Pregnancy upsets the balance between blood pressure-raising hormones – pregnancy hormones and hormones that make up the placenta – and the blood pressure-lowering hormone insulin. Insulin is thus impaired in its ability to control blood glucose levels. Because of this impairment, insulin secretion is increased. As a result, 5-10% of pregnant women develop a semidiabetic metabolic state – high blood glucose levels – or develop manifest gestational diabetes.
Risk factors
Risk factors that increase the incidence of gestational diabetes:
- Maternal obesity
- Familial predisposition to diabetes mellitus in relatives l. Degree and an age of the pregnant woman > 30 years.
- Excess weight of the pregnant women (body mass index > 27 kg/m2).
- Fasting urine glucose excretion in pregnancy despite normal blood glucose levels.
- Gestational diabetes in a previous pregnancy
- Arterial hypertension (high blood pressure)
- Premature birth or near-term infant death in previous pregnancies.
- Occurrence of unexplained malformations in previous pregnancies.
- Mothers older than 30 years of age or who have already given birth to children with a birth weight above 4,000 grams
Diabetes in pregnancy – especially in the first trimester – can harm both the mother and the child. The risk to a disturbed development of the placenta, a deficiency supply of the child and abortions (miscarriages) increases sharply.
Consequential diseases
Consequences of gestational diabetes – symptoms in the child:
- Disproportionate growth – macrosomia over 4,500 grams birth weight.
- Cushingoid – truncal obesity, “full moon face,” neck thickening with slender extremities, tomato-red skin, dense mop of hair, underdevelopment of sexual characteristics (hypogenitalism), growth disturbances; psychological changes (endocrine psychosyndrome); arterial hypertension, insulin-resistant high blood sugar levels – hyperglycemia with the development of steroid diabetes – excess of steroid hormones, such as cortisol, which reduce the effect of insulin and thus contribute to the increase in blood sugar.
- Organ maturation disorders (enlarged but immature organs) – thereby acute respiratory distress syndrome (ARDS) due to lack of lung maturity.
- Hyperbilirubinemia (too high bilirubin in the blood) – icterus (jaundice).
- Cardiomyopathy (heart muscle disease) – impaired pumping function, reduced efficiency of the heart, heart failure (cardiac insufficiency).
- Increased insulin production leads to low blood sugar levels – hypoglycemia.
- Hypoglycemia leads to minimal damage to the central nervous system, which can cause psychomotor problems and behavioral abnormalities
- Hypocalcemia (calcium deficiency) with muscle spasms.
- Increased mortality rate before and after birth.
- Tendency to obesity
- Increased risk of developing diabetes mellitus in old age
Pregnant women with gestational diabetes (gestational diabetes) are more likely to suffer from infections, such as those of the urinary tract, nausea and vomiting, elevated blood sugar levels and pregnancy-related hypertension – preeclampsia. Furthermore, there is a sharp increase in the amount of amniotic fluid. Women with gestational diabetes are at increased risk for developing gestosis – edema formation, high protein excretion, and high blood pressure – and for developing type 2 diabetes in the following years. Type 2 diabetes is among the most common conditions accompanying pregnancy, which mostly affects overweight women, as well as pregnant women whose families have a history of type 2 or even gestational diabetes.
Diagnostics
Because pregnant women with gestational diabetes usually have no clearly identifiable symptoms – no sugar in the urine – the diagnosis can only be made with a glucose load test.
Therapy
If maternal glucose metabolism is normalized early, the risks to both mother and child can be significantly reduced. In addition to additional insulin administration as needed, dietary changes and moderate exercise are of considerable importance in this regard. Prenatal therapy is particularly important from the 24th week of pregnancy, since at this time the disproportionate growth of the child can still be prevented by adjusting blood glucose levels.Prevention and treatment of gestational diabetes – diet and exercise:
- More frequent and smaller meals, for example, spreading the daily food intake over six meals
- Adequate intake of complex carbohydrates – potatoes, whole grain cereal products, and meal-based cereals – to avoid hypoglycemia (low blood sugar)
- At least 30 grams of fiber daily – whole grain products, vegetables, possibly wheat bran.
- Foods with high nutrient and vital substance density (macro and micronutrients) – low-fat milk and dairy products, low-fat meat, offal, poultry, low-fat fish, such as pollock, haddock, plaice, cod, 1-2 times a week, fresh fruits and vegetables, fruit and vegetable juices.
- Use little fat for the preparation of food, consumption of mainly unsaturated fatty acids, polyunsaturated fatty acids – vegetable fat and oils, such as sunflower, canola, soybean, corn germ and olive oil, cold water fish, such as mackerel, herring, tuna or salmon.
- Fluid intake daily about 40 milliliters per kilogram of body weight in the form of medicinal and natural mineral waters, vegetable and fruit juices diluted with water, herbal, fruit or green tea.
- Regular but moderate physical activity increases insulin activity
- Supplemental gifts of zinc, chromium and vitamin C stabilize the glucose level
In about 15% of women, additional insulin treatment is required. Especially insulin supplementation is needed if the therapy was started after the 24th week of pregnancy. This is to prevent increased insulin production by the child and the risk of hypoglycemia after birth. The aim of this treatment is to normalize blood glucose levels before and after meals. Fasting blood glucose should be below 90 mg/dl and about two hours after eating it should be below 120 mg/dl. Small doses of insulin before the main meals are often sufficient, although in some cases a long-acting insulin is also injected before bedtime and possibly in the morning. Such doses cover the insulin requirement independent of food and prevent high blood glucose before meals. Because of the decrease in insulin requirements, in 98% of affected women the symptoms of gestational diabetes resolve after pregnancy, and 80% of all women who develop gestational diabetes suffer from it again during a second pregnancy.
