Diabetes in pregnancy (gestational diabetes)

Gestational diabetes in the expectant mother is one of the most common complications during  pregnancy . It is particularly insidious that the disease often goes undetected because it often causes no symptoms. Experts estimate that around five percent of pregnancies are affected. What exactly is gestational diabetes, what are the symptoms and what are the consequences and risks for the unborn child? You can find out here.

Gestational diabetes – what is it?

Gestational diabetes is also known as gestational diabetes (GTD) or pregnancy diabetes. This is a special form of  diabetes that is diagnosed for the first time during pregnancy – regardless of whether the disease first appeared during pregnancy or was previously undetected.

The mother’s blood sugar level is either permanently or unusually long after meals. In most cases, the condition returns to normal after the end of the pregnancy.

Above all, this sugar tolerance disorder damages the child, because the risk of pregnancy complications, including premature birth and stillbirth, increases considerably. However, gestational diabetes can also have consequences for the mother.

risks for the child

How dangerous is gestational diabetes for the child? In principle, gestational diabetes causes two main problems in the child: 

  1. increased growth during pregnancy with problems during childbirth, including premature birth and stillbirth
  2. health problems of the child after birth

The unborn child reacts to the mother’s high blood sugar level with extreme nutrient uptake. This leads to excessive growth of the child in the womb (so-called macrosomia) with delayed development at the same time – this combination is referred to as diabetic fetopathy. Babies with untreated gestational diabetes can weigh 4.5 kg or more at birth.

In addition, the placenta or the organs of the unborn child – especially the lungs – may not mature, which can lead to respiratory distress syndrome in the affected baby (especially after a premature birth). Malformations of the heart can also be the result if the disease occurs early in pregnancy. Furthermore, too much amniotic fluid is often formed (polyhydraminion), which limits the space for the child and promotes premature birth.

These and other factors put the child at high risk of complications during pregnancy and during and after birth.

More consequences for the baby

In a normal delivery, large children are more at risk of not being pushed forward sufficiently in the birth canal (so-called shoulder dystocia), which is why nerve paralysis in the shoulder-arm area (plexus paresis) occurs more frequently as a result.

In addition, the body of the unborn child often reacts to the high sugar level with increased insulin production in order to keep its own sugar level low. After childbirth, the infant therefore often suffers from hypoglycaemia as soon as the mother stops supplying sugar. During childhood, metabolic disorders or shifts in the salt balance can occur.

If gestational diabetes remains undiagnosed and untreated, the risk of children   developing diabetes and obesity in later years is increased.

risks for the mother

Mothers with gestational diabetes must also expect complications during and after pregnancy, such as high blood pressure, increased urinary tract infections, edema, kidney problems or a tendency to sometimes life-threatening seizures (pre-eclampsia). The difficult birth of the child also increases the risk of pelvic floor damage.

Another problem: Around 40 to 60 percent of the affected women develop type 2 diabetes mellitus within ten to fifteen years after the birth, which requires treatment – ​​even if the gestational diabetes disappears immediately after the birth.

It is therefore crucial to diagnose gestational diabetes in good time – then the risk of serious consequences for mother and child can be minimized.

Identify symptoms of gestational diabetes

Typical symptoms of diabetes such as frequent urination,  fatigue  and severe thirst usually do not occur in gestational diabetes or are attributed to the pregnancy itself. Pregnant women usually do not realize that they are sick.

The following signs can indicate diabetes during pregnancy:

Diagnosis by gestational diabetes test

The simple screening test to detect gestational diabetes is part of routine care, so the costs for the so-called oral glucose tolerance test (OGTT) are covered by health insurance companies. The diabetes test is  carried out between the 24th and 28th week of pregnancy (GW)  and is not dangerous for the baby.

The procedure is quite simple: for the test, the woman drinks a sugar solution made from 200 ml water and 50 g glucose (50 g oGTT). After an hour, a  blood sample is  used to determine whether the sugar level is elevated. If the  blood sugar level  is elevated (from a value of 135 mg/dl or 7.5 mmol/l), the oGTT is repeated under different conditions.

Second diabetes test

The second test for gestational diabetes (75 g OGTT) is carried out in the morning on an empty stomach and with a higher amount of glucose (75 g). In addition to measuring the blood sugar value twice (after one and two hours), the fasting value is also determined this time, i.e. blood is taken before drinking the glucose solution.

The relevant  values ​​for this test  are:

  • 92 mg/dl (5.1 mmol/l) fasting
  • or 180 mg/dl (10.0 mmol/l) after one hour
  • or 153 mg/dl (8.5 mmol/l) after two hours

The second test is therefore much more meaningful and is recommended by experts even if the first test was negative but there are symptoms that could indicate the disease. However, the costs are only covered by health insurance if the pre-test has been carried out beforehand.
By the way: In order to rule out gestational diabetes, the determination of the urine sugar is unsuitable.

What to do with gestational diabetes?

A consistent change in diet often helps, and insulin injections are only   necessary in rare cases. Studies have shown that when  blood sugar is well controlled, there  are significantly fewer complications during birth and less often obesity in the child. 

Therefore, the most important action to take immediately after the diagnosis of gestational diabetes is a lifestyle change. A balanced and high-fiber diet and avoiding sweets and  soft drinks as far as possible are important . You can find more  tips on diet for gestational diabetes here .

In addition, regular – if possible daily – exercise and close monitoring of blood sugar levels are crucial components of treatment.

Causes of diabetes in pregnancy

The exact causes of the development of gestational diabetes have not yet been conclusively clarified. A genetic predisposition probably plays a role in the affected women.

In addition, there are major changes in the hormonal balance during pregnancy. Presumably, this leads to interactions between the female sex hormones (estrogen,  progesterone ), the placenta hormones ( HCG , HPL) and the blood sugar-regulating hormone insulin. These hormones are mainly produced in the second half of pregnancy. As a result, either the cells respond less well to the insulin or its production is impaired.

It is assumed that insulin is also increasingly broken down in the placenta, which is why the sugar levels in the blood rise.

Risk groups for gestational diabetes

There are risk groups that are more frequently affected by gestational diabetes and for whom the oGTT is recommended before the 24th week of pregnancy. Who is at risk?

  • overweight pregnant women, especially if they do not exercise much and smoke
  • Pregnant women over 30 years of age
  • Pregnant women with diabetes in the family
  • Pregnant women who have already suffered multiple miscarriages
  • Pregnant women who have already given birth to a child with a birth weight of more than 4,000 g
  • Pregnant women who had gestational diabetes in a previous pregnancy

Certain  medications , such as  beta-blockers  or  cortisone,  can also promote the development of gestational diabetes.

If you are pregnant and have at least one of these risk factors, talk to your  gynecologist . In this case, the screening test can already be carried out in the first trimester of pregnancy and several times during the course of the pregnancy.

Regular checks of blood sugar levels after pregnancy

If gestational diabetes is diagnosed, the blood sugar is checked again after the pregnancy and after two months. Even if these values ​​are normal, the woman should have her sugar level checked by her family doctor at regular intervals.

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