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Gestational diabetes can be dangerous for the mother-to-be and for the baby, so pregnant women should carefully monitor blood glucose levels. If the sugar concentration of the pregnant woman starts to rise, she will require specialist care. The presence of gestational diabetes requires frequent examination of the condition of the fetus, and the delivery should be assisted by a neonatologist.

There is good news though: gestational diabetes is not a common disease as it affects only 2-4 percent of pregnant women. Above normal blood glucose levels in the earlier weeks of pregnancy may indicate type 2 diabetes not diagnosed before pregnancy or type 1 diabetes that develops during pregnancy. Usually, the disease resolves after childbirth.1

Gestational diabetes

Gestational diabetes is a carbohydrate intolerance that occurs during pregnancy in women who previously had normal blood glucose levels. The disease is the result of an endocrine disruption.

Gestational diabetes can occur in any pregnant woman, but women who were significantly overweight before becoming pregnant, or who had cases of type II diabetes in their immediate family, are more likely to develop it.

In addition, the risk increases with age and subsequent pregnancy (especially if the previous pregnancy had elevated blood sugar levels) 1.

Undiagnosed or poorly treated gestational diabetes may cause preterm labor, metabolic immaturity of many organs of the fetus (especially the respiratory system), fetal heart muscle hypertrophy and the related impairment of its function after delivery.

In pregnant women with diabetes, intrauterine deaths occur more often than in he althy pregnant women.

Complication of gestational diabetes is also the so-called macrosomia, i.e. the risk of having a child weighing too much in relation to the gestational age (the child weighs over 4.2 kg). This, in turn, is associated with the risk of prolonged and difficult labor and perinatal injuries for both mother and baby.

If gestational diabetes is left untreated, newborns are often born with respiratory disorders caused by immaturity of the lungs and often require connection to a ventilator despite their on-term delivery. Maternal gestational diabetes can also cause jaundice to become more severeneonatal.

Diagnosing Gestational Diabetes: Test One

The complications of gestational diabetes can be avoided if the condition is recognized early and treated properly. Signs of anxiety may be dizziness, fainting, severe thirst caused by excess glucose in the blood. However, in most women, gestational diabetes is asymptomatic and develops asymptomatically, which may result in serious complications1 . That is why blood glucose tests are performed several times during pregnancy.

The blood glucose level is tested for the first time until the 10th week of pregnancy to assess whether the expectant mother has diabetes, which she does not know about yet. The test is very simple - it is a simple fasting blood donation.

Important

The diet for gestational diabetes is very similar to that recommended for people with diabetes. Meals should contain adequate amounts of carbohydrates, protein and fat and provide between 2,300 and 2,500 kcal / day. The amount of protein ingested should not exceed 1.5-2 g / kg body weight.

Women with gestational diabetes are advised to follow a high-residual diet. Residual ingredients are found in vegetables, fruits and grain products; they inhibit the excessive absorption of glucose.

Avoid all kinds of sweets.

Fats in a proper diet should constitute approx. 30 percent. daily energy demand.

The recommended diet should include:

40-50 percent carbohydrates (fruit, dark bread, oatmeal, groats);

30 percent proteins (poultry, fish);

20-30 percent fats.

Note, there is no universal diet!

The doctor develops dietary recommendations individually for each patient.

Diagnosis of Gestational Diabetes: Test Two

Between the 24th and 26th week of pregnancy, a second test, the so-called oral glucose loading test; it is a more time-consuming study. First, the nurse takes blood, then the pregnant woman must drink a glass of water containing 50 g of glucose. The solution is very sweet, so you can add the juice of half a lemon to it. This does not affect the test result, but it improves the taste of the liquid.

Blood is drawn again after one hour and two hours.

This test does not have to be performed on an empty stomach.

Before the test is due, make sure that glucose is available at the office, or you should bring it with you. The result is usually picked up the next day.

If the result is normal, i.e. your blood glucose level is below 140 mg / dL, everything is OK.okay.

Diagnosis of gestational diabetes: third test

If the result of the second oral glucose load test is greater than 140 mg / dL and not greater than 180 mg / dL (a higher result indicates diabetes), the pregnant woman is referred to the so-called diagnostic test.

This study is very similar to the previous glucose load test; in this case, however, the test is performed on an empty stomach, the solution is sweeter - 75 g of glucose should be drunk, and blood is drawn not after an hour, but two hours after drinking the solution. During this time, you cannot eat anything, as even a small snack will affect the test result.

If the result of this test is greater than 95 mg / dL and two hours after the meal is greater than 140 mg / dL, the woman is referred to a diabetes clinic or maternity center for diabetes in pregnant women.

Lower results mean the patient does not have gestational diabetes.

Please note that the 75g glucose load test is correctly performed when:

  • is performed on an empty stomach;
  • the previous day, the pregnant woman did not eat a lot of sweets;
  • last meal was consumed approximately 12 hours prior to testing.

This test is not repeated anymore - incorrect results indicate the presence of gestational diabetes. Another examination would only unnecessarily extend the time to start treatment.

