Gestational diabetes or gestational diabetes is a temporary phenomenon in most cases. During pregnancy, the glucose metabolism in affected women is disturbed in this case due to the formation of pregnancy hormones. After the birth of the child, however, sugar levels return to normal.
What is gestational diabetes?
Gestational diabetes is characterized by the first occurrence of a glucose tolerance disorder during pregnancy. With some certainty, the so-called gestational diabetes is one of the most common pregnancy-related diseases ever. The pregnancy hormones estrogen, prolactin, progesterone and placental lactogen, which provide the female body with the necessary glucose during pregnancy, are probably to blame for the occurrence of gestational diabetes. In some women, however, the pancreas cannot produce enough insulin to deliver this glucose to the body’s cells (true insulin deficiency). Or, the pancreas may be able to produce more insulin, but the cells no longer respond to it (relative insulin deficiency).
Causes
Many pregnant women who have already been diagnosed with gestational diabetes are bound to wonder why it has hit them of all people. This question is certainly justified, but cannot be answered one hundred percent in all cases. One risk factor that should not be underestimated is usually body weight. With a body mass index of > 27, there is an increased risk of developing gestational diabetes. Equally problematic are hereditary factors (type 2 diabetes mellitus in the family) and an age of over 30 years. Past pregnancies and births are also a focus of interest. If all of the following questions can be answered with a “yes”, the pregnant woman should consult a gynecologist immediately:
Has a child of more than 4500 g birth weight already been born? Have there been more than three miscarriages? Did gestational diabetes already exist during the last pregnancy? Nevertheless, the cause of gestational diabetes cannot always be clearly determined. Sometimes it just hits women without the risk factors mentioned.
Symptoms, complaints and signs
Although gestational diabetes is not rare, it remains undetected in many cases. This is because the course of the disease is usually asymptomatic. As a rule, it remains completely undetected until the 24th week of pregnancy. In addition, the signs of gestational diabetes are quite nonspecific if they occur only sporadically. During pregnancy, the specific symptoms of diabetes are usually not perceived as such. This is because frequent urination, constant fatigue or a feeling of weakness can also be typical accompanying symptoms of pregnancy. However, there are also abnormalities during pregnancy that are indicative of diabetes. These include high blood pressure, sudden rapid weight gain of the pregnant woman and/or the unborn baby due to the strikingly high blood glucose level and rapid increase in the amount of amniotic fluid (this can be detected during an ultrasound examination). If several of the above-mentioned signs of the disease are noticeable, then the disease is much easier to diagnose. On the other hand, increased urinary tract infections and vaginal infections clearly indicate gestational diabetes. These infections are triggered by the high amount of sugar in the urine, because sugar promotes the development of fungi and bacteria. Many women manage the symptoms of gestational diabetes well, but the disease is sometimes accompanied by serious consequences for mother and child. If necessary medical measures are not taken, the disease may linger beyond pregnancy.
Diagnosis and course
Gestational diabetes can only be reliably detected with what is known as an “oral glucose tolerance test.” The good news is that the examination costs for the test have been covered by all health insurance companies since March 3, 2012. From the 24th week of pregnancy, the doctor measures the patient’s fasting blood glucose, gives her a glucose solution to drink and waits until the next measurement three times an hour.Thus, blood glucose is measured every hour, and each time there is a limit value that must not be exceeded in any case. The fasting value after 8 hours of abstinence from food should be no more than 95 mg/dl, after one hour 180 mg/dl must not be exceeded, 2 hours after drinking the glucose solution the value must be below 155 mg/dl and after 3 hours the blood glucose should have settled back to values below 140 mg/dl. If only one upper limit is exceeded, it may already be gestational diabetes.
Complications
Gestational diabetes puts both the mother and the unborn child at risk for complications. The risk increases if gestational diabetes is not treated. Among the greatest risks of gestational diabetes in the mother is preeclampsia. This is excessive blood pressure associated with increased protein concentration within the urine. At the same time, the risk of a seizure (eclampsia) increases. In addition, pregnant women are more susceptible to inflammation of the vagina and urinary tract infections. Women who suffer from gestational diabetes also have to undergo a cesarean section more often, partly due to the complications or the size of the child. If the mother later becomes pregnant again, the risk of another gestational diabetes is about 50 percent. Furthermore, the risk of developing type 2 diabetes mellitus increases. Complications due to gestational diabetes also threaten the child. It is possible, for example, that the placenta will develop incorrectly, resulting in an inadequate supply of nutrients to the fetus. Furthermore, maturation disorders of organs such as the liver or lungs may occur. In the worst case, intrauterine amniotic death occurs. The consequences of diabetes are also noticeable after birth. It is not uncommon for affected babies to suffer from prolonged jaundice. Calcium deficiency, hypoglycemia and brain damage are also possible. In severe cases, the newborn baby shows respiratory failure or seizures.
