Article by Dr Pham Thi Tuyet Mai – Specialist 2 Pham Thi Tuyet Mai – Obstetrics and Gynecology Department – Share99 Hai Phong International Health Hub
Gestational diabetes mellitus is one of the pathular conditions that can be seen in pregnant women during pregnancy. Accordingly, gestational diabetes mellitus can lead to health hazards for both mother and child. Therefore, depending on the state of health obstetrician will consider maternity should give birth normally or cesarean section.
Gestational diabetes mellitus can cause many events for both mother and pregnancy that have long been proven. However, mild gestational diabetes mellitus affects the fetus and the mother is still not well understood. The previous definition of gestational diabetes did not allow to distinguish the degree of mild severeness. Accordingly, gestational diabetes mellitus can range from glucose tolerance disorder to severe hypoglycemia and is there any difference in post-birth monitoring?
1. What is gestational diabetes mellitus?
Gestational diabetes mellitus is also known as the sugar tolerance disorder that occurs during pregnancy. About 5% of pregnant women experience this disorder and are common in the middle 3 months of pregnancy.
- To diagnose gestational diabetes mellitus at weeks 24-28, perform a glucosetolerance test , by giving the patient a nightly fasting, the next morning try a hungry blood glucose sample and a blood glucose sample 2 hours after taking 75g of Glucose.
- Diabetes mellitus is clear if FPG ≥ 126mg/dL.
- Gestational diabetes mellitus if: at least one hungry blood glucose sample of 92-125mg/dL, blood glucose 1 hour after oral 75g of glucose ≥ 180mg/dL and or blood glucose 2 hours after oral 75g of glucose ≥ 153mg/dL
- Every pregnant woman who has been diagnosed with gestational diabetes mellitus or true diabetes mellitus throughout pregnancy should be monitored for continued blood glucose after birth.
- Obstetrician doctors should be given early screening for real diabetes mellitus (including hungry blood glucose and HbA1c) for high-risk pregnant women at the first pregnancy visit. At the same time, all pregnant women should check their blood glucose levels and conduct a glucose tolerance test at the 24-28 weeks of pregnancy.
- Women who have been diagnosed with gestational diabetes mellitus or real diabetes mellitus during pregnancy should continue to monitor post-birth blood glucose.
2. Is gestational diabetes dangerous?
Gestational diabetes mellitus has severe consequences for both mothers and babies, increasing the incidence of disease and death.
Accordingly, the fetuses of women with gestational diabetes are at risk:
- Suffering from congenital malformations: heart, nervous system, large blood vessels, bones, urinary tract.
- Increased perimeter mortality especially after childbirth due to hypoglycemia, blood calcium, due to premature calving.
- Pregnancy is larger than 4,000 grams or the pregnancy is underdeve developed.
- Multiple amniotic fluid or lack of amniotic fluid.
- Miscarriage or still still death.
- Trauma due to large pregnancy, difficult childbirth
Women with gestational diabetes are at risk:
- Increases the risk of complications for the mother such as conversion disorders,bacterial infections, coronary damage.
- Pre-productionjerks, jerks, young peeled vegetables.
- Laying difficulties, trauma in calving
- Post-birth bleeding due to uterine sputum.
- Increased infection rate
- The risk of becoming type 2 diabetes later.
- Obesity and excessive weight gain.
Treatment of diabetes mellitus during pregnancy aims to control blood glucose positively and safely for a narrow period of time, to ensure the safety of both women and fetuses (Blood glucose during hunger < 5,8mmol/l, đường huyết 1 giờ sau ăn 7,8mmol/l và 2 giờ sau ăn < 7,2mmol/l. It is also not recommended to leave blood glucose levels at hunger as low as 3.4 mmol). Treatment includes therapeutic nutrition and medications.
3. Is gestational diabetes normal?
3.1 Time of childbirth for women with gestational diabetes mellitus
Based on the results of the examination, obstetrician and gynecologist will decide when to give birth to a woman with diabetes mellitus. Unless the mother or fetus has complications, the best time of birth is at the 38-41 week to prevent some complications from premature calving, especially respiratory failure caused by im imm adult lungs. However, it is possible to give birth before the 38th week if a large pregnancy is detected. If it is decided to give birth prematurely before week 37, it is necessary to consider the lung development of the fetus with an amniotic fluid test.
3.2 It is recommended to give birth often to a woman with diabetes mellitus
If it is predicted that the lungs of the pregnancy are mature, then the choice for maternity by any route is the same as for women who do not have gestational diabetes. However, if a clinical examination and ultrasound of the pregnancy is large, a caesarean section should be considered to avoid the risk of a child dislocating their shoulder or injury during lower calving.
Women with gestational diabetes mellitus without obstetrics and gynecology are still monitored for childbirth often because the risks to the mother will be lower when giving birth to lower sugar. During labor, it is still necessary to continue monitoring the gestational heart and regulating blood glucose. Mmomic blood glucose during childbirth should be controlled < 6,1 mmol/l, nếu để trên 8,3 mmol/l thì khả năng thai nhi bị thiếu oxy sẽ cao.
4. Notes on childbirth with mothers with gestational diabetes
Possible risks in babies in the first week after childbirth with women with gestational diabetes mellitus. Namely the following:
Acute respiratory failure
Children of women who do not have good blood glucose control are at increased risk for acute respiratory failure due to underded development of the lungs, often severe illness, and high mortality. Children with acute respiratory failure usually breathe very quickly more than 60 times / minute, wheezing,chest contractions and also abdomen, cyanosis … the treatment is quite complicated but today there are some methods that achieve good results.
Babies may have hypoglycemia within the first 48 hours of calving, blood glucose may be less than 1.7 mmol/l. This is because an increase in blood insulin persists after calving. Often the child is in a coma rather than irritation, and hypotensive blood glucose can be coordinated with apnea, or rapid breathing, purpleness, or convulsions. Prevention by giving sugar water or giving through gastric sonde after calving about 1 hour, if this measure is unsuccessful, intravenous glucose infusion.
Some other disorders are hypocalcemia, increased blood bilirubin (causing jaundice), polyethemia and poor appetite.
All patients with gestational diabetes should receive active treatment to control blood glucose well during pregnancy. In addition, the fetus needs to be monitored regularly to be able to detect malformations early, the risks affecting the development of the fetus, from which doctors plan to intervene in the most timely and effective way.
Share99 International Health Hub offers a full maternity care program for women from the very beginning of pregnancy from the first months with a full range of pregnancy examinations, 3D ultrasounds, 4D routines and routine tests to ensure the mother is always healthy and the fetus develops comprehensively.
Obstetrics and Gynecology will be consulted and checked under the close supervision of experienced and professional obstetrician, helping mothers have more knowledge to protect their health during pregnancy as well as minimize complications affecting mothers and children.
Customers can directly go to Share99 Health System nationwide for examination or contact the hotline here for assistance.
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