First, the cause of GDM
During pregnancy, the mother will have a series of metabolic changes of growth and development for maternal and fetal exchange. Substance insulin resistance in pregnant women placental lactogen hormone, progesterone, estrogen, adrenal cortical hormone and placental insulin enzymes increase, enable pregnant women to insulin sensitivity decreased, in order to maintain normal glucose metabolism, insulin secretion amount of reaction Xing Zenggao, third trimester maternal pancreatic island pigment secretion is 3-4 times the pre pregnancy, pregnant women and less beta cell reserve is unable to compensate for the physiological changes and may occur abnormal glucose tolerance.
Two, GDM harm to the mother and infant
Failure to get timely diagnosis and proper treatment of GDM can cause a variety of adverse pregnancy outcomes, serious harm to the health of mother and infant. On the fetus, pregnant women with high blood sugar can be through the placenta and cause fetal hyperglycemia, secondary hyperinsulinemia and increased the risk of macrosomia, neonatal hypoglycemia; at the same time, affect fetal pulmonary surfactant synthesis and release, resulting in fetal lung maturation delay; in addition, fetal malformation, fetal death in uterus, placental abruption etc. incidence increased. For pregnant women, GDM increases the risk of preeclampsia, childbirth, and later development of type 2 diabetes.
Three, GDM screening and diagnosis
All pregnant women should be screened for 75g glucose 24-28 at OGTT weeks of gestation in order to be able to have sufficient time to treat the abnormal. For the high-risk groups should be the pre pregnancy diabetes screening in the first prenatal examination, when necessary to repeat screening.
high risk group
Previous miscarriage, fetal death intrauterine, monster, fetal macrosomia, neonatal unexplained death history; obesity (BMI greater than or equal to 24); a previous history of diabetes; family history of diabetes; pregnancy mould sex vaginitis repeatedly history. Pregnancy intermittent twice found diabetes; aged 30 or above; pregnancy number is more than or equal to 3 times.
(1) the purpose of catering management
Maintain maternal weight of reasonable growth, ensure the nutritional needs of maternal, fetal growth and development, by all means make blood sugar stable, does not appear hypoglycemia, hyperglycemia and ketoacidosis, with the clinical prevention and treatment of diabetic complications, such as kidney disease, gastrointestinal disease.
(2) daily diet "3 step song"
The first step to determine the total amount of calories a day:
First, calculate the ideal body weight, ideal weight (kg) = height (CM) -105
Secondly, according to the actual weight of the estimated body size, the ideal weight of 10% between normal; obesity: more than 20% of the ideal body weight for obesity; less than 20% of the ideal weight for weight loss.
The second step is to calculate the required daily food exchange portion: number = total calories, 90
Third step reasonable distribution of three meals a day: the most common distribution program is the breakfast 1/5, lunch 2/5, dinner 2/5, or morning, afternoon, evening each accounted for 1/3 of the heat. Also confirm the distribution ratio of the three major nutrients, protein 15-20%, fat < 30%, carbohydrate 50-60%.
(3) diet management tips
Control quantity of food: use standard measuring tools such as standard plate, bowl, cup and the oil spoon portion control, avoid excessive intake of food.
Increase the sense of fullness: slow down the speed of eating, eat more green leafy vegetables, increase the amount of drinking water, after a short walk to stick.
Thirdly, cooking methods to science: as far as possible the use of steaming, boiling, stewing, boiling and mixing way of cooking. This can reduce the amount of oil; less fried, fried, burning, excessive oil consumption of these methods, make dishes must heat exceeded.
The day of healthy eating advice: collocation breakfast to have nutrition, eat lunch and dinner should be light and rich. Dine together with family need to pay attention to: staple food can use standard bowl Sheng rice to ensure intake does not exceed the standard, the meat a day can not be more than the size of a deck of cards, eat a small snack, but want to reduce the amount of the corresponding from staple foods.
(4) the common problems in the diet management
How do the hungry?
Small meals, dining, fine grains instead of grain, gradually reduced.
How to eat fruit?
The total energy in low sugar, fruit, apples, tomatoes, oranges, two meals plus meals, according to the blood sugar adjustment.
How to prevent hypoglycemia?
Meals, food, symptoms immediately eat, eat, eat, so that physical tolerance.
How to prevent ketosis?
High glucose ketosis and low sugar ketosis are to prevent, drinking lots of water, appropriate control, few many meal, pay attention to identification of starvation ketosis and hyperglycemia of diabetic ketoacidosis.
Assessment movement testify to exclude cannot move, exercise time should be at 1 hour after the meal, 30-40 minutes at a time, to prevent hypoglycemia, symptoms of abdominal pain, vaginal bleeding, headache, dizziness, shortness of breath, chest pain, etc. should immediately terminate the movement, timely medical treatment.
Traditional oral hypoglycemic agents because of their potential role in the birth, and may cause neonatal persistent hypoglycemia, etc., in general after pregnancy should not be used. At present, it is generally accepted that drugs that can be used safely in the control of blood glucose during pregnancy are mainly insulin. If you can't reach the standard by lifestyle intervention, you should consider the application of insulin.