Synonyms
gestational diabetes, gestational sugar, gestational diabetes
Definition
A distinction is made between pre-existing diabetes mellitus and so-called gestational diabetes (pregnancy diabetes), which is only triggered by pregnancy and lactation. Approximately one in a hundred pregnant women is affected. The main symptom of both forms is the impaired utilization of carbohydrates, so that the blood sugar level is too high. In the case of pre-existing diabetes, pregnancy diabetes is increasingly caused by hyperglycaemia or hypoglycaemia, whereby the latter is usually triggered by the reduced need for insulin in the first third of the pregnancy.
Gestational Diabetes
Gestational diabetes (gestational diabetes) is relatively symptom-free, so that the pregnant woman is dependent on a doctor to detect the disease. Diabetes carries some risks for the pregnant woman: The weakened immune system can lead to increased urinary tract infections (e.g. cystitis) and the probability of developing pre-eclampsia or eclampsia (S. gestation) is increased. The complications on the retina (S. eye) of a diabetic (diabetic retinopathy) can also rapidly worsen during pregnancy, so regular visits to the ophthalmologist are recommended!
In some cases there are also deposits under the skin in the eye area, so-called xanthelasma. The dangers of gestational diabetes on the foetal side are, on the one hand, the increased rate of malformation, which leads to the so-called fetopathia diabetica with heart defects and malformations of the lower half of the body (caudal regression syndrome). On the other hand, the growth of the fetus is slowed down by poorer blood circulation in the placenta (small-for-date baby).
Furthermore, the foetus starts to produce insulin itself due to the increased blood sugar levels in the maternal blood, since the otherwise sufficient maternal insulin is no longer sufficient. This leads to the excessive size (macrosomia) of the fetus with a birth weight of often more than 4000g. At the same time there is a certain immaturity.
In this case the birth should be induced about 2 weeks before the calculated date of birth to avoid complications. The likelihood of coagulation disorders, a respiratory distress syndrome or of developing one is increased for such newborns. Also hypoglycaemic states occur in these newborns, which must be avoided due to the risk of brain damage.
Furthermore, in gestational diabetes, just like diabetics, the fetus must urinate more frequently, which increases the volume of amniotic fluid (hydramnion). This in turn, due to the increased mobility of the fetus, carries the risk of an unfavorable position for the birth and of the umbilical cord wrapping around the child’s neck. To detect gestational diabetes, the urine is examined for sugar.
At later stages of pregnancy, the test may be positive without diabetes mellitus. Nevertheless, if the test result is positive, a so-called oral glucose tolerance test should be performed. In this test, the pregnant woman drinks a fixed amount of sugar liquid and then undergoes a measurement of her blood sugar level at regular intervals.
A low-carbohydrate diet is often sufficient as therapy for gestational diabetes. If the blood sugar level is not normalized below this level, the pregnant woman must inject insulin. Pregnant women who have already had diabetes must also follow a diet and, if possible, switch to insulin before pregnancy, as oral antidiabetics are not suitable because of the side effects on the fetus during pregnancy (S. Therapy Diabetes mellitus).