Gestational diabetes treatment

Treatment begins with a visit to a diabetologist. The first step is always to change your diet to one that will normalize your blood glucose levels.

You need to limit the amount of consumed simple sugars (i.e. sweets and fruit juices) and fats. The specialist selects a diet taking into account the period of pregnancy, the pregnant woman's weight and the level of her physical activity.

Women are advised to check their glucose levels four times a day: in the morning on an empty stomach and then one hour after each main meal.

Glucometers are used for self-testing of blood glucose, i.e. special devices with a fine needle and a measuring strip. The needle punctures the skin on the finger and squeezes a drop of blood onto the test strip. The result is soon available on the meter display.

Fasting glucose should not exceed 90 mg / dL, and after meals - 120 mg / dL.

If, after one week of dieting, the glucose level is still above the above-mentioned target values, insulin treatment is necessary.

Management of gestational diabetes

A woman has to start systematically keeping a special diary, in which eachTogether, it will record your glucose levels and insulin doses, as well as detailed all meals and snacks.

It should also count the so-called carbohydrate exchangers (WW), also referred to as bread units. This is the equivalent of 10 g of carbohydrates absorbed by the body (starch, sucrose, lactose).

It is important not only to have a proper diet, but also exercise, which improves glucose burning, reduces insulin resistance of tissues and increases their insulin sensitivity1 .

Therefore, if the expectant mother is well and has no other contraindications, the doctor recommends special sets of exercises to accelerate the metabolism.

Gestational diabetes - frequent checkups with a doctor necessary

Pregnant with diabetes more often than he althy women have to visit the attending physician in order to monitor the child's condition. Check-ups should take place every two weeks from the diagnosis of diabetes to the 34th week of pregnancy and once a week - after the 36th week of pregnancy.

During such an inspection, the doctor assesses, among others, the size of the child, as well as the work of his heart using cardiotocography (CTG).

If necessary, the biophysical profile of the fetus is additionally assessed, all in order to prevent fetal death (even several years ago, pregnant women with diabetes often gave birth to stillborn babies).

If your fetus is well assessed and your blood glucose control is showing good results, you can wait until your baby is due to deliver. In this case, there are also no contraindications to natural childbirth. However, it should not take place in a regular hospital, but in a reference center (hospital specializing in difficult deliveries).

Where to go for help

Counseling centers for pregnant women with diabetes

  • Independent Public Clinical Hospital of the Medical University, Department of Endocrinology, Diabetology and Internal Medicine, Białystok, ul. M. Skłodowskiej 24 a, phone: (0-85) 746 86 07 and 746 82 39
  • University Hospital, Diabetes Outpatient Clinic, Kraków, ul. Kopernika 15, phone: (0-12) 424 83 14
  • Polish Mother's He alth Center, Diabetes Clinic, Łódź, ul. Rzgowska 281/289, phone: (0-42) 271 11 52
  • Department and Clinic of Metabolic Diseases and Diabetology, Silesian Medical Academy, Zabrze, ul. 3 Maja 13, phone: (0-32) 370 44 27
  • Gynecology and Obstetrics Clinical Hospital, Medical University of Diabetes, Poznań, ul. Polna 33, phone: (0-61) 841 92 87
  • Pomeranian Medical University, Regional Diabetes Clinic, Szczecin, ul. Arkońska 4, tel. (0-91) 45 40 112 and 45 41 007 ext. 557
  • Independent Public Central Clinical Hospital, Medical University of Warsaw, Diabetology Clinic, Warsaw, ul. Banacha 1a, phone (0-22) 599 15 65
  • Department and Clinic of Internal Diseases and Diabetology, Medical University, Diabetes Clinic, Warsaw, ul. Kondratowicza 8, phone: (0-22) 326 53 08
  • Provincial Hospital No. 2, Department of Internal Medicine, Rzeszów, ul. Lwowska 60, tel. (0-17) 866 40 00
  • Provincial Specialist Hospital, Department of Endocrinology and Diabetology, Olsztyn, ul. Żołnierska 18, tel. (0-89) 538 64 82
  • Independent Public Clinical Hospital No. 4, Lublin, ul. Jaczewskiego 8, tel. (0-81) 742 51 49.

Childbirth with gestational diabetes

A neonatologist should be present during the delivery, who immediately assesses the condition of the baby after the baby is born.

On the other hand, if something disturbing happens to the baby or it is too big (weighs more than 4,200 g), doctors often have to terminate the pregnancy earlier, usually by caesarean section. It is most advantageous if it is after 37 weeks of pregnancy, because then the baby is generally able to breathe on its own.

After delivery, the mother's blood glucose levels usually return to normal. However, during the first two weeks of the postpartum period, it must be monitored regularly, and 2-3 months after the birth, an oral glucose load test of 75 g should be performed.

Most often the problem ends with pregnancy. But it is worth being vigilant, because it happens that diabetes persists and the patient must also remain under the care of a diabetes clinic after having a baby.

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Pregnant examinations