Gestational diabetes or during pregnancy is a diabetic condition that is diagnosed for the first time during pregnancy. It manifests itself with symptoms very obvious, which is why frequently women do not realize the development of the disease.
It is a disease that affects only pregnant women. The gestational diabetes mellitus is related only to pregnancy, but denotes in every case a condition predisposing to type II diabetes, as they are two diseases with natural histories distinct.
It consists in an alteration of glucose metabolism, for which, during pregnancy, there is an increase in the values of glucose in the blood. It affects about 6-7% of pregnant women and is a disorder that usually disappears after delivery.
Of course, it is not a disease to be underestimated. In fact, if not diagnosed and treated properly, it may generate problems at the time of delivery. In addition, it represents a risk factor for the possible onset of type II diabetes.
Therefore, to avoid complications, it is imperative to understand the causes and the possible treatments. In fact, specific therapies and a proper diet allow you to keep it under control.
With the right tricks, you can carry the pregnancy in full serenity in spite of the gestational diabetes, without danger, neither for the baby nor for the mom.
What is gestational diabetes?
Our body, in normal conditions, assimilate food carbohydrates, turning them into glucose, the main energy source for our body.
After digestion, the glucose is absorbed by the blood and then made usable by the cells through a hormone called insulin, which is produced by the beta cells of the pancreas.
Hormonal changes related to pregnancy make some of the hormones produced by the placenta, prevent the action of insulin. In this way, the cells become less sensitive to the action of this hormone.
It is a natural process. In some women with genetic characteristics particular, however, the pancreas fails to compensate for this deficit through an increase in the production and release of insulin. Thus, the blood glucose rises, with the risk of complications for the mother and the fetus.
Gestational diabetes is particular, as manifested in women suffering in the past from diabetes, and appears only during pregnancy.
It is not, therefore, necessarily related to a pre-existing diabetes pregnancy, and that, in the course of gestation, it could get complicated, giving rise to pathologies also complex.
Gestational diabetes: as is
The causes and risk factors
The cause of gestational diabetes is the state of pregnancy. As explained previously, is a disease that occurs because, during pregnancy, the placenta produces hormones that inhibit the action of insulin. For this reason, in pregnancy it is normal to experience a small rise in blood glucose after meals.
Do you think that a woman is pregnant, towards the end of gestation, of equal calories, produces an amount of insulin that is higher than a woman not pregnant. Sometimes, however, this condition of hyperinsulinism fails to compensate for insulin resistance. It then assists the increase of blood glucose and the onset of gestational diabetes.
Why some pregnant women do not develop gestational diabetes and other yes?
There are of course risk factors that have an impact on the occurrence of this disease:
overweight. Being overweight before pregnancy is the main risk factor, as well as an increase in weight important in the early months of gestation;
familiar, that is, the presence of diabetes mellitus of type II in the family of the first degree;
previous gestational diabetes in previous pregnancies;
macrosomia in previous pregnancies. Speaking of macrosomia when the fetus at birth weighs more than 4 kg;
belonging to ethnic groups considered at risk, such as those of the Middle East, the Caribbean, and South Asia;
- strong glycosuria, or the presence of sugar in the urine;
- over the age of 35 years;
- the polycystic ovary syndrome.
- Most of the times it is not a symptoms of gestational diabetes.
In other cases, the hyperglycemia is manifested by:
- frequent need to urinate;
- body weight loss increased hunger;
- increase undue thirst;
- urinary infections (such as cystitis, and candidiasis) are very frequent;
- vision disturbances;
- nausea and vomiting: these disorders are very frequent in pregnancy, so not very significant.
- Gestational diabetes: diagnosis and complications
- Diagnosis and testing
Being a disease is practically asymptomatic, it is important to perform appropriate screening for early diagnosis.
In general, the new guidelines for gestational diabetes include that it be done in a screening, between the 24th and 28th week of gestation, all pregnant women with risk factors average.
In women with high risk factors, screening is expected to start from the 16th-18th week. However, if no risk factors are present, there is no screening for gestational diabetes.
- In the assessment of risk, the key parameters to consider are
- the fasting blood glucose and two hours after a meal;
- the glycated hemoglobin, a test that shows the average of the amount of sugar present in the blood of a person in the last 2/3 months.
Women who present with high and medium risk factor, will have to undergo a glucose tolerance test (OGTT) with repeated measurements after a glucose load of 75g.
The parameters to be considered are the following:
- fasting glucose ≥ 100 mg/dl
- value of blood glucose ≥ 180 mg/dl after an hour
- blood glucose ≥ 140 mg/dl after two hours
- *mg/dl means milligrams of glucose in 100 milliliters of blood.
- If one of these values is altered, we are in the presence of gestational diabetes.
When the gestational diabetes is not properly treated, complications to the mother arise from a possible failure, diabetes, and excessive growth of the child. This can lead to a difficult delivery, with the potential for bleeding post-partum.
In addition, contracting gestational diabetes can increase the risk for the mother of cardiovascular disease, such as heart attack, stroke, hypertension, and high cholesterol. In fact, these complications are more related with the diabetes and classic type II, rather than with the pregnancy, because the latter disappears with the birth. There is also the possibility that the gestational diabetes recur in a subsequent pregnancy. Finally, as already pointed out, a woman who in pregnancy had gestational diabetes, it becomes more likely to develop in the time type II diabetes. For this reason, it is even more important to monitor in the future the patient, to identify the development of type II diabetes, which is more exposed.
The complications of gestational diabetes for the nascituropossono occur in the course of gestation (fetal distress), during childbirth (dystocia of the shoulder).
With the birth of the baby is also private suddenly certain levels of sugar, a factor which may give rise to a maladattamento metabolic, with serious risks of hypoglycemia. With age, the child also has an increased risk of developing diabetes, hypertension, and obesity.
A note on the birth: if the diabetes was kept under control during the period of gestation, the birth must be experienced in a natural way and without concern. It is not mandatory to perform a caesarean section, which is indicated only in the case of macrosomia or fetal distress with delivery anticipated.