Gestational/gestational diabetes
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Reasons
The reason for the development of gestational diabetes is that the hormones produced by the placenta and the insulin-degrading enzyme together reduce the effect of insulin on the cells, thus causing insulin resistance. The pancreas tries to compensate for this by producing more insulin. If you are unable to do this, your blood sugar levels will remain high after a meal, leading to gestational diabetes.
Symptoms
Gestational diabetes usually has no noticeable symptoms. In the vast majority of cases, pregnant women do not even suspect that they are affected until it is revealed during screening. In some cases, a large rise in blood sugar can cause complaints, such as:
- thirst
- more frequent urination than average
- dry mouth
- exhaustion.
The listed symptoms can also be a natural part of pregnancy, so if you notice the above symptoms, be sure to share them with your gynecologist!
Diagnosis
The gestational diabetes test is usually between 24 and 28 weeks. it is diagnosed during a weekly OGTT (oral glucose tolerance test, commonly known as sugar load) screening. During the test, after 10 hours of fasting (you must arrive in the morning on an empty stomach), you must consume 75 g of glucose dissolved in a glass of water. The patient's blood sugar level is measured using a venous blood sample before consuming the glucose, and if this is the so-called If the fasting blood sugar level is above 7 mmol/liter, the diagnosis of gestational diabetes can be made. If this value is below 7 mmol/liter, it is necessary to drink the sugar solution, followed by a repeated blood sample after 120 minutes. If this time the blood sugar value is 7.8 mmol/liter or above, the diagnosis of gestational diabetes can be made. There is no need for a test to diagnose the disease if the (so-called random) blood sugar value measured at any time is above 11 mmol/l on 2 occasions.
In the presence of certain risk factors, the OGTT test should be performed earlier, at 16-18 days of pregnancy. to be done in a week. Such risk factors can be:
- the mother is older than 30 years
- in case of overweight
- occurrence of diabetes in the family
- habitual (i.e. recurrent, spontaneous) miscarriage, premature birth, gestational diabetes, preeclampsia (pregnancy syndrome with high blood pressure and proteinuria), recurrent genital (Candida species are common in diabetes) and urinary tract infections (pyelonephritis, cystitis) occurring in the obstetric history, > A 4,000-gram newborn, a fetus born with a developmental disorder.
- the current pregnancy is a twin pregnancy, or there are complications, such as: the appearance of sugar in the urine, polyhydramnios (too much amniotic fluid), developmental disorders, fetal weight greater than appropriate for gestational age.
- The fetus was conceived as a result of IVF treatment (in vitro fertilization).
If the early OGTT test yields a negative result, it is still worth repeating it on the 24th-28th. and 30-32. week as well.
Treatment
It is important to constantly monitor and treat gestational diabetes. In this way, the pregnancy can proceed smoothly for both the mother and the fetus. A healthy lifestyle, a diet recommended by your doctor, and regular, light exercise may be enough to suppress the disease. If these do not prove to be sufficient, it is necessary to start insulin treatment!
Complications
Improper treatment can cause complications.
Common maternal complications:
- preeclampsia (pregnancy syndrome with high blood pressure and proteinuria)
- Due to the large size of the fetus, childbirth can be prolonged and complications can occur, which often leads to a caesarean section.
- infections
Common fetal complications:
- polyhydramnios (too much amniotic fluid), which can lead to premature birth and complications during childbirth
- premature birth: the fetus is born earlier than ideal, before reaching the 37th week
- diabetic fetopathy: a disease that threatens the life of the newborn, which is characterized by high birth weight and the newborn's insulin-sugar imbalance
It is important to emphasize that both the mother and the fetus have a higher risk of developing type 2 diabetes later in life! During the next pregnancy(s), there is a high chance of developing gestational diabetes again, so consult your doctor when planning your pregnancy!
Follow up
Regular home blood sugar measurement six times a day (6-point blood sugar profile test) may be necessary. The order of this is: we check the current blood sugar concentration with the help of a sample taken from the fingertip 1 hour before and after the three main meals. With the help of this method, the condition of the mother can be monitored, and the direction of the treatment can be changed based on the results.
Detection of HbA 1c from blood: it is due every 3 months, it is recommended to keep its value below 6% during pregnancy!
In most cases, gestational diabetes goes away after childbirth. To prove this, we perform a 4-point blood sugar profile test on the third day after delivery. If the result is favorable, we order another OGTT test in the 6th week. Once breastfeeding is over, the blood glucose test can be repeated. Even in case of no symptoms, the annual sugar load test is recommended!
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