Laboratory diagnostics and management of gestational diabetes at the current stage

Л. А. Луценко

Abstract


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.


Keywords


pregnancy; gestational diabetes; glycated hemoglobin; glucose

References


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GOST Style Citations


1. Hod, M. Textbook of diabetes and pregnancy. London and New York: Martin Dunitz (2003): 628 p.

2. Айламазян, Э.К. Акушерство (национальное руководство). – М.: ГЭОТАР- Медиа. – 2007. – 1197 с.

3. Hod, M., Carrapato, M. Diabetes and Pregnancy Evidence Based Update and Guidelines (Working group on Diabetes and pregnancy). Prague (2006).

4. Gabbe, S.G., Graves, C. “Management of diabetes mellitus complicating pregnancy.” Obstet Gynecol 102 (2003): 857–68.

5. Hedderson, M., Gunderson, E., Ferrara, A. “Gestational weight gain and risk of gestational diabetes mellitus.” Obstet Gynecol 115.3 (2010): 597−604.

6. Garg, S.K., Rosenstock, J., Ways, K. “Optimized basal-bolus insulin regimens in type 1 diabetes: insulin glulisine versus regular human insulin in combination with basal insulin glargine.” Endocr Pract 11.1 (2005): 11–17.

7. Lindsay, R. “Many HAPO returns. Maternal glycemia and neonatal adiposity: new insights from the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) study.” Diabetes 58 (2009): 302−3.

8. Vaarasmaki, M., Pouta, A., Elliot, P., et al. “Adolescent Manifestations of Metabolic Syndrome Among Children Born to Women With Gestational Diabetes in a General- Population Birth Cohort.” Oxford University 172 (2010): 1209−15.

9. Lawrence, J.M., Contreras, R., Chen, W., Sacks, D.A. “Trends in the prevalence of preexisting diabetes and gestational diabetes mellitus among a racially/ethnically diverse population of pregnant women, 1999–2005.” Diabetes Care 31.5 (2008): 899–904.

10. Краснопольский, В.И. Гестационный сахарный диабет – новый взгляд на старую проблему / В.И. Краснопольский, В.А. Петрухина, Ф.Ф. Бурумкулова // Акушерство и гинекология. – 2010. – № 2. – С. 3−6.

11. Наказ МОЗ України № 1021 від 29.12.2014 р. «Про затвердження та впровадження медико-технологічних документів зі стандартизації медичної допомоги при цукровому діабеті 1 типу у молодих людей та дорослих».

12. Gonen, B.A., Rubinstein, A.H., Rochman, H., et al. “Hemoglobin A1: An indicator of the metabolic control of diabetic patients.” The Lancet 310 (1977): 734–37.

13. Koenig, R.J., Peterson, C.M., Jones, R.L., et al. “Correlation of glucose regulation and hemoglobin A1c in diabetes mellitus.” New England Journal of Medicine 295.8 (1976): 417–20.

14. International Association of Diabetes and Pregnancy Study Groups. “International Association of Diabetes and Pregnancy Study Groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy.” Diabetes Care 335.3 (2010): 676–82.

15. Cokolic, M., Zavratnik, A. Pregnant women with gestational diabetes and insulin therapy. Abstract of the 5th international simposium on Diabetes and Pregnancy. Sorrento (2009): 325 р.

16. American Diabetes Association. “American Diabetes Association Standards of Medical Care in Diabetes 2016.” Diabetes Care 3.1 (2016).





DOI: http://dx.doi.org/10.18370/2309-4117.2016.29.100-104

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ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)