When should you see a doctor?
In the case of gestational diabetes, a doctor should be consulted in any case. Only proper treatment of the disease can guarantee ordinary fetal development. If gestational diabetes is not treated, the child may develop severe malformations, which must be treated after birth. The earlier a doctor is consulted in the case of gestational diabetes, the better the further course of this disease. As a rule, a doctor should be consulted when the pregnant woman suffers from low blood pressure and significant weight gain. In this case, the increase in weight exceeds the usual increase during pregnancy. Furthermore, inflammation in various parts of the body may also indicate gestational diabetes and should be examined by a doctor. A doctor should be consulted especially in case of sudden occurrence of these symptoms. The urine of the affected person may smell sweet and indicates gestational diabetes. In case of gestational diabetes, a general practitioner or a gynecologist can be consulted. Usually, the disease can be treated well, so the life expectancy of the mother and the life expectancy of the child are also not reduced by this disease.
Treatment and therapy
If gestational diabetes is diagnosed, referral to a diabetologist is usually made, who will analyze the patient’s diet in detail and have suggestions for improvement ready. If the patient from now on renounces the so-called “short-chain carbohydrates“, such as sugar, white bread and sweets, the blood sugar values can be well adjusted in over 80% of patients. From now on, the diet will include whole-grain products, lots of vegetables and fewer fruits containing fructose, such as berries or apples. The diabetologist checks the patient’s blood glucose levels once a week, and she logs her levels at least three times a day from the time of the first nutritional consultation:
In the morning after getting up, at noon and in the evening. If the blood glucose values are within limits and there are few “outliers,” the lower-carbohydrate diet is perfectly sufficient to prevent excessive weight gain in the mother and developmental delays in the infant.Insulin administration is then unnecessary and gestational diabetes does not lead to any further complications, such as excessive birth weight, which can lead to a problematic delivery.
Prevention
Gestational diabetes cannot always be prevented. Hereditary factors, obesity, and the increasing gestational age of patients take their toll. It is not crucial to “eat a lot” during pregnancy, but just healthy and varied. In this way, some gestational diabetes may not develop in the first place and an already existing gestational diabetes can be treated well.
Aftercare
The patient has in most cases only a few and also only limited measures of a direct aftercare available. For this reason, the affected person should ideally see a doctor early in the disease to prevent the occurrence of other complaints or complications. There can be no self-healing, so treatment by a doctor should be initiated in time. This is the only way to prevent various malformations of the child. In most cases, the symptoms of gestational diabetes can be alleviated relatively well if the diet is changed accordingly. In doing so, the affected person should avoid sugar and white bread and generally pay attention to a healthy lifestyle with a healthy diet. Regular check-ups and examinations by a doctor are very important in order to detect further symptoms at an early stage. In some cases, the disease can be completely cured by administering insulin, so that no special aftercare measures are necessary afterwards. Gestational diabetes does not reduce the life expectancy of the patient in this case and does not usually limit it.
What you can do yourself
Often, blood glucose levels in gestational diabetes can be normalized with just a change in diet and physical activity. An individual nutritional counseling pregnant women with this diagnosis should definitely take advantage of. In the case of gestational diabetes, the daily amount of energy should be between 1,800 and 2,400 kilocalories, depending on eating habits, daily routine and body weight. In terms of diet, pregnant women should ensure that their daily carbohydrate intake is between 40 and 50 percent and consists primarily of slowly absorbable carbohydrates (e.g., whole-grain products). Expectant mothers with gestational diabetes should avoid white flour products, fruit juices and sweets, as these foods cause blood sugar to rise excessively quickly and sharply. To avoid this, it is further advisable to consume about 30 grams of dietary fiber daily in the form of whole grain products, fruits, vegetables and legumes. Furthermore, it is advised to preferentially consume vegetable fats and to cover protein requirements with low-fat milk and milk products as well as low-fat meat and sausage products. To avoid blood sugar spikes after a meal, five to seven smaller meals spread throughout the day are advisable. For overweight pregnant women – whether with or without gestational diabetes – a diet ban applies. In addition to diet, regular exercise is the key. Exercise in moderation can help lower elevated blood glucose levels naturally.