New Diagnostic Criteria and Current Approach in Gestational Diabetes
In the study of the recently concluded hyperglycemia and poor pregnancy results (HAPO), it was reported that even the sugar heights that do not meet the classical criteria are high in birth weight, large baby, serum C peptide levels above 90%, increased cesarean rate and may cause hypoglycemia in the newborn. At the same time, a close relationship has been found with increasing sugar levels in terms of preterm delivery, shoulder attachment at birth, preclampsia and neonatal jaundice. The importance of the new values detected in the 75 gram and 2 hour sugar loading test in the HAPO study was that the threshold values were associated with clinical results.
New threshold values determined for 75g 2 hour oral glucose tolerance test
- Fasting: 92 mg / dl
- 1st hour 180 mg / dl
- 2nd hour 153 mg / dl
If only 1 of these values is higher, it is diagnostic in terms of pregnancy sugar. When these diagnostic criteria are taken, while pregnancy sugar is detected in 16% of the society, this ratio is in line with the rates in today's general society if the increase in obesity and prediabetes in the general population is also taken into consideration.
In high-risk pregnants (over 35 years of age, those with gestational diabetes in the past, those with a large baby history, and those with a family history of diabetes), the pregnancy glucose screening should be done at the beginning of pregnancy, and the test should be repeated at the 24th week in the non-risk group. It is suggested that it should be done after 2 hours test.
In these patients, pregnancy glucose should be tried to be improved by closely following the blood sugars in the morning, at 1 or 2 hours after meals and at night. With a professionally prepared diet to be applied first, fasting blood sugars should be reduced to 95 mg and toughness 2. hour sugars below 120 mg / dl. If the values are above these values in blood glucose monitoring, insulin treatment should be started. Insulin treatment is required only in 10-20% of patients who are monitored in this way. Insulin treatment has no harmful effects on the fetus, as the insulin delivered to the mother does not pass to the baby.