Abstract: Gestational diabetes is a special type of diabetes. It refers to the phenomenon of gestational hyperglycemia that occurs in the absence of diabetes before pregnancy. The incidence rate is approximately 1% to 3%. A young woman, Xiao Liu, had normal blood pressure, blood sugar, and blood lipids before marriage, but found that her blood sugar was high during pregnancy. Upon further examination, it turned out to be gestational diabetes. Gestational diabetes is a special type of diabetes. It refers to the phenomenon of gestational hyperglycemia that occurs in the absence of diabetes before pregnancy. The incidence rate is approximately 1% to 3%. So, why does this 1% to 3% probability happen to Xiao Zhang? It turns out that gestational diabetes favors certain groups of people.
Pregnant
Preventing diabetes is important
For pregnant women, the prevention of diabetes is very important. Diabetes screening should be performed at 24-28 weeks of pregnancy: drink 50g of sugar water and measure blood sugar 1 hour later.
Of course, high blood sugar in pregnant women does not necessarily mean diabetes. High blood sugar during pregnancy is actually very different from true diabetes. The main characteristics of diabetes are decreased pancreatic islet function and hyperglycemia. If diabetes is not treated effectively, it can cause greater harm to the body\’s systems. For women with high blood sugar during pregnancy, as long as they pay attention to diet control, adjust their diet in time, exercise appropriately, and control their blood sugar, their bodies can return to normal after pregnancy.
According to the requirements of the \”Guidelines for the Prevention and Treatment of Diabetes in China\” (2017 Edition), patients with gestational diabetes should control blood sugar. Pre-pregnancy blood sugar target: Fasting blood sugar and postprandial blood sugar should be as close to normal as possible without hypoglycemia. It is recommended to become pregnant when the glycosylated hemoglobin is 6.5%. The glycated hemoglobin of patients treated with insulin can reach 7.0%, the blood sugar before meals is controlled at 3.9-6.5mmol/L, and the blood sugar after meals is below 8.5mmol/L. Therefore, patients with diabetes are advised to plan pregnancy when their HbA1c is 6.5% to reduce the risk of congenital anomalies.
give you one
Guidelines for use of hypoglycemic drugs during pregnancy
Another question for pregnant women with diabetes: Should I stop taking my medication during pregnancy? Because we often hear that \”medicine is three times poisonous\”, but if you stop taking anti-diabetic drugs, your blood sugar may spike immediately. How to do it? Should I continue taking the medication or stop taking it?
\”Guidelines for the Prevention and Treatment of Diabetes in China\” (2017 Edition) recommends the use of hypoglycemic drugs during pregnancy:
1. Insulin:
(1) Types of insulin that can be used during pregnancy: including all human insulins: (short-acting, NPH and premixed human insulin). Insulin analogs include: insulin aspart and insulin lispro.
(2) Insulin application plan during pregnancy: Both fasting and postprandial blood sugars are elevated. Short-acting/rapid-acting insulin before meals and NPH before bed are recommended. Since postprandial blood glucose increases more significantly due to placental insulin resistance during pregnancy, the application of premixed insulin has limitations and is not routinely recommended.
2. Oral hypoglycemic drugs:
Several head-to-head studies on the use of metformin and insulin during pregnancy have confirmed the effectiveness and safety of metformin during pregnancy. Multiple domestic and foreign meta-analyses on metformin have shown that the use of metformin can control postprandial blood sugar and reduce maternal weight gain and the occurrence of severe hypoglycemia in newborns. However, since there are currently no indications for the use of metformin during pregnancy in my country, and there is still a lack of long-term safety data on oral hypoglycemic drugs for gestational diabetes, this guideline does not recommend the use of oral hypoglycemic drugs during pregnancy.
It can be seen that patients with gestational diabetes should avoid using oral hypoglycemic drugs and should use insulin therapy when their blood sugar cannot be controlled through dietary treatment. Human insulin is superior to animal insulin. Preliminary clinical evidence suggests that the rapid-acting insulin analogues insulin lispro, insulin aspart, and insulin detemir are safe and effective during pregnancy.
Antidiabetic drugs cannot be stopped at will
Don\’t eat casually
The 2014 \”Guidelines for the Diagnosis and Treatment of Diabetes in Pregnancy\” points out that most pregnant women with gestational diabetes can achieve blood sugar goals through lifestyle intervention, and those with gestational diabetes who cannot achieve the goals should first be recommended to use insulin to control blood sugar. The insulin regimen that best meets the physiological needs of pregnant women with gestational diabetes is: basal insulin combined with ultra-short-acting or short-acting insulin, used before meals. Routine use of premixed insulin is generally not recommended. Insulin is a large molecule substance that does not pass through the placenta and has no impact on the health of the fetus. Diabetic patients should take insulin therapy to maintain blood sugar close to normal without hypoglycemia before considering pregnancy. During pregnancy, insulin may be used to control blood sugar.
Currently, insulin aspart (an ultra-short-acting human insulin analog) and insulin detemir (a long-acting insulin analog) have been approved by the former State Food and Drug Administration for use in pregnancy.
Insulin aspart has a rapid onset of action and a short duration of effect. It has the strongest and best effect on lowering postprandial blood sugar, making hypoglycemia less likely to occur. It is used to control blood sugar levels after meals. Insulin detemir can be used to control blood sugar at night and before meals.
The 2014 key points of the \”Guidelines for the Diagnosis and Treatment of Diabetes in Pregnancy\” also point out that for pregnant women who take large amounts of insulin or who refuse to use insulin, the potential risks of oral hypoglycemic drugs (metformin and glyburide) are much smaller than uncontrolled hyperglycemia during pregnancy itself. Harm to the fetus. Therefore, on the basis of informed consent, some pregnant women with gestational diabetes may use it with caution.
It can be seen that patients with gestational diabetes can neither stop taking medicine at will nor take medicine at will. Reliable and reasonable treatment options should be sought under the reasonable guidance of specialists.
tip
Which pregnant women are prone to gestational diabetes?
1. Advanced maternal age.
2. History of gestational diabetes.
3. The baby has been given birth to a giant baby (weighting more than 8 pounds).
4. Obese expectant mothers whose body weight exceeds 20% of the standard body weight, or pregnant women who blindly increase nutrition after childbirth, eat too much, exercise too little, and gain too much weight.
5. Pregnant women with a family history of diabetes, especially those whose immediate relatives have had gestational diabetes.
6. Fasting urine glucose is positive multiple times in early pregnancy.
7. Suffer from polycystic ovary syndrome.
8. Multiple spontaneous abortions, fetal malformations or stillbirths without obvious reasons.
9. The fetus with neonatal respiratory distress syndrome has been delivered.
Text/Wu Shimin (Shanghai Licensed Pharmacists Association)