Pregnant mothers often eat much during pregnancy to ensure their baby’s adequate nutrition. Additionally, the significant hormonal changes that occur during pregnancy can lead to insulin resistance, further increasing the risk of gestational diabetes.

Gestational diabetes can have severe consequences, including increased risks of miscarriage, difficult labor, postpartum hemorrhage, and future development of type 2 diabetes. It can also affect the newborn, causing jaundice, respiratory distress syndrome, and even macrosomia and birth defects.

What is gestational diabetes? There are two types of diabetes that can occur during pregnancy:

1. Pre-existing diabetes, where diabetes is diagnosed before pregnancy. This is known as “diabetes complicating pregnancy.”
2. Gestational diabetes (GDM), where normal glucose metabolism or potential impaired glucose tolerance develops during pregnancy, resulting in the diagnosis of diabetes during pregnancy.

Today, we will talk about the second type – gestational diabetes. More than 80% of diabetic pregnant women fall into this category.

According to the “Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 Edition)” diagnostic criteria for gestational diabetes, the diagnosis can be made if any of the following criteria are met:

• Fasting blood glucose between 5.1 mmol/L and 7.0 mmol/L
• 75g oral glucose tolerance test (OGTT) with a 1-hour blood glucose level of ≥10.0 mmol/L or a 2-hour blood glucose level between 8.5 mmol/L and 11.1 mmol/L

It is important to note that a single elevated fasting blood glucose level above 5.1 mmol/L in early pregnancy cannot be used to diagnose gestational diabetes. Consultation with a doctor and regular follow-up are necessary in such cases.

How can gestational diabetes be managed?

Diet is crucial! The principles of a pregnancy diet aim to maintain blood glucose within a normal range and prevent starvation ketosis. It is important to control calorie intake, with carbohydrates accounting for 50% to 60% of the diet, protein comprising 10% to 15%, and fat making up 20% to 35%. Adequate supplementation of vitamins and micronutrients should also be considered.

As the pregnancy progresses, nutrient intake before 16 weeks should be the same as that of a non-diabetic pregnant woman. After 16 weeks, an additional 300-400 kcal and 25g of protein per day are necessary. It is recommended to have 5 to 6 small meals throughout the day, with regular timing and portion control being essential for blood glucose control.

Taking exercise regularly! Exercise can reduce insulin resistance during pregnancy without adversely affecting the mother or baby. It is recommended to engage in low to moderate-intensity aerobic exercises such as walking, running in place, or climbing stairs. Exercise should start at 10 minutes a day and gradually increase to 30 minutes. It is advisable to exercise after meals, with a frequency of 3 to 4 times a day.

However, exercise should not be blindly pursued, especially for pregnant women. The following exercise precautions should be remembered:

• Pregnant women with type 1 diabetes, heart disease, retinopathy, multiple pregnancies, cervical incompetence, threatened preterm labor or miscarriage, fetal growth restriction, placenta previa, or pregnancy-induced hypertension should not engage in exercise without the guidance and advice of a doctor.
• Pregnant women should be vigilant against hypoglycemic reactions and delayed hypoglycemia. If blood glucose levels fall below 3.3 mmol/L or exceed 13.9 mmol/L, exercise should be stopped immediately. Carrying biscuits or candy during exercise can be helpful in managing low blood sugar symptoms.
• If abdominal pain, vaginal bleeding, leakage of amniotic fluid, shortness of breath, dizziness, severe headache, chest pain, muscle weakness, or any other severe symptoms occur during exercise, immediate medical attention should be sought. Pregnant women using insulin should avoid exercising before their morning insulin injection, choose exercise times that avoid peak insulin action, and avoid injecting insulin into the limbs used for exercise. Blood glucose should be monitored before exercise.

Ensure reasonable weight gain! Both pre-pregnancy obesity and excessive weight gain during pregnancy are high-risk factors for gestational hyperglycemia. Therefore, it is important to establish a weight gain plan in early pregnancy based on BMI and understand the recommended weight gain for pregnancy. Regular check-ups and monitoring of weight changes throughout pregnancy are necessary to ensure reasonable weight gain.

Strict blood glucose management is crucial! Pregnant women with stable blood glucose control or those who do not require insulin treatment for gestational diabetes should measure blood glucose at least once a week, including fasting and 2-hours after meals. Additional measurements may be necessary for other patients. The recommended blood glucose targets for all types of gestational hyperglycemia during pregnancy are as follows:

• Fasting blood glucose < 5.3 mmol/L
• 1-hour postprandial blood glucose < 7.8 mmol/L
• 2-hour postprandial blood glucose < 6.7 mmol/L
• Nighttime blood glucose > 3.3 mmol/L