Gestational diabetes – is it dangerous? How to recognize and treat it?

 What is gestational diabetes?

Gestational diabetes mellitus is a hyperglycemic condition involving impaired glucose tolerance by the body of an expecting woman. It therefore means that blood glucose levels are consistently above normal. This condition occurs only during this period of life and is one of the common complications of pregnancy. It mostly affects ladies who have not previously had health problems of this type, but also not only. Diabetes can also be experienced by women burdened by endogenous disorders involving congenital insulin production processes, or those with signs of insulin resistance observed even before pregnancy.

In addition, pregnant women whose diabetes (of various types) already existed before pregnancy, but was not detected, are at risk of developing it. While the prognosis for pre- and postnatal complications is more favorable when prompt and comprehensive treatment is undertaken, untreated gestational diabetes poses a particular danger. Diabetes in pregnancy usually does not manifest itself in characteristic ways. The hidden course of gestational diabetes makes the disease dangerous for the baby, but it can be recognized early in pregnancy.

Also find out: Pregnancy testing calendar

What can cause gestational diabetes?

The pathogenesis of gestational diabetes mellitus is complex and multifactorial, but primarily underlying the disease are changes in carbohydrate metabolism and abnormal adaptive processes occurring in the mother’s body concerning mainly insulin resistance, which is further aggravated by hormonal fluctuations and other endo- and exogenous conditions. The risk of developing gestational diabetes and, consequently, the risk of increasing insulin deficiency, which the body compensates by overproducing insulin, causing health problems, increases even more as a result of loading the body with excessive body fat. This, in turn, stimulates insulin secretion, and hyperinsulinemia accelerates fat gain, resulting in the so-called “fat gain”. A vicious cycle of disease.

A woman’s age also contributes to the development of gestational diabetes, in which abnormal ratios of glucose and insulin concentrations occur. The older a mother-to-be gets, the adaptive processes in her body to ensure proper hormone levels may not be working properly. The risk of the disease usually increases in pregnant women over 35. year of age. This is because the physiology of pregnancy at this stage of life, can affect carbohydrate metabolism. Unfavorable factors further include hypertension, a diagnosis of gestational diabetes in previous pregnancies, and the burden of diabetes before pregnancy and in the immediate family.

Symptoms of gestational diabetes

The symptoms with which gestational diabetes manifests itself are not clear, and this would enable early diagnosis and reduce the risk of developing health complications in the child. The uncharacteristic course, that is, the absence of the presence of specific complaints, makes the disease a latent form and sometimes dangerous. It is not uncommon for ladies who have already been diagnosed with gestational diabetes to notice a deterioration in health and a decrease in overall energy, but this is mainly related to the progressive physiology of pregnancy. The presence of an illness is also sometimes taken as an acquiescence or justification for feeling bad.

Metabolic disorders of this type alone usually do not cause symptoms of either a somatic or psychological nature. A diabetes-laden body only heralds symptoms that coincide with ailments typical of the pregnancy period at the time, which the mother-to-be may interpret as symptoms of gestational diabetes.

For this reason, symptoms of diabetic pregnancy are commonly considered to include:

• Frequenturia,
• exhaustion,
• Drowsiness,
• dizziness,
• greater fatigability,
• attacks of wolf hunger,
• Increased thirst or dry mouth.

It is also worth remembering that gaining weight during pregnancy is natural and does not necessarily immediately mean developing diabetes in pregnancy. It is only a contributing factor in addition not in all women, and usually in ladies burdened with overweight or obesity even before pregnancy.

Read also: OGTT in pregnancy-when should it be performed?

How is gestational diabetes diagnosed?

Despite its asymptomatic course, gestational diabetes can be diagnosed in time. For this purpose, special laboratory tests are carried out, which are recommended at the first gynecological visit. The frequency of their performance in the later stages of pregnancy is determined by the results, as well as the information obtained from the woman during the interview for her medical history and immediate family or BMI.

Ladies at risk of developing a disease such as gestational diabetes, even before planning to become pregnant, should systematically undergo such checks. In addition, they may be advised to undergo diabetic tests much more frequently than healthy women or even those who are only diagnosed with diabetes during pregnancy.

To be able to rule out or confirm the disease, the results obtained are compared to top-down guidelines. The norms for gestational diabetes are 100 mg/dl (5.6 mmol/l) on a fasting basis. If, on the other hand, the result value is 100-125 mg/dl (5.6 – 6.9 mmol/l), a glucose load test is performed, which is otherwise known as a sugar curve. A mother-to-be enjoying results within the normal range does not need to undergo additional tests besides those of a control nature. For a pregnant woman with unsuccessful results, it is recommended to repeat the tests with appropriate frequency. The material for the analysis of gestational diabetes is blood from the ulnar vein.

Is gestational diabetes dangerous for the baby?

Gestational diabetes and the baby at 1. trimester are the biggest threat to each other. The disease adversely affects the process of organogenesis in particular, which is most often associated with the development of serious birth defects primarily affecting the heart and central nervous system.

Irregularities that may arise include:

• arterial deformations,
• no-brainer,
• spinal hernias,
• Underdevelopment of the lower limbs and hip rim.

Early and properly managed treatment of a woman burdened with a condition such as gestational diabetes is an essential condition for a toddler to develop properly from the earliest stages of his life. Only the compensation of metabolic disorders lasting the entire pregnancy until its termination reduces the risk of complications occurring both pre- and postnatally, childhood and beyond. Their nature and extent are significantly determined by glucose levels, as well as the gestational age at which they last.

