Diabetes occured during gestation is called gestational diabetes.
l Pregnancy in diabetes: diabetic patients get pregnant, accounting for 10~20%
l Gestational diabetes: diabetes occurs after gestation more than 80%, account for 2～3％ of gestational women
Note: Retest OGTT at 6 months after parturition for reevaluation
The relationship between gestation and diabetes
l Influence of diabetes on gestation
1. Low pregnancy rate: caused by poor physical condition and turbulence of incretion
2. Increased polyhydramnios rate: 20 times higher than the rate of non-diabetic women ( related to blood sugar)
3. Increased pregnancy toxemia: 3~5 times higher than the rate of non-diabetic women
l Influence of gestation on diabetes
1. Greater changes in blood sugar: associated with diet and increased insulin resistance
2. Changes in insulin infusion algorithm: decreasd during early pregnancy, increased during late pregnancy, and decreased greatly after parturition.
3. Ketoacidosis: probably induced by inducements when acute diabetic complications occur frequently and glucose fluctuates greatly
4. Increased chronic complications: caused by improper blood sugar management, which may result in death or disability
Influence of diabetes on fetus
l Abnormality rate will increase, which is about 3~5 times higher than those of non-diabetes, associated with the blood sugar management level and the disease degree. Hyperglycemia and hyperketonemia in the first 7 weeks of pregnancy are the main reasons.
l Macrosomia occurrence increases. Newborns who weigh more than 4kGs are called macrosomia. The chance for diabetic women to have macrosomia is 3~4 times higher than that for non-diabetic women, resulting from the fetuses’ insulin incretion stimulated by the diabetic pregnant women’s high blood sugar and high fatty acid.
Macrosomia will cause abnormal parturition, adding more danger.
l The occurrence of abnormal newborns will increase:
1. Insulin resistance: hypoglycemia rate among newborns will increase; especially one third macrosomias may have hypoglycemia.
2. The occurrence of neonatal respiratory distress complication increases, which is 5~6 times as that of non-diabetes, resulting from lung hypogenesis of fetus. The fetus mortality in perinatal period will increase, especially the occurrence of fetus ketoacidosis is up to 50%.
3. Diabetes occurs in the next generation.
Diagnosis (OGTT oral glucose is 50 or 75g)
l Gestation in diabetes: diabetic patients get pregnant
l Gestational diabetes: the same as non-diabetes
Fasting glucose: ≥7.0mmol/L (126mg/dL)
Postprandial glucose: ≥11.1mmol/L(200mg/dL)
Postprandial glucose ≥7.8mmol/L and ≤11.1mmol/L: impaired glucose tolerance.
Gestational impaired glucose tolerance should be treated in the same way as diabetes.