Gestational diabetes (mellitus)
Summary/Definition
Gestational diabetes mellitus is an increase in blood glucose that first occurred or was detected during pregnancy, as opposed to cases where diabetes was already present before pregnancy. This is the result of strong physiological changes in sugar metabolism during pregnancy. It can be defined as a glucose metabolism disorder that is first recognized or occurs during pregnancy. Gestational diabetes is broadly divided into pregestational diabetes and gestational diabetes, when a woman with pregestational diabetes becomes pregnant, it is defined as pregestational diabetes, not gestational diabetes. Risk factors include elderly mothers (over 35 years old), multiple pregnancies, obesity before pregnancy, high blood pressure during pregnancy, the birth of a large child in anamnesis (more than 4 kg), polycystic ovary syndrome, a diet high in saturated fat, multiple pregnancies in anamnesis and family history of type 2 diabetes, prediabetes in the anamnesis, for example, impaired glucose tolerance or impaired fasting blood sugar, a history of gestational diabetes during a previous pregnancy, as well as a history of stillbirth or birth defects.
The exact cause of gestational diabetes is unknown, but it is assumed that it is associated with the action of placental hormones such as placental lactogen, follicular hormone and progesterone, suppression of insulin secretion and the action of placental enzyme that breaks down insulin.
Gestational diabetes can cause amniotic fluid hyperplasia, gestational hypertension (gestosis), pyelonephritis, premature birth, complications during surgical delivery, other problems that may occur in newborns include macrosomia (more than 4 kg), birth trauma, hypoglycemia, hypocalcemia, hyperbilirubinemia, erythropoietinemia and neonatal dyspnea. Newborns born to mothers with gestational diabetes have a higher risk of developing obesity or type 2 diabetes in adolescence or adulthood than other control groups.
Symptoms
In most cases, there are no special symptoms, but sometimes fatigue or weakness may appear, which may be accompanied by gestational hypertension.
Diagnostics
- Diagnosis of gestational diabetes
- The first stage of the approach:
- At 24-28 weeks of pregnancy, gestational diabetes is diagnosed if one or more of the following criteria correspond to consuming 75 g of sugar in the morning after fasting for at least 8 hours and measuring blood sugar levels.
– Fasting plasma glucose level ≥ 92 mg/dl
– Plasma glucose level ≥ 180 mg/dl 1 hour after glucose loading
– Plasma glucose level ≥ 153 mg/dl 2 hours after glucose loading
- At 24-28 weeks of pregnancy, gestational diabetes is diagnosed if one or more of the following criteria correspond to consuming 75 g of sugar in the morning after fasting for at least 8 hours and measuring blood sugar levels.
- The second stage of the approach:
- Step 1 (screening): At 24-28 weeks of pregnancy, regardless of the time of the study or meal, consume 50 g of sugar and the plasma glucose concentration will reach 140 mg/dl or more (130 mg / dl for high-risk mothers). After 1 hour, with a positive test result, an oral glucose tolerance test is performed with a dose of 100 g .
- Step 2 (diagnostic test): After fasting for at least 8 hours in the morning, consume 100 grams of sugar and measure your blood sugar level. If two or more of the following criteria are met, gestational diabetes is diagnosed.
– Fasting plasma glucose level ≥ 95 mg/dl
– Plasma glucose level ≥ 180 mg/dl 1 hour after glucose loading
– Plasma glucose level ≥ 155 mg/dl 2 hours after glucose loading
– Plasma glucose level ≥ 140 mg/dl 3 hours after glucose loading
- The first stage of the approach:
- Testing during pregnancy after diagnosis
- Tests during pregnancy after diagnosis include self-measurement of blood sugar levels, a ketone body test and a glycated hemoglobin test.
- By measuring your blood sugar level after a meal, you can easily see how the type and amount of food you eat affects the change in blood sugar levels. The ketone body test is used during pregnancy to assess whether the total amount of calories and carbohydrates in your diet is sufficient. The analysis for glycated hemoglobin is an indicator reflecting the level of sugar in the blood for the last 2-3 months.
- Postpartum examination
- 4-12 weeks after delivery, an oral glucose tolerance test with a dose of 75 g is performed, and general standards for measuring blood sugar levels for non-pregnant women are also applied to determine whether diabetes continues or whether there is prediabetes. Even if the test results are normal, if you had gestational diabetes, the risk of developing type 2 diabetes in the future increases significantly, so periodic control tests are necessary.
Treatment and course of the disease
Gestational diabetes disappears after childbirth, but after childbirth it can gradually progress into diabetes mellitus, so constant monitoring is required. Diabetes treatment includes diet, exercise, medication, and self-control. Medications used for treatment include insulin and oral hypoglycemic agents. Insulin rarely penetrates the placenta, therefore, if medication is necessary, since it does not have a direct effect on the fetus, the introduction of insulin is recommended first of all. Metformin and glyburide have proven their effectiveness and short-term safety, but some drugs penetrate the placenta, and long-term safety has not yet been proven. Self-care methods include weight control, diet, and exercise.
