Gestational diabetes

La gestational diabetes It is the elevation of blood sugar levels favored by the situation of pregnancy.

Early detection and treatment of this diabetes during pregnancy can improve pregnancy and delivery outcomes.

Most women with gestational diabetes can achieve normal blood glucose values ​​through proper nutrition.

Only approximately 30% of women require drug treatment.

At the Dra. Gómez Roig Institute, in Barcelona, ​​our specialists and our midwife will offer you good advice and pregnancy control to reduce the risks in cases of gestational diabetes.

If you have any doubts or questions about Gestational Diabetes, do not hesitate to contact us.

What is gestational diabetes

As its name suggests, gestational diabetes is a type of diabetes that first diagnosed in pregnancy and that it is caused by the gestational changes themselves.

However, when the diagnosis occurs in the first weeks of pregnancy, it is considered that the woman already had diabetes previously, but it had not been diagnosed.

In these cases, the trigger for the increased blood sugar it would not be pregnancy.

People with diabetes have blood glucose levels that are too high, since their bodies are not able to regulate these levels properly.

Not only does it have a negative impact on the health of the woman, but also on the health of the baby.

For this reason, it is very important to detect it early, in order to act immediately to protect the woman and the fetus from possible associated risks.

Why gestational diabetes develops

La gestational diabetes It usually develops between weeks 24 and 28 of pregnancy.

This happens because During pregnancy, a series of changes take place that give rise to the existence of insulin resistance. That is, the body cannot use insulin properly.

To understand this, we must first understand what the function of the insulin.

Under normal conditions, the body processes the food we eat, obtaining glucose from it and releasing it into the bloodstream.

By what is glucose can be used in the form of energy has to enter the cells. That is where insulin intervenes, since it is the hormone in charge of allowing the passage of glucose from the blood to the cells.

During pregnancy, a series of changes occur that are necessary to ensure an adequate supply of nutrients to the fetus.

An example is the secretion, by the placenta, of a series of hormones that favor diabetes, such as growth hormone, placental lactogen, or prolactin.

Although these changes are common to all pregnancies, not all women develop gestational diabetes, since, usually, the body is capable of compensating for them.

However, approximately 1 in 6 women develop it, because their pancreatic function is insufficient to compensate for the insulin resistance of pregnancy.

As a consequence, an increase in maternal and fetal blood glucose levels is caused.

Are there women who are more at risk than others?

Although any woman can develop diabetes in pregnancy, a series of factors are known that make women who have them more at risk of experiencing this problem.

Risk factors are:

• First-degree relatives with diabetes mellitus.
• Obesity: BMI ≥27.5 in Asian pregnant women and ≥30 in the rest of the pregnant woman.
• Personal history of macrosomia: baby weighing more than 4 kg at birth.
• Personal history of diabetes mellitus, gestational or prediabetes.
• For unknown reasons, the following ethnic groups have a higher prevalence of type 2 DM: Hispanic American, African American, Native American, South Asian, East Asian, or Pacific Islander.
• Maternal age of more than 35 years.

Although there are factors that cannot be controlled, a healthy life style that includes a good diet, not smoking, and regular exercise, have a direct impact on a normal weight and therefore reduce the risk of suffering from it.

Overweight or obese women who lose weight before pregnancy have been shown to reduce the risk of developing gestational diabetes.

With this in mind, a good recommendation before seeking a pregnancy is to first try to achieve a Healthy weight through positive lifestyle changes.

How is it diagnosed

screening and early diagnostic of gestational diabetes are essential to reduce maternal-fetal morbidity.

In particular the macrosomia fetal weight (fetal weight > 97th percentile), shoulder dystocia at birth, and preeclampsia.

For this reason, among the different routine pregnancy tests, there is a specific circuit for screening or screening for this diabetes.

Adherence to said protocol is essential since, generally, this pathology It does not present specific symptoms, other than, in some cases, a possible increase in thirst, the desire to urinate, or excessive weight gain.

