gestational diabetes

Pregnancy sugar, gestational diabetes, gestational diabetes or diabetes during pregnancy are different names for one and the same disease: gestational diabetes.
Any glucose metabolism disorder detected during pregnancy is called gestational diabetes, regardless of whether the diabetes occurred during pregnancy or was previously unrecognized. Clearly delimited from the already before the onset of pregnancy manifest diabetes (= diabetes in graviditate). This is usually a Type I diabetes.

Causes of gestational diabetes

About 2.5 percent of all pregnant women are diabetic. The reason for the occurrence of the disorder is not clear. There is probably a genetic predisposition to the diabetic metabolic state. The affected women probably already have the potential for an elevated blood sugar level before pregnancy.

Since there is a major change in the hormone balance during pregnancy, it is believed that there is an interaction between the female sex hormones (estrogen, progesterone), the placental hormones (HCG, HPL) and the blood sugar-regulating hormone insulin. The high-concentration hormones may stimulate the release of insulin until the reserves are exhausted, or they may reduce its effect on the end organ (muscle, liver).

At the same time, it is believed that in the placenta (mother cake) increased insulin degrades, which further throttles the sugar utilization and favors a high sugar content in the blood.

Symptoms and signs

Gestational diabetes differs from "ordinary" diabetes in that the high sugar levels occur especially after ingestion. In addition, in the first few months of pregnancy an increased tendency to vomiting, which complicates the regulation of blood sugar levels by a targeted food intake.

For pregnant women, diabetes also means increased susceptibility to urinary tract infections and greater risk of developing gestosis, a serious pregnancy complication. Frequently increased production of amniotic fluid by the fetus (hydramnion) can lead to tension pains in the abdomen, a disturbance of food intake and to difficult breathing. There is also the danger that the metabolic imbalance will persist after delivery.

For the unborn, the consequences are usually more serious than for the mother. The negative effect of sugar on the vessels leads to a reduced blood flow to the placenta, which endangers the diet of the fetus (placental insufficiency). This problem is exacerbated by the mechanical pressure that can emanate from the hydramnion.

Untreated diabetes pregnancy

If a diabetes pregnancy is carried out untreated, the newborn often shows (in about 40 percent of cases) the typical features of so-called diabetic fetopathy. This is characterized by the contrast between an abnormally large child (4.5 kilograms and more) and a significant developmental backlog. The immaturity of the lungs is particularly affected, which can lead to respiratory distress syndrome.

During pregnancy, the unborn child responds to the mother's sugar overreach with increased insulin secretion to keep her own blood sugar level low (insulin lowers the sugar concentration in the blood). Another problem thus arises from the low blood sugar level in the newborn shortly after delivery. Due to the lack of high maternal sugar intake, the child has too high an insulin level in relation to the now limited sugar supply.

Check placental perfusion

In Switzerland, all pregnant women are routinely monitored for blood sugar. If suspected, the size and condition of the fetus is measured by ultrasound in addition to the usual diabetes studies. These regular observations can detect both abnormalities and the development and growth of the unborn child.

Control of placental perfusion is performed by Doppler sonography. In the 16th week of pregnancy, the alpha-fetoprotein (AFP) is additionally determined to exclude malformations. With optimal therapy, the risk for mother and child can be reduced to a minimum. The complications during and after birth can often be avoided by careful monitoring and immediate action. Happily, the metabolic disorder disappears after pregnancy in the majority of cases.

complications

The main danger for the mother (and therefore also for the child) is that it can lead to a massive circulation derailment (gestosis, grafting) with edema, kidney dysfunction (increased protein excretion) and hypertension. In this case also a premature birth threatens, especially if at the same time there is an infection. If no timely and professional treatment, life-threatening spasms (eclampsia) can occur.

Birth problems arise from the insufficiently functioning placenta and the size of the child. The fruit may be disturbed by the mother's diabetes in early development. This can lead to abortion or permanent damage (two to three times more frequent than in non-diabetics) in the embryo (embryopathy). These affect especially the lower extremities, heart and kidneys.

After birth, a problematic metabolism (low sugar level, disturbed electrolyte and water balance, high bilirubin levels) and respiratory problems (ANS, respiratory distress syndrome) can threaten the baby's life. In about one third of the affected children, the immature lung can not fully perform its function.

Preventive measures

Pregnant women can contribute significantly to their and the child's well-being by regularly measuring their blood sugar levels and disciplined dietary habits. From the medical side, the early detection and treatment of diabetes is of great importance.

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