- 1 What is gestational diabetes?
- 2 What if I was already diabetic before I got pregnant?
- 3 Causes of gestational diabetes
- 4 Risk factors
- 5 Symptoms
- 6 How does diabetes affect pregnancy?
- 7 How is the diagnosis of gestational diabetes made?
- 8 Is gestational diabetes a cure?
- 9 How to treat gestational diabetes?
- 10 Exercises for gestational diabetes
- 11 Gestational diabetes diet
- 12 Medications for gestational diabetes
- 13 Risks for pregnant women
- 14 Risks for the baby
- 15 How to prevent gestational diabetes
What is gestational diabetes?
The diabetes gestational is an increase in blood sugar ( hyperglycemia ) during pregnancy in women who, before becoming pregnant, did not have diabetes. It usually appears in the 3rd trimester of pregnancy and heals itself shortly after delivery. Requires treatment to avoid complications.
The problem affects about 7% of women, and it can often facilitate the development of type 2 diabetes between 10 and 20 years after pregnancy.
It is worth remembering that this is a disease exclusive to the gestational period and, outside of it, the woman may suffer from other types of diabetes.
Sometimes women are diagnosed with gestational diabetes when, in fact, they already had diabetes before conceiving. In such cases, the problem is not resolved after the baby is born.
There are also women who already know they have diabetes and want to become pregnant. In such cases, the expectant mother will need medical advice before she even tries to conceive. This is because some diabetes drugs are contraindicated during pregnancy and, in addition, poorly controlled diabetes can be responsible for malformations in the fetus.
To decrease the amount of sugar in the blood, the pancreas produces a hormone called insulin. It allows the excess to be stored, while the other part is used as an energy source.
Diabetes happens when the pancreas does not make enough insulin or when the insulin produced is prevented from doing its job for some reason. Thus, there are two possibilities in gestational diabetes:
The body does not produce enough insulin
Have you ever heard that a pregnant woman has to eat for two? Well, pregnant also has to metabolize for two! When you are pregnant, there is one more life inside you, and it depends on your metabolism.
This means that the baby needs his insulin to be able to balance the levels of sugar in his own body. Thus, the demand for insulin increases as the baby grows and, sometimes, the mother’s body cannot keep up.
In such cases, the body continues to produce good quality insulin that works perfectly, but it is not enough for either the mother or the baby.
The effect of insulin is hampered by pregnancy hormones
Another possibility is that the hormone festival in the mother’s body is the problem. That’s because some of these hormones – especially placental lactogen – end up interfering with the action of insulin, partially blocking it, which makes it unable to work properly.
Although this is normal in every pregnancy, many women do not have gestational diabetes, why? Then we go back to the previous topic: the body cannot produce enough insulin to get around the situation, as a healthy mother would.
Some of the factors that put a mother at risk for developing gestational diabetes are very similar to the risk factors for diabetes in general. Are they:
- Obesity: Excess weight appears to be related to impaired insulin function;
- Getting fat quickly during pregnancy: Although it is normal to get fat during pregnancy, if this process is very accelerated, it also increases the chances of gestational diabetes;
- Age: The older the mother, the greater the chance of having the disease;
- Family history: Having first-degree relatives with diabetes – of any kind – increases the chances of gestational diabetes;
- Family history of gestational diabetes: Daughters of mothers who suffered from the problem are more likely to develop it;
- Suffering from sugar intolerance (pre-diabetes): Future mothers who already have a certain deficiency in insulin function are at greater risk of suffering gestational diabetes;
- Having given birth to overweight babies: Women who have given birth to babies considered to be large are at greater risk of developing the problem in subsequent pregnancies;
- Having had gestational diabetes: Having had the disease increases the risk of recurrence by 6 times.
Symptoms? What symptoms? If the symptoms of diabetes itself are usually quite silent, those of gestational diabetes are even more so, since they are very similar to other sensations that the pregnant woman experiences during pregnancy.
Unless blood sugar levels are very high, the mother is unlikely to feel any difference from normal pregnancy symptoms. Some of them are:
- Excess hunger and thirst;
- Exaggerated weight gain – both mother and baby;
- Urgency to urinate;
- Swelling in the legs and feet;
- Blurred vision;
- Candidiasis and frequent urinary infections.
