Pregnancy is not only a happy event in a couple’s life, but also a period of both physiological and psychological challenges. Today we will focus on a metabolic disorder in pregnant women characterized by impaired glucose tolerance. We are talking about gestational diabetes.
What are the causes of gestational diabetes?
First of all, it should be taken into account that hormonal changes increase insulin resistance, making cells less sensitive to its action. The pancreas, in turn, is not always able to compensate for this deficiency with a proportional increase in the synthesis and release of insulin. Thus, gestational diabetes is, in a sense, a “physiological” phenomenon. Usually, gestational diabetes does not pose a serious danger to the mother or the unborn child.
It is well known that the period of greatest risk of congenital malformations in the fetus occurs between conception and the tenth week of pregnancy, while gestational diabetes develops after the twenty-fourth week, when the development of organs and systems is completed. However, to prevent possible complications, it is extremely important to maintain glycemic control within the recommended limits.
What are the signs of gestational diabetes and risk factors?
Symptoms of gestational diabetes are most often absent. In rare cases, pregnant women may experience signs and symptoms typical of hyperglycemia, such as increased thirst and frequent urination, nausea and vomiting, urinary tract infections, and blurred vision.
A high risk of gestational diabetes exists in women with a family history of diabetes in first-degree relatives; impaired fasting glucose tolerance or glucosuria; macrosomia in previous pregnancies; or obesity. If one or more of these conditions are present, glucose level testing should be carried out as early as possible.
Glucose tolerance test: why is screening important?
Due to the tendency of gestational diabetes to develop without symptoms or with minimal symptoms, accurate screening is of paramount importance for its detection. Screening is carried out between the 24th and 28th weeks of gestation, with the possibility of moving it to the 14th–18th weeks in the presence of significant risk factors. In addition, if the result is negative, the test should be repeated at 24–28 weeks.
The most common screening method is the so-called GCT, or glucose challenge test. Essentially, it is a glucose load test that includes 50 g of glucose and measurement of blood glucose levels 60 minutes after taking the glucose solution. If after one hour the blood glucose level is greater than or equal to 140 mg/dL but less than 180 mg/dL (7.8–10.2 mmol/L), the test is considered positive, although gestational diabetes has not yet been diagnosed.
To confirm the diagnosis, an oral glucose tolerance test (OGTT) with 100 grams of glucose is required, this time after 8–12 hours of fasting. This test is not required if the blood glucose level exceeds 198 mg/dL, which is sufficient for diagnosing diabetes.
What complications can occur with gestational diabetes?
The main complications for the baby include excessive birth weight, which increases the risk of getting stuck in the birth canal and birth injuries. High blood sugar levels can increase the risk of preterm birth or require early delivery due to the baby’s overgrowth. Premature babies may develop respiratory distress syndrome, a condition that makes breathing difficult.
For the mother, gestational diabetes may increase the risk of high blood pressure and preeclampsia; cesarean section; and the development of type 2 diabetes in the future. Fortunately, with early diagnosis and changes in diet and lifestyle, the risks associated with gestational diabetes can be minimized or completely eliminated. Specialists at the Bogolyuby Medical Center who monitor your pregnancy will recommend the necessary examinations and measures that may be required during pregnancy in case of gestational diabetes.
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