Complications of gestational diabetes

The complications that gestational diabetes causes in the child at a later stage of life are mainly metabolic and manifest after birth in the form of hyperglycemia or hypocalcemia, for example, but also others. Untreated disorders of carbohydrate metabolism affect the birth weight in the newborn, which in such a situation is well above normal in relation to gestational age. This phenomenon is called macrosomia, which sometimes causes termination of pregnancy by cesarean section. High weight also promotes perinatal injuries and other ailments such as asphyxia, meconium aspiration syndrome and susceptibility to infection. In addition, the child may develop pancreatic islet cell hypertrophy, but this is nevertheless extremely rare.

Complications of diabetic pregnancy can become apparent in early childhood. They especially concern the shakiness of the child’s psycho-physical development, including intellectual abilities. The impact of metabolic disease in fetal life may be reflected through the offspring’s predisposition to obesity and the development of metabolic syndrome in adolescence, including insulin resistance or impaired glucose tolerance.

What is the treatment of gestational diabetes?

In a situation where the disease is confirmed, the mother-to-be should take the following steps Multidisciplinary treatment involving the cooperation of multiple specialists, including. diabetologist, nutritionist and neonatologist. Treatment of gestational diabetes is aimed at achieving an adequate and stable blood glucose norm. To determine the course of action, White’s division is used to determine the severity of the disease and treatment options. He distinguishes between type G1, which is dominated by a pregnancy diet, and type G2, which requires insulin therapy. Invaluable support in regulating metabolism, and by the way other biochemical processes, is physical activity during pregnancy. However, it must be properly matched to the age of pregnancy and the psychophysical capabilities of the mother-to-be.

How does insulin therapy work in pregnancy?

Insulin therapy is a common treatment method used for people with diabetes. Nevertheless, it is a method that is used when proper diet and physical activity have failed. Insulin therapy is based on the administration of insulin via the subcutaneous route. Insulin doses and injection times are individually tailored to the mother-to-be and her sugar metabolism.

If a pregnant woman notices her glucose levels are too high in the morning, such as after breakfast, a shot of short- and rapid-acting insulin is likely to be needed before that meal. If, on the other hand, a woman has a rise in glucose in the morning, then there is a possibility that she will need to administer longer-acting insulin before bedtime. It is worth remembering that such recommendations are always made by the attending physician.

Gestational diabetes – general recommendations

If a woman expecting offspring is diagnosed with gestational diabetes, she should:

• Monitor blood glucose levels regularly – at least 4 times a day under different circumstances (fasting and after meals),
• Stick to a balanced diet and incorporate physical activity into your daily routine, which improves insulin sensitivity and lowers sugar levels;
• Take care to maintain a healthy body weight,
• Limit consumption of simple sugars,
• Use insulin therapy as prescribed by a specialist,
• Monitor the fetal condition periodically with ultrasound.

Diet associated with gestational diabetes – what to avoid and what to implement into the menu?

The diet in gestational diabetes, first of all, should not deviate significantly from the diet recommended for diabetics and should be low in calories, but at the same time ensure an adequate daily caloric supply (about 35 kcal more per kg of body weight than usual for ladies with a BMI within the normal range, and for ladies with a higher BMI about. 25 kcal more). An important rule of thumb is the regularity of meal consumption and the number of meals. Optimally, 5-6 meals are recommended, the last of which (the so-called 2nd dinner) should take place in the evening, shortly before bedtime. It is advisable to sit at the table or reach for a snack even when you do not feel hungry. Portions don’t have to be generous, but they do have to be worthwhile.

How and what to eat with gestational diabetes? The menu must not lack complex carbohydrates, protein and healthy fats, of which lean white meat, fish, oils and legumes are valuable sources. Hydration is also important. Meals should be as little processed as possible. Frying is discouraged in favor of steaming and boiling, as well as stewing by various means. A diabetic pregnancy diet can be just as tasty and varied, but requires some modifications, such as choosing kefir rather than a flour roux to thicken a sauce, and eating yogurt with homemade granola rather than flavored yogurt from the store for a snack.

Postpartum gestational diabetes – recommendations

After childbirth, a woman can discontinue the diabetic diet, but it is nevertheless still worthwhile to continue to stick to a balanced diet. Fasting glucose levels should continue to be monitored for about 7 – 10 days. If the pregnant woman used insulin therapy and insulin doses did not exceed 10 IU/injection, then she can completely discontinue the drug. On the other hand, if the doses exceeded this value, then immediately after delivery it is advisable to reduce it by half, and then day by day reduce it by 1-2 units until complete withdrawal. The above-mentioned recommendations should be consulted with the doctor and midwife, whose task is to present the woman with the rules of nutrition during the postpartum period.

Gestational diabetes – and did you know that…?

• One in ten pregnant women develops gestational diabetes.
• The risk of developing gestational diabetes again in a subsequent pregnancy is 30-69%.
• 18-50% of patients with gestational diabetes develop type 2 diabetes.
• Many women have permanently changed their eating habits thanks to gestational diabetes.
• There are many ways recommended by nutritionists to reduce the glycemic index of meals.
• Stress affects the development of diabetes during pregnancy.
• Gestational diabetes is not a sentence – sticking to your doctor’s recommendations and taking care of yourself minimizes the risk of complications and possible abnormalities in the baby.

FAQ:

• What is gestational diabetes?

Gestational diabetes is a condition when there is abnormal insulin production in the body, which in turn causes an increase in blood glucose. This is a very common condition – it affects 1 in 25 pregnancies.

• What tests are performed for gestational diabetes?

Gestational diabetes mellitus is diagnosed using a laboratory test called an oral glucose load. It is a test that is part of the standard of care for pregnant women and is performed on all moms-to-be between 24 and 28 weeks of pregnancy.

• How is gestational diabetes treated?

Treatment of this condition is based on a well-balanced diet and physical activity. However, if lifestyle changes do not work, the doctor may decide to implement insulin therapy.