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Gestational Diabetes Mellitus
Exercise for Gestational Diabetes
Exercise can increase insulin sensitivity and can lower blood sugar independently of insulin. Therefore, patients with gestational diabetes can also exercise appropriately, which is beneficial for the utilization of blood sugar and helps lower it. The exercise for gestational diabetes generally involves regular, rhythmic aerobic exercises, which can include upper body exercises, gymnastics, and previously mentioned activities. The duration of exercise should generally be around 20-30 minutes, and it is advisable to exercise about one hour after meals. The frequency of exercise should be three to five times per week. During exercise, the heart rate should not exceed 120 beats per minute to avoid intense physical activity.
Symptoms of gestational diabetes
Gestational diabetes refers to abnormal glucose tolerance that occurs during pregnancy. It usually involves only mild, asymptomatic hyperglycemia without the typical symptoms of diabetes such as dry mouth, excessive thirst, frequent urination, and weight loss. However, significant increases in blood sugar can lead to symptoms such as dry mouth, excessive thirst, frequent urination, and weight loss. It is important to be vigilant for gestational diabetes in patients who exhibit symptoms such as excessive amniotic fluid, a large fetus, or recurrent urinary tract infections. Therefore, it is generally recommended for pregnant patients to complete an OGTT (Oral Glucose Tolerance Test) by the 24th week of pregnancy to confirm whether they have gestational diabetes. After childbirth, blood sugar levels in women with gestational diabetes generally return to normal, but the risk of developing Type 2 diabetes in the future significantly increases. Therefore, patients with gestational diabetes should undergo diabetes screening 6 to 12 weeks postpartum and be monitored over the long term.
Gestational diabetes screening time
The screening time for gestational diabetes refers to all pregnant women undergoing a 75-gram glucose tolerance test between 24 to 28 weeks of pregnancy to measure blood sugar levels and determine the presence of gestational diabetes. However, for pregnant women at high risk, including those with a history of gestational diabetes, delivery of a large fetus, obesity, polycystic ovary syndrome, a family history of diabetes, positive urinary glucose in early pregnancy, or unexplained recurrent miscarriages, fetal malformations, stillbirths, or even a history of childbirth with neonatal respiratory distress syndrome, blood sugar should be monitored as early as possible to understand the situation.
How to reduce blood sugar in gestational diabetes
Gestational diabetes cannot be treated with oral medications, as they can affect the fetus. Currently, the main treatment for gestational diabetes in China is insulin, with options for short-acting or rapid-acting insulin. If fasting blood glucose is high, long-acting insulin can be used to control fasting blood glucose levels. If post-meal blood glucose is high, short-acting or rapid-acting insulin can be used to control post-meal blood glucose levels. The blood glucose control standards for gestational diabetes are fasting blood glucose between 4.0 and 5.3, and two hours post-meal blood glucose between 4.4 and 6.7.
High-risk factors for gestational diabetes
High-risk factors for gestational diabetes include: women older than 35 years, those with a history of gestational diabetes, history of delivering large babies, obesity, patients with polycystic ovary syndrome, first-degree relatives with a family history of diabetes, early pregnancy checks showing fasting hyperglycemia or positive glucosuria, patients who have had multiple spontaneous miscarriages without obvious causes, fetal malformations, stillbirths, and patients with a history of delivering newborns with respiratory distress syndrome. Women with the above high-risk factors should undergo early testing for fasting blood glucose and a 75-gram glucose tolerance test to diagnose gestational diabetes and initiate early intervention.
