Gestational diabetes: causes, treatment

Gestational diabetes (gestational diabetes) is a very common condition that affects about 3.7 percent of pregnant women. As a rule, it is largely symptomless, but the disease can lead to complications for mother and child. Elevated blood glucose levels can often be lowered by adjusting the diet. Read all about gestational diabetes here.

Gestational diabetes is a form of diabetes mellitus that first occurs and is diagnosed during pregnancy. He is sometimes referred to as Type 4 diabetes. If diabetes precedes pregnancy, it is not referred to as gestational diabetes.

The number of gestational diabetes (SS diabetes) cases has been increasing in Pakistan for several years. It is estimated that about 3.7 percent of pregnant women currently have gestational or gestational diabetes.

Gestational Diabetes

Gestational diabetes: symptoms

In most cases, gestational diabetes is largely asymptomatic. The typical symptoms of diabetes mellitus such as severe thirst (polydipsia), frequent urination (polyuria), fatigue and weakness are often very mild and are interpreted differently in the context of pregnancy. On gestational diabetes, however, may indicate the following other symptoms:

• Frequent urinary tract infections or vaginal inflammation: The sugar in the urine provides bacteria and fungi with good conditions for reproduction.
• The increased amount of amniotic fluid (polyhydramnios): can be detected by the gynecologist on ultrasound.
• Excessive weight and size of the unborn child (macrosomia): The children of mothers with gestational diabetes often have a birth weight of more than 4500 grams.
• Hypertension (arterial hypertension): often occurs with gestational diabetes.

Gestational diabetes: causes and risk factors

According to current knowledge, the release of various hormones during gestation is primarily responsible for gestational diabetes. In addition, certain risk factors increase the likelihood of developing gestational diabetes.

Hormones as a cause of gestational diabetes

The hormonal balance changes especially in the second half of the pregnancy. The body produces larger amounts of the hormones estrogen, progesterone, cortisol, placental lactogen and prolactin during this phase of pregnancy. Among other things, these hormones provide greater amounts of energy in the body to ensure the optimal development of the child. The effect of hypoglycemic insulin is reduced.

The hormones are thus, so to speak, antagonists of insulin: they reduce the effect of insulin, which is why, similar to type 2 diabetes, insulin resistance sets in. Normally, pregnant women still produce enough insulin to counteract high blood sugar levels. If insulin production in the second half of pregnancy is no longer sufficient to cover the additional needs, gestational diabetes develops.

Risk factors

Risk factors that increase the likelihood of gestational diabetes include:

Overweight: Women who are overweight (body mass index> 27) before or during pregnancy have a higher risk of developing gestational diabetes. It has been proven that especially the fat cells of the abdominal fat release certain inflammatory substances, which promote insulin resistance of the body cells. The tissue is then only attenuated to the insulin produced by the pancreas. As a result, larger amounts of insulin are needed to absorb the circulating in the blood sugar (glucose) in the cells can.

Age and genetic factors: Even if a family member of the pregnant woman has diabetes, there is a higher risk of diabetes during pregnancy. Diabetes in pregnancy also occurs more frequently when the pregnant woman is older than 30 years or has a birth weight of more than 4,325 grams at birth. Pregnant women who have already had multiple miscarriages also have more often on gestational diabetes than other women.

Gestational diabetes: examinations and diagnosis

The right contact for suspected gestational diabetes is a specialist in gynecology and obstetrics. As a rule, diabetes tests are carried out in pregnant women during the 24th to 28th week of pregnancy (SSW). Patients with risk factors undergo a diabetes screening test as early as the 24th week of pregnancy. For this, a so-called oral glucose tolerance test (LGBT) is recommended.

Even though gestational diabetes is symptom-poor in most cases, the doctor will already be able to provide you with important information about your state of health by accurately describing the symptoms. Possible questions could be, for example:

• Do you feel a strong thirst?
• Do you suffer from fatigue and lack of concentration?
• Have you been dizzy lately?
• Are you suffering from blurred vision since pregnancy?
• Have you had an increased incidence of urinary tract infections or vaginal infections since pregnancy?

The gynecologist will then physically examine you. A blood pressure measurement, as well as a measurement of body weight and waist circumference and ultrasound, are among the routine tests during pregnancy. To help diagnose gestational diabetes, the doctor will arrange a renewed appointment with you for blood sampling and a sugar stress test (oral glucose tolerance test). Other typical diabetes tests, such as determination of glucose content of urine, HbA1c or fasting blood glucose, are not suitable as a screening test.

