Description

Diabetes (diabetes) and pregnancy

Gestational diabetes is an increasingly common condition
in recent years. Thanks to advances in diagnosis and treatment, thousands
of diabetic women can now 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 the pancreas.

The main metabolic disorder in diabetic patients is the
inability of sugar transported through the blood to enter the cells. As a
result of insufficient production of the insulin hormone or the cells not being
able to use it, sugars cannot enter the cell. High amounts of sugar
accumulate in the blood in untreated patients.

There are 3 types of diabetes, type 1 diabetes, type 2
diabetes and gestational diabetes. When conception occurs while having
type 1 or type 2 diabetes, this condition is called pregestational
diabetes. Diabetes that occurs during pregnancy in the expectant mother
who has not had diabetes before is called gestational diabetes, in other words
gestational diabetes.

Due to the physiology of pregnancy, some hormones are
secreted more than normal for the development of the baby during
pregnancy. Also, the placenta (the organ that provides oxygen and food to
the baby – the baby’s partner) produces hormones that can affect the normal
functioning of insulin in the body. Gestational diabetes may occur as a
result of the production of these hormones and the increase in the energy need
of the baby, especially from the second half of pregnancy.

If women with pre-pregnancy diabetes want to have
children, they should definitely see a doctor beforehand. There is a need
for a preparation process in order to control blood sugar and to be examined in
terms of complications related to diabetes. Generally, these tests are
performed a few months before conception, necessary treatment changes are made,
and HbA1c (blood test showing three-month sugar control) is ensured to be below
7. Studies have shown that women with diabetes who conceive when the HbA1c
value is below 7 minimizes the risks related to infant disability, pregnancy
and birth problems.

Those who have diabetes in their first degree relatives,
those who are overweight, those who gave birth to four kilos or more in their
previous pregnancies, those with a history of previous stillbirth, recurrent
miscarriage, disabled baby birth, those with polycystic ovarian problem and a
history of gestational diabetes in their previous pregnancies are at risk for
gestational diabetes. .

Diabetes can lead to many adverse events in the course of
pregnancy: The likelihood of cardiovascular complications
increases. Hypertension may develop during pregnancy. The possibility
of excess fluid in the baby (polyhydramnios) increases. With a difficult
birth or cesarean section, the risk of birth increases. Ketoacidosis,
hyperglycemia (high blood sugar), and hypoglycemia (low blood sugar) may
develop.

Sugar in the mother is the most important nutrient that
feeds the baby. Glucose, which passes through the placenta to the baby, is
used as fuel. However, higher than normal glucose in the mother is harmful
for the baby. The high glucose level in the first two months may cause
various congenital disabilities in the baby of the diabetic mother. Not
only glucose but also ketone bodies can pass to the baby and adversely affect
the development of the baby. Therefore, development of hyperglycemia and
ketoacidosis in the mother should definitely be prevented. High blood
sugar levels seen after the second month can cause different problems. The
baby in the womb, whose pancreas can now produce insulin, increases insulin
production in order to adapt to the high sugar amount taken from its
mother. This increase in glucose and insulin of the baby in the mother’s
womb causes an increase and excessive growth in adipose tissue especially
towards the last months. the baby’s birth weight exceeds 4 kg. The
size of the baby can cause problems such as birth injuries, shoulder
dislocation and nerve damage. Immediately after birth, the baby may have
excessive sugar drop, jaundice and respiratory problems.

In all pregnant women, it is between the 24th and 28th
days of pregnancy. Between weeks, 50 grams or 75 grams of oral glucose
screening test (OGTT), ie sugar loading test, should be performed; There
is no harm for the pregnant or the baby. Gestational diabetes is diagnosed
at the height of any of these test values:

* Two-step diagnostic method : If 50 g glucose
tolerance test (can be done hungry or full at any time of the day) is
performed, if blood glucose is above 140 mg / dl, 100 g glucose tolerance test
is required. 50 g OGTT is a screening, 100 g OGTT is a diagnostic
test. 100 g sugar loading test is done in the morning after fasting for at
least 8 hours. Fasting blood glucose is 95 mg / dl in 100 gr OGTT, 1st hour
blood glucose is 180 mg / dl after loading, 2nd hour blood glucose is over 155
mg / dl and / or 3rd hour blood glucose is over 140 mg / dl. gestational
diabetes is diagnosed. or  Single-step diagnostic method:  75 g sugar
loading test is done in the morning after fasting for at least 8 hours. In
this test, gestational diabetes is diagnosed if the fasting blood glucose is
above 92 mg / dl, the 1st hour blood glucose is above 180 mg / dl and / or the
2nd hour blood glucose is above 153 mg / dl.

If there are signs and symptoms of diabetes (urinating
too much, drinking too much water, frequent urination at night, recurrent
vaginal infections), the sugar loading test is applied immediately, regardless
of the period of pregnancy.

If there is gestational diabetes, the most important part
of the treatment is keeping blood sugar within normal limits as much as
possible. Diet, exercise and regular blood glucose measurements should be
done under the supervision of a dietician or doctor, if necessary. If
success cannot be achieved despite these precautions, treatment should be
started. Sugar-lowering drugs cannot be used in pregnancy as they may be
harmful to the baby; Therefore, it is the best treatment to use insulin
until the pregnancy ends. Making insulin in the amount recommended by the
doctor; blood glucose levels and the development of the baby must be
followed closely.

If there is gestational diabetes, there are some points
to be considered in nutrition. The pregnant woman should not starve: this
is harmful for both the pregnant woman and the baby. Small but frequent
meals should be eaten. Sugary drinks and sweets should be avoided because
they are digested quickly and raise blood sugar quickly. Fruits are a
source of vitamins and minerals – but shouldn’t be eaten more than one or two
servings. Fibrous and pulp foods should be emphasized. Ideally, he /
she should take sufficient amount of carbohydrate, protein, fat, folic acid by
following the nutrition program recommended by the dietician; 3 times a
day and 3 snacks should consume plenty of water (2-2.5 liters). 8 to 12 kg
should be gained during pregnancy.

In the postnatal period, after the baby is born, the
placenta will also be expelled from the body and the effect of the placenta on
insulin will pass, and the gestational diabetes will most likely pass. In
order to find out if the diabetes is over, the sugar loading test should be
done again at the control six weeks after birth, ie the control examination at
the end of the puerperium.

Even if gestational diabetes has passed, there is a risk
of recurrence in subsequent pregnancies. This story should be shared with
the doctor at the first pregnancy examination. Having had gestational
diabetes once is an early indicator that you are at higher risk of developing advanced
Type 2 diabetes. Losing excess weight, eating healthy and making exercise
a part of life can prevent or delay this.