Will gestational diabetes get better?

Written by Chen Li Ping
Endocrinology
Updated on December 03, 2024
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Gestational diabetes refers to diabetes that appears or is diagnosed during pregnancy and is a distinct type of diabetes. Many women with gestational diabetes may see their blood sugar levels return to normal after delivery as insulin resistance diminishes. It is recommended to conduct an OGTT (oral glucose tolerance test) screening six weeks after childbirth, as the majority of women with gestational diabetes will have normal fasting blood glucose or OGTT values at six weeks postpartum. Approximately 25% to 70% of women with gestational diabetes may develop diabetes again within 16 to 25 years after delivery. Therefore, it is essential to continue monitoring the patient's blood glucose postpartum and to screen early for diabetes.

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Does gestational diabetes require hospitalization?

Patients with gestational diabetes who initially have adequate blood sugar control do not need to be hospitalized; however, those with poor blood sugar control require further hospitalization for observation and treatment. In addition to diet and exercise, medication control such as insulin therapy is currently recommended for managing blood sugar in gestational diabetes. Insulin therapy must be used under strict medical supervision to avoid hypoglycemia. Since both high and low blood sugar levels can have a dual impact on pregnant women and fetuses, the need for hospitalization for patients with gestational diabetes mainly depends on their blood sugar levels.

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How to self-test for gestational diabetes

Gestational diabetes refers to conditions where there was no diabetes before pregnancy, and during the course of the pregnancy, specifically between the 24th to 28th weeks, a standard glucose tolerance test is conducted to screen for glucose metabolism. The specific procedure involves not eating after 8 p.m. the night before, though drinking water is allowed, followed by fasting for more than ten hours. The first blood sample is taken on an empty stomach. Then, 75 grams of anhydrous glucose, as prescribed by the doctor, is dissolved in 250 to 350 milliliters of water and consumed within 3 to 5 minutes. Starting from the first sip of this glucose solution, blood samples are taken again one hour and two hours later. The results from these three blood samples are used to determine the possibility of gestational diabetes.

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Gestational diabetes blood sugar standards

The diagnostic criteria for gestational diabetes involve a pregnant woman undergoing a 75-gram glucose test at any time during pregnancy to measure fasting blood glucose, blood glucose one hour after consuming glucose, and blood glucose two hours after consuming glucose. The thresholds are: fasting blood glucose equal to or greater than 5.1 mmol/L, blood glucose one hour after glucose intake equal to or greater than 10.0 mmol/L, and blood glucose two hours after glucose intake equal to or greater than 8.5 mmol/L. Diagnosis of gestational diabetes can be made if blood glucose levels exceed these standards at any of the three time points. In China, pregnant women typically undergo the 75-gram glucose test between the 24th to 28th week of pregnancy. Women at high risk for gestational diabetes are advised to undergo the 75-gram glucose test early.

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Standards for Blood Sugar Control in Gestational Diabetes

The control of blood sugar in gestational diabetes mainly involves monitoring fasting blood glucose, postprandial blood glucose, and ketone bodies in urine. Patients can monitor their fasting and postprandial blood glucose 4-6 times daily. The target for blood sugar control is to maintain fasting blood glucose, pre-meal, or pre-sleep blood glucose levels between 3.3 to 5.3 mmol/L, postprandial blood glucose after one hour should be less than or equal to 7.8 mmol/L, and postprandial blood glucose after two hours should be less than or equal to 6.7 mmol/L. Ketone bodies should be negative, and glycated hemoglobin should be controlled below 6%. Only by meeting these standards can the control of blood sugar in gestational diabetes be considered adequate, which can reduce risk factors for both the mother and the fetus.

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How to control gestational diabetes

For diabetes during pregnancy, it is important to manage the condition in pregnant women. Initially, for blood sugar control during pregnancy, we recommend that the blood sugar levels before meals and two hours after meals be less than or equal to 5.3 mmol/L and 6.7 mmol/L, respectively, and nighttime blood sugar levels should not be lower than 3.3 mmol/L. For patients with diabetes complicated by pregnancy, the blood sugar control during pregnancy should meet the following targets: early pregnancy blood sugar control does not need to be overly strict to prevent hypoglycemia. Blood sugar levels before meals and during the night, as well as fasting blood sugar, should be controlled between 3.3 to 5.6 mmol/L, and post-meal peak blood sugar levels should be between 5.6 to 7.1 mmol/L. For both diabetes during pregnancy and diabetes complicated by pregnancy, if blood sugar levels cannot meet the above standards through diet and exercise management, insulin or oral hypoglycemic drugs should be used for further blood sugar control. Pregnancy is a special physiological period, and blood sugar control in diabetic pregnant women must not only be within the normal range but also ensure reasonable nutrient intake for the mother and fetus, reducing the occurrence of maternal and fetal complications. Most patients with gestational diabetes can control their blood sugar satisfactorily through reasonable dietary control and appropriate exercise therapy. The total daily nutrient intake should be determined based on the weight before pregnancy and the rate of weight gain during pregnancy.