PT Health Life

Be careful of complications of gestational diabetes

0 23,450

PT health Life – Gestational diabetes, if not detected and well controlled, can seriously affect the health of the mother and fetus.

Pregnant women have ketonuria due to subjective management of gestational diabetes

Recently, the Department of Reproductive Endocrinology – Central Endocrine Hospital received and treated a 40-year-old female patient. When admitted to the hospital, the patient had high blood sugar , ketonuria, and fetal macrosomia. The patient has a history of gestational diabetes in two previous pregnancies and must be treated. In addition, the patient had 2 stillbirths at 7 – 8 weeks of pregnancy. This was her 5th pregnancy, but the patient did not go to the doctor and assess the risk factors for gestational diabetes and instead adjusted her regimen herself. eat and drink. At the 28th week of pregnancy, when going for a prenatal check-up, the obstetrician predicted that the fetus was large (1.5kg), so she instructed the patient to have a gestational hyperglycemia test to detect gestational diabetes. .

The results showed: Fasting blood sugar was 10.3 mmol/l. After 1 hour of drinking glucose, blood sugar increased to 18.4mmol/l, after 2 hours blood sugar increased to 18.92mmol/l. In addition, other tests showed that the patient had ketonuria; being overweight…

At the Central Endocrine Hospital, the examining doctor concluded that the patient had diabetes  before pregnancy. That is, in the case of pregnant diabetic patients.

1. Risk factors for gestational diabetes

High risk factors for gestational diabetes include any of the following:

  • Family history of first-degree relationship with diabetes.
  • History of giving birth to children weighing 4kg or more.
  • History of blood sugar disorders/gestational diabetes in a previous pregnancy.
  • Urinary glucose during pregnancy.
  • Polycystic ovary syndrome.
  • Obesity before pregnancy.

For the above patient case, there are many high risk factors for gestational diabetes, including:

  • Pregnancy at an advanced age.
  • Overweight before pregnancy.
  • History of 2 pregnancies with gestational diabetes.
  • History of miscarriage.
  • My father has diabetes.

However, the patient did not have regular check-ups to detect diabetes. Furthermore, even though she had gestational diabetes twice before, this pregnancy the patient did not go to the doctor to be tested for early diagnosis of gestational diabetes, which led to the above conditions.

The patient had to be hospitalized for treatment due to subjective failure to manage gestational diabetes.

2. Complications of gestational diabetes

According to doctors at the National Endocrine Hospital, common complications of gestational diabetes include hypertension and preeclampsia. These are two serious complications that threaten the lives of mother and child. Increased risk of premature birth, spontaneous abortion, urinary tract infections…

For the fetus, higher than normal blood sugar levels in the mother cause the fetus to grow too quickly, leading to large birth weight (usually over 4kg). A fetus that is too large will easily experience injury during birth. This complication can lead to brachial nerve paralysis, clavicle fracture, fetal distress, and asphyxia. The risk of fetal weakness is 4 times higher; susceptible to birth defects. There is a risk of premature birth and the baby will experience respiratory distress syndrome, often requiring special care after birth. Potential risks of diseases for children such as metabolic disorders such as neonatal hypoglycemia, hypocalcemia (due to functional hypoparathyroidism), hyperbilirubinemia, polycythemia (due to hypoxia); Risk of cardiovascular disease, obesity, hypertension, dyslipidemia…

Therefore, women with a history of gestational diabetes should note:

  • Regular blood sugar test every 6 months.
  • Examination and blood sugar testing before pregnancy.
  • When pregnant, you need to have a blood sugar test immediately to assess the risk.
  • Follow your diet according to your doctor or nutritionist’s instructions.

3. Treatment of diabetes in pregnant women

Treating diabetes in general and diabetes in pregnant women in particular requires a combination of methods: Nutrition, exercise and medication. Depending on the specific case, for example gestational diabetes or people with gestational diabetes, there will be different treatment regimens and goals.

The goal for gestational diabetes is to control glucose levels to:

  • Mother’s fasting capillary blood glucose =< 5.3 mmol/L.
  • Capillary blood glucose 1 hour after eating =< 7.8 mmol/L.
  • Capillary blood glucose 2 hours after eating =< 6.7 mmol/L.

For pregnant diabetics, they need to reach:

  • Fasting capillary blood glucose =< 5.3 mmol/L.
  • Capillary blood glucose 1 hour after eating =< 7.8 mmol/L.
  • Capillary blood glucose 2 hours after eating =< 6.7 mmol/L.
  • HbA1C < 6 – 6.5% and no excessive hypoglycemia.

Nutritional treatment to achieve goals:

  • Achieve normal glucose levels.
  • Avoid hyperketonemia.
  • Gain weight appropriately.
  • Healthy fetus.

Nutrition needs to be individualized, recommendations are as follows:

The diet needs to balance the ratio of nutritional groups and well control the amount of calories consumed each day.
  • Women with gestational diabetes with ideal weight need 30kcal/kg/day.
  • Overweight women need 22-25kcal/kg/day.
  • Obese women reduce their energy needs by 30% or limit them to less than 22kcal/kg/day.
  • Underweight women need 40 kcal/kg/day.

Recommended nutrient group composition according to the ratio:

  • Carbohydrates should be distributed into several meals to avoid increased blood glucose after meals. The proportion of carbohydrates accounts for about 40% of the energy supply but is guaranteed not to increase blood ketones. Limit carbohydrates such as bread, rice, potatoes, sweet fruits, fruit juice.
  • Use foods with a low glycemic index.
  • Protein makes up about 20% of energy supply.
  • Lipids account for 40% of energy supply, of which saturated fat accounts for less than 7%.
  • Need to provide enough vitamins and minerals necessary for mothers.
  • Monitor patient weight regularly.

Exercise regime: Pregnant women should be advised to exercise if there are no obstetric contraindications. Pregnant women should maintain light to moderate intensity exercise for 20 – 30 minutes at a time, 3 times a week.

Treatment with medication: According to Associate Professor,  “if you are pregnant, you must use insulin to lower blood sugar whether it is gestational diabetes or type 2 diabetes during pregnancy.” .

Up to now, there have been a few studies that show that some oral medications can be used to treat people with gestational diabetes or type 2 diabetes during pregnancy. But these opinions are not supported by the majority of experts. It is also recommended to choose certain types of insulin for pregnant women, but the type of insulin to use and the insulin dosage should still be chosen according to each patient. Insulin dosage during pregnancy also needs to change according to gestational age. Therefore, patients need to see a doctor regularly every 4 weeks for advice and appropriate medication dosage.

People with gestational diabetes also have their own dietary advice that changes according to gestational age.

After giving birth, whether or not diabetes medication is needed will be decided by a confirmed diagnosis after birth from 6 to 12 weeks using an oral hyperglycemia test.

Đánh giá bài viết
Leave A Reply

Your email address will not be published.