DIABETES IN PREGNANCY
(GESTATIONAL DIABETES)
Diabetes is the most common medical complication of pregnancy. If diabetes is known before pregnancy, it is called pregestational or overt diabetes. However, if it is diagnosed during pregnancy, it is called gestational diabetes. The incidence of gestational diabetes has increased by about 40% in the last 20 years due to the increase in obesity and excessive consumption of sugar-containing foods.
I HAVE DIABETES AND I WANT TO GET PREGNANT.
WHAT SHOULD I DO?
In overt diabetes, a woman with known diabetes before pregnancy, the embryo, fetus and mother are at risk of serious complications directly related to diabetes. A healthy pregnancy and delivery in overt diabetes depends on blood glucose control and the degree of underlying cardiovascular and renal disease. Uncontrolled diabetes can lead to pregnancy loss, premature birth, malformations in the baby and unexplained fetal death. Therefore, it should be known whether there is diabetes before pregnancy, and if there is a known disease, pregnancy should be planned after regulation is achieved.
First of all, the diabetic woman must prepare herself physically, emotionally and psychologically for the nine months of pregnancy, which can be very demanding. The full support of family and husband is very important at this point. Then she should consult an endocronologist, a specialist in hormone diseases, and normalize her blood sugar 3 months before conception. This approach reduces the likelihood that the baby will be born with a disability.
WHAT ARE THE RISK FACTORS FOR GESTATIONAL DIABETES?
Risk factors include advanced age, being overweight, being physically inactive, having high blood pressure, having a history of heart disease, having polycystic ovary syndrome, having a family history of diabetes or diabetes in a previous pregnancy. However, gestational diabetes can also occur in people with no risk factors.
HOW IS GESTATIONAL DIABETES DIAGNOSED?
Pregnant women are tested for diabetes from the sixth month of pregnancy. Those with a family history of diabetes, those who become pregnant at an advanced age and those who are overweight should be tested earlier. Gestational diabetes is detected with a simple test performed between 24-28 weeks of pregnancy. Detection of gestational diabetes will protect the mother and the baby from many possible risks listed below and will ensure that precautions are taken in advance.
GESTATIONAL DIABETES, EXERCISES and TREATMENT
Once gestational diabetes is detected, it is first checked whether it can be regulated with diet and exercise. A diabetic diet consisting of 3 main meals and 2 snacks is prescribed and exercise is recommended 5 days a week. In addition to aerobic exercise, walking for 15 minutes after each meal is ideal for blood sugar regulation. However, if regulation is not achieved with lifestyle change, insulin may be required. Since insulin does not cross the placenta, it does not reach the baby and does not harm it. In this case, you may need to get a glucometer to monitor your own blood sugar levels at home during the day. You should measure and record your blood glucose levels as often as your doctor tells you to and show them at every doctor’s visit. Accordingly, your insulin level can be adjusted, cut or increased.
Does gestational diabetes affect the timing of delivery?
In addition to monitoring the mother’s blood sugar and general condition during pregnancy, the baby also needs to be monitored more frequently than in other pregnancies. The well-being of the baby in the womb is monitored by NST test, fetal biophysical profile measurement, and tracking of baby movements.
Most of the time, patients with gestational diabetes give birth on time, but if there are some complications, premature induction of labor and cesarean delivery may be necessary. Especially if the baby is macrosomic, i.e. too big for normal delivery, a caesarean section may need to be planned.
What are the future risks of gestational diabetes for mother and baby?
During pregnancy, the chances of losing the baby in the womb are slightly increased compared to normal pregnancies. Since the babies of mothers with gestational diabetes are usually large, the possibility of postpartum bleeding is higher than in other women. Vaginal tears may develop more during normal delivery. Pregnant women with gestational diabetes are also more likely to have pre-eclampsia (pregnancy poisoning). 1/3 of expectant mothers who have had gestational diabetes are likely to have diabetes or high blood sugar in the future.
As for the risks for the baby; when the baby is born, it may have respiratory distress or extremely low blood sugar. At the same time, the possibility of birth trauma is higher in these pregnancies because of the larger size of the baby. For the baby, the possibility of shoulder impingement is higher in vaginal delivery. Sometimes babies may need to be followed up in the neonatal intensive care unit, and babies have the risk of being obese or overweight in childhood. For this reason, a mother with gestational diabetes should definitely inform the pediatrician who follows her baby after birth.
Postnatal follow-up of gestational diabetes
A blood sugar test is performed 4-12 weeks after birth. If it is normal, the mother should be screened annually for diabetes. If the blood glucose level is high, the patient is referred to an endocrinologist and treatment is organized.