestational diabetes. According to the survey, among pregnant women diagnosed with diabetes before 24 weeks of gestation, 63.7% of pregnant women were 30 years old and older, while only 45.2% were diagnosed after 24 weeks of gestation (P<0.01=.< p="">
Reason 2: Obesity. Obesity is an important risk factor for impaired glucose tolerance and diabetes, and gestational diabetes is no exception. Other environmental factors such as age, economy, education level, and diet have synergistic effects with obesity.
Reason 3: Race. Similar to the relationship between type 2 diabetes and ethnicity in adults, gestational diabetes mellitus has clear geographic and ethnic associations. Compared with white European women, the prevalence of gestational diabetes was 11, 8, 6, and 6 times higher in the Indian subcontinent, Asian, Arab, and black, respectively. In addition to genetic factors, the role of ethnic factors and economic, cultural, dietary habits and other reasons cannot be ruled out.
Reason 4: Family history of diabetes and poor obstetric history. Family history of diabetes is a risk factor for gestational diabetes mellitus. People with a family history of diabetes were 1.55 times more likely to develop gestational diabetes than those without a family history of diabetes. Up to 2.89 times.
Obstetric factors associated with gestational diabetes include high birth rate, macrosomia, history of stillbirth, major congenital malformations, and history of gestational diabetes. 8.5 times, 22.5 times and 23.2 times. Pregnant women with these medical histories were 2.0 times, 5.8 times, 8.5 times, 22.5 times, and 23.2 times more likely to develop diabetes than normal pregnant women.
What are the diagnostic criteria for gestational diabetes?
The diagnosis of gestational diabetes can be diagnosed by the following 4 methods, which can diagnose whether pregnant mothers have gestational diabetes.
1. Determination of urine sugar
Patients with positive urine glucose should not only consider gestational physiologic diabetes, but also further conduct fasting blood glucose tests and glucose screening tests.
2. Fasting blood glucose measurement
Diabetes can be diagnosed when the fasting blood glucose is ≥5.8mmol/L for two or more times.
3. Sugar screening assay
GDM screening is recommended at 24-28 weeks of pregnancy. Dissolve 50g of glucose powder in 200ml of water and take it within 5 minutes. Blood sugar ≥7.8mmol/L after 1 hour, that is, positive sugar screening. Fasting blood sugar should be checked for abnormal fasting blood sugar. Diabetes can be diagnosed, and those with normal fasting blood glucose should undergo a glucose tolerance test (OGTT).
4. Oral glucose tolerance test (OGTT)
More use of 75g glucose tolerance test. Refers to oral 75g glucose after 12 hours of fasting, the upper limit of normal is:
Fasting 5.6mmol/L,
10.3mmol/L for 1 hour,
8.6mmo1/L for 2 hours,
6.7 mmol/L for 3 hours.
Two or more of them meet or exceed the normal value, which can be diagnosed as gestational diabetes. Only 1 item was higher than the normal value, and it was diagnosed as abnormal glucose tolerance.
Methods of controlling gestational diabetes
Method 1: Diet control: The nutritional requirements are the same as those of normal pregnant women, including calories, protein, calcium, iron, folic acid, and vitamin B group. In the case of the same total calories, it is best to eat small meals and pay attention to the distribution of quality and quantity, so that blood sugar can be more stable. In addition, the intake of sweets and high-fat foods should be avoided, and dietary fiber should be increased. The specific principles are as follows:
1. Increase calorie requirements: No need to increase calories in the first trimester, 300 kcal/day in the middle and later stages.
2. It is recommended to eat small and frequent meals: Eating a large amount of food at one time will lead to a rapid rise in blood sugar, and when the mother is fasting for too long, it is easy to produce ketone bodies, so it is recommended to eat a small amount of time. - 6 meals. Have a snack before bed.
3. Control sweets: Avoid sugar-sweetened beverages and sweets containing sucrose, granulated sugar, fructose, glucose, rock sugar, honey, and maltose to avoid rapid rise in blood sugar after meals.
4. Multiple choices for coarse grains: Taking bread as an example, the GI (glycemic index) of white bread is 70, but bread mixed with 75-80% barley grains is 34, so it is recommended to use coarse flour Replace white bread with bread made with shredded grains.
5. Simple is the main thing: Vegetables should not be cut as much as possible, and grains may not be ground.
6. Eat less or avoid food: Sweet food, high starch food, oily, starchy food cooked too long or too thin.
Method 2: Motor Control: Participate in outdoor activities appropriately, especially walking after meals.
Method 3: Drug control: If there is drug control, you must strictly cooperate with the doctor for treatment and do self-examination. Feel good: It's important to stay in a good mood and take your condition seriously, but don't worry too much.
Method 4: Choice of delivery method: Cesarean section should be performed for those with diabetes, macrosomia, poor placental function, abnormal fetal position or other obstetric indications. For pregnant women with diabetes course of more than ten years, accompanied by retinopathy and renal damage, severe preeclampsia, and pregnant women with a history of stillbirth, the indications for cesarean section should be relaxed.
Causes of gestational diabetes mellitus
Gestational diabetes is a general term for abnormal glucose tolerance, abnormal fasting blood glucose and diabetes that are found or developed during pregnancy. Current research shows that age, obesity, ethnicity, adverse reproductive history and family history of diabetes are the main factors affecting gestational diabetes.
