Seshiah Veeraswamy, Balaji Vijayam, Banerjee Samar, Sahay Rakesh, Divakar Hema, Jain Rajesh, Chawla Rajeev, Das Ashok Kumar, Gupta Sunil, Krishnan Dharani
Dr. Balaji Diabetes Care Center and Dr. Seshiah Diabetes Research Institute, Chennai, 600029 India.
Vivekananda Institute of Medical Sciences, Calcuta, India.
Int J Diabetes Dev Ctries. 2020 Sep;40(3):329-334. doi: 10.1007/s13410-020-00860-1. Epub 2020 Sep 9.
Limited medical facilities are available due to Covid-19 pandemic. Nevertheless, all efforts should be made in planning judicial and possible methods of delivering health care, particularly to pregnant woman with GDM. GDM may play a crucial role in the increasing prevalence of diabetes and obesity and also may be the origin of cardiometabolic diseases.
It is mandatary to diagnose and care pregnant woman with GDM. The test suggested to diagnose GDM has to be evidence based and in this regard "a single test procedure" evaluated meets this requirement. This doable test has been accepted by the Diabetes in Pregnancy Study Group India (DIPSI) and approved by MHFW-GOI, WHO, International Diabetes Federation, and International Federation of Obstetricians and Gynecologists. MHFW-GOI also recommends testing at first antenatal visit and then at 24-28 weeks of gestation. This opportunity can also be utilized for performing ultrasonography for assessing fetal development.
The first-line management is MNT and life style modifications. Non-responders may require insulin or OHA. The target glycemic control is FPG ~ 5.0 mmol/dl (90 mg/dl) and 2 h PPPG ~ 6.7 mmol/dl (120 mg/dl). The goal is to obtain newborns birth weight appropriate for gestational age between 2.5 and 3.5 kg, a step to prevent offspring developing diabetes.
The essential precaution required during COVID pandemic is to wear face mask, avoid crowded places, and maintain social distancing. Finally, the economical and evidence based "single test procedure" of DIPSI is most appropriate for screening during the COVID pandemic.
由于新冠疫情，可用的医疗设施有限。尽管如此，仍应尽一切努力规划合理且可行的医疗保健提供方式，尤其是针对患有妊娠期糖尿病（GDM）的孕妇。GDM可能在糖尿病和肥胖症患病率上升中起关键作用，也可能是心脏代谢疾病的起源。
诊断和护理患有GDM的孕妇是必需的。建议用于诊断GDM的检测必须基于证据，在这方面，所评估的“单一检测程序”符合这一要求。这种可行的检测已被印度妊娠糖尿病研究组（DIPSI）接受，并得到印度卫生部、世界卫生组织、国际糖尿病联合会和国际妇产科联合会的批准。印度卫生部还建议在首次产前检查时进行检测，然后在妊娠24 - 28周时再次检测。这个时机也可用于进行超声检查以评估胎儿发育。
一线管理是医学营养治疗（MNT）和生活方式改变。无反应者可能需要胰岛素或口服降糖药（OHA）。血糖控制目标是空腹血糖（FPG）5.0 mmol/dl（90 mg/dl）和餐后2小时血糖（PPPG）6.7 mmol/dl（120 mg/dl）。目标是获得出生体重适合孕周、在2.5至3.5千克之间的新生儿，这是预防后代患糖尿病的一个步骤。
新冠疫情期间所需的基本预防措施是佩戴口罩、避免拥挤场所并保持社交距离。最后，DIPSI的经济且基于证据的“单一检测程序”最适合在新冠疫情期间进行筛查。
