Gestational diabetes mellitus: what is it, causes, sugar rate

What is gestational diabetes mellitus?

Diabetes Is a disease characterized by high glucose level in blood. Diabetes can occur at any age and affects people of any race and gender. This is a common pathology that affects about 5-15% of the adult population of the planet.

Gestational diabetes mellitus (diabetes mellitus in pregnancy) is a specific form that affects a woman during pregnancy and usually disappears after childbirth. Therefore, in most cases it is a transient condition, but potentially dangerous due to the negative effects that high blood glucose levels (hyperglycemia) can have on the fetus. In addition, it is an important risk factor that increases the likelihood of a diagnosis of diabetes in women in the future.

Gestational diabetes is the most commonly diagnosed disease in pregnant women and affects about 10% of them.

Causes of Gestational Diabetes: Why Can Pregnant Women Develop Diabetes?

Glucose levels in the human body are very precisely regulated, and under physiological conditions, they are maintained in the range of 70 to 120 mg / dL.

Every time we eat or drink, the concentration of glucose in the blood increases. The extent of this increase depends on the amount and type of food consumed. The human body reacts to an increase in blood glucose levels by producing insulin (a hormone produced pancreas). Insulin transfers glucose from the blood to the cells, which use it to carry out their vital functions. Thus, the level of glucose in the blood decreases. Under physiological conditions, the pancreas produces the amount of insulin necessary to maintain stable glucose concentration (from 70 to 120 mg / dl - the normoglycemic interval), regardless of what we eating.

The flow of glucose from the blood into the cells can be altered two different factors: An insufficient amount of insulin produced by the pancreas, or cell insensitivity to the action of the insulin itself. The reduced sensitivity of cells to the action of insulin is called insulin resistance, and more insulin is required to counteract it.

Insulin resistance during pregnancy is a physiological phenomenon due to the effect of hormones on the maternal body, the release of which is necessary to complete the pregnancy. An increase in insulin resistance leads to an increase in insulin production, which allows glucose levels to be maintained in the normoglycemic range. However, in 10% of pregnant women, the pancreas cannot increase the production of insulin, which leads to an increase in blood glucose levels and, therefore, the occurrence of gestational diabetes mellitus.

Factors that increase the risk of developing gestational diabetes are: overweight and obesity, age equal to or greater than 35 years old, relatives of the first degree (brothers, sisters, parents) with type 2 diabetes mellitus, previous history of gestational diabetes, polycystic ovary syndrome, previous birth of a newborn weighing more than 4 kg, high-risk ethnic groups (South Asia, Middle East) and impaired fasting blood glucose (100-125 mg / dl).

All women who have at least one risk factor will be screened for gestational diabetes.

This test consists of a special blood test called a standard glucose tolerance test (sugar curve). To do this, you need to take 75 g of glucose, and then take three blood samples: on an empty stomach, after 60 minutes and 120 minutes after taking glucose.

On the days leading up to the test, meals should be light and include at least 150 grams of carbohydrates per day. The study should be carried out in the morning, on an empty stomach (at least 8/12 hours should pass from the moment of the last meal), and during the test, the patient should remain at rest, should not eat, smoke, or perform any physical load.

Diagnosis gestational diabetes is determined by the presence of one or more values ​​equal to or greater than the following:

• fasting: 92 mg / dl;
• after 60 minutes: 180 mg / dl;
• after 120 minutes: 153 mg / dl.

What are the risks of complications in gestational diabetes

Glucose is the main source of energy for the fetus, which uses it for its development. However, if the mother's blood contains too much glucose, the baby's body converts the excess glucose into fat, and some organs and tissues develop excessively (subcutaneous adipose tissue, muscles, heart, liver). Because of this condition, called macrosomia, the baby's body does not develop in proportion to the increase in body weight. Consequently, the baby may be large but still have signs typical of premature babies, such as severe neonatal hepatitis.

Maternal hyperglycemia can also lead to neonatal hypoglycemia in the baby.

Macrosomia of the fetus can cause problems during natural childbirth, which leads to an increase in the frequency of caesarean sections, possible damage to the uterine canal and the baby itself. Newborns weighing more than 4 kg at birth are more likely to suffer from obesity, diabetes and high blood pressure than infants of normal birth weight.

The severity and risk of complications described above are closely related to the degree of hyperglycemia: the higher the blood glucose level, the higher the risk of complications.

If neglected, gestational diabetes can have consequences:

• macrosomia (large baby weight at birth);
• hypoglycemia and other neonatal disorders;
• increased risk of caesarean section and perinatal injury;
• obesity and the possible development of diabetes mellitus in a child.

How to control high blood glucose levels and what are the correct levels?

The first thing to do to combat hyperglycemia is Healthy food and exercise regularly. In 70-80% of women, these two interventions are sufficient to restore normal glucose levels. Otherwise, insulin needs to be given (usually only during pregnancy) to help the body counteract insulin resistance.

