Diabetes and pregnancy (gestational diabetes)

Diabetes mellitus is a metabolic disease in which there is hyperglycemia (increased blood sugar, which, however, cannot enter the cells and be used) due to relative or absolute insulin deficiency – disorders in the secretion and/or action of insulin.

Epidemiological data: The incidence of diabetes mellitus is increasing. Diabetes diagnosed during pregnancy (gestational diabetes) is an increasingly common complication. Abnormal blood sugar regulation occurs in 3-10% of pregnancies. In most women, glucose tolerance normalizes after delivery, but they remain at increased risk (30-60%) of developing diabetes later in life.

Classification of diabetes:

  1. Diabetes mellitus type 1.
    Diabetes mellitus type 2.
    3. Other specific types of diabetes that can occur with pancreatitis, hemochromatosis, acromegaly, hypercorticism, intake of diuretics, corticosteroids, genetic defects of pancreatic beta-cell function and others.
    4. Gestational diabetes – diabetes that is diagnosed during pregnancy.

Etiopathogenesis:

Metabolism during normal pregnancy.

During pregnancy, endocrine and metabolic changes occur, much of which is due to hormonal signals from the feto-placental unit. Early in pregnancy, glucose tolerance is normal or improved with increased peripheral tissue insulin sensitivity. This is due to increased maternal estrogens and progesterone, which lead to an increase in the beta cells of the pancreas that produce and secrete insulin, and an increase in its plasma level. Later in pregnancy, insulin resistance increases with an increase in the release of counterinsular hormones (hormones that counteract insulin) – glucagon, somatomedins, catecholamines, prolactin. In addition, the placenta produces the enzyme insulinase, which breaks down insulin. Correspondingly, insulin secretion also increases, and by the third trimester, average 24-hour insulin levels are about 50% higher than non-pregnancy levels. Increasing insulin resistance stimulates the mother’s cells to use other sources of energy besides glucose – e.g. free fatty acids, thus increasing the supply of glucose to the fetus. Pregnant women are more likely to have episodes of hypoglycemia (low blood sugar) between meals or at night.

Disorders in diabetes.

In some women, there is an inadequate response to increasing insulin resistance – pancreatic insulin secretion does not increase sufficiently, resulting in maternal and fetal hyperglycemia. This is accompanied by episodes of fetal hyperinsulinemia (increased insulin plasma levels in the fetus). The greater amount of insulin stimulates synthesis processes and the mass of the fetus increases significantly (“big baby syndrome”, macrosomia). In the conversion of glucose to fat, more energy is used and the oxygen levels of the fetal blood decrease – episodes of hypoxia in the fetus are observed. They are associated with increased release of catecholamines (noradrenaline and adrenaline) from the adrenal gland, which lead to increased blood pressure, changes in the heart, increased formation of erythrocytes, increased hematocrit and thickening of the blood.

Risk factors for gestational diabetes are:
– overweight;
– family history of diabetes;
– history of previous birth of a baby with a high weight;
– becoming pregnant at a later age;
– gestational diabetes in previous pregnancies, etc.

Impact of diabetes on the mother:

Diabetes in pregnancy can lead to:
– an increase in blood pressure – the frequency of preeclampsia is greater in diabetics. Chronic hypertension in combination with diabetes increases the risk of superimposed preeclampsia, premature detachment of the placenta, vascular accidents.
– more frequent infections – of the excretory, genital system, wounds, etc.
– severe early toxicoses of pregnancy – hyperemesis gravidarum.
– manifestations of the complications of diabetes – diabetic nephropathy and retinopathy in type 1 diabetes with a longer history and/or poor control.

Effect of diabetes on fetus:

In the fetus, diabetes can cause:

  • spontaneous abortion.
  • higher incidence of congenital anomalies.
  • delayed development of the fetus (intrauterine retardation) – observed in vascular damage to the placental vessels – placental insufficiency.
  • hydramnios– increased amount of amniotic fluid.
  • perinatal infant mortality in diabetes is mainly due to congenital malformations, respiratory distress syndrome, excessive fetal immaturity at birth.
  • postpartum hypoglycemia due to elevated insulin levels.
  • increased hematocrit, increased bilirubin.
  • macrosomia – greater weight for gestational age. Macrosomia is associated with a reduced head:shoulder girdle ratio, and in vaginal delivery after cephalic delivery, there is an increased risk of shoulder dystocia (difficult delivery of the shoulder girdle) and trauma to the brachial nerve plexus.
  • increased risk of developing metabolic syndrome (obesity, hypertension, dyslipidemia, impaired glucose tolerance).
  • increased cardiovascular risk.

Behavior:

– Before becoming pregnant, women with diabetes should achieve optimal and stable blood sugar levels. Information on the long-term control of diabetes is provided by the value of glycated hemoglobin (HbA1c).

– During pregnancy, glycated hemoglobin and blood sugar are tested, fetal development is monitored.

– To detect gestational diabetes, fasting blood sugar is tested, after feeding, an oral glucose tolerance test is performed.

Treatment:

Treatment of diabetes in pregnant women includes:
– appropriate diet – avoidance of fast carbohydrates, intake of long-chain carbohydrates and fiber.
– physical activity.
– if needed – insulin.

According to the condition of the mother and the fetus, the delivery is due or before – with/without induction naturally or by caesarean section.

Prevention: Prevention of diabetes in pregnant women is:
– primary – combating the risk factors;
– secondary – early detection and adequate control of diabetes.

Abbas Jahangir

I am a researcher and writer with a background in food and nutritional science. I am the founder of Foodstrend.com, our reputable online platform offering scientifically-backed articles on health, food, nutrition, kitchen tips, recipes, diet, and fitness. With a commitment to providing accurate and reliable information, we strive to empower our readers to make informed decisions about their health and lifestyle choices. Join us on Foodstrend.com's journey toward a healthier and happier lifestyle.

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