Diabetes during pregnancy – causes, diagnosis and treatment

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Diabetes mellitus during pregnancy occurs in 1 out of 350 full-term pregnancies and is one of the most common endocrine problems in pregnancy. To some extent, it reduces fertility, increases the risk of early miscarriage, causes changes that may cause hypertension and even eclampsia, and also increases the risk of fetal malformations.

Diabetes during pregnancy – characteristics

Diabetes occurring during pregnancy is associated with disturbances in the body’s hormonal balance during pregnancy. During pregnancy, cells are more resistant to the hormone insulin, so glucose obstructs its way into the body, increasing the need for insulin. This is not a big problem for most women as their pancreas increases insulin production. However, there are times when the pancreas cannot keep up with the production of more insulin, with the consequent increase in blood glucose levels and the development of gestational diabetes. It usually starts in the fifth or sixth month of pregnancy and usually resolves after the baby is born. After diabetes develops during pregnancy, there is a risk that it will also develop in the next pregnancy. Therefore, it is very important for women at risk to change their lifestyle, pay more attention to physical activity and avoid being overweight. Diabetes in pregnancy poses a threat not only to the pregnant woman, but also to the child. In a diabetic pregnancy, central nervous system defects, impaired development of the sacro-lumbar spine and defects of the cardiovascular, genitourinary and skeletal systems may occur much more frequently. Therefore, treatment is very important.

Taking into account the enormous progress that has been made in the treatment of diabetes in recent years, a pregnant woman with diabetes should be treated in a specialized center for the treatment of pathological pregnancy, because the correct treatment of this disease allows for very good results.

Women struggling with diabetes who plan to enlarge their family should discuss changes in treatment with their doctor in advance. However, there is a fairly large group of women in whom diabetes develops during pregnancy and disappears after its termination, therefore every pregnant woman in the period between 24 and 26 weeks of pregnancy must undergo tests to make a correct diagnosis, as appropriate treatment reduces the number of complications. in the mother and the birth of a healthy child.

The causes of diabetes during pregnancy

In women with diabetes during pregnancy, the body produces the right amount of insulin, but its action can be blocked by hormones that increase during pregnancy, such as prolactin, progesterone, cortisol or estrogens. Then, insulin resistance develops. It is not fully understood why diabetes occurs in some women and not in others. The reasons are complex. However, there are some risk factors that increase your chance of getting sick:

1. family history of gestational diabetes
2. PCOS syndrome (polycystic ovaries),
3. overweight and obesity,
4. mother’s age over 35,
5. having a child with a birth defect,
6. giving birth to a child over 4,5 kg in an earlier pregnancy,
7. occurrence of premature birth of unknown cause in the past,
8. hypertension,
9. the occurrence of gestational diabetes in a previous pregnancy.

There is a group of patients whose risk of diabetes during pregnancy is much lower, including:

1. women under 25,
2. patients with a healthy body weight, not belonging to the group of high risk of diabetes, e.g. of Spanish or South American origin,
3. women who have not been diagnosed with high blood sugar in the past
4. people who do not have relatives suffering from diabetes,
5. patients without complications characteristic of gestational diabetes in previous pregnancies.

Symptoms of diabetes during pregnancy

Symptoms that may suggest gestational diabetes include:

1. nausea,
2. constant fatigue,
3. excessive thirst
4. blurred vision,
5. frequent urination,
6. bladder and vaginal infections,
7. skin infections.

The influence of diabetes on pregnancy and childbirth

Diabetes during pregnancy, regardless of whether it occurred after pregnancy or before pregnancy, always increases the risk of miscarriage. Babies who receive too much glucose from the mother’s body may develop macrosomia (intrauterine hypertrophy), which is characterized by too much growth of the fetus in the womb. The child is above the 90th percentile on the percentile grid. Children with macrosomia have a characteristic appearance – very often their torso is disproportionate to the head. In addition, the skin is red and there is hair on the auricles.

Vaginal delivery of a child with macrosomia is contraindicated because it is exposed not only to injuries, but also to brain damage, which in turn causes mental retardation and even death of the toddler. In addition, having a baby through natural childbirth may cause hypoglycaemia, i.e. hypoglycaemia, and, as a result, diabetic coma, hyperbillirubinemia and too high levels of red blood cells. Macrosomia is also associated with other unpleasant complications that may appear later in life, such as insulin resistance, metabolic syndrome, overweight and obesity. In turn, possible developmental defects concern the gastrointestinal tract, kidneys, heart, nervous system and limb structure. During the birth itself, the fetus may have a fracture of the humerus, a dislocated shoulder or a fracture of the sternum.

However, complications in the mother include:

1. polyhydramnios,
2. miscarriage,
3. urinary tract infections,
4. risk of pre-eclampsia,
5. caesarean section.

In a woman giving birth to a child with macrosomia, the birth canal may be damaged, and even in extreme cases the symphysis of the pubis may be separated.

Diabetes during pregnancy – diagnosis

Gestational diabetes is usually diagnosed during routine testing in pregnant women. Most often it is performed:

– blood sugar level test in the first trimester of pregnancy (performed on an empty stomach);

– general urine test (performed monthly);

– blood glucose test performed one hour after drinking 50 g of glucose (performed between 24 and 28 weeks of pregnancy);

– fasting glucose load test; the patient donates blood for testing before drinking sweet liquid, then drinks a glucose solution and gives blood for testing again after about two hours. In Poland, there is a screening program that covers all pregnant women, regardless of the glucose result. A test result showing a glucose concentration between 140–200 mg% is an indication for the extension of the diagnosis and the performance of an additional test to establish the final diagnosis. A glucose result greater than 200 mg% indicates the presence of diabetes in pregnancy or gestational diabetes.

If the results of the above tests are normal, the next test is to measure blood glucose at 32 weeks of pregnancy. The results of the sugar curve suggest the likelihood of diabetes when the following results are present:

1. 95 mg / dL or more on an empty stomach
2. 180 mg / dL or more (one hour after glucose ingestion),
3. 155 mg / dl or more (after 2h),
4. 140 mg / dL or more (after 3h).

How to treat diabetes during pregnancy?

Treatment implemented in a pregnant woman is aimed at achieving the correct concentration of glucose in the mother’s blood. It should be applied as soon as possible after diagnosis. At the beginning, the patient is recommended to follow a diabetic diet, which should include the lowest possible amount of simple sugars. If, after one week of dieting, the glucose level does not balance out, insulin therapy is introduced. It can be used in two ways: in the form of insulin injections or infusions with an insulin pump. Women on insulin therapy should consider the risk of hypoglycaemia, even if they are taking insulin at certain times. Hypoglycaemia may be the result of not enough carbohydrate in a meal, missing a meal, increasing physical activity, taking too little insulin in relation to your needs, skin warming.

The diet of a diabetic woman should be selected according to her body weight, week of pregnancy and physical activity. For this, a woman should visit a dietitian or diabetologist who will arrange an individual diet for her. The recommendations are similar to those for type II diabetics, and include:

1. eating meals at fixed times (every 2-3 hours),
2. eating small meals,
3. eating a diet rich in dietary fiber, which is found in vegetables,
4. eating less fruit due to the content of simple sugars in them,
5. limiting the consumption of table salt to 6 grams per day,
6. limiting the consumption of meat, canned food, cold cuts, ready meals and vegeta,
7. replacing forbidden products with: whole grain bread, lean dairy products, poultry, fish, lean meats, lots of vegetables, vegetable oil, nuts,
8. avoiding fatty meats, butter, cream, offal.