Gestational diabetes: treatment

The goal of the therapy for gestational diabetes is a substantial normalization of blood sugar levels. Sober, ie after eight hours of fasting, the blood sugar should be below 95 mg/dl. Two hours after eating, the blood sugar should not be higher than 120 mg/dl. For most affected pregnant women, blood sugar levels can be achieved with the help of the right diet. If this is not enough, treatment with insulin is necessary. The oral antidiabetics (metformin, sulfonylureas, etc.) have not yet been approved for use during pregnancy.

Pregnancy and diabetes: nutritional recommendations

In most cases, gestational diabetes can be adequately treated through proper nutrition. The recommended amount of energy should be between 1800 and 2000 kilocalories (kcal) per day. On the other hand, it is also important which food is consumed: Women with gestational diabetes should refrain from using so-called "rapidly absorbed carbohydrates". These are carbohydrates, such as those contained in white flour and fruit juices. Through them, the blood sugar level rises excessively fast and strong.

For example, carbohydrates from whole-grain products that give off their energy slowly and continuously are more recommendable. Pregnant women with gestational diabetes should also watch for light but regular exercise and absorb enough fluid.

A targeted weight loss is not recommended during pregnancy since the child needs enough energy to grow freely. On the other hand, permanent weight loss can be achieved during breastfeeding, since breastfeeding gives the child plenty of energy and makes it easier for many women to lose weight.

Gestational diabetes: blood-sugar-lowering drugs

Unless the blood sugar levels in gestational diabetes can be normalized by a change in diet and physical activity, drug therapy with insulin may be required. In most cases, small amounts of short-acting insulin before meals are sufficient to prevent excessive blood sugar levels. The insulin is injected under the skin (subcutaneously).

Sometimes, even in the morning after getting up and in the evening before going to bed, long-acting insulin is injected, which covers the basic needs of this hormone and can be supplemented with short-acting insulin doses before meals. Especially important is a comprehensive training of pregnant women, so always the right insulin dose is selected. Too high a dose of insulin could cause hypoglycemia and have serious consequences for mother and child.

Anti-diabetic medications in tablet form (oral antidiabetics) should not be taken in gestational diabetes. It is not yet clear whether these drugs can harm you during pregnancy. In some countries, the active substance metformin is also approved for pregnant women, as long as the blood sugar level can not be lowered sufficiently with the help of insulin. In Pakistan, however, this drug is not yet approved in gestational diabetes and is used only in special cases after sufficient education. While breastfeeding, metformin may be used.

Gestational diabetes: disease course and prognosis

In most cases, gestational diabetes disappears after delivery on its own. About nine out of ten women achieve an adequate blood sugar level with an adapted nutritional style. Nevertheless, a pregnancy in which gestational diabetes develops, a so-called risk of pregnancy. This means that the risk of complications is increased. The elevated blood sugar level can cause various complications.

Complications of gestational diabetes

First, the mother is threatened by pregnancy-related complications such as high blood pressure (preeclampsia), urinary tract infections or premature birth. On the other hand, the child is at higher risk in gestational diabetes to suffer from hypoglycemia or respiratory distress syndrome after birth. The risk of malformations of the child is particularly high if gestational diabetes already occurs from early pregnancy.

Pre-eclampsia, eclampsia & HELLP syndrome: A poorly adjusted gestational diabetes promotes the development of high blood pressure (hypertension) during pregnancy. In some women, in addition to high blood pressure, there is still a loss of protein in the urine (proteinuria) and water retention (edema) in the legs. This symptom triad during pregnancy is also known as pre-eclampsia and is more common in women with gestational diabetes.

Pre-eclampsia is a precursor to the potentially life-threatening symptoms of eclampsia and HELLP syndrome. Eclampsia is manifested by neurological disorders. It can cause headaches, flicker, and seizures. The so-called HELLP syndrome can develop within a very short time (about one hour). HELLP stands for H = hemolysis (decay of blood cells), EL = elevated liver values and LP = low platelets.

Eclampsia and HELLP syndrome is also more common in women with gestational diabetes than in healthy women.

Urinary tract infections (cystitis, pyelonephritis): The kidney usually prevents the excretion of sugar with the urine. If the blood sugar levels are too high (> 150 to 180 mg/dl), the kidney can no longer completely transport (reabsorb) the sugar molecules back into the blood, which is why sugar molecules enter the urine (glucosuria). In urinary tract infections, they form pathogens such as bacteria and fungi an ideal breeding ground for reproduction. Urinary tract infections can therefore easily rise from the urethra and urinary bladder into the ureters and kidneys.