Pregnancy diabetes is an increasing and frequently encountered condition in recent years. Thanks to advances in diagnosis and treatment, thousands of diabetic women can have a healthy baby by having a problem-free pregnancy. The carbohydrates found in the combination of the foods we take are digested and passed into the blood as sugar (glucose) and used by our cells as energy. For this, we need the insulin hormone secreted by the organ called pancreas.
The main metabolic disorder in diabetic patients is the inability of blood-borne sugar to enter the cells. Sugars cannot enter the cell as a result of insufficient production of the insulin hormone or the inability of the cells to use it. In untreated patients, high amounts of sugar accumulate in the blood.
There are 3 types of diabetes, type 1 diabetes, type 2 diabetes and pregnancy diabetes. When pregnant with type 1 or type 2 diabetes, this condition is called pregestational diabetes. In a mother who does not have diabetes before, the diabetes that occurs during pregnancy is called gestational diabetes.
Due to the physiology of pregnancy, some hormones are secreted more than normal for the development of the baby during pregnancy. In addition, the placenta (the organ that supplies the baby with oxygen and food) produces hormones that can affect the normal functioning of insulin in the body. Especially as of the second half of pregnancy, pregnancy diabetes may occur as a result of the production of these hormones and the increase in the energy needs of the baby.
If women with pre-pregnancy diabetes want to have children, they should see their doctor beforehand. A preparatory process is needed to control blood sugar and to examine for complications related to diabetes. Generally, these tests are performed a few months before conception, the necessary treatment changes are made and HbA1c (blood test showing three months of sugar control) is below 7. Studies have shown that while the HbA1c value is less than 7, the risks related to infant injuries, pregnancy and birth problems are minimized in pregnant women with diabetes.
Those who have first degree relatives with diabetes, who have an excess weight, who have given birth to four pounds or more in their previous pregnancies, who have a history of stillbirth, recurrent miscarriage, disabled baby birth, those with polycystic ovary problems and those with a history of pregnancy diabetes are at risk for gestational diabetes. .
Diabetes can cause many bad conditions to develop in the course of pregnancy: The likelihood of cardiovascular complications increases. Hypertension may develop during pregnancy. The probability of the baby’s fluid being high (polyhydramnios) increases. The risk of childbirth increases with difficult birth or caesarean section. Ketoacidosis, hyperglycemia (high blood sugar) and hypoglycemia (low blood sugar) may develop.
The mother’s sugar is the most important food for the baby. Glucose passing through the placenta to the baby is used as fuel. However, the mother’s glucose is higher than normal for the baby is harmful. High glucose levels in the first two months may cause various congenital injuries in the baby of the diabetic mother. Not only glucose but also ketone bodies can pass to the baby and adversely affect the baby’s development. Therefore, the development of hyperglycemia and ketoacidosis in the mother should be prevented. Elevated blood sugar levels after the second month may cause different problems. Now the pancreas can produce insulin, which increases the production of insulin to adapt to the high sugar content of the mother. This increase in the baby’s glucose and insulin in the womb, especially in the last few months causes an increase in fat tissue and overgrowth, the baby’s birth weight exceeds 4 kg. The large size of the baby may cause problems such as injuries during delivery, shoulder dislocation and nerve damage. Immediately after birth, the baby may have excessive sugar fall, jaundice and respiratory problems.
In all pregnant women, 24-28. Between the 50th and 50th weeks, an oral glucose screening test (OGTT), ie, a sugar loading test, should be performed; there is no harm to either the pregnant or the baby. If any of these test values are high, the diagnosis of gestational diabetes is:
* Two-step diagnostic method: 50 g sugar loading test (can be done at any time of the day fast or full) If the blood sugar is over 140 mg / dl 100 g sugar loading test is required. 50 g OGTT is a screening and 100 g OGTT is a diagnostic test. The 100 g sugar loading test is examined at least 8 hours in the morning after fasting. 100gr OGTT fasting blood sugar 95 mg / dl, 1 hour after loading blood sugar 180 mg / dl, 2. hour blood sugar 155 mg / dl and / or 3rd hour blood sugar above 140 mg / dl is diagnosed as pregnancy diabetes.
* Single-step diagnostic method: 75 g sugar loading test, at least 8 hours after starvation in the morning. In this test, if the fasting blood glucose is above 92 mg / dl, after the 1st hour after the loading the blood sugar is 180 mg / dl and / or the 2nd hour blood sugar is above 153 mg / d, the diagnosis of pregnancy diabetes is made.
If there are signs and symptoms of diabetes (urination, drinking too much water, frequent urination at night, recurrent vaginal infections), sugar loading test is applied immediately regardless of the period of pregnancy.
If there is diabetes in pregnancy, the most important part of the treatment is keeping blood sugar as normal as possible. Diet, exercise and regular blood glucose measurements should be performed in the follow-up of a dietician or doctor if necessary. In spite of these measures, treatment should be started if success is not achieved. Sugar-lowering drugs can not be used in pregnancy because they can be harmful to the baby during pregnancy; therefore, it is best to use insulin until the end of pregnancy. Doing insulin in amounts recommended by the doctor; Blood sugar levels and the development of the baby need to be closely monitored.
If there is diabetes in pregnancy, there are some issues to be considered in nutrition. Pregnant should not starve: it is harmful to both the pregnant and the baby. Less but often should be eaten. Sugary drinks and sweets should be avoided because they are quickly digested and increase blood sugar rapidly. Fruits are a source of vitamins and minerals – but they should not be eaten more than one or two servings. Fiber and pulp foods should be given weight. Ideally, you should take sufficient carbohydrates, proteins, fats, folic acid in accordance with the nutrition program recommended by the dietitian; should take 3 moments and 3 snacks a day and consume plenty of water (2-2.5 liters). 8 to 12 kg should be taken during pregnancy.
In the postnatal period, after the baby is born, the placenta will also be excreted from the body and the effect of the placenta on insulin will probably pass and pregnancy diabetes will pass. In order to determine whether diabetes has passed or not, diabetes should be re-tested at six weeks postpartum, ie at the end of the postpartum check.
There is a risk of recurrence in subsequent pregnancies even if pregnancy diabetes has passed. This history should be shared with the doctor during the first pregnancy examination. Once gestational diabetes has occurred, it is an early indication that it is at higher risk of developing advanced Type 2 diabetes. Getting rid of excess weight, eating healthy and making exercise a part of life can prevent or delay it.