Impact of gestational diabetes on the fetus and pregnant women
The effects of gestational diabetes on the mother mainly include an increased risk of miscarriage, concurrent conditions such as gestational hypertension and preeclampsia, as well as the potential for diabetic ketoacidosis. The presence of a large fetus can lead to difficult labor, damage to the birth canal, prolonged surgical delivery, and an increased likelihood of postpartum hemorrhage. Additionally, women with gestational diabetes have an increased risk of developing the condition again in future pregnancies. In terms of long-term effects, the risk of developing type 2 diabetes significantly increases after experiencing gestational diabetes. For the fetus, the impacts of gestational diabetes primarily manifest as an increased risk of spontaneous miscarriage, congenital anomalies, and abnormal development. There is also a heightened risk of hyperinsulinemia, which can even affect the proper development and maturity of the fetal lungs, leading to delays. After birth, conditions such as hypoglycemia and neonatal respiratory distress syndrome are more likely to occur. In the long term, offspring of women with gestational diabetes are at higher risk for glucose intolerance, diabetes, obesity, and metabolic syndrome. These conditions significantly increase the risks to the cardiovascular system and can affect neuromotor development.
How is gestational diabetes treated?
The treatment of gestational diabetes includes dietary therapy, exercise therapy, and insulin therapy. For dietary therapy, we mainly control the total calorie intake and supplement with elements such as calcium, iron, folic acid, and various vitamins; in exercise therapy, we aim to control the speed of weight gain, improve the peripheral tissues' utilization of glucose, and improve the lipid profile. For patients whose blood glucose levels do not meet the standards after two weeks of diet and exercise therapy, we initiate insulin therapy. The goal of insulin therapy is to control fasting blood glucose below 5.3 and postprandial blood glucose below 6.7. The methods of insulin therapy include twice daily injections, multiple daily injections, or the use of an insulin pump.
Effects of gestational diabetes on the fetus
The impact of gestational diabetes on the fetus mainly manifests in early stages as spontaneous miscarriage, fetal malformations, and abnormal fetal development. As the fetus grows, the high maternal blood sugar levels can lead to a large fetus, which increases the risk of birth injuries during delivery. Due to the high insulin levels in the mother, the fetus may have hyperinsulinemia, which can cause recurrent hypoglycemia at birth. Additionally, the development and maturation of the fetal lungs are delayed, making the newborn more susceptible to respiratory distress syndrome. Furthermore, gestational diabetes also increases the risk of preterm birth.
Gestational diabetes standards
Before addressing this question, let's first clarify another concept: if diabetes is diagnosed before pregnancy, this is referred to as pre-existing diabetes in pregnancy, which is different from gestational diabetes. Gestational diabetes refers to cases where there is no pre-existing diabetes diagnosis before pregnancy, but abnormal blood glucose levels are detected after becoming pregnant. Generally, a glucose screening test is conducted between the 24th and 28th weeks of pregnancy. Currently in China, there are two approaches: the one-step and the two-step methods. The one-step method involves a direct 75-gram oral glucose tolerance test. However, most of China uses the two-step method, which starts with a 50-gram glucose challenge test. If the blood glucose level one hour after eating is greater than or equal to 7.8 mmol/L, a 75-gram oral glucose tolerance test is recommended. For the 75-gram glucose test, the fasting blood glucose level should generally be less than or equal to 5.6 mmol/L, one hour post-glucose intake should be 10.3 mmol/L, two hours post-glucose should be 8.6 mmol/L, and three hours post-glucose should be 6.7 mmol/L. If two or more of these values exceed the diagnostic criteria, gestational diabetes can be diagnosed. If only one value is abnormal, impaired glucose tolerance can be diagnosed. It is recommended that anyone who experiences abnormal blood glucose levels during pregnancy undergo another 75-gram oral glucose tolerance test six months post-pregnancy to determine if blood glucose levels are still abnormal and whether treatment should continue.
Gestational diabetes symptoms
Gestational diabetes shows several symptoms, the most typical being the "three more one less" syndrome, namely increased thirst, increased appetite, urination, and weight loss. The second common manifestation is fatigue, which is due to glucose not being utilized effectively in the body and being broken down too quickly, leading to insufficient energy replenishment. The third is unexplained frequent fungal infections, such as recurring candidal infections of the vulva and vagina, at which point blood sugar screening should be considered. The fourth symptom is pregnancy accompanied by excessive amniotic fluid or a large fetus. The fifth is glucose positivity in urine from two fasting morning samples.