It is worth remembering that these symptoms are also present in other possible complications of pregnancy, such as pre-eclampsia .
When poorly controlled, diabetes presents several risks for the pregnant woman and the baby. That’s because about two-thirds of the sugar in the mother’s bloodstream crosses the placenta and reaches the baby, causing her pancreas to produce more insulin than it should.
The problem is that insulin is also an anabolic hormone, which causes the baby to grow more than it should in the womb. In addition, it also promotes the growth of other organs and tissues, causing malformations in the visceral structures of the fetus.
Thus, it can present hypertrophy in several organs, which can impair its function, as in the case of the heart and liver. Air passages can also change, making breathing difficult.
These changes can be so significant that the baby may not be able to survive after birth. Therefore, it is extremely important that the future mother has a correct diagnosis and receives the appropriate treatment.
If the symptoms are so imperceptible, how will the pregnant woman know if she needs to see a doctor? Fortunately, this is not necessary, because in prenatal care, the gynecologist or obstetrician already looks for risk factors and performs the necessary tests to make sure that everything is going well.
In addition, around 20 weeks of gestation – when gestational diabetes usually appears – it is common for tests to be done to check blood glucose, even if there are no obvious risk factors for the problem.
Some tests that help in the diagnosis of gestational diabetes are:
Although he cannot measure the amount of sugar in the patient’s blood, the ultrasound performed in prenatal consultations is very important to detect changes in pregnancy that can mean gestational diabetes.
When it detects an increase in amniotic fluid and accelerated growth of the baby, it may be a sign that the mother’s body is having trouble controlling glucose. The doctor should then order additional tests to confirm the diagnosis.
Fasting glucose is an exam that measures the amount of sugar in the blood after the mother is between 8 and 12 hours fasting. It is performed as a normal blood test, in which blood is collected by means of a puncture on the inside of the arm.
If the glucose level is too high, it may be a sign that the insulin is not working properly.
When fasting glucose gives an altered result, the doctor may order a glycemic curve test. This means that it measures how much glucose is still in the blood at certain times after eating foods with sugars.
To perform this test, the patient must drink a sweet liquid and, after an hour, a blood sample will be collected. After two hours, another sample, and, in the third hour, another sample. In this way, it is possible to see how much the blood glucose has declined over time, generating a downward “curve” graph.
Each of these exams has reference values.
In fasting glucose, the normal is that the blood glucose does not exceed 85mg / dL. The glycemic curve should be as follows:
- After 1 hour: less than 180mg / dL;
- After 2 hours: less than 155mg / dL;
- After 3 hours: less than 140mg / dL.
If plotted on a graph, the result of the glycemic curve test should look like the following:
You can understand, then, why the name is “glycemic curve”, right?
It is worth remembering that women who are diagnosed with gestational diabetes should monitor the glycemic level by performing tests frequently, in order to avoid complications.
About 1 ½ months after the baby is born, the tests should be repeated to make sure it was gestational diabetes, not a diabetes that already existed that had not yet been diagnosed.
Yes, gestational diabetes can be cured ! In fact, it usually disappears on its own after delivery, when the new mom’s metabolism returns to its normal pace.
If, by chance, the woman continues to show symptoms of diabetes about 1 and a half months after delivery, it may be that she was already diabetic before even getting pregnant, and the situation only worsened with pregnancy. In such cases, she should seek treatment for diabetes with an endocrinologist.
When the diagnosis of gestational diabetes is confirmed, pregnancy is treated as a high-risk pregnancy , due to possible complications to the fetus.
Fortunately, however, the treatment of the condition is quite simple, being based on changes in diet and the practice of moderate physical exercises, which help to keep glucose at a normal level.
Physical activities are beneficial for pregnant women too! Although little is said about it because of the risks to the baby, pregnant women can do some low-impact physical activities that will only do them good for their health.
It is important to seek professional help before starting the exercises, as some activities are not recommended for this delicate period as it may cause harm to the baby. Look for a qualified physical education professional to deal with pregnant women and plan your exercise routine with his help to avoid any complications!
