About 12 percent women find out during pregnancy that they have diabetes. Prof. dr hab. n. med. Krzysztof Czajkowski, obstetrician gynecologist. Find out why it is so important to recognize the disease and treat it properly.
Diabetes that occurs during pregnancy, the so-called Is gestational diabetes a temporary phenomenon or the beginning of type 2 diabetes?
Let's first define whatgestational diabetes is . During pregnancy, the woman's body works at a higher speed compared to the period outside it. This applies, inter alia, to the functionof the liverin terms of metabolismglucoseand the functionof the pancreas , which must secrete much more insulin during pregnancy. This is because the body produces more glucose for the baby's needs and the tissues are less sensitive to insulin. In some women, the pancreas is not able to produce the right amount of insulin, and then in 3-4 percent. patients develop gestational diabetes. For the mother, it is primarily information that her pancreas may work worse in the future. Studies of women who develop gestational diabetes show that about half of them after 10 years have some type of disorder: either glucose intolerance or type 2 diabetes. you may have diabetes in the future! After such information, the woman may, thanks to this warning, first try not to gain weight, and thus significantly reduce the likelihood of developing diabetes in the future, and secondly - check the blood sugar level every two or three years to catch the onset of diabetic disorders and start therapy. .
What are the consequences of having excess blood sugar for the baby?
During pregnancy, a hormone called placental lactogen, produced by the placenta, protects the interests of the fetus: in order to provide the baby with a relatively constant supply of glucose, in the event of a longer break between meals, it breaks down the mother's fat and transforms it into glucose in the liver. If the mother is not diabetic, that's fine. But when the mother's sugar levels are much higher than normal in diabetes, the baby gets a lot more sugar in his diet with each mother's meal. Like any other organism, potentiallya he althy person on a diet with excess glucose, the fetal body tries to do something with this sugar. All it can do with it is store excess sugar in the form of body fat. By storing excess body fat, it begins to gain weight. This has negative effects. First, you may find that an extremely large newborn does not fit into the birth canal at the time of birth. Secondly, a child who is used to receiving a large amount of glucose at every meal may have severe hypoglycaemia after delivery. Excess sugar also adversely affects the functioning of the placenta, which may become insufficient. In this situation, even intrauterine deaths of children are observed. Thirty years ago, prof. Weiss analyzed the data of all high-born children who died in Austria. And it turned out that at least one third of the cases were due to undiagnosed diabetes in pregnancy.
Do the consequences of gestational diabetes for a child end with childbirth?
In the group of children who are "fattened" during pregnancy, there are later more obese adults with heart disease, type 2 diabetes, who potentially live at least a few years shorter. Therefore, the effort that should be made by the mother - the diet, and in approx. 20 percent insulin treatment - has positive effects for the child for life. Adipose tissue, like any other, is most produced in utero, in part in early childhood and adolescence. Of course, by eating a lot of fats and carbohydrates, we will gain body fat, but actually gaining weight and losing weight is filling up or emptying the fat cells that already exist in the body. Some of us are slim no matter what they eat, because we have had few fat cells from their fetal life and childhood. Some of them have to lose weight all their lives, because the cells during the diet did not so much disappear, but emptied temporarily.
Fortunately, all pregnant women in our country are tested for diabetes …
In Poland, many years ago, on the forum of the Gynecological Society, we decided that every pregnant patient must be included in the tests. To exclude all these cases, when patients have disorders, but do not know about them, at the beginning of pregnancy, fasting sugar is measured, and between 24 and 28 weeks of pregnancy, a glucose load test is performed - the patient drinks 75 g of glucose before the test.
What happens when gestational diabetes is diagnosed?
We limit the patient to simple carbohydrates and fats, and we also borrow a glucometer to measure blood sugar, i.e. the level of glycemia. We invite her for an after-checktwo weeks, and if the blood sugar level was high, then after a week. And we observe - if the appropriate diet has been able to stabilize the level of glycemia, which is successful in 80%. of patients, then the woman is ordered to measure the blood glucose level every 2-3 days and she is taken to the hospital a little earlier before delivery. If the normalization has not occurred after two weeks, we recommend the use of insulin.
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The second group of pregnant women were women who had diabetes before pregnancy. The risk of complications in this case has been limited by self-monitoring and treatment, but it still exists. What are the risks for the mother?
The mother is in danger of pregnancy poisoning, premature birth, pre-eclampsia, recurrent urinary tract infections. It used to be mostly vision loss in the mother. More detailed research in the 1990s revealed that significant deterioration of eyesight or even blindness was caused by too rapid glycemic control for the needs of pregnancy. Lowering the blood sugar too quickly can be dangerous for a patient who has already experienced, for example, changes in the fundus of the eye. Diabetes in pregnancy, due to excessively high blood sugar levels, may also aggravate damage to peripheral nerves, i.e. polyneuropathy. Particularly dangerous and difficult to control during pregnancy is vegetative neuropathy, manifested by constant vomiting. Most often, diabetes causes changes in large (macroangiopathy) or small (microangopathy) blood vessels, which in turn damages organs, e.g. kidneys and eyes. Good control prevents these changes.
What is threatening the child?
A baby in the first weeks of fetal life is at risk of dying from miscarriage or "excessive nutrition", causing developmental defects and prematurity. We know that if diabetes is poorly balanced at the beginning of pregnancy, the risk of birth defects in a baby increases two to three times. Most of the birth defects associated with diabetes develop in the first weeks of pregnancy. That is why we encourage diabetic patients to plan their pregnancy and prepare for it. It is important that they take care of sugar balance before conception and during pregnancy. As in gestational diabetes, here too the baby is at risk of excessive body weight due to "excessive nutrition" and, consequently, birth injuries of the newborn.
How does pregnancy affect the mother's existing diabetes?
Increases insulin requirement. This is not a complicated problem - you just have to adjust the doses. Nowadays, it is facilitated by fast-acting insulin analogues, which are effective in reducing the excess of glucose in the blood followinga meal, and long-acting - with an evenly prolonged effect, maintaining the correct level of sugar in the blood between meals and at night. Overall, these insulins improve the quality of life of pregnant women with diabetes.
Does a pregnancy complicated by diabetes require special care?
Since caring for a pregnant woman with diabetes requires some medical experience, we strive in Poland to ensure that patients are treated in specialized centers. The Swedes once compared the risk of pregnancy loss and child death in centers that specialized in managing pregnancies with diabetes and those that did not. These studies showed a tenfold difference! A non-diabetic gynecologist is unable to see some nuances, he has no experience.
You must do itGlucose load test. It is performed between the 24th and 28th week of pregnancy. Blood is collected from the pregnant woman two hours after drinking a solution of water containing 75 g of glucose. The correct test result is less than 140 mg / dL. Higher values confirm Gestational Diabetes.
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