Patient's question:
How is gestational diabetes acquired? What are the harms to the fetus and the pregnant woman, and what should be paid attention to?Doctor's answer:
Many pregnant women do not have diabetes before pregnancy, but develop diabetes during pregnancy. Why is this?1. After pregnancy, the body's endocrine system changes, and the placenta produces some hormones that have an anti-insulin effect;
2. Carbohydrate metabolism increases during pregnancy, and the required amount of insulin also increases accordingly;
3. The placenta can produce insulin-degrading enzymes that break down insulin in the body.
The presence of these factors increases the need for insulin during pregnancy, so the body must also increase its insulin secretion. However, for pregnant women with reduced insulin reserve function, this can lead to abnormal glucose metabolism and the development of gestational diabetes. Therefore, women without diabetes before pregnancy may develop it for the first time during pregnancy.
Not all women develop diabetes after pregnancy. Pregnant women with the following conditions should pay attention:
① Those with a family history of diabetes;
② Those with a history of abnormal deliveries, such as unexplained multiple miscarriages, stillbirths, neonatal deaths, birth defects, or large for gestational age;
③ Suspected fetal macrosomia or polyhydramnios in the current pregnancy;
④ Recurrent candidiasis of the vagina that does not respond to treatment;
⑤ Obese pregnant women;
⑥ Pregnant women over 30 years old;
⑦ Repeatedly positive for glucose in early urine tests;
⑧ Those with polydipsia, polyphagia, and polyuria.
For these women, paying attention to a reasonable dietary structure, reducing the intake of high-sugar foods, avoiding excessive daily calorie intake, and appropriately increasing physical activity during pregnancy can help reduce and prevent the occurrence of gestational diabetes. At the same time, doctors should strengthen blood sugar monitoring for these pregnant women to enable early diagnosis of diabetes.
In the past, it was rare for pregnant women to have diabetes. In recent years, the incidence of diabetes in the population has sharply increased, and the number of diabetic mothers giving birth has also risen, becoming a common issue faced by obstetricians and gynecologists. Pregnant women with diabetes face a high risk of both maternal and fetal complications. Based on extensive clinical experience, timely and appropriate blood sugar control for diabetic pregnant women, along with strict maternal-fetal monitoring, allows most women to deliver healthy babies safely. Most complications are now less common.
Gestational diabetes primarily includes two situations:
1. Pregnant women who have already been diagnosed with type 1 or type 2 diabetes before pregnancy, medically known as diabetes complicated by pregnancy;
2. Pregnant women who develop or discover diabetes during pregnancy, known as gestational diabetes.
In recent years, the incidence of diabetes has continued to rise, and the number of diabetic women who become pregnant has also increased. Additionally, due to the widespread screening for gestational diabetes during pregnancy, the detection rate of gestational diabetes has also risen. In the future, the incidence of gestational diabetes will continue to increase, and the pregnancy-related issues of diabetic women will attract more attention.
Gestational diabetes is relatively mild for these patients, with most exhibiting abnormal glucose metabolism that returns to normal after delivery. However, as they age, the risk of developing type 2 diabetes later in life is higher than for women who have never had gestational diabetes. Although gestational diabetes is relatively mild, if it is not diagnosed and treated early during pregnancy, it can still pose certain risks to the fetus.
The Impact of Diabetes on Pregnancy
Diabetes has a significant impact on pregnancy. High blood sugar in early pregnancy can increase the risk of fetal malformations and spontaneous abortions. High blood sugar during mid-to-late pregnancy can lead to fetal hyperglycemia through the placenta, followed by fetal hyperinsulinemia, which can result in fetal overgrowth and an increased incidence of macrosomia. These children are more likely to experience neonatal hypoglycemia after birth. In late pregnancy, fetal intrauterine hypoxia increases, and severe cases can lead to fetal death in utero. At the same time, pregnancy itself can exacerbate glucose metabolism disorders in diabetic women, making timely treatment essential to prevent ketoacidosis. Severe cases can lead to diabetic ketoacidosis, coma, or even death.
