Gestational diabetes, first diagnosed during pregnancy, impacts the health of the mother and baby before and after birth. On the eve of World Diabetes Day, which is celebrated annually on November 14th, we talk about the risks, diagnosis, control and prevention of gestational diabetes.
Gestational diabetes is diabetes that is diagnosed during pregnancy in women without prior diabetes. It occurs as a consequence of hormonal changes during pregnancy, and can affect between 5 and 15% of pregnant women. Its prevalence has been increasing due to the increase in maternal age, as well as the increase in overweight and obesity in the general population.
Any pregnant woman can develop gestational diabetes, but it is more common in pregnant women over 35 years of age, overweight or obese, with excessive weight gain during pregnancy, with a history of diabetes in their immediate family, with a history of pregnancies with gestational diabetes and/or babies with high birth weight (over 4000g).
It is due to an inability to produce enough insulin to control blood glucose levels, which result from increased needs during pregnancy. Gestational diabetes is more common in the second and third trimester and, in most cases, disappears after birth.
The importance of diagnosing and treating gestational diabetes is due to associated maternal and fetal complications. The main complication is the possibility of the baby being overweight, which is associated with a greater risk of a prolonged and difficult birth, potential injuries to the mother and baby, the need for an instrumented birth, to induce labor, to perform a cesarean section, or the risk of premature birth.
Furthermore, large babies born to mothers with gestational diabetes also have a higher risk of developing diabetes and obesity later in life. Other complications include polyhydramnios (excess amniotic fluid), pre-eclampsia (which can lead to hypertension during pregnancy), neonatal jaundice, hypoglycemia in the newborn, and later development of type 2 diabetes in mothers.
Symptoms and diagnosis
The diagnosis is made based on laboratory analyses, including measuring fasting blood glucose levels at the first prenatal surveillance appointment and carrying out the Oral Glucose Tolerance Test (OPT), generally between the 24th and 28th weeks of gestation. This test evaluates glucose levels before and after ingesting a sugar solution and, if the results are altered, it indicates the need for more rigorous monitoring.
Many pregnant women with gestational diabetes have no specific symptoms. When symptoms exist, they are generally dry mouth and increased thirst, the need to urinate more frequently, tiredness, changes in vision and itching in the genital area. Symptoms that are, in essence, common during pregnancy, and therefore difficult to associate with gestational diabetes
Treatment and control
If the diagnosis is confirmed, it is essential to adopt a healthier lifestyle. A balanced diet, physical activity in accordance with professional guidance and frequent blood sugar control. This monitoring must be done under the supervision of health professionals. Ideally a team consisting of an obstetrician, endocrinologist, nutritionist and a nurse specializing in maternal health.
If you cannot control your blood sugar levels, treatment with oral antidiabetics or insulin may be necessary. It is essential that all women receive adequate guidance from the beginning of pregnancy. Prevention, adopting a healthy lifestyle, is the best way to reduce the risk.
In most cases, after birth, blood glucose stabilizes. Even so, all women must take a reclassification test, 6 to 8 weeks after giving birth, which again consists of an oral glucose tolerance test. Due to the increased risk of recurrence in a future pregnancy, or of developing type 2 diabetes, these women are advised to maintain healthy lifestyles and more frequent medical surveillance.