Pay attention to the screening of diabetes during pregnancy

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Gestational diabetes mellitus (Gestational diabetes, GDM) refers to the occurrence of pregnancy or the first discovery of varying degrees of

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Gestational diabetes mellitus (Gestational diabetes, GDM) refers to the occurrence of pregnancy or the first discovery of varying degrees of impaired glucose tolerance, accounting for about 90% of pregnancy associated with diabetes mellitus (about mellitus). In recent years, through strict control of gestational diabetes mellitus in pregnant women's blood glucose, fetal monitoring, maternal complications significantly reduced perinatal mortality significantly decreased. However, in the treatment of pregnant women who did not receive timely diagnosis and treatment of diabetes, the incidence of maternal and fetal complications was still high. Pre pregnancy diabetes, duration of diabetes, the disease degree is relatively heavy, if the pregnancy blood glucose control is not satisfactory or not during pregnancy were closely monitored, maternal and fetal complications will significantly increase.

GDM maternal blood glucose increased mainly in the middle and late stages of pregnancy, fetal tissues and organs have been formed, so the incidence of fetal malformations and spontaneous abortion in GDM pregnant women does not increase. But the early pregnancy diagnosis of GDM in pregnant women, especially patients with elevated fasting blood glucose (FBG), namely the GDMA2 sufferers, the fetal malformations and the incidence of spontaneous abortion and pregnancy similar to pre pregnancy diabetes.

Pregnant complication

1 spontaneous abortion: pre pregnancy and early pregnancy hyperglycemia, will affect the normal development of the embryo. If the embryo is severely deformed, the embryo will cease to develop and produce an abortion.

2 the incidence of pregnancy induced hypertension syndrome (PIH) was significantly increased in patients with diabetes mellitus (DM), long duration of diabetes, microvascular disease and poor glycemic control during pregnancy. The incidence of PIH in diabetic nephropathy is as high as 54%. Once pregnant women with PIH, perinatal prognosis is poor, so, during pregnancy should actively prevent the occurrence of PIH.

3: early pregnancy complicated with ketoacidosis, DKA will increase the incidence of fetal anomalies; middle and late pregnancy complicated with ketoacidosis, will increase the degree of fetal hypoxia, resulting in severe fetal death, but also affect the development of fetal nervous system. Mainly in type I diabetic ketoacidosis complicating pregnancy and failed to timely diagnosis and treatment of GDM patients. Compared with non pregnant women, pregnant women, blood sugar increased slightly from 8.33 to 13.gmmol/L, can cause severe ketosis and even induce ketoacidosis.

4 intrauterine growth restriction: mainly seen in diabetic patients with microvascular disease. Hyperglycemia in early pregnancy can inhibit the development of embryo. In addition, diabetic patients with microvascular disease, placental blood vessels are often associated with abnormal, resulting in reduced fetal blood supply, affecting fetal development.

5 excess amniotic fluid: the cause is not clear, may be associated with high levels of fetal blood glucose, leading to high osmotic diuresis, fetal urination increased. Fetal malformation is also one of the causes of excessive amniotic fluid.

6 giant fetus: the incidence rate of 25% of a total of 40%. Common in GDM and pre pregnancy diabetes without vascular disease, huge fetal obesity rate was significantly increased in diabetic pregnant women. The incidence of fetal macrosomia was positively correlated with the level of blood glucose in pregnant women in middle and late pregnancy.

The incidence of urinary tract infection was also increased in 7 GDM patients with suboptimal blood glucose control.

8.GDM 5 a year after the birth of pregnant women, about one in 63% of the development of type 2 diabetes in the second trimester of pregnancy, the recurrence rate of GDM is as high as one of the 69%, and more than 52% weeks before the onset of pregnancy in the past 24 weeks, the incidence of.

