Maternal diabetes mellitus – known in medicine as embryofetopathia diabetica – causes an increased risk of prenatal and postnatal complications in the child during pregnancy. Of particular importance is the extent of the blood glucose imbalance and its onset during pregnancy.
What is embryofetopathia diabetica?
Embryofetopathia diabetica refers to a prenatal developmental disorder of the unborn child caused by poorly controlled, undiagnosed diabetes mellitus or diabetes mellitus that is derailed during pregnancy in the mother. Depending on the time of onset of the elevated blood glucose levels, various complications may occur in the child. During the embryonic period (early pregnancy), organs are formed in the child. In addition, arm and leg buds are formed. If sugar-related disorders occur during this period, severe malformations can result. This is also known as embryopathy diabetica. Two thirds of diabetes-associated malformations affect the cardiovascular and nervous systems. Miscarriages also occur more frequently during this period in mothers with metabolic disorders than in healthy pregnant women. Fetopathia diabetica, on the other hand, is the term used to describe the consequences of elevated maternal glucose levels in the unborn child during the fetal period (from the 9th week after fertilization). Elevated blood glucose levels also occur in the fetus via the placenta, with subsequent increased insulin production.
Causes
The metabolic disorder in the mother may involve preexisting diabetes mellitus. Here, a distinction is made between type 1 and type 2. While type 1 diabetes mellitus is an autoimmune disease with gradual destruction of the insulin-producing cells in the pancreas, type 2 is based on insulin resistance. The insulin that is actually present in sufficient quantity no longer achieves a sufficient effect. On the other hand, embryofetopathia diabetica can also be caused by diabetes that occurs for the first time during pregnancy, so-called gestational diabetes (= gestational diabetes). This usually occurs from the 24th week of pregnancy and with increasing frequency. Regardless of the cause, the pregnant woman’s elevated blood glucose levels also lead to elevated glucose levels in the fetal blood via the placenta. The fetus produces counter-regulating amounts of insulin. This has a growth-promoting effect in addition to its blood sugar-lowering effect. This leads to disproportionate growth of the unborn child. Birth injuries are thus favored. Other consequences of hyperinsulinemia can include impaired or delayed lung maturity or increased production of red blood cells in the child with subsequent pathologically increased blood viscosity. Furthermore, the risk of premature birth is increased.
Symptoms, complaints, and signs
Typical symptoms of diabetes mellitus are severe thirst, dry skin, increased urination and fatigue. In some cases, there is also weight loss or increased susceptibility to infection. The symptoms can be present in varying degrees. However, diabetes often remains undetected for a long time due to a lack of pain. Sonographic evidence of embryofetopathia diabetica may include increased amniotic fluid formation (polyhydramnios), increased or comparatively too rapidly increasing fetal abdominal circumference, and the presence of diabetes-associated malformations.
Diagnosis
Therefore, prenatal care with regular blood, urine, and ultrasound examinations is of particular importance. Before the 24th week of gestation, manifest diabetes mellitus should be specifically excluded if risk factors are present. Furthermore, a standardized oral glucose tolerance test with 75 grams of glucose should be performed between the 24th and 28th week of gestation in every pregnant patient who has not previously suffered from diabetes.
Complications
Embryofetopathia diabetica is one of the prenatal developmental disorders. The causes of the symptom are either unrecognized diabetes mellitus in the expectant mother or poorly controlled variant diabetes. Due to the high blood glucose level, insulin production is also increased in the unborn child via the placenta.If the signs of the symptom, such as extreme fatigue, a permanent feeling of thirst, dry tense skin and a constant urge to urinate, as well as unexplained weight loss and susceptibility to infections, are not clarified by the expectant mother by a doctor, significant pregnancy complications will occur. During the embryonic period, malformations of the arm and leg buds as well as organ damage to the heart, liver and kidneys can occur. Neonatal adaptation disorders, delayed lung maturity and increased red blood cell production are not uncommon. In addition to the risk of miscarriage or stillbirth, neonatal mortality is higher. If the newborn does not show any visible malformations, he or she is nevertheless monitored closely during the first days of life, as the metabolism starts up at a slower rate. Another complication of embryofetopathia diabetica is birth injury, where the newborn can get stuck in the birth canal with one shoulder during the birth process and risk suffocation. If diabetes is diagnosed during pregnancy or is previously known, monitoring of the expectant mother, as well as the birthing process and subsequent follow-up examinations, takes place in a diabetic-focused clinic.
When should you see a doctor?
If an expectant mother has a vague feeling of a health discrepancy, she should see a doctor. If there is a perception of unusual changes in herself or the unborn child that cannot be explained rationally, it is generally advisable to discuss concerns openly with a doctor or obstetrician. If fears, panicky behavioral traits, uncertainties or brooding thoughts occur, a visit to the doctor is necessary. This is especially true if the symptoms continue unabated for a long time or increase in intensity. If there is a sudden strong feeling of thirst, a persistent tiredness despite sufficient as well as healthy sleep or an unexplainable urge to urinate, a medical examination should be initiated. If an unwanted loss of weight occurs despite an adequate and substantial food intake, this is considered a cause for concern. A doctor should be consulted to clarify the cause of this development. If the pregnant woman’s abdominal girth increases in an atypical manner to the pregnancy development, a doctor should be consulted. In case of a feeling of illness, changes in mood as well as behavioral abnormalities that cannot be explained by a normal course of pregnancy, a doctor should be consulted. If the expectant mother suffers from a strong susceptibility to infection despite adequate protection as well as appropriate precautions, these observations should be discussed with a medical professional.