Regular self-monitoring of glucose levels using an appropriate instrument (glucometer) allows the doctor to assess how effective diabetes therapy is and the correctness of the diet introduced. Through self-monitoring of glycemia, a woman can also test the positive effects of physical activity on the body.

Reference blood sugar levels during pregnancy:

• fasting: <= 95 mg / dl;
• one hour after starting a meal: <= 140 mg / dl;
• two hours after starting a meal: <= 120 mg / dl.

Remember to measure your glucose as directed by your doctor, record the time, and measure correctly.

The collaboration between you and your doctor will minimize the risk of complications associated with gestational diabetes.

Physical activity

Physical activity has a positive effect on both the health of the mother and the health of the unborn child. The most recommended exercise is outdoor exercise because, in addition to improving muscle function, it provides the body with a large supply of oxygen and vitamin Dwhich is produced by the skin when exposed to sunlight. The choice of the type of exercise depends on the preferences and abilities of the expectant mother. Anyway it is recommended to devote at least 30 minutes a day to physical activity.

If you are at risk for premature birth or have had contractions, you should avoid certain exercises:

YES	NO
Walking; Swimming; Gymnastics.	Volleyball basketball; Tennis; Intense sports; Excessive stretching.

Did you know?

• Exercise lowers blood glucose levels - exercise regularly, preferably at the same time every day.
• Usually, the highest peak in glucose is recorded after breakfast, so this is the best time for walking;
• Children of mothers who are physically active during pregnancy feel better balance than children whose mothers did not exercise;
• Practicing many physical activities during pregnancy can have a positive impact on labor and recovery.

Do not forget:

• Check with your gynecologist on the type of physical activity that is most suitable for you;
• Attend a prepared course;
• Exercise every day!

Insulin therapy

If diet and exercise are not enough to maintain your glycemic levels, your doctor will prescribe insulin for you. Do not worry! Insulin poses no risk to you or your baby. It is done by subcutaneous injection, which can be done at home. The introduction of insulin therapy will require more careful control of glucose levels. You will be asked to perform additional tests before meals and during the night, and you will likely be given further dietary guidance. The purpose of this procedure is to set the correct dose of insulin for you.

Insulin therapy is selected for each patient individually.

This is easy to deal with. Your doctor will determine the correct dose of insulin and the nurse will teach you how to inject. Examinations will be carried out more often and more thoroughly, but insulin treatment, in most cases, will only be necessary until the end of pregnancy. After giving birth, after a doctor's examination, you can probably stop the treatment.

Remember:

• Maintaining normal blood sugar levels protects your child from complications;
• Every woman can reach a normal glycemic level by following an appropriate diet, exercising or taking insulin;
• Insulin therapy does not pose any risk to the mother or child.

Childbirth and after childbirth

Women with gestational diabeteswho are able to maintain their blood sugar levels as close to normal as possible will usually give birth without major complications. Gestational diabetes by itself does not necessarily entail a C-section. However, it is advisable to schedule labor with your gynecologist. In fact, it is the gynecologist who decides when and where (if you need to contact a specialized center) you will have to give birth.

After giving birth, it is recommended that you continue to monitor your glucose levels for a couple of days.

6-12 weeks after giving birth, you will need to retest your blood glucose levels to make sure your metabolism is normal. Thereafter, a blood test is recommended each year to assess glycemia. Before planning another pregnancy, you will need to undergo a glucose tolerance test (sugar curve), since the risk of diabetes for a subsequent pregnancy will be 30-50%.

Lactation

We recommend all mothers to breastfeed their babies! For a baby, breast milk is a very valuable resource, not only because it contains all the nutritional substances in the right quantities and proportions, but also antibodies that protect the child from any diseases. In addition, physical contact between mother and child creates a very strong emotional bond.

In addition, breastfeeding women regain their fitness and weight faster than before pregnancy. Finally, in women with gestational diabetes, breastfeeding reduces the risk of developing type 2 diabetes and contributes to the overall health of the child.

Remember:

• Breastfeeding best meets the energy and nutrient needs of the baby;
• Protects the child from diseases in the first years of life;
• Breastfeeding creates a strong bond between mother and baby;

There are very few contraindications to breastfeeding and diabetes is NOT one of them.

What diet to follow when breastfeeding?

The diet used during pregnancy may be slightly less restrictive, but there are some basic rules to keep in mind:

• Eat little, but often;
• The calorie requirement varies from woman to woman and is set taking into account the possible need to lose a few pounds in order to return to normal weight;
• Breastfeeding involves an energy expenditure of about 500 calories per day;
• The diet must include the right amount of nutrients, minerals, vitamins and trace elements;
• The amount of milk produced depends mainly on the amount of fluid consumed, and not on the food; therefore, it is advisable to drink 1.5 liters more water per day.