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妊娠糖尿病(GDM)的妇女产后发生2型糖尿病、高血压的危险增高。妊娠糖尿病易导致巨大儿,其次还会导致流产、早产、死胎的发生率增高等。高风险的妇女应在怀孕后即进行糖耐量试验,若未发现血糖的异常,则应在妊娠24～28周复查。经饮食控制后空腹血糖大于5.8 mmol/L或餐后2 h血糖大于6.7 mmol/L的患者需用药物治疗,治疗首选人胰岛素,其剂量和剂型应个体化。ADA指南推荐空腹时低于5.3 mmol/L,餐后1 h低于7.8 mmol/L,2 h低于6.7 mmol/L。

Updates on diagnosis and treatment of gestational diabetes mellitus

Women with gestational diabetes mellitus(GDM) during post-partum period are at higher risk of developing type 2 diabetes and hypertension.In addition to the risk of delivering macrosomia,patients with GDM are more likely to have abortion,premature delivery and stillbirth.According to the ADA guidelines,high-risk women should receive oral glucose tolerance test(OGTT) once pregnancy was confirmed,and those with normal blood glucose should repeat OGTT between week 24 and 28 of gestation.Ideally,the goal for blood glucose control in patients with GDM is 3.3 ～ 5.6 mmol / L when fasting,3.3 ～ 5.8 mmol / L before meal and 4.4 ～ 6.7 mmol / L at 2 hours postprandially.Medications should be recommended in patients with a fasting blood glucose level ≥5.8 mmol / L or a 2-hour postprandial level ≥6.7 mmol / L after rigorous dietary modification,with human insulin being the first-line treatment which is subject to personalized dosage and form selection.The blood glucose levels,as recommended in ADA guidelines,should be targeted at < 5.3 mmol / L when fasting,< 7.8 mmol / L at 1 hour postprandially,and < 6.7 mmol / L at 2 hours postprandially.