In any case, all these symptoms are common in pregnancy, so they are not always useful in identifying a sugar surge.

There are different tests depending on the quarter and its objective:

First trimester

On first quarter, a basal fasting blood glucose.

That is, a measurement of blood glucose levels, to all pregnant women with any of the risk factors mentioned in the previous section.

The objective of this determination is to distinguish those women who already had pre-pregnancy diabetes undiagnosed of those with an early pregnancy.

Second quarter

On second quarter a screening universal through the O'Sullivan's test.

Universal means that it is done for all pregnant women, regardless of their risk factors.

La O'Sullivan's test It does not require fasting, so it can be done at any time of the day.

This test consists of a first determination of blood glucose, followed by the administration of 50 grams of glucose orally, and the subsequent determination of blood glucose levels after 60 minutes.

The O'Sullivan test is considered positive or abnormal when the blood glucose result is greater than 140 mg/dL one hour after ingesting the drink.

When the O'Sullivan comes out altered, a second test should be requested, in this diagnostic case, known as oral glucose load test (OGT).

This second test requires a prior preparation of three days, during which women must follow a diet rich in carbohydrates.

It will also be necessary to go fasting for approximately 8 hours. During the test, the woman will not be able to go for a walk, smoke, eat or drink.

In this case, a basal glycemia is first performed, 100 g of oral glucose, and blood glucose measurement is repeated 60, 90 and 120 minutes after ingesting the sugary drink.

For a diagnosis of DG to occur, there must be at least 2 of the 4 values ​​altered. In the event that only an altered value appears, the same test should be repeated after four weeks.

Third trimester

Those pregnant women who have not been studied in the second trimester for some reason. Or that they have tested negative in the second trimester screening, but that in the third trimester they develop complications suggestive of diabetes of pregnancy, the SOG will be performed directly.

Such complications include sonographic finding macrosomia and/or excessive increase in amniotic fluid or polyhydramnios.

How it can affect me and my baby

When gestational diabetes is not adequately controlled, the risk of risk of a number of complications associates. We detail them below:

Baby large for gestational age or macrosomia

A large-for-gestational-age baby is one above the 90th percentile.

And a suspected baby macrosome is one that has an estimated fetal weight of more than 4500g.

These two complications are the most common associated with gestational diabetes, and occur as a consequence of the persistence of elevated maternal blood glucose values.

These complications, in turn, are related to a higher risk of complications during childbirth, such as higher rates of instrumental deliveryOr a shoulder dystocia.

Which increases the risk of neonatal damage: fracture, brachial plexus injury or neonatal respiratory depression.

Preeclampsia

La preeclampsia It is a pregnancy complication that, among other signs, occurs with high blood pressure.

Women with gestational diabetes are at higher risk of developing it, and the cause appears to be insulin resistance.

Polyhydramnios

El polyhydramnios It is defined as an excessive volume of amniotic fluid.

Although the exact etiology is unknown, it has been seen that this condition occurs more frequently in women with this type of diabetes.

Fetal death

Diabetes has been linked to an increased risk of fetal death, specifically in cases in which there is poor glycemic control.

women with this well controlled pathology they do not seem to have a higher risk of fetal death compared to the rest of the obstetric population.

neonatal morbidity

Babies of women with high blood sugar in blood seem to have a greater risk of morbidities such as: hypoglycemia low blood glucose, hyperbilirubinemia, hypocalcemia, hypomagnesemia, polycythemia increase in blood cells, respiratory distress and/or cardiomyopathy.

These risks are highly associated with the state of maternal hyperglycemia. Therefore, once again, with good control of this situation, it is possible to reduce the risk of the appearance of these possible complications.

Long-term

La diabetes of pregnancy it is also related to a greater risk that the baby, in his adult life, will be more prone to obesity, glucose intolerance or metabolic syndrome.

On the other hand, women who suffer from it are also at greater risk of developing Diabetes Mellitus type 2 or adult.

I have gestational diabetes, now what?

once has confirmed the diagnosis using the oral glucose load test, it is important to start treatment as soon as possible.