Treatment and therapy
Once the diagnosis is made, the goal is to normalize maternal glucose metabolism as the cause of the embryofetal disorder as quickly as possible. The type of therapy depends on the type of maternal diabetes. Type 1 diabetic women must always inject insulin in addition to an optimal diet. In type 2 diabetics and mothers with gestational diabetes, a purely dietary treatment can be tried first, depending on the severity of the sugar imbalance. If the effect is insufficient, insulin therapy is also indicated. The sonographically measured abdominal circumference is used to monitor the success of the therapy in the child. Common to all diabetes diseases is the absolutely necessary diabetes training of the mothers. This should teach them how to monitor their own blood glucose levels using glucose meters and the basics of a balanced diet. In the case of diabetics on a diet, the birth should take place in a clinic experienced in treating diabetic mothers and their children. Pregnant women with diabetes requiring insulin must be delivered in a level 1 or 2 perinatal center according to current guidelines. Delivery should occur no later than term. Primary cesarean section should be recommended for macrosomic infants with an estimated weight of 4500 grams. The goal here is to avoid birth injuries such as shoulder dystocia as well as fetal oxygen deprivation caused by obstetric arrest. Treatment of the newborn is in addition to routine neonatal therapy according to the complications that arise. The quantitatively most common is hypoglycemia (low blood sugar). Newborns of diabetic mothers must therefore be monitored closely.If necessary, intravenous glucose must be administered in addition to consistent feeding or early feeding. If symptoms of calcium or magnesium deficiency occur, this must also be treated by calcium or magnesium substitution. Neonates with increased blood viscosity should be monitored and adequately hydrated. Depending on the severity, infusion therapy may be necessary. Cardiomyopathy that may occur should also be monitored and treated supportively with fluid administration and drug therapy if symptoms develop.
Outlook and Prognosis
Embryofetopathia diabetica is not a curable disease. It occurs exclusively in expectant mothers and must be closely managed and monitored by physicians. With adequate medical care, a good prognosis can be obtained. The development of the unborn child is intensively monitored until, in most cases, a pre-planned delivery takes place. Subsequently, multiple check-ups of the infant also take place so that immediate action can be taken in case of abnormalities. During pregnancy, the expectant mother must take various precautionary and safety measures. Drug treatment takes place throughout the entire period. The therapy depends on the severity of the disease. Various impairments of the way of life occur and often an early hospitalization of the pregnant woman is recommended. A special diet is necessary for a good outlook of further developments. If complications occur during gestation, the prognosis worsens. Organ damage, premature birth or birth injuries are possible. Oxygen deprivation of the infant may occur, leading to irreparable damage. In severe cases, the infant will die. If no or inadequate medical care is sought, the prognosis is unfavorable. The risk of miscarriage is significantly increased. In addition, malformations are possible, which further reduces the quality of life.
Prevention
Embryofetopathia diabetica is caused by poorly controlled, pregnancy-derailed, or previously undetected diabetes mellitus in the mother. The severity of the consequences correlate with the extent and duration of elevated blood glucose levels. Consistent therapy of preexisting diabetes as well as targeted and early gestational diabetes screening followed by sufficient treatment can reduce the risk of sequelae in the child. Pregnancies with pre-existing diabetes mellitus should be planned if possible. Preconception blood glucose values close to normal should be achieved for at least three months.
Follow-up
In the case of embryofetopathia diabetica, the affected person is usually always in need of intensive medical treatment first to prevent further complications or further discomfort. The earlier the disease is detected and treated, the better the further course of this disease usually is. However, a complete cure of embryofetopathia diabetica cannot be achieved in every case, so that the children not infrequently also suffer from malformations or other defects that have to be treated after birth. The main focus in this disease is therefore the early detection and subsequent treatment of the child’s defects. The symptoms themselves are treated with the help of medication and other therapies, depending on their severity. In many cases, those affected are dependent on regular examinations to prevent complications. In their daily lives, the women are dependent on the support of their partners and families to prevent depression or other psychological upsets. The child should also be monitored after birth and regularly examined by a pediatrician. No general prediction can be made about the child’s life expectancy in embryofetopathia diabetica.
What you can do yourself
The expectant mother should consult a physician immediately if she has a diffuse feeling that something may be wrong with her or her unborn child. A checkup is then advised. In addition, a balanced and healthy diet is important. Despite possible weight loss in embryofetopathia diabetica within pregnancy, food intake should not be too high in sugar or fat.It is helpful if the ingested food is well controlled and documented. This is easy to achieve via digital programs and reveals irregularities more quickly. With a good diet and adherence to a recommended fluid intake, conspicuous changes are easier to detect. The abdominal circumference should be checked independently on a regular basis and compared with the normal values of the pregnancy progress. An expectant mother must protect herself more strongly against an infectious disease. Contact with infected persons during the incubation period should be avoided. Clothing should be selected and worn according to the weather conditions. Preventive measures against infections should be optimized and strengthened. If the pregnant woman complies with these precautions and an infection still occurs, this should be classified as a warning.
