Diabetes Mellitus (diabetes): It is a progressive metabolic disease with high blood sugar level, which occurs as a result of a defect in insulin secretion, insulin action or both of these factors.
Gestational diabetes mellitus (gestational diabetes mellitus): It is a carbohydrate metabolism disorder that starts with pregnancy or occurs during pregnancy and progresses with blood sugar levels above normal. These patients usually return to normal in the postpartum period but are candidates for diabetes mellitus later in life.
There are two periods in terms of insulin hormone, which regulates blood sugar in the body, depending on the variability of hormonal effects that occur during pregnancy.
In the first half of pregnancy;
Fasting blood sugar drops to lower levels than before pregnancy, and blood sugar drops more slowly after a meal. Developments in this period reveal the tendency of low blood sugar.
In the second half of pregnancy;
The metabolic effect is reversed and a relative resistance develops to insulin, the main hormone that regulates blood sugar. This causes blood sugar to rise. This rise in blood sugar rises above the normal limits in some pregnant women. This condition is called gestational diabetes. Gestational diabetes is a type of diabetes that occurs due to the increased metabolic load during pregnancy in pregnant women who do not have any complaints and disappears after pregnancy ends.
Apart from this situation, which is expressed as gestational diabetes, there may be expectant mothers who are known to have diabetes beforehand or who have become pregnant without realizing it. In the treatment of pregnant women in this group, insulin will be required to adjust the blood sugar level.
A more severe clinical picture will occur compared to gestational diabetes. In order to prevent this situation and to prevent damage that may occur during pregnancy, pre-pregnancy care and counseling will be very important.
How common is gestational diabetes?
In the presence of uncontrolled sugar levels in women with overt diabetes, the probability of getting pregnant is low due to metabolic effects. In diabetic patients whose fertility rates were very low with insulin therapy, pregnancy rates reached normal women’s levels with insulin therapy. The frequency of gestational diabetes is approximately 3-5%.
Who is more at risk for gestational diabetes?
Having a genetic predisposition to the development of diabetes (Diabetes, obesity, etc. in the mother or father)
being overweight,
Having a history of a baby over 4000 grams,
Presence of a baby with congenital anomaly,
Having a history of stillbirth of unknown cause,
Pregnancy over 35 years old,
Those with fasting blood sugar above 105 mg/dl and postprandial blood sugar above 120 mg/dl constitute the risky group.
Pregnancy consequences of high blood sugar level:
The results listed here are conditions caused by uncontrolled high blood sugar. And it is seen in overt diabetes mellitus rather than gestational diabetes.
Miscarriage (Abortus): The frequency of miscarriage increases especially in mothers with uncontrolled blood sugar in the first three months or in pregnancies with vascular changes due to chronic diabetes. While investigating the causes of habitual abortion (more than three consecutive miscarriages), one of the causes screened is diabetes.
Intrauterine fetal death: This risk is high in pregnant women with long-term and uncontrolled diabetes and diabetes-related vascular damage in organs such as eyes and kidneys.
Polyhydramnios: It is more than normal amniotic fluid with the baby’s uterus. Polyhydramnios is seen in 20% of pregnant women with diabetes. Polyhydramnios increases the risk of premature birth, premature placental abruption. The possibility of diabetes should be considered in pregnant women with polyhydramnios.
Preeclampsia: It is a serious disease that progresses with high blood pressure during pregnancy and is seen at a higher rate in diabetic pregnant women.
Congenital anomalies: Cardiac anomalies, sacral agenesis (absence of the bone in the posterior middle part of the pelvis), trachea-esophageal fistula (abnormal connection between the esophagus and trachea) ), it is reported that the frequency of congenital anomalies such as short bowel syndrome is increasing.
Maternal urinary tract infections and vaginal yeast infections are more common in patients with gestational diabetes due to decreased immunity.
