Navigating Pregnancy with Abnormal Blood Sugar: A Comprehensive Guide
Upon embarking on the journey of motherhood, it's not uncommon for expectant mothers to encounter a crucial health check: the diabetes screening, typically scheduled around the 24th to 28th week of pregnancy. The conventional method employed is the Oral Glucose Tolerance Test (OGTT), a pivotal step in ensuring a healthy pregnancy.
Reacting to Abnormal Blood Sugar Discoveries
In light of the diabetes epidemic and the relaxation of the two-child policy, older pregnant women have become a focal point for diabetes screening. Many obstetricians now initiate blood glucose monitoring from the initial prenatal visit, occasionally revealing abnormal blood sugar levels soon after pregnancy confirmation. In such instances, referral to a diabetes specialist (endocrinologist) or a seasoned obstetrician-gynecologist becomes paramount.
Personalized Support in Maternal Care Settings
In my capacity within maternal and child healthcare, I adopt a tailored approach to address these concerns. First, I extend a digital hand of support by adding the expectant mother on WeChat, assuring her, "Feel free to message or call anytime you need assistance." This simple act of connecting via social media fosters a sense of empathy and personalized care, especially for young, first-time mothers and their equally concerned family members.
Next, I introduce my WeChat official account, encouraging her to peruse articles on managing hyperglycemia during pregnancy in her leisure. My aim is to equip her with knowledge upfront, minimizing any potential missteps in her newfound journey with high blood sugar.
I advise a 2-3 day home-based blood sugar monitoring regimen: fasting blood sugar plus readings 2 hours post each meal,强调 the importance of maintaining a log for future reference.
Addressing the common query regarding the redundancy of finger-prick tests when venous blood tests are available, I clarify that this dual approach serves to distinguish stress-induced hyperglycemia, often triggered by anxiety during in-hospital testing, from actual conditions.
I emphasize the correct technique for post-meal testing: consume meals as usual, initiating the 2-hour countdown from the first bite of carbohydrates, and caution against squeezing the finger during blood sampling to avoid skewed results. Repeating this process after every meal over 2-3 days, with strict documentation, sets the foundation for effective management.
Decoding the Spectrum of Gestational Hyperglycemia
The "China Type 2 Diabetes Prevention and Treatment Guidelines (2020 Edition)" delineates three categories of gestational hyperglycemia: gestational diabetes, overt diabetes in pregnancy, and pre-existing diabetes, accounting for 83.6%, 8.5%, and 7.9% respectively. Each category varies in severity and therapeutic approach, with pre-existing diabetes often necessitating insulin therapy prior to pregnancy due to its more severe hyperglycemic state.
Tailoring Treatment Strategies
Post-diagnosis, a tailored treatment plan is crucial. Women with uncontrolled pre-existing diabetes or those presenting with post-meal glucose levels exceeding 10.0-11.1mmol/L may require hospitalization for intensive monitoring and likely insulin treatment. Those with levels between 7.0 and 9.0mmol/L after meals may benefit from inpatient education on dietary and exercise management, with varying lengths of stay. However, if fasting glucose remains under 5.3mmol/L and post-meal glucose is below 7.0mmol/L, ongoing observation may suffice, considering the natural decline of fasting glucose as pregnancy progresses.
Empowering the 'Sugar Mummy'
Equipping oneself with essential knowledge and skills is vital:
- Blood Sugar Monitoring: Invest in a user-friendly glucose meter with a 33G lancet for less painful testing.
- Diet & Exercise: Embrace a food scale for portion control and maintain a food diary. Post-meal walks for 20-30 minutes aid in stable glucose control.
- Weight Management: For obese diabetics, balanced weight control is key, respecting nutritional needs during pregnancy.
- Insulin Injection Techniques: If prescribed, mastering insulin administration is imperative.
- Understanding Hypoglycemia: Awareness of low blood sugar symptoms and management is as crucial as managing hyperglycemia.
- Delivery & Beyond: Anticipate guidance on postpartum weight and glucose monitoring, along with neonatal care.
With these insights and proactive measures, a 'sugar mother' can navigate pregnancy safely, ensuring a healthy outcome for both mother and baby. Clinical prevalence of gestational hyperglycemia underscores the significance of this preparedness, making the journey towards motherhood a well-informed and healthy experience.