Gestational diabetes

In normal situations, the carbohydrates that are absorbed when eating produce an increase in blood glucose, that is, blood sugar level. The body's response to ingestion is to increase the production of insulin in the pancreas, since it is the hormone that allows the passage of sugar into the cells and, therefore, lowers blood glucose.

Hormones are produced in pregnancy that can block the action of insulin and prevent its normal functioning. This alteration usually occurs after week 20 and most of the time disappears after delivery (only between 1 and 3% of patients continue with this problem after giving birth). Two out of every three women will present this pathology again in a future pregnancy and most of them will develop type 2 diabetes in the future.

What can happen to the baby?

If a woman has diabetes during pregnancy and does not have good glycemic control, the fetal pancreas will produce more insulin than necessary since, when blood with a high sugar content arrives, it will not be able to normalize this parameter. Insulin does not pass through the placenta to the fetus, but sugar does.

• High levels of insulin cause the fetus to store more glucose in the body than necessary and, therefore, to produce a “fat” baby, which is called macrosomia. Is increases the rate of cesarean sections since it makes it difficult for the baby's shoulders to come out of the mother's pelvis, which can cause a greater number of clavicle fractures in the newborn or an injury to the nerves of the arm and cause a limitation in their mobility (paralysis brachial).
• It is more common for these babies to have postnatal hypoglycemia since their pancreas is used to producing more insulin and, by not receiving a continuous supply of sugar as before, the blood sugar level drops very suddenly, so they need more controls in the nursery.
• Children of diabetic mothers are at greater risk of lung immaturity, so preterm deliveries (before week 37) should be very well controlled.
• Pregestational diabetics have a three times higher risk of malformations, especially of the neural tube, and heart disease, but this does not happen in the children of mothers with gestational diabetes since it is a pathology that occurs while the baby is growing but once it is already formed.

How is it detected?

Between week 24 and 28 of pregnancy should be performed the test or to all pregnant women except those already diagnosed with diabetes. Women with risk factors may also be tested in the first and third trimesters. This test consists of the oral administration of a liquid It contains 50 grams of glucose and is used to determine the blood glucose value after one hour.

If this value reaches or exceeds 140 mg / dl it is considered positive and oral glucose overload should be performed to confirm whether the pregnant woman has gestational diabetes or not. In the event that proof of a negative result will not be necessary any further study.

The glucose overload, the so-called “long curve”, consists of the determination of fasting blood glucose, the administration of 100 grams of glucose and the determination of blood glucose at 60, 120 and 180 minutes after ingesting the liquid. During the test the pregnant woman must remain seated and without smoking, and the previous days a diet that is not restrictive in carbohydrates is recommended. If two of these four values ​​were above the limits, gestational diabetes is diagnosed. If a single value is altered, carbohydrate intolerance is diagnosed.

Which is the treatment?

Treatment of diabetes consists of following a diet that controls sugar levels. It will be the specialist who determines the specific type of diet since it will depend on each case.

• Women of adequate weightFor example, they will not be prescribed a hypocaloric diet, but their intakes will be further divided throughout the day and the carbohydrates to be consumed will be selected.
• To overweight womenOn the other hand, they will be on a restrictive diet. In addition, they are taught how to perform daily sugar checks by obtaining a drop of blood from the fingertip. The goal is to keep a fasting blood glucose below 95 mg / dl, and one hour after eating below 140 mg / dl.

Diet must go accompanied by moderate physical exercise as it helps to maintain correct sugar levels. If these measures are not enough, insulin treatment should be considered. In the postpartum period, the usual controls and a control of sugar levels or a glucose curve should be carried out between six and eight weeks after delivery and also at the end of lactation.

Specialist in gynecology and obstetrics