Perinatal complications

1 neonatal respiratory distress syndrome (RDS): fetal hyperinsulinemia can inhibit glucocorticoid induced release and promote the synthesis of pulmonary surfactant cells during pregnancy, the fetal pulmonary surfactant production and secretion, resulting in fetal lung maturation delay, neonatal RDS increased. The occurrence of neonatal RDS in diabetic pregnant women is not only related to the delayed development of fetal lung, but also related to the following factors: early termination of pregnancy, cesarean delivery and neonatal asphyxia. In recent years to strengthen the treatment of gestational diabetes, delayed termination of pregnancy, the incidence of neonatal RDS has been significantly reduced. Kjos et al. Study showed that the incidence of RDS in pregnant women with ideal blood glucose control and 38 weeks after delivery was similar to that of normal pregnant women.

2 neonatal hypoglycemia due to fetal hyperinsulinemia, leaving maternal hyperglycemia environment after neonatal, if not promptly added sugar, neonatal hypoglycemia incidence rate reaches as high as 30% to 50%, mainly occurred in the 12 hours after birth. Because the blood glucose level of pregnant women is closely related to the occurrence of neonatal hypoglycemia, maternal blood glucose should be maintained at 4.4 6.7mmol/L. In the process of hyperglycemia, intravenous infusion of small doses of insulin.

3 neonatal polycythemia: chronic fetal hypoxia can induce erythropoietin production increased, stimulate fetal bone marrow hematopoietic, resulting in increased production of red blood cells, leading to neonatal polycythemia, the incidence rate of up to 30%. After the birth of a large number of red blood cells, the body is destroyed, increase the production of bilirubin, resulting in neonatal hyperbilirubinemia. As with asphyxia, will aggravate the neonatal hyperbilirubinemia.

4 neonatal hypertrophic cardiomyopathy: one in 20% of newborns with cardiac enlargement, the cause is not clear, mainly in the control of blood glucose control is not ideal for the delivery of macrosomia in pregnant women. Echocardiography showed cardiac enlargement, 75% ventricular septal hypertrophy, myocardial hypertrophy. Only a small number of newborns have difficulty breathing, severe heart failure will occur. Enlargement of the heart of most newborns can return to normal.

5 neonatal low calcium and magnesium deficiency: diabetic pregnant women often accompanied by low blood magnesium, which leads to increased incidence of neonatal low blood magnesium. About 30% to 50% of pregnant women with diabetes mellitus with neonatal hypocalcemia, mainly occurred in 24 to 72 hours after birth, most are asymptomatic, and neonatal hypomagnesemia, followed by reduced production of parathyroid hormone related.

6 renal vein thrombosis: extremely rare, the cause is not very accurate. If the disease is not timely diagnosis and treatment, neonatal mortality is extremely high.

7 long term complications of newborns: increased risk of obesity in offspring of diabetic mothers. The study found that children aged 1 years of age, normal weight, but childhood obesity; adult type 2 diabetes increased. Studies have shown that breastfeeding can delay the onset of childhood diabetes. Long term follow-up results showed that the effects of GDM on the intelligence development of offspring were not consistent.

8 neonatal malformation: pregnant women with diabetes before pregnancy fetal malformation significantly increased the incidence of 2% to 10%. In 2002 Sheffield reported incidence of 6.1% fetal malformation. The fetus is usually a multiple malformation, and the common deformity is the malformation of the cardiovascular system, such as the transposition of the great vessels, ventricular septum or ventricular septal defect and single ventricle. The central nervous system malformations, such as anencephaly, hydrocephalus, cerebral meningocele, spina bifida and holoprosencephaly. Abnormalities of the digestive system, such as anal and rectal atresia, and other forms of renal hypoplasia, polycystic kidney disease, hypoplasia of the lung, and skeletal abnormalities such as regression's syndrome (caudal). Cardiovascular system and nervous system malformations are the most common, the most serious impact on the fetus. The pre pregnancy glycemic control in diabetic patients and to maintain normal blood sugar in normal range during early pregnancy, fetal malformation was significantly reduced.

9 perinatal death: in recent years, it is important to pay attention to the control of blood glucose during pregnancy and to strengthen the monitoring of maternal and fetal during pregnancy. There is no significant occurrence of fetal death in the late pregnancy. In patients with gestational diabetes mellitus who missed diagnosis and did not receive treatment, it is easy to be complicated with fetal distress in late pregnancy. Pregnant women with ketoacidosis, intrauterine fetal death rate as high as 50%.

 

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