Tests needed to diagnose gestational diabetes

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Gestational diabetes is a case where high blood sugar is detected for the first time during pregnancy. Gestational diabetes is on the rise due to the increasing prevalence of obesity. Therefore, it is necessary to do diagnostic tests for gestational diabetes as soon as possible for timely intervention.

1. Gestational diabetes

Gestational diabetes is diabetes diagnosed in the second or third trimester of pregnancy, without specifying type 1 diabetes or type 2 diabetes. As for women who have diabetes. Diabetes before pregnancy is called type 1 diabetes or type 2 diabetes.
Gestational diabetes causes extremely dangerous complications such as:
1.1 For the mother High blood pressure Pre-eclampsia, or eclampsia Miscarriage, stillbirth, Urinary tract infection, Preterm birth Polyhydramnios, Increased risk have actual diabetes in the future Increase the risk of gestational diabetes in the next pregnancy

1.2 For the fetus Large fetus Intrauterine growth retardation Perinatal acute respiratory failure Perinatal death Neonatal malformations Increased risk of hypoglycemia at birth Hypocalcemia, polycythemia, and hyperbilirubinemia cause neonatal jaundice Easy to be obese and increase the risk of diabetes. To prevent complications, pregnant women need to check and perform tests to diagnose gestational diabetes or not, for timely intervention.

2. Time to screen for gestational diabetes

Perform diagnostic testing for diabetes (for previously undiagnosed diabetes) at the first prenatal visit for those with risk factors for diabetes. If testing is done in the first 3 months of pregnancy, then the same criteria for diagnosing diabetes will be used (remove criteria for HbA1c).
For women with risk factors for gestational diabetes such as age > 35, obesity, history of gestational diabetes, giving birth to a baby larger than 4 kg (> 4 kg), polycystic ovaries , stillbirth of unknown cause and family history of diabetes, urinary tract (+) should be tested for gestational diabetes from the first prenatal visit.
Perform diagnostic testing for gestational diabetes at 24 to 28 weeks of pregnancy for women who have not been previously diagnosed with diabetes.
Test to diagnose true (sustained) diabetes: In women with gestational diabetes 4 to 12 weeks after giving birth. Use an oral glucose tolerance test and clinically relevant diagnostic criteria for nonpregnancy. Use the criteria for the diagnosis of diabetes in the normal population (the criteria for HbA1c do not apply).
Women with a history of gestational diabetes should be tested for the development of diabetes or prediabetes at least every 3 years.
Women with a history of gestational diabetes, later found to have diabetes: Need to be treated with an active lifestyle intervention or metformin to prevent diabetes.

3. Screening and diagnosis of gestational diabetes

One of the following methods can be used to diagnose gestational diabetes:
3.1 Fasting blood sugar, glucose tolerance test One-step strategy
Perform a 75g glucose tolerance test Oral (75-g OGTT): Measure plasma glucose concentrations at fasting and at 1 hour, 2 hours, at 24 to 28 weeks of pregnancy in women with no prior diagnosis of diabetes.
The oral glucose tolerance test must be performed in the morning on an empty stomach, after an overnight fast for at least 8 hours. Gestational diabetes is diagnosed when any blood glucose value meets the following criteria:
Fasting blood sugar ≥ 92 mg/dL (5.1 mmol/L) Blood sugar at 1 hour ≥ 180 mg/ dL (10.0 mmol/L) Blood sugar at 2 hours ≥ 153 mg/dL (8.5 mmol/L) Two-step strategy
Step 1: Perform 50g oral glucose test or oral glucose loading test 50 grams (glucose loading test: GLT): Take 50 grams of glucose (before without fasting), measure plasma glucose at 1 hour, at 24 to 28 weeks of pregnancy for pregnant women. have not been previously diagnosed with diabetes.
If the plasma glucose level measured 1 hour after oral administration is 130 mg/dL, 135 mg/dL, or 140 mg/dL (7.2 mmol/L, 7.5 mmol/L, 7.8). mmol/L) continue with the 100g oral glucose tolerance test.
Step 2: Perform 100g oral glucose tolerance test (100-g OGTT): The test must be performed when the patient is fasting: The patient fasts, then drinks 100g of glucose mixed in 250ml - 300 ml of water, measure fasting blood glucose at 1 hour, 2 hours, 3 hours, after taking glucose.
3.2 Urinalysis Urinalysis Urine test indicators for gestational diabetes:
Glucose
Glucose is a type of sugar found in the blood. Normally, there is no or very little glucose in the urine. When blood sugar levels are very high, such as uncontrolled diabetes, the sugar is released into the urine. Glucose can also be found in the urine when the kidneys are damaged or diseased.
Allowable glucose index: 50-100 mg/dL or 2.5-5 mmol/L. If you eat a lot of sweet foods before the test, the presence of glucose in the urine is normal. But if the sugar level on the second test is higher than the first test, this is a warning sign that the mother is at risk of diabetes. In addition, if there are additional symptoms such as: fatigue, always thirsty, weight loss, you should see a doctor to check blood sugar Ketone
This index often occurs in people with diabetes, low-carbohydrate diet, alcoholism or physical weakness. Permissible index: 2.5-5.0mg/dL or 0.25-0.5 mmol/L. Usually absent or sometimes low in pregnant women. Ketone is a substance excreted in the urine, indicating that the mother and fetus are undernourished or have diabetes. When the amount of Ketone is detected, and accompanied by signs such as loss of appetite, fatigue, the pregnant woman may be prescribed by the doctor for intravenous fluids and medication. To reduce the amount of Ketones, pregnant women should relax, rest and absolutely not skip meals.

In addition, the doctor may order some other tests to diagnose gestational diabetes such as:
Thyroid function test: TSH, FT4, FT3 or T3 Total cholesterol, HDL-cholesterol, LDL -cholesterol, Fasting Triglycerides SGOT, SGPT Blood Protein Serum Creatinine, Estimated GFR HbA1c (repeat every 3-6 months) Electrocardiogram Straight chest x-ray Fundus examination (if available for retinal color imaging)/yearly . Gestational diabetes can cause dangerous complications not only for the mother but also for the fetus. Therefore, testing should be done in the first 3 months of pregnancy for early diagnosis, especially in those at risk of diabetes, testing should be done at the first prenatal visit and measures to prevent diabetes should be taken. diabetes. Vinmec International General Hospital offers a comprehensive maternity care program for pregnant women right from the first months of pregnancy with a full range of prenatal check-ups, regular 3D and 4D ultrasounds. period and routine tests to ensure that the mother is healthy and the fetus is developing comprehensively. Pregnant women will be consulted and checked for health under the close supervision of experienced and specialized obstetricians, helping mothers gain more knowledge to protect their health during pregnancy as well as minimize complications affecting mother and child.

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