Additionally, diabetes increases the incidence of pregnancy complications, such as hypertensive syndrome, by 4 to 6 times, and makes the risk of polyhydramnios higher. Diabetic ketoacidosis in pregnant women not only poses serious risks to the mother but also has significant effects on the fetus. Ketoacidosis in early pregnancy can affect embryonic development, leading to fetal malformations. Ketoacidosis during mid-to-late pregnancy can worsen fetal intrauterine hypoxia, and severe cases can result in fetal death. Previous studies have also shown that pregnant women with poor glycemic control during pregnancy, in addition to an increased risk of fetal death in late pregnancy, often have delayed lung maturation in newborns. These newborns are more likely to develop respiratory distress syndrome (a severe acute lung injury caused by various factors, leading to impaired gas exchange in lung tissue, respiratory failure, and often multiple organ failure). The incidence of neonatal hypoglycemia, polycythemia, hypocalcemia, and hypomagnesemia also increases. Therefore, pregnancy in diabetic women is a relatively complex issue.
Recent studies have shown that if diabetic women are diagnosed and treated promptly during pregnancy, most of them can achieve satisfactory pregnancy outcomes, with the majority able to deliver healthy babies under the supervision of medical professionals. The aforementioned maternal-fetal complications are less common.
Women with severe diabetes, those with diabetic retinopathy, or those with combined cardiac or renal dysfunction should not become pregnant. Other patients with poor blood sugar control should also avoid pregnancy.
Preparing for Pregnancy
Before pregnancy, diabetic women must undergo a comprehensive physical examination and consult a doctor. Only those who meet the criteria should become pregnant. Oral hypoglycemic drugs should be discontinued during pregnancy and replaced with insulin. Before pregnancy, blood sugar levels should be maintained within the normal range to prevent the impact of high blood sugar during conception on normal fetal development. During pregnancy, continue with dietary control and insulin therapy. Regularly monitor blood sugar and urine ketones. If blood sugar control is poor or ketoacidosis occurs, seek hospital treatment early. At the same time, strengthen fetal monitoring. If necessary, consider induced labor to terminate the pregnancy.
Once a pregnant woman is diagnosed with gestational diabetes, dietary control should be the first step. The main focus is to maintain stable carbohydrate intake, with a daily staple food intake of 250 to 300 grams. It is best to eat small, frequent meals, with five to six meals a day. Limit sweet foods and consume low-sugar fruits in moderation. If the patient's appetite cannot be satisfied, small additional meals between meals can be provided, with a focus on protein-rich foods. Adequate intake of vegetables and fiber-rich foods is also important.
Adjustments do not mean eating less; insufficient carbohydrates in the diet can lead to ketoacidosis in pregnant women, which is harmful to both the mother and the fetus. Therefore, dietary control for diabetic pregnant women should be conducted under the guidance of experienced doctors and nutritionists. If blood sugar control is still unsatisfactory after dietary control, such as fasting or pre-meal blood sugar > 5.8 mmol/L; post-meal 2-hour blood sugar > 6.7 mmol/L, insulin should be added to control blood sugar.
As the gestational age changes, the blood sugar levels of diabetic pregnant women will also change. Therefore, even after normal blood sugar control, regular monitoring should continue during pregnancy, and insulin dosage should be adjusted based on blood sugar levels. Due to the decrease in renal glucose threshold during pregnancy, urine glucose cannot accurately reflect blood sugar levels. Therefore, urine glucose should not be used to monitor the condition of diabetic pregnant women during pregnancy. Additionally, during late pregnancy, strengthen fetal intrauterine monitoring to detect fetal hypoxia early.
If blood sugar control is poor during pregnancy, the pregnancy should be terminated. Before termination, amniocentesis should be performed to determine fetal lung maturity.
After birth, newborns should be closely monitored and cared for to detect complications early.