When to screen for gestational diabetes with high-risk people

The article was consulted professionally by Specialist I Truong Nghia Binh – Obstetrician and Gynecologist – Share99 Da Nang International Health Hub. Doctors have more than 13 years of experience in the field of obstetrics and gynecology.

Mothers with gestational diabetes can have negative effects on the fetus such as overweight, premature birth, birth defects or serious complications from increased blood pressure. Therefore, screening for gestational diabetes mellitus should be carried out, especially with the group of people at high risk of the disease.

It is estimated that about 5% of pregnant women have gestational diabetes mellitus. This is a glucose tolerance disorder that causes high blood glucose, oncologically or is first detected during pregnancy. The term applies to pregnant women who simply adjust their diet without taking insulin.

Gestational diabetes mellitus is a type of diabetes mellitus, which appears only and persists during pregnancy. Gestational diabetes mellitus on-the-go during pregnancy and self-curing after birth. If within 6 weeks after birth, the mother has not cured the disease, it is not determined that gestational diabetes mellitus but type 1 diabetes mellitus, type 2 diabetes mellitus, nutritional diabetes mellitus or symptomatic diabetes mellitus.

Gestational diabetes mellitus is on the rise due to an increase in the incidence of obesity, type 2 diabetes and insulin resistance in polycystic ovary syndrome. In addition, people with a history of diabetes mellitus in the family, a history of childbirth ≥ 4kg, ≥ 35 years old, diagnosed with blood glucose disorders at hunger, have an abnormal obstetric history (still-death pregnancy, unsubrdinal miscarriage) ,… are at increased risk for gestational diabetes mellitus.

Screening for timely detection and intervention for patients with gestational diabetes mellitus is extremely important. The cause is that if not detected early, increased blood sugar during pregnancy can harm the fetus, causing congenital abnormalities, large pregnancies or miscarriages.

In the last 6 months of pregnancy, if the mother has hypertension, it can cause increased blood glucose in the fetus and cause an increase in insulin in the fetus. After birth, because the child does not receive as much sugar as when he was in the womb, an excess of insulin will lower the child's blood sugar than normal. Hypothymemia can damage a child's brain neurons if not treated promptly.

Besides, the pregnancy of mothers with gestational diabetes also tends to be larger than usual so there is a risk of premature birth. Due to premature birth, babies are at increased risk for respiratorydiseases , especially respiratory distress syndrome in babies. At the same time, hypertension in pregnant women also causes preetasis (edema, hypertension,…) if blood glucose is not well controlled, threatening the lives of both mother and fetus.

Therefore, it is necessary to perform screening for gestational diabetesmellitus , especially for people at high risk of getting sick at the appropriate time as recommended by the doctor.

3.1 For low-risk pregnancies

Pregnant women with blood glucose at previous hunger reach < 92mg/dL đều được chỉ định sàng lọc đái tháo đường vào tuần thứ 24 – 28 của thai kỳ.

For diagnosis, perform glucose tolerance testing by giving patients night-time hunger, the next morning try a hungry blood glucose sample and a blood glucose sample 2 hours after taking 75g of glucose. The result returns as follows:

• True diabetes mellitus if FPG ≥ 126mg/dL;
• Gestational diabetes mellitus if at least 1 hungry blood glucose sample has an index of 92-125mg/dL, blood glucose at 1 hour after taking 75g of glucose is ≥180mg/dL and/or blood glucose 2 hours after taking 75g of glucose is ≥153mg/dL;
• Normal results if post-oral blood glucose is 75g below the threshold for diagnosis of gestational diabetes mellitus.

Pregnant women who have been diagnosed with gestational diabetes mellitus or real diabetes mellitus throughout pregnancy should continue to be monitored for post-birth blood glucose.

3.2 For pregnant women with high-risk gestational diabetes mellitus

High-risk pregnant women (families with people with diabetes, obese pregnant women,…) need a blood glucose test at hunger,HbA1c and any blood glucose test in the first 3 months of pregnancy. The result returns as follows:

• True diabetes mellitus if blood glucose is ≥ 126mg/dL, HbA1c ≥ 6.5% or any blood glucose ≥ 200mg/dL.;
• Gestational diabetes mellitus if blood glucose is hungry at 92-125mg/dL;
• Normal results if blood glucose < 92mg/dL. These pregnancies need to be tested for glucose tolerance at the 24th – 28th week of pregnancy.

If the pregnant woman has a test for gestational diabetes, an end end of end end of specialty should be examined, in combination with a regular pregnancy examination. With cases that qualify for the diagnosis of true diabetes mellitus, the same treatment and monitoring of patients who have had diabetes mellitus before.

Note: Pregnant women with gestational diabetes should be tested every 3 years to detect the progress of diabetes or pre-diabetes.

• Combining treatment between internal medicine and obstetrician during pregnancy;
• Balance nutrition and maintain a workout regime as advised by your doctor;
• Control blood glucose levels with diet or with insulin medications to reduce complications for pregnant women and fetuses;
• Can monitor natural labor, prescribe caesarean section during large pregnancy or pregnancy failure;
• During labor it is necessary to control the blood glucose of the maternity (it is best to fluctuate between 3.3 – 5.6 mmol/l);
• During labor, it is necessary to monitor the pregnancy heart for timely detection and treatment if there is pregnancy failure. The use of insulin should be very cautious because after taking all the vegetable cakes, the loss of insulin resistance can cause hypoglycemia. It is necessary to closely monitor blood sugar levels to adjust the drug for use accordingly;
• Closely monitor babies for the first 3 days after birth to detect and promptly handle complications.

All pregnant women, especially high-risk pregnant women, should be screened for gestational diabetes mellitus. When determining gestational diabetes, patients should re-examine on schedule and coordinate according to the advice of their doctor in treating the disease to avoid the risk of dangerous complications for both mother and baby.

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.