What Causes High Blood Sugar in Pregnancy?

After a woman becomes pregnant, the secretion of sex hormones increases, and they have the effect of resisting insulin in the periphery of human tissues. With the increase of gestational weeks, increasing estrogen and progesterone promote the body to secrete more insulin to maintain normal glucose metabolism. Due to individual differences, not all pancreatic islets have such a good compensatory ability. For people who are not so good in compensatory ability, they may show abnormal glucose metabolism or insufficient insulin sensitivity. These are the causes of gestational diabetes.

High blood sugar during pregnancy

Hyperglycemia during pregnancy refers to diabetes that occurs during pregnancy or different degrees of glucose intolerance, that is, diabetes that occurs first and then occurs later. Most diagnosed at the 24th week of pregnancy; 28 weeks. After childbirth, most patients return to normal blood glucose and diabetic symptoms disappear. About 20% of patients develop type 2 diabetes years or decades after delivery. Screening in the United States found that from 1991 to 2000, the incidence increased from 5.1% to 7.4%. Domestic literature reported that the domestic incidence ranged from 5% to 20%, and it was increasing year by year.

Affected area

whole body

Related diseases

Hypertension pregnancy with diabetes type 1 diabetes type 2 diabetes gestational diabetes diabetes and hypertension

Affiliated Department

Department of Internal Medicine

Related symptoms

Hyperglycemia in pregnancy

After a woman becomes pregnant, the secretion of sex hormones increases, and they have the effect of resisting insulin in the periphery of human tissues. With the increase of gestational weeks, increasing estrogen and progesterone promote the body to secrete more insulin to maintain normal glucose metabolism. Due to individual differences, not all pancreatic islets have such a good compensatory ability. For people who are not so good in compensatory ability, they may show abnormal glucose metabolism or insufficient insulin sensitivity. These are the causes of gestational diabetes.

1. Age Factors Old age pregnancy is currently recognized as a major risk factor for gestational diabetes. Vereellini et al. Found that pregnant women aged 40 and over were 8.2 times more likely to develop gestational diabetes than those aged 20 to 30. Other scholars have more similar findings. In addition to age factors affecting the occurrence of diabetes, the older the person, the smaller the gestational week when a pregnant woman is diagnosed with gestational diabetes. Berkovitz et al. Found that among pregnant women diagnosed with diabetes before the 24th week of pregnancy, women aged 30 and over accounted for 63.7%, while only 45.2% were diagnosed after the 24th week of pregnancy (P0.01).

2. Race and adult type 2 diabetes is similar to race, and gestational diabetes has obvious regional and racial correlation. Compared with the prevalence of gestational diabetes in white European women, the Indian subcontinent, Asia, Arabia, and black are 11 times, 8 times, 6 times, and 6 times the former respectively. Apart from genetic factors, racial factors cannot exclude the role of economic and cultural factors and dietary habits.

3. Obesity Obesity is an important risk factor for impaired glucose tolerance and diabetes, and it is no exception for gestational diabetes. Other environmental factors such as age, economics, cultural level, and dietary structure all have synergistic effects with obesity.

The screening method is to require pregnant women (without fasting) to drink 50gm sugar water, and take a blood test to check the blood glucose value after an hour. If it is greater than 140mg / dL, gestational diabetes is suspected, but the diagnosis cannot be determined. You must further do the so-called 100gm glucose tolerance test, draw blood once on an empty stomach, then drink 100gm sugar water, and then take a blood glucose test after one hour, two hours, and three hours (you can clearly understand why not At the beginning, 100gm was used for screening diagnosis, because if the blood was drawn once at 50gm, the possibility could be ruled out, and then there was no need to be punctured so many times.

The diagnostic criteria are as follows:

1.Fasting blood glucose: 105mg / dL

2.1hourafter100gmglucosetaken: 190mg / dL

3, 2hourafter100gmglucosetaken: 165mg / dL

4, 3hourafter100gmglucosetaken: 145mg / dL

If two of the four values are greater than the standard value, the diagnosis of gestational diabetes is determined.

Screening for gestational diabetes is recommended between 24 and 28 weeks of pregnancy. Especially for pregnant women who:

1. Pregnant women who are significantly overweight.

2. In family history, there is obviously a genetic predisposition to diabetes (many people in the family have diabetes).

3. You have had gestational diabetes before pregnancy.

4, urine examination has always been the case.

5. Older women.

6. Have had a giant baby before (for Taiwanese, if the baby weighs more than 4000gm, it is considered a giant baby); or before, at the end of pregnancy, if the baby died of unknown reason.

7. The baby's estimated weight is too big (more than two weeks) and / or too much amniotic fluid at the time of delivery.

Differential diagnosis of high blood sugar during pregnancy:

Gestational diabetes mellitus: Diabetes is a common endocrine and metabolic disease with a certain genetic predisposition and an unclear etiology. Its basic pathophysiological changes are metabolic disorders such as sugar, protein, fat, water and electrolytes caused by relative or absolute deficiency of insulin, which is characterized by high blood sugar. There are also some diseases that have hyperglycemia, called symptomatic diabetes or secondary diabetes, which only account for a very small number, such as pancreatitis, post-pancreatectomy, acromegaly, and Cushing syndrome. Diagnosis based on related medical history.

Whether it is hyperglycemia or pregnant women who have been diagnosed with diabetes, the first step is to adjust and control the diet. The purpose is to control the elevated blood sugar of pregnant women, while ensuring the normal development of the fetus. The principles of dietary treatment are: pregnant women do not lose weight; adjust the food structure ratio and calories according to body shape; eat less and eat more, it is best to divide 3 meals, 3 small meals; eat less sugary fruits; 400-500 grams of vegetables a day Vegetables are not less than 50%.

Compared with ordinary diabetes patients, pregnant women with diabetes need more calories to make up for the loss of urine sugar and fetal needs. Daily heat energy should be supplemented by 30-50 kcal per kilogram of body weight, of which 200-300 grams of carbohydrates. However, we need to have certain requirements on the types of carbohydrate sources. Mainly polysaccharides such as rice and wheat should be strictly restricted. Pure sugar products such as honey, syrup, and maltose and desserts with high sugar content should be strictly restricted. Try to choose varieties with lower glycemic index in cereal staples, such as oatmeal, cornmeal and buckwheat noodles. When pregnant women suffer from diabetes, because protein breakdown is multiplied, protein intake should be increased, and high-quality protein foods such as fish, meat, poultry milk, and beans should be consumed. Among them alpha; whey protein is a kind of high quality protein.

At the same time, dietary fiber intake should be increased. It has a good effect on lowering blood sugar. Vegetables, low sugar fruits, seaweed and beans are all rich in dietary fiber. Cellulose has a strong water absorption, slowing down certain nutrients and reducing hunger. In addition, sufficient vitamins, inorganic salts and trace elements are also essential. Zinc is a component of many enzymes in the body and is involved in protein synthesis. Such as zinc deficiency, low protein utilization will affect fetal development, and chromium will activate insulin. Animal foods such as pigs, sheep, cattle, fish, and meat are high in zinc. Oysters and egg yolks contain a lot of chromium and should be eaten more.