Gestational diabetes requires more insulin doses

• May 2, 2024

Gestational diabetes presents, without known cause, in those women who are pregnant and have no diabetic background, but whose sugar levels in blood they rise during that period.
While hormones from the placenta help the baby's development, they prevent the action of the insulin in the mother's body. This problem is called insulin resistance and it is very likely that the future mother I need up to three times more insulin.

Women at increased risk of gestational diabetes are those who are overweight before or during pregnancy, are over 35 years of age, have a family history of diabetes, have presented the disease during the previous pregnancy, or gave birth to a baby who weighed more 3.8 kg or with some malformation.

Of every 100 pregnant women, approximately 4 of them develop gestational diabetes

Gestational diabetes begins when the body is not able to produce and use all the insulin it needs for pregnancy. It manifests in the mother in the last months of pregnancy, after the baby's body is fully formed but while the baby is growing. Because of this, gestational diabetes does not cause birth defects such as those seen in mothers with diabetes before pregnancy. However, lack of treatment or lack of control of gestational diabetes can affect the baby.

The detection and diagnosis of gestational diabetes include the determination of blood glucose levels. Values ​​higher than 125 mg / dl, in two determinations, fasting, establish the diagnosis of diabetes.
Every woman between weeks 24 and 28 of pregnancy should have a blood sugar test done, one hour after having ingested 50 grams. of glucose.

When a woman has gestational diabetes her pancreas works too much to produce insulin, but insulin does not lower blood glucose levels. While insulin does not pass through the placenta, glucose and other nutrients do. Therefore, too much glucose in the blood passes through the placenta giving the baby high glucose levels. This causes the baby's pancreas to produce more insulin to rule out blood glucose. As the baby receives more energy than it needs for growth, the excess energy becomes fat.

Excess fat can lead to macrosomia, a "fat" baby. Babies with macrosomia face health problems, including shoulder injury at birth. Because of the excess insulin produced by the baby's pancreas, newborns may have low blood glucose levels and are at higher risk of complications with breathing. Babies with excess insulin become children at risk of obesity and adults at risk of developing type 2 diabetes.

Complications

Women with pre-existing or gestational diabetes can have an uncomplicated pregnancy and a healthy baby, as long as they control the concentration of sugar in their blood. Women who do not control their condition properly, however, have a higher risk of suffering certain complications during pregnancy, among which are:

• Pre-eclampsia This disorder is characterized by high blood pressure and the presence of proteins in the urine. In severe cases it can cause seizures and other problems in the mother, as well as insufficient development and premature birth of the baby.
• Polyhydramnios This disease causes the mother to produce an excessive amount of amniotic fluid and may increase the risk of premature delivery.
• Cesarean birth. When the baby is too large, doctors usually recommend a cesarean delivery.

Treatment for gestational diabetes

Because gestational diabetes can affect the health of the mother and the baby, treatment should be started immediately. The goal of treatment for gestational diabetes is to maintain blood glucose levels equal to those of pregnant women who do not have gestational diabetes. The treatment always includes a special feeding plan and a physical activity program. It may also include daily tests of blood glucose and insulin injections.

For the expectant mother, the treatment helps reduce the risk of a cesarean birth that is required for very large babies. Following the treatment for gestational diabetes will provide a healthier pregnancy and delivery and the baby can help you avoid health problems in the future.

Usually gestational diabetes disappears after pregnancy, but once you have had gestational diabetes there is a chance that 2 out of 3 women will have this disease again in future pregnancies. However, in some women pregnancy helps to discover type 1 or type 2 diabetes.

It is very difficult to know if the expectant mothers had gestational diabetes or begin to present the symptoms of diabetes during pregnancy. These women must continue a treatment for diabetes after childbirth.

Many of the women who have had gestational diabetes later develop type 2 diabetes. There seems to be a connection between the trends of gestational diabetes and type 2 diabetes. Gestational diabetes and type 2 diabetes lead to insulin resistance. Certain basic changes in lifestyle can help prevent the development of diabetes after gestational diabetes.

Hyperglycaemia (higher than normal blood glucose concentration) and for long periods of time are associated with spontaneous pregnancy interruptions, malformations of the baby, excess weight of the baby and, as a consequence, more difficult deliveries.

Pregnancy can aggravate existing complications of diabetes, especially visual problems such as retinopathy, which should be treated before the start of pregnancy.

Risk factor's

• Age over 45 years
• Diabetes during a previous pregnancy
• Excessive body weight (especially around the waist)
• Family history of diabetes
• Give birth to a baby weighing more than 4 kg
• HDL cholesterol less than 35
• High levels of triglycerides, a type of fat molecule, in the blood (250 mg / dl or more)
• High blood pressure (greater than or equal to 140/90 mmHg)
• Impaired glucose tolerance
• Low level of activity
• Poor diet

Tests to detect complications during pregnancy

The doctor must strictly monitor the size and condition of the fetus, especially during the third trimester of pregnancy.

In some cases, the pregnant woman will be instructed to perform one or more of the following tests:

• Ultrasound. This test can be done more than once to check that the fetus is growing normally. If the baby reaches a weight of nine pounds with 14 ounces or more, the doctor is likely to recommend a cesarean delivery when it comes to term.
• Fetal monitoring without stress. This procedure controls the baby's heart rate. It can be repeated weekly or more frequently.
• Biophysical profile. This test combines stress-free fetal monitoring with an ultrasound. It can also be repeated weekly or more frequently.
• Fetal movement count. Every day the pregnant woman registers the number of kicks she feels for one or two hours.

Video Medicine: Gestational Diabetes: Managing Risk During and After Pregnancy Video - Brigham and Women’s Hospital (May 2024).