Information about gestational diabetes

Gestational diabetes is a disorder of sugar metabolism that occurs or is noticed for the first time during pregnancy. The endogenous hormone insulin is responsible for regulating sugar metabolism. Due to the hormonal changes during pregnancy, the insulin requirement increases strongly. Some women cannot produce enough insulin or the effect of insulin on their body cells is reduced. As a result, the sugar from the blood can no longer be properly utilized and the blood sugar level is too high.

Who is at risk?
Gestational diabetes is one of the most common concomitant diseases during pregnancy. The trend is rising: in 2010, around 3.7% of pregnant women – equivalent to approx. 24.000 women – affected.

There is an increased risk in women who have the following characteristics:

  • Excess weight
  • Diabetes in parents or siblings
  • Previous birth of a child with> 4500 g birth weight
  • Gestational diabetes in a previous pregnancy
  • Repeated miscarriages
  • High blood pressure or lipometabolic disorders

How is gestational diabetes diagnosed?

In most cases, gestational diabetes occurs between 4. and 8. Month of pregnancy to. It usually has few symptoms, i.e. the typical signs of diabetes, such as strong thirst or frequent urination, are absent.

For this reason, the law states that all pregnant women must be tested between the 24th week of pregnancy. and 28. Some women are tested for impaired glucose metabolism by their gynecologist during the first week of pregnancy as part of the preventive medical checkups. The gynecologist will either perform a so-called screening test (blood glucose determination after drinking a defined sugar solution) as part of the normal consultation. You do not have to be sober for the screening test. Alternatively, your gynecologist may perform. Already the oral glucose tolerance test (s.u.) under standard conditions by. You must be fasting for this.

Your gynecologist will refer you to us if there are any abnormalities in the screening test. We will then perform the oral glucose tolerance test to confirm your diagnosis. You must be sober and have a little time, as the test will take 2.5 hours. Since we determine the blood glucose value with laboratory method directly in our practice, the result is already available immediately after the end of the test.

Oral glucose tolerance test (oGTT)
The oGTT provides information about your body’s ability to break down a defined amount of sugar (glucose) within a certain period of time. For this, you need to drink 75 g of glucose as a sugar solution on an empty stomach. Afterwards, blood will be taken from you at certain intervals and tested for sugar levels. For the test to be carried out correctly, you should be asleep the evening before the test from 22.00 a.m. Don’t eat or drink anything, and don’t exercise excessively either.

Gestational diabetes is when your blood sugar level exceeds one of the following:

  • Fasting value:> 92 mg / dl
  • 1 hour after drinking the sugar solution:>180 mg / dl
  • 2 hours after drinking the sugar solution:> 153 mg / dl

If you are diagnosed with gestational diabetes, immediate counseling and initiation of therapy will take place in our office.

What gestational diabetes means for your baby?

The umbilical cord provides your baby with all the necessary nutrients. If your blood sugar level is too high, too much sugar will also enter the fetal circulation. In order to process the sugar in the blood, the fetus must produce more insulin. The excessive insulin and sugar levels in the blood cause the baby to have more nutrients available for growth than usual. Therefore, the baby grows faster and gains more weight than average (macrosomia). Due to the size of the baby, problems may occur during delivery. To prevent injuries and other complications to the mother and baby, sometimes a cesarean section is performed.

If gestational diabetes is not treated, it can lead to various maturational disorders. Incomplete lung maturation, for example, can lead to respiratory problems in newborns. Permanently elevated blood glucose levels in the mother increase the risk of preterm birth. In extreme cases, the baby may even die in the womb.

Hypoglycemia
If your blood glucose levels are too high at the end of pregnancy, your baby’s body has become accustomed to producing more insulin. This does not mean that your baby will be born with diabetes. However, the overproduction of insulin continues for a few days after birth, even though your baby does not need as much of it now. In the first days of life, your baby’s blood glucose level can therefore drop sharply, and must be checked regularly.