The goal of treatment for gestational diabetes is to maintain glucose values in normal blood. Since it is the key intervention to reduce the frequency or severity of complications associated with the disease, both for the mother and for the baby.

For this, the first line of action in the management of elevated glucose will consist of: glycemic controls, nutritional therapy and the physical exercise.

glycemic controls

When the diagnosis is made, the pregnant woman is asked to perform a control of glucose levels in blood about four times a day: fasting when getting up, and one or two hours after each of the main meals.

The results must be written down in a notebook to keep an adequate control.

which makes it easy to identify the pattern of glycemia in the pregnant woman, and determine if antihyperglycemic therapy is required.

Both American Diabetes Association (ADA) as the American College of Obstetricians and Gynecologists (ACOG) recommend the following blood glucose limits, as well as starting antihyperglycemic therapy if these are exceeded:

• Fasting: < 95 mg/dL
• 1 hour after meals: < 140 mg/dL
• 2 hours after meals: < 120 mg/dL

nutritional therapy

It is considered that the majority of women with GD, approximately 75 to 80%, can achieve normal blood glucose values with nutritional therapy only.

After diagnosis of diabetes, the pregnant woman should be referred to the endocrinologist, who will be in charge of supervising glycemic controls, in addition to providing specific nutritional advice.

The objectives of the nutritional therapy are normal blood glucose levels, prevention of ketosis, ensuring adequate weight gain based on baseline body mass index, and ensuring fetal well-being.

Although nutritional guidelines must be personalized and appropriate to the specificities and lifestyle of each woman, there are a number of common general guidelines:

• You must take one healthy nutrition, non-restrictive, that helps control weight gain during pregnancy, with foods from all groups: vegetables, legumes, fruits, dairy products, farinaceous foods, meat, fish, eggs, etc.
• We recommend eating 5 to 6 meals a day in order to avoid ketosis: breakfast, mid-morning, lunch, snack, dinner and snort.
• should be restricted fast-absorbing carbohydrates, such as pastries, both natural and artificial juices, sugary drinks, cookies, refined flours such as white bread or white pasta, candies, chocolates, etc.
• Sweetener such as Aspartame can be used.

Physical exercise

The recommendations of physical activity they are the same as for any low-risk pregnant woman.

It has been seen that the increase in muscle mass, resistance exercise, seems to improve glycemic control.

In addition, regular physical activity can help control blood glucose levels by improving insulin sensitivity.

A good recommendation is to go for a walk about 30 minutes after the main meals.

Pharmacotherapy

If, despite adequately implementing the first line of action: nutritional therapy and physical exercise, optimal glycemic values ​​are not achieved, pharmacological treatment should be started with the antihyperglycemic agent prescribed by the endocrinologist.

The drug of choice is insulin, since it does not cross the placental barrier and has more conclusively demonstrated the maternal-fetal risk reduction when added as a treatment to the first line of action.

After delivery

Most women who suffer from diabetes during pregnancy will return to normal blood glucose values ​​after delivery.

However, it has been seen that these women will have a higher risk of developing diabetes mellitus or prediabetes in the following five years.

On the other hand, one to two thirds of women with gestational diabetes will develop diabetes in future pregnancies.

For this reason, after 6-8 weeks after delivery, and once breastfeeding has finished, a glucose test should be repeated.

As for the baby, we know that after birth it has a higher risk of suffering hypoglycemia, drop in blood glucose level.

So after birth, your blood glucose levels will be checked to make sure you are able to maintain them.

It will also be important to offer early feeding, ideally within the first hour of life.

Finally, it has been seen that performing the skin to skin with the mother is beneficial in helping to regulate blood glucose levels in the newborn.

On Dra. Gómez Roig Institute, located in Barcelona, ​​we carry out pregnancy control in women without risk and also with pathology, as is the case of Gestational diabetes.

Our specialists, as well as our midwife, carry out the correct follow-up of the mother and her baby to allow good results.

You can trust our team that will always serve you with humanity and professionalism.

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