trước bữa ăn và không mg / dL (6,7 mmol / L) lớn hơn 120 2 giờ sau bữa ăn. Bằng chứng cho thấy phong phú, như tăng glucose máu, nguy cơ gia tăng kết quả chu sinh bất lợi. Trong một số nghiên cứu, mối quan hệ này là tuyến tính. Ở mức độ glucose máu lúc đói | GESTATIONAL DIABETES PRACTICE GUIDELINES 267 95 mg dL mmol L pre-meal and no greater than 120 mg dL mmol L 2 hours post-meal. Ample evidence shows that as blood glucose rises the risk of adverse perinatal outcome increases. In some studies this relationship is linear. At fasting blood glucose levels of 95 mg dL mmol L the risk of a macrosomic infant is seven times greater than at 75 mg dL mmol L .10 At 105 mg dL mmol L the risk rises to 14 times greater than normal. It has also been noted that at blood glucose levels less than 75 mg dL mmol L intrauterine growth retardation may result. Setting the targets within these narrow parameters appears to be the most effective way to reduce risk of adverse perinatal outcome. The targets refer specifically to self-monitored blood glucose because of the need for continuous data on blood glucose level. These values are for the duration of the pregnancy regardless of the type of therapy. Normal HbA1c should result from reaching these target blood glucose levels. HbA1c may be assessed at the start of therapy as a baseline measure however it is generally not used in treatment. HbA1c provides an approximation of the average blood glucose for 8-10 weeks before the test. An elevated HbA1c percentage points above the upper limit of normal may suggest that the patient is actually an individual with pregestational diabetes most likely type 2 diabetes and had persistent hyperglycemia earlier than the time of screening. Under such circumstances closer fetal evaluation for abnormalities is advisable. Under most conditions the HbA1c will be at or near normal since increased glycosylation of hemoglobin is not normally detected until blood glucose reaches an average of 140 mg dL mmol L over an extended period of time. Once in treatment the HbA1c would not be a sensitive indicator of mild hyperglycemia 120-150 mg dL or mmol L and therefore is not generally used for clinical decisionmaking. Because .
