29/07/2022
1. What is gestational diabetes?
As defined by the World Health Organization (WHO), gestational diabetes (or gestational diabetes) “is a state of glucose intolerance of any degree, with onset or first detected during pregnancy". This condition often has no symptoms, so it is difficult to detect and will disappear after 6 weeks of birth.
People at high risk for gestational diabetes:
Overweight, obese.
Family history: Someone with diabetes, especially someone with first-generation diabetes.
Birth history ≥ 4000g.
History of abnormal glucose tolerance including history of previous gestational diabetes, positive urine glucose.
The older the age, the higher the risk, ≥ 35 years is a high risk factor for gestational diabetes.
Abnormal obstetric history: unexplained stillbirth, unexplained recurrent miscarriage, preterm birth, fetal malformation.
Race: Asians are a high-risk ethnic group for gestational diabetes.
Polycystic o***y syndrome.
Gestational diabetes accounts for 3-7% of all pregnant women, poses many risks to the mother and fetus if not properly monitored and treated.
gestational diabetes
Gestational diabetes accounts for 3-7% of all pregnant women
2. Is gestational diabetes dangerous?
2.1 Influence on the mother
Pregnant women with gestational diabetes may increase the rate of miscarriage, stillbirth, preterm birth, hypertension in pregnancy, polyhydramnios, urinary tract infection, pyelonephritis, cesarean section. In the long term, pregnant women with gestational diabetes have an increased risk of developing type 2 diabetes and related complications, especially cardiovascular complications. Pregnant women with gestational diabetes have a higher risk of complications during pregnancy than normal pregnant women. Common adverse events are:
High blood pressure
Pregnant women with gestational diabetes are more likely to have high blood pressure than normal pregnant women. High blood pressure in pregnancy can cause many complications for mother and fetus such as: preeclampsia, eclampsia, cerebrovascular accident, liver failure, kidney failure, intrauterine growth retardation, preterm delivery and increased perinatal mortality. The proportion of pregnant women with gestational diabetes with preeclampsia is about 12% higher than that of women without gestational diabetes. Therefore, measuring blood pressure, monitoring weight, finding protein in the urine regularly for pregnant women with gestational diabetes is very necessary in each periodical antenatal check-up.
Premature birth
Pregnant women with gestational diabetes have an increased risk of preterm delivery compared with women without gestational diabetes. Causes of preterm birth are delayed glycemic control, urinary tract infection, polyhydramnios, preeclampsia, and hypertension.
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Polyhydramnios
Excessive amniotic fluid usually begins to be seen between the 26th and 32nd weeks of pregnancy. Excessive amniotic fluid also increases the risk of preterm birth in pregnant women.
Miscarriage and stillbirth
Pregnant women with gestational diabetes have an increased risk of spontaneous abortion, and women with recurrent miscarriages need to have their blood glucose checked regularly.
Urinary tract infection
Pregnant women with gestational diabetes, if plasma glucose control is not good, increase the risk of bacteriuria. Urinary tract infection may be asymptomatic, but it causes the mother's plasma glucose to become unbalanced and requires treatment. If not treated, it will easily lead to acute pyelonephritis, thereby causing many other complications such as ketosis, premature birth, amniotic infection.
Long-term effects
Many studies have found that women with a history of gestational diabetes have an increased risk of developing type 2 diabetes in the future. In addition, pregnant women with gestational diabetes have an increased risk of developing diabetes in subsequent pregnancies. They are also prone to obesity, excessive weight gain after giving birth without proper diet and exercise.
2.2 Effects on the fetus
gestational diabetes
Excessive fetal growth is a consequence of increased glucose transport from the mother to the fetus
Gestational diabetes affects fetal development mainly in the first and third trimesters of pregnancy. In the first 3 months, the fetus may not develop, spontaneous abortion, birth defects, these changes usually occur in the 6th to 7th week of pregnancy. In the second trimester, especially in the last three months of pregnancy, there is an increase in fetal insulin secretion, causing the fetus to grow excessively.
Excessive growth and large fetus
Excessive fetal growth is a consequence of increased glucose transport from the mother to the fetus. This amount of glucose has stimulated the pancreas of the fetus to secrete insulin, increasing the energy requirements of the fetus, stimulating the development of the fetus.
Hypoglycemia and metabolic diseases in the neonate
It accounts for about 15% - 25% of newborns with diabetes in pregnancy. The cause is usually due to the fetal liver's poor response to glucagon, causing decreased gluconeogenesis from the liver.