Long-term consequences
Children born to mothers with gestational diabetes have an increased risk of developing obesity, diabetes or high blood pressure in the first 20 years of life. You can reduce this risk by trying to keep your blood sugar levels in the target range during pregnancy. After birth, you can prevent by breastfeeding your child for as long as possible, then following a healthy infant and toddler diet, and encouraging physical activity early on.

All the consequences and problems occur due to the elevated blood glucose levels that pass into the child’s circulation. If the therapy goals are achieved during pregnancy, no sugar passes from the mother’s circulation into the child’s circulation. This can cause o. g. Complications can be avoided. The child does not even realize that the mother has gestational diabetes.

What consequences can gestational diabetes have for you??

Frequent infections
Women with gestational diabetes have an increased risk of infection. Bladder infections and vaginal infections are particularly common, which further increase the risk of premature birth. Therefore, have symptoms clarified by your doctor at an early stage and treated if necessary. Gum infections also develop more often.

High blood pressure
Pregnancy in general, even in women without diabetes, can cause high blood pressure. However, this occurs more frequently in women with gestational diabetes. Sometimes a complication of pregnancy called preeclampsia can develop in connection with it. In addition to the high blood pressure levels, there are other symptoms: protein is excreted in the urine and water retention in the tissues (edema) develops. In addition, headache, eye floaters and nausea may occur. This situation is dangerous for both mother and baby and requires specialist treatment.

Risk of diabetes later in life
In most of the women the diabetes regresses after the delivery. However, in about 5% of affected women, manifest diabetes persists after pregnancy. Around 20% no longer have diabetes in the first year after pregnancy, but already have a permanently disturbed blood sugar metabolism (prediabetes). This means their risk of developing diabetes later is significantly increased. Overall, after gestational diabetes, up to 60% of women develop manifest diabetes over the course of 10 years. This risk is further increased by overweight. In addition, women with gestational diabetes are at risk of having it recur in another pregnancy.

Gestational diabetes

What you can do about gestational diabetes?

In the case of gestational diabetes, joint cooperative care was provided by our diabetes center and your gynecologist.

Your diabetic care team consists of the diabetologist and a diabetes educator. You learn to control your blood glucose level regularly yourself and receive accompanying nutritional advice. In most cases, the therapy goals can be achieved through a controlled change in diet alone. If this is not successful, we will help you to initiate the necessary insulin therapy, which is limited to the duration of the pregnancy.

To avoid complications for you and your baby, the most important thing is to normalize your blood glucose levels. Therefore it is important not to exceed certain blood glucose target values.

These blood sugar target values are:

  • In the morning and before the main meals 65-90 mg / dl
  • 1 hour after you finish eating< 120 mg / dl

Measure your blood glucose yourself

To keep your blood sugar levels in the target range, it is important that you check them regularly yourself. This can be done easily, quickly and painlessly with modern self-measuring devices. Your blood glucose level changes throughout the day. It is usually lower before meals and highest after meals. Therefore, you may need to check your blood sugar 4 to 6 times a day:

  • Before each main meal
  • 1 hour after the end of the main meal

Carefully note down the measured values in the diary given to you.

Based on your measurements, we can assess whether the treatment is successful or whether the therapy may need to be changed. Please bring your meter with you to every doctor’s appointment, as it must be checked regularly for accuracy. Since the hormonal situation and thus also the blood sugar control change continuously during pregnancy, regular contacts with the diabetes team, usually every 14 days, are necessary to assess the metabolic situation.

Keep an eye on weight gain

In order to keep your metabolism under control more easily, it is important to keep to the recommended weight gain during pregnancy. How much you can gain depends on your body weight before pregnancy.

  • If you were of normal weight, a weight gain of between 11 and 16 kg is okay.
  • In the case of slight, previous overweight, the increase should not exceed 11.5 kg.
  • If you were already heavily overweight prior to pregnancy, the increase should be kept to a minimum between the two pregnancies
    5-9 kg remain.