If you experience any unpleasant symptoms such as abdominal pain , discharge or blood loss from the vagina while exercising or a few hours later, contact your gynecologist / obstetrician immediately .
Some examples of exercises that can be done are:
For women who were sedentary before becoming pregnant, walking is a great support. This is because the lack of physical conditioning would be an obstacle to carry out other heavier activities, which would lead to injuries more easily.
So mom, who didn’t used to exercise, get your walking shoes, light and elastic clothes and a nice bottle of water and head to the nearest park to move that body a little! After all, there is another little body inside you that needs your health to come into the world without any major problems.
It is recommended to walk 3 to 5 times a week, preferably before 10 am and after 4 pm, times when the sun is at its weakest.
Light running ( jogging )
Women who used to exercise before becoming pregnant can benefit from light running, which is not as striking and poses no risk to the baby’s health.
Don’t feel guilty if you can’t run like you did before. This is quite normal since, over time, the belly grows and weighs more. Just be sure to move!
The tips here are the same as for walking: light clothes, proper shoes and a bottle of water to stay hydrated are essential for everything to go well.
It is recommended to practice light running (with low intensity) 3 times a week for 30 minutes.
Improvement in posture, breathing, heart rate and strengthening of muscles are just some of the benefits of pilates , which can also be practiced by future moms 3 times a week. However, it is extremely important that the instructor has experience with pregnant women and knows what can and should not be done!
One of the most recommended activities for people who cannot do high intensity exercises, water aerobics can be performed during all 9 months of pregnancy , 2 to 4 times a week.
Among its benefits are the reduction of pain in the feet and in the lumbar spine (lower portion of the spine), in addition to helping with swelling of the legs.
Exercise bike ( spinning )
Do you know that bicycle that goes nowhere that many women use to better define their legs and butt? Well, it can also help the expectant mother to stay in shape during pregnancy. However, the spinning exercise should only be performed during the first 2 trimesters of pregnancy, because afterwards the belly grows too much and can hinder the use of the equipment.
Since the bike isn’t going anywhere, don’t be in a hurry! Pedaling too hard can increase your heart rate a lot, which is harmful to your baby.
So be aware and never let your heart rate exceed 140 bpm. Prefer equipment that can display this information.
Stretching is widely used as a warm-up before physical exercise and can be good for the future mom too! This is because it prevents the muscles from atrophying and promotes greater resistance against injuries.
As the belly grows, some types of stretching become more difficult. In such cases, look for those you can perform comfortably, without harming the abdominal region.
Exercises prohibited during pregnancy
There are some types of exercises that should not be done at all during pregnancy. Find out what they are:
- Abdominal exercises;
- At high altitudes;
- Fights like jiu jitsu;
- Jumps like jump classes;
- Ball games, such as football, basketball and volleyball;
- Moderate or intense runs;
- Bicycle, especially during the past few months;
- Heavy bodybuilding.
When something goes wrong during the exercises, the body sends a signal. It is important for Mom to be aware of these symptoms and seek medical help as soon as possible when you experience them while doing physical activities. Are they:
- Blurred or blurred vision;
- Lack of air;
- Abdominal pain;
- Feeling faint;
- Chest pain;
- Vaginal bleeding;
- Uterine contractions.
Contraindications to exercises
There are some conditions that make physical exercises dangerous for pregnant women. Are they:
- Cardiac, pulmonary or orthopedic diseases;
- Twin pregnancy, especially when there is a risk of prematurity;
- Placenta previa (placenta in the lower part of the uterus) after 26 weeks of gestation;
- Pre eclampsia;
- Uterine or vaginal bleeding;
- Decreased movements of the fetus;
- Intrauterine non-growth delay;
- Poorly controlled hypertension and hypothyroidism.
The mother’s diet with gestational diabetes is based on low glycemic index foods, that is, there is no total cut in sugar, but a significant decrease.
The foods listed below are just a suggestion of what to eat during that time. However, we always recommend looking for a nutritionist or nutrologist with experience in pregnancy in order to plan a safe and complete route with the necessary nutrients for your health and that of the baby.