Reason 1: Age factor. Advanced pregnancy is currently recognized as a major risk factor for gestational diabetes. The risk of gestational diabetes in women aged 40 and older was 8.2 times that of women aged 20 to 30. In addition to age factors that affect the onset of diabetes, the older the woman, the smaller the gestational age at which a pregnant woman is diagnosed with gestational diabetes. According to the survey, among pregnant women diagnosed with diabetes before 24 weeks of gestation, 63.7% of pregnant women were 30 years old and older, while only 45.2% were diagnosed after 24 weeks of gestation (P<0.01=.< p="">
Reason 2: Obesity. Obesity is an important risk factor for impaired glucose tolerance and diabetes, and gestational diabetes is no exception. Other environmental factors such as age, economy, education level, and diet have synergistic effects with obesity.
Reason 3: Race. Similar to the relationship between type 2 diabetes and ethnicity in adults, gestational diabetes mellitus has clear geographic and ethnic associations. Compared with white European women, the prevalence of gestational diabetes was 11, 8, 6, and 6 times higher in the Indian subcontinent, Asian, Arab, and black, respectively. In addition to genetic factors, the role of ethnic factors and economic, cultural, dietary habits and other reasons cannot be ruled out.
Reason 4: Family history of diabetes and poor obstetric history. Family history of diabetes is a risk factor for gestational diabetes mellitus. People with a family history of diabetes were 1.55 times more likely to develop gestational diabetes than those without a family history of diabetes. Up to 2.89 times.
Obstetric factors associated with gestational diabetes include high birth rate, macrosomia, history of stillbirth, major congenital malformations, and history of gestational diabetes. 8.5 times, 22.5 times and 23.2 times. Pregnant women with these medical histories were 2.0 times, 5.8 times, 8.5 times, 22.5 times, and 23.2 times more likely to develop diabetes than normal pregnant women.
What are the diagnostic criteria for gestational diabetes?
The diagnosis of gestational diabetes can be diagnosed by the following 4 methods, which can diagnose whether pregnant mothers have gestational diabetes.
1. Determination of urine sugar
Patients with positive urine glucose should not only consider gestational physiologic diabetes, but also further conduct fasting blood glucose tests and glucose screening tests.
2. Fasting blood glucose measurement
Diabetes can be diagnosed when the fasting blood glucose is ≥5.8mmol/L for two or more times.
3. Sugar screening assay
GDM screening is recommended at 24-28 weeks of pregnancy. Dissolve 50g of glucose powder in 200ml of water and take it within 5 minutes. Blood sugar ≥7.8mmol/L after 1 hour, that is, positive sugar screening. Fasting blood sugar should be checked for abnormal fasting blood sugar. Diabetes can be diagnosed, and those with normal fasting blood glucose should undergo a glucose tolerance test (OGTT).
4. Oral glucose tolerance test (OGTT)
More use of 75g glucose tolerance test. Refers to oral 75g glucose after 12 hours of fasting, the upper limit of normal is:
Fasting 5.6mmol/L,
10.3mmol/L for 1 hour,
8.6mmo1/L for 2 hours,
6.7 mmol/L for 3 hours.
Two or more of them meet or exceed the normal value, which can be diagnosed as gestational diabetes. Only 1 item was higher than the normal value, and it was diagnosed as abnormal glucose tolerance.
Methods of controlling gestational diabetes
Method 1: Diet control: The nutritional requirements are the same as those of normal pregnant women, including calories, protein, calcium, iron, folic acid, and vitamin B group. In the case of the same total calories, it is best to eat small meals and pay attention to the distribution of quality and quantity, so that blood sugar can be more stable. In addition, the intake of sweets and high-fat foods should be avoided, and dietary fiber should be increased. The specific principles are as follows:
1. Increase calorie requirements: No need to increase calories in the first trimester, 300 kcal/day in the middle and later stages.
2. It is recommended to eat small and frequent meals: Eating a large amount of food at one time will lead to a rapid rise in blood sugar, and when the mother is fasting for too long, it is easy to produce ketone bodies, so it is recommended to eat a small amount of time. - 6 meals. Have a snack before bed.
3. Control sweets: Avoid sugar-sweetened beverages and sweets containing sucrose, granulated sugar, fructose, glucose, rock sugar, honey, and maltose to avoid rapid rise in blood sugar after meals.
4. Multiple choices for coarse grains: Taking bread as an example, the GI (glycemic index) of white bread is 70, but bread mixed with 75-80% barley grains is 34, so it is recommended to use coarse flour Replace white bread with bread made with shredded grains.
5. Simple is the main thing: Vegetables should not be cut as much as possible, and grains may not be ground.
6. Eat less or avoid food: Sweet food, high starch food, oily, starchy food cooked too long or too thin.
Method 2: Motor Control: Participate in outdoor activities appropriately, especially walking after meals.
Method 3: Drug control: If there is drug control, you must strictly cooperate with the doctor for treatment and do self-examination. Feel good: It's important to stay in a good mood and take your condition seriously, but don't worry too much.
Method 4: Choice of delivery method: Cesarean section should be performed for those with diabetes, macrosomia, poor placental function, abnormal fetal position or other obstetric indications. For pregnant women with diabetes course of more than ten years, accompanied by retinopathy and renal damage, severe preeclampsia, and pregnant women with a history of stillbirth, the indications for cesarean section should be relaxed.