Avoid ketosis

Your body cells normally burn sugar for energy. However, if your body can’t use sugar properly because of gestational diabetes, cells will use fat as an energy source instead. A breakdown product of fat burning is called ketones.

A high excess of ketones in your blood (ketosis) can make your blood very acidic and dangerous for your baby.

During pregnancy, ketones are produced more often if you do not eat enough calories or carbohydrates. In some cases, it may be necessary to check the ketone content in the urine itself in the morning with special urine test strips.

Tips for avoiding ketosis

  • Stick to your feeding schedule:
  • Consume the recommended amount of carbohydrates and calories.
  • Eat a small, carbohydrate-rich late meal, z.B. a sandwich. This avoids ketone formation during the night.
  • Do not skip a meal.

Keep moving

Physical exercise can help lower your blood sugar levels. You will also remain more resilient throughout pregnancy and during delivery. If you exercised before pregnancy, you can usually continue to do so. However, light endurance or strength training can still be started during pregnancy.

It is important to get advice from your gynecologist beforehand in any case. It is a good idea to do regular exercise of light to moderate intensity 3 times a week. The easiest option is brisk walking for at least 30 minutes or moderate muscle training, such as with an exercise band.

When insulin therapy is needed?

If you still have excessive blood glucose levels despite dietary changes and increased exercise, treatment with insulin may be necessary. About 15% of women with gestational diabetes need to inject insulin. Insulin is the only diabetes medication that can be used during pregnancy and will not harm your baby. Your diabetology care team will explain during an education session:

  • What types of insulin are right for you
  • At what times you need to inject your insulin
  • How much insulin you need. Your insulin needs will change depending on your metabolic levels and your baby’s growth as the pregnancy progresses.
  • How to administer insulin correctly

Are there any special examinations during pregnancy?

Ultrasound
If you have gestational diabetes, ultrasounds are performed more frequently to check that your baby is developing healthily. Ultrasounds will be done every 2-3 weeks during the last trimester of pregnancy to monitor your baby’s growth. It is especially important to know your baby’s size before delivery so that your health care provider can choose the safest method of delivery.

Cardiotocography (CTG)
CTG records your baby’s heartbeat and your contractions. Towards the end of pregnancy, from the 32nd week. After the first week, CTG checks for insulin-treated gestational diabetes will be 2 times per week, slightly more often than for a normal pregnancy.

What happens after the birth?

If you have gestational diabetes, it is recommended that you deliver at a maternity hospital that provides around-the-clock medical care for newborns. There you can pay special attention to avoid hypoglycemia in your baby. Immediately after birth and during the first 24 hours in the neonatal unit, your baby will have regular blood draws to monitor blood glucose levels. If your baby’s levels are too low, he or she will need to be fed more frequently. Hypoglycemia can be prevented, for example, by giving your baby its first breastfeeding meal very soon after birth. Therefore, you will usually be given your baby’s first feeding in the delivery room.

Breastfeed your baby

Gestational diabetes does not affect your ability to breastfeed your baby. Breast milk is the best source of nutrition for your baby. Breastfeeding exclusively for at least 4 months prevents developing obesity or also a sugar metabolism disorder in adulthood.

Take care!

In most cases, the sugar metabolism disorder recedes after pregnancy. Nevertheless, there remains an increased risk of diabetes. You therefore still need special health care. If you have injected insulin during pregnancy, this therapy will end with birth.

All pregnant women with gestational diabetes should have another oral glucose tolerance test after 6-12 weeks to make sure their sugar metabolism has returned to normal. This can be done with your primary care physician or with us at the Diabetes Center. Over half of all women with gestational diabetes develop manifest diabetes over the years. Therefore, even if the result is normal, the test should be repeated every 2-3 years. Continue to pay attention to a healthy lifestyle, and you can effectively prevent the risk of developing diabetes later in life:

  • Eat a healthy, balanced diet that meets your needs
  • Make sure you get enough physical activity
  • Normalize or. Maintain your weight
  • Do not smoke

Remember to have your blood glucose levels checked before continuing with pregnancy.

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