Laboratory diagnostics and management of gestational diabetes at the current stage
Keywords:pregnancy, gestational diabetes, glycated hemoglobin, glucose
Gestational diabetes is a violation of carbohydrates tolerance of any severity that detected for the first time during pregnancy. The need for timely and accurate diagnosis of gestational diabetes is caused by a high frequency of pregnancy complications and neonatal morbidity.
The oral glucose tolerance test is recommended to use for the gestational diabetes diagnostics. This test is considered positive (the diagnosis of gestational diabetes installed), if at least one of the glucose indicators exceeds normal levels. The optimal duration of oral glucose tolerance test is 24–28 weeks of pregnancy; in exceptional cases is up to 32 weeks (at high risk for gestational diabetes, ultrasonic symptoms of diabetic fetopathy).
Glycated hemoglobin (HbA1c) evaluations can a useful as a test to assess the state of carbohydrate metabolism during pregnancy. HbA1c provides an integrated view of the level of blood glucose over a long period of time, can be used in the detection and monitoring of carbohydrate metabolism disorders during pregnancy. Many studies have confirmed the assosiation of glycated hemoglobin and blood glucose level. Determination of glycated hemoglobin has several advantages: the test result on HbA1c is independent of food intake (possible evaluation is not an empty stomach, which is important for toxicosis in pregnant), patient’s psycho-emotional state, blood samples can be carried out at any time (stable over a wide temperature interval and time).
If diagnosis of “gestational diabetes” confirmed it is recommended diet with restriction of carbohydrate and fat, dosed physical activity and glycemic control. Criteria for gestational diabetes compensate on the diet background: fasting glucose level < 5.0 mmol/l, in 1 hour after ingestion < 7.5 mmol/l. Inability to achieve glycemic targets within 2 weeks of self-control or the presence of ultrasonic signs of diabetic fetopathy are indications for insulin therapy.
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