Gestational diabetes

What is gestational diabetes?
The definition of gestational diabetes (or gestational diabetes) is impaired glucose tolerance that occurs during pregnancy and is a condition associated with an increased concentration of glucose in the blood.

Such a form of diabetes is caused by a hormone produced in the placenta called placental lactogen, which interferes with the action of insulin.
The form of gestational diabetes can be called “physiological” because the action of placental actogen hormone is counteracted by the pancreas, which produces larger amounts of insulin to fix the problem.
Very often, this increase in insulin on the part of the pancreas is not sufficient to counteract the action of the placental lactogen. The result is a reduced glucose tolerance with the resulting increase in blood sugar. The onset of gestational diabetes occurs in the second trimester of pregnancy and usually ends at the time of birth, when the concentration of the hormone placental lactogen decreases very rapidly and blood sugar levels return to normal.


Glucose metabolism, hypoglycemia and hyperglycemia

Sugar is the fuel for the cells.
Once in the digestive tract, it is absorbed by the intestinal mucosa and enters the blood, which distributes it to the cells of all organs and tissues to nourish them.

The transfer of sugar into the various cells is controlled by a hormone produced in the pancreas, insulin.
If the insulin level in the blood is at the right level, the cells absorb the right amount of sugar and there is the right concentration of sugar (glucose) in the blood.
A larger amount of insulin causes increased transmission of sugar to cells and a decrease in blood sugar (hypoglycemia).
Conversely, a decrease in insulin leads to an increase in the concentration of sugar in the blood (hyperglycemia), with a consequent decrease in cell nutrition. Diabetes is a disease that alters this mechanism.

There are 2 types of diabetes Type 1 diabetes
is characterized by a complete lack of insulin.
It is an autoimmune disease in which the immune system recognizes the cells of the pancreas as an enemy and completely destroys them.
Type 2 diabetes is characterized by a low rate of insulin and the inability to match natural function.
Gestational diabetes is type 2 diabetes.
This disorder arises during pregnancy and regresses with the birth of the child.
In some cases, however, it recurs and stabilizes over time.

Spread of the disease

Gestational diabetes is very common, statistics estimate that one woman in seven is at risk of developing this disease and that it occurs with a frequency of 2 to 4%.
The disease is less common in pregnant women under 25 years of age, while it is very common in pregnant women over 35 years of age.

What are the risk factors that increase the possibility of developing gestational diabetes?

There are several risk factors, including:

  • Age of mother: Gestational diabetes usually develops in women over the age of 35.
  • Mother’s body weight: An overweight or obese woman has a greater risk of developing gestational diabetes.
  • Diet and nutrition: A high-fat diet leads to an increase in cholesterol and triglycerides in the blood, which becomes “oily” and hinders insulin activity.
  • Family predisposition: Women who have decreased glucose intolerance, fasting blood sugar, first-degree diabetes relatives, or previous pregnancies that developed gestational diabetes are at increased risk.
  • Fetal macrosomia: A woman in her second pregnancy who previously gave birth to a child who weighed more than 4 kg has an increased risk of developing gestational diabetes in the second pregnancy.
  • Other risk factors: Other risk factors include smoking, twin pregnancies due to increased production of human placental lactogen, and polycystic ovary syndrome, which determines insulin resistance even before pregnancy.

Risks for the child: from malformations to obesity

Gestational diabetes can lead to miscarriage or stillbirth in the last trimester of pregnancy (later death of the fetus) and lead to problems in the child that can be fatal:

  • Fetal malformations: They are associated with increased ketones (characteristic of diabetes) and hyperglycemia, causing delayed growth of various organs, such as delayed development of the nervous system. The result is mental retardation.
  • Fetal development: The main consequence of gestational diabetes is excessive development of the fetus due to increased blood sugar. The child will have a larger abdominal circumference than normal.
    The excessive development of the fetus can pose a risk of fracture and dislocation of the shoulder at birth. In these cases, a cesarean section is recommended.
    In order to prevent macrosomia, one sometimes resorts to an induction of labor, which, however, does not reduce the other complications.
  • Hypoglycemia: Gestational diabetes can lead to hypoglycemia in the newborn. After living in hyperglycemic states, the child has a decreased concentration of blood sugar at birth and may develop severe hypoglycemia in the first 48 hours after birth. The situation may return to normal during breastfeeding, but often blood transfusion and glucose substitution are necessary to normalize blood sugar levels in the newborn.
  • Hyperbilirubinemia, which causes neugborenenjaterus, which is characterized by yellowing of the skin, respiratory stress, shortness of breath of the newborn and lack of minerals such as calcium.
  • Premature birth, mainly due to an increase in amniotic fluid due to hyperglycemia. When pregnant