Dr Aidin Rawshani

All about gestational diabetes: diabetes during pregnancy

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Gestational diabetes — Getting diabetes during pregnancy

Gestational diabetes is a form of diabetes that occurs when you have high blood sugar levels (hyperglycaemia) during your pregnancy. Gestational diabetes develops most often in the third trimester (between weeks 24 and 28) and usually disappears shortly after childbirth. Research shows that women who develop gestational diabetes are a more likely to develop type 2 diabetes later in life. Developing gestational diabetes can be worrying because it is usually exhausting enough to be pregnant and getting a disease diagnosis only makes the situation more difficult. Most people with gestational diabetes are worried about their own and the health of the baby. Gestational diabetes is associated with an increased risk of multiple complications and not only type 2 diabetes in the mother later in life. There is an increased risk of obstetric complications and an impact on the health of the fetus if the mother does not treat her increased blood sugar levels. In those situations where the blood sugar levels in the mother are not normalized after delivery, you should consult a doctor to exclude type 1 diabetes, type 2 diabetes or other form of diabetes.

Why develop gestational diabetes?

Insulin is a vital hormone produced in the pancreas (pancreas) and released into the bloodstream where it lowers blood sugar levels by releasing blood sugar into the body’s various cells. If the body is unable to produce sufficient levels of insulin, it develops diabetes, but there are also other causes that can lead to the development of diabetes, such as reduced insulin sensitivity (insulin resistance).

During pregnancy, the body undergoes several changes to optimize the growth and development of the fetus. In, above all, the second and third half of pregnancy, a decrease in sensitivity to insulin occurs, this is due to various hormones formed in the placenta. Therefore, the pancreas of the mother must increase its production and secretion of the hormone insulin to compensate for the increased need. If the mother’s pancreas is unable to increase insulin levels sufficiently, blood sugar rises and then you develop gestational diabetes.

It has recently been discovered that gestational diabetes is not only caused by a lack of insulin production by also reduced insulin sensitivity (insulin resistance). Various hormones, including from the placenta, tend to bind to the insulin receptor in all different cells of the body. This leads to the fact that the mother’s own insulin activates fewer insulin receptors.

Below are examples of various pregnancy hormones that contribute to insulin resistance:

  • Cortisol
  • Progesterone
  • Prolactin
  • Estradiol

Complications associated with gestational diabetes

Most women with gestational diabetes usually have normal pregnancies and good health of the fetus. But the condition is associated with an increased risk of fetal malformation, this risk is directly related to the blood sugar level in the mother. This means that the higher the blood sugar level the mother has, the higher the risk of malformation in the fetus. Precisely for this reason, it is extremely important to control your blood sugar levels if you have gestational diabetes.

Why is high blood sugar levels dangerous for your fetus?

If the mother has elevated blood sugar levels, this leads to increased blood sugar levels in the fetus because the sugar (glucose) is also transferred to the fetus via the placenta. Interestingly, the fetus registers that blood sugar levels have increased and this leads to insulin production also in the fetus to be able to take care of blood sugar.

Remember that insulin is not only important for metabolism and blood sugar metabolism but it is also a growth hormone (anabolic hormone). The increase in insulin levels in the fetus leads to a sharp increase in weight and excessive, which can lead to damage during childbirth, both in the mother and in the fetus.

Gestational diabetes is associated with the following complications:

  • The fetus is larger than normal, this can lead to problems during childbirth and increases the risk of induced childbirth or cesarean section.
  • Polyhydramnios — a condition with too much fluid surrounding the fetus in the womb, this fluid is called amniotic fluid.
  • Preterm birth — gestational diabetes is associated with premature birth, i.e. before week 37.
  • Pre-eclampsia — a condition where blood pressure rises and kidney damage. This can lead to a birth injury.
  • Your fetus may develop low blood sugar (hypoglycemia) during childbirth that may require hospitalization. Miscarriage is a very rare complication.
  • For women with gestational diabetes, where blood sugar levels are normalized after delivery, the risk of gestational diabetes in the next pregnancy sharply elevated (50 -70%).

Risk factors for gestational diabetes

  • Overweight
  • Age
  • Heredity for diabetes
  • More pregnancy with gestational diabetes
  • If you have previously given birth to a large child.

How do you know that you have suffered from gestational diabetes?

Gestational diabetes usually does not give rise to any symptoms, unless the mother has a strong increase in blood sugar levels and then you develop symptoms that are common in diabetes such as increased thirst, feeling tired and diuresis

In Sweden and internationally there are screening programs and diagnostic criteria for gestational diabetes. Screening is usually done in a women’s consultation, where blood sugar is measured several times during pregnancy. Usually, the women’s consultation measures blood sugar randomly four times during pregnancy.

In 2015, the Swedish National Board of Health and Welfare issued recommendations that health care should offer women care and treatment to lower blood sugar if they meet the following criteria:

Fasting≥ 5,1 mmol/l
1 h after 75 g oral glucose load≥ 10,0 mmol/l
2 h after 75 g oral glucose load≥ 8,5 mmol/l

Glucose load is generally recommended to be done in pregnancy week 24-28. If the blood sugar is above 8.8 mmol/l, an oral glucose load is made. The diagnosis is stalls of glucose load, which is to drink 75 g of glucose (sugar) and then measure blood sugar again after 1 and 2 hours.

For women who develop gestational diabetes, they should have the following blood glucose targets (capillary p-glucose):

  • Fasting glucose < 5,3 mmol/l
  • Before other meals < 6,0 mmol/l
  • 1 hour after meal < 8,0 mmol/l
  • Before bedtime < 7,0 mmol/l

How to treat Gestational Diabetes?

In the first place, the condition is treated with dietary treatment. The pregnant woman should meet a nutritionist for dietary advice and a physiotherapist for advice on increased physical activity, usually via the antenatal clinic or via your health centre. If the diet is not enough, then metformin tablets are usually offered. Start with a low starting dose, preferably 500 mg 1 tablet daily, then increase the dose every week by 1 tablet until you reach the target dose of 2 grams per day.

How should women with gestational diabetes be followed up after childbirth?

National guidelines from 2017 suggest general advice on lifestyle habits and systematic follow-up after pregnancy. The mother should receive oral and written information about diet and physical activity and be encouraged to continue healthy eating and exercise habits. In addition, the doctor or nurse at delivery must send a referral to the health center for follow-up within 1 year.

During the follow-up visit to the health center, several factors in the mother must be checked. All these samples give an indication of the metabolic health of the mother.

The following samples shall be checked during the follow-up visit:

  • Long-term blood sugar (HbA1c)
  • P-glucose
  • Cholesterol
  • Triglycerides
  • Dipstick (U-prot)
  • Length
  • Weight
  • Waist circumference
  • Blood pressure
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