Maternal death: It is very rare and is usually due to rare but serious events such as preeclampsia, cerebro-vascular events, diabetic coma in pregnant women whose pregnancies have not been followed up and thus treated.
Problems with birth:
• Due to the large baby, shoulder wear, normal postpartum bleeding and tears may be more, and babies born with respiratory distress as a result of difficult delivery need neonatal care units more often.
• The increase in the frequency of going to cesarean section is observed.
Some metabolic problems (hypoglycemia, hypocalcemia, hyperbilirubinemia and polycythemia) are observed more frequently in the baby after birth.
How is gestational diabetes diagnosed?
Ideally, if it was not possible when the pregnancy was planned, fasting and postprandial blood sugar should be checked as soon as possible during pregnancy. The high blood sugar detected during these examinations requires a three-hour hundred-gram oral glucose tolerance test (100 g OGTT), which is used as a diagnostic test. In general, in our country, it is a screening test for all pregnant women at 24-28th of pregnancy. A 50 g oral glucose tolerance test (50 g OGTT) is applied between weeks and weeks, and if high blood sugar is detected in this test, 100 g OGTT is started. If the expectant mother is in the risk group for diabetes, 100 g OGTT should be performed directly from the beginning.
What is 50 g OGTT?
Plasma blood glucose is measured one hour later by giving 50 g of glucose-containing liquid orally, at any time of the day, on an empty or full stomach, to the expectant mother. If it is between 140mg/dl -190mg/dl, the diagnostic test is started. However, if it is over 190mg/dl, there is no need for a diagnostic test. The patient is diagnosed with gestational diabetes. And the treatment is planned.
What is 100 g OGTT?
Four blood glucose measurements are made immediately, at the first, second and third hours, by giving fluid containing one hundred grams of glucose orally, on an empty stomach, to the mother who is at risk for gestational diabetes. Evaluation of results; Gestational diabetes is diagnosed if at least two of the values found below are above the lower limits.
Hunger; 95mg/dL,
1. Clock; 185mg/dL
2. Hour165 mg/dL ,
3. Hour 145 mg/dL
Treatment in gestational diabetes:
The vast majority of patients are followed up only with diet and exercise. 15-20% of all pregnant women with gestational diabetes need treatment with insulin. The calorie requirement in the diet is calculated as 35 kcal/kg. With an approach parallel to the principle of eating less and often during pregnancy, 25% of the total calorie requirement should be taken at breakfast, 30% at lunch, 30% at dinner, and 15% during snacks. If glucose levels cannot be reduced to normal with this diet, it means that the need for insulin has arisen.
After diagnosis, the target is to keep fasting blood sugar below 95 mg/dl, and the 1st hour of postprandial blood sugar below 140 mg/dl. This result is sought by measuring blood glucose twice a day, one week after the diet treatment. If the desired level is achieved, the same follow-up is continued.
Otherwise, the diet is adjusted again, and if the desired result is not achieved, the need for insulin has arisen.
Regardless of the level of treatment followed in patients with gestational diabetes, blood glucose should be measured once a week. Pregnancy follow-up frequency should be reduced to once a week starting from the thirty-second week.
Babies of mothers with gestational diabetes should be carefully evaluated in the last weeks because of macrosomia (large baby) and late lung development.
I have gestational diabetes, should I have a cesarean section?
Gestational diabetes is known to cause large baby formation. However, this is not true for all patients. In addition, having a large baby does not necessarily mean having a cesarean. In studies, cesarean section is recommended for babies with an estimated weight of over 4500 grams. Apart from this, the need for cesarean section is the same as for other pregnant women.
Postnatal follow-up:
Mothers with gestational diabetes usually do not need treatment with insulin after delivery. If this need persists, treatment with insulin should be continued in nursing mothers. When the mothers with gestational diabetes come to the postpartum control after six weeks, the 100 g OGTT should be repeated and examined for permanent diabetes. Although the results are found to be normal, gestational diabetes should be considered a warning and annual and then three-year check-ups should be recommended.