Some foods that can be eaten are:
- Fresh, little sweet fruits with peel and bagasse, preferably accompanied by something salty like toast or Minas cheese;
- Raw vegetables such as salads, which decrease the entry and exit of blood sugar, helping to maintain a stable glycemic level;
- Vegetables and greens such as chard, eggplant, cauliflower, spinach, peppers, cabbage, parsley, tomatoes, leeks, broccoli, beets, carrots, chayote, among others;
- Oats and cereals rich in fiber, with no added sugar;
- Lean meats with little fat, such as chicken breast (without skin), fish with white meat, rabbit, among others;
- Skimmed milk or yogurt;
- White cheese.
The raw vegetables in salads must be washed thoroughly before consumption in order to avoid toxoplasmosis , a disease that can have serious consequences for the fetus.
What can I not eat during pregnancy?
Unfortunately, some foods are banned for moms suffering from gestational diabetes, many of which are the object of many pregnant women. Understand:
- Sweets – homemade or industrialized, no matter what type;
- Soft drinks, alcoholic beverages (which should not be eaten during pregnancy even in healthy moms) and industrialized juices;
- Dried fruits, such as apricots, dried figs and raisins;
- Any type of frying;
- Any food that contains hydrogenated fat, such as crackers and cookies;
- Fatty meats;
- Whole milk and yogurts;
- Yellow cheeses.
Because they cannot eat sugar normally, diabetics tend to use synthetic sweeteners to sweeten their food. However, some types of sweeteners are not recommended during pregnancy and therefore should be avoided. If in doubt, consult your nutritionist and see which option is best for you.
Rarely, in the most severe cases, mom will have to take doses of insulin to lower blood glucose and, at times, may need oral hypoglycemic drugs, although this is not recommended due to the lack of evidence that these drugs are safe during pregnancy .
The metformin , for example, is a drug that generates controversy over its safety for pregnant women. However, there are studies that show that there are no significant changes between dietary treatment and medication with regard to the safety of the fetus and the mother.
It is worth remembering that only 20% of pregnant women need drug treatment for gestational diabetes and that it can be very well controlled with diet and exercise alone.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Like any disease, gestational diabetes carries some risks for mom. Some of them are:
- Rupture of the amniotic pouch before the expected date;
- Premature delivery;
- Fetus that does not turn upside down before delivery;
- Increased risk of pre-eclampsia, a condition characterized by a sudden rise in blood pressure that poses risks to the fetus;
- Need for cesarean section due to the size of the baby;
- In the case of normal delivery, there may be laceration of the perineum (portion of skin that separates the entrance of the vaginal canal and anus) by the size of the baby;
- Genital infections due to changes in vaginal pH during pregnancy and low immunity caused by diabetes;
- Development of type 2 diabetes in the next 10 or 20 years after childbirth, as the liver has already shown itself not to be able to handle large amounts of glucose in the blood.
As if the mother were not enough, the baby also suffers serious risks due to gestational diabetes.
It is worth remembering, however, that the chances of these complications happening are greatly reduced when the mother undergoes treatment and has her blood glucose under control.
Some of them are:
- Respiratory distress syndrome, characterized by difficulty in breathing at birth;
- Overgrowth of the baby, which increases the chances of him becoming obese during childhood or adolescence;
- Hypertrophy (enlargement) of the heart, leading to heart and circulatory diseases;
- Hypertrophy of the liver;
- Hypoglycemia after birth due to lack of glucose that came from the mother’s body;
- Increased subcutaneous fat;
- Born dead or die shortly after birth.
There is no good way to prevent diabetes during pregnancy, as it can occur in both healthy people and people with different risk factors for the disease.
However, it is known that maintaining a balanced diet and exercising are important measures to maintain normal blood glucose levels. Therefore, the mother’s nutritional choices must be in accordance with her needs, without exaggerating the consumption of sugars and carbohydrates .
Women who have suffered from gestational diabetes should have a preference for continuing on a balanced low-carb diet because of the risk of developing type 2 diabetes after a few years after giving birth.
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