Disease Description (Causes and Symptoms)
- Definition: An abnormality in blood glucose regulation first recognized or occurring during pregnancy, distinguished from diabetes that existed before pregnancy.
- Causes/Pathophysiology: Placental hormones such as human placental lactogen, estrogen, and progesterone, along with placental insulinase, inhibit insulin action, increasing insulin resistance. It occurs when pancreatic insulin secretion cannot compensate for this. In some cases, autoantibodies against pancreatic beta cells may be involved.
- Main symptoms: Most patients are asymptomatic, but fatigue and weakness may occur, and symptoms related to high blood glucose may rarely develop. It is associated with maternal and fetal complications such as gestational hypertension, macrosomia, and preterm birth.
Treatment Methods
- Treatment goals: Maintain maternal blood glucose within a range that minimizes fetal risks before and during pregnancy (targets: fasting <95 mg/dL, 1 hour after meals <140 mg/dL, 2 hours after meals <120 mg/dL).
- First-line treatment: First try dietary therapy (carbohydrate distribution and calorie control) and regular exercise (moderate aerobic exercise).
- Medication treatment: When dietary therapy and exercise do not adequately control blood glucose, insulin therapy is used as the standard treatment. Oral glucose-lowering medications are generally not recommended during pregnancy (although metformin may be used in some clinical settings, consultation with the attending physician is necessary).
- Fetal and pregnancy course management: Ultrasound growth monitoring according to blood glucose control status (fetal growth and amniotic fluid volume), as well as monitoring of fetal movement and fetal condition through non-stress tests/stress tests. The timing and method of delivery are determined by considering the degree of blood glucose control, fetal size, and pregnancy complications.
- Newborn care: Monitor and treat as necessary for neonatal hypoglycemia, hypocalcemia, polycythemia, jaundice, respiratory distress, and other conditions immediately after birth.
- Precautions (self-management): Follow instructions for self-monitoring of blood glucose, keep records when changing meals, exercise, or medications, and consult medical staff immediately in the event of an infection, medication use, or a change in dosage.
Checklist Before an Outpatient Visit (Including Items to Bring, Records, and Example Questions)
- Items/documents to bring:
- A list of all medications currently being taken (including prescription drugs, over-the-counter medications, and herbal medicines)
- Previous test results (including OGTT results, blood glucose records, and HbA1c if available)
- Recent weight and blood pressure records, and the maternal health handbook showing the gestational age
- Self-monitored blood glucose records (fasting and postprandial values), and meal and exercise logs
- Things to check before the visit:
- Changes in symptoms (fatigue, increased urination and thirst, etc.)
- Changes in fetal movement or any bleeding or leakage of amniotic fluid
- Changes in eating habits and patterns of weight gain
- Examples of materials to present and questions to ask at the outpatient visit:
- “Would it be helpful if I showed you my self-monitored blood glucose records from the past week?”
- “Did you bring the results of the OGTT (50 g, 100 g) performed previously?”
Examples of General Questions to Ask the Doctor
- “What are the side effects of this medication (or insulin)?”
- “What is the prognosis for my pregnancy? What is the level of long-term risk, such as developing diabetes in the future?”
- “What should I pay particular attention to regarding lifestyle habits (exercise and diet)?”
- “What criteria are used to determine the timing and method of delivery?”
Examples of Condition-Specific Questions
- “What are the criteria for starting insulin treatment in my case (fasting/postprandial blood glucose levels, HbA1c, etc.)?”
- “What measures are needed to prevent hypoglycemia in the newborn after delivery, and what is the plan for testing and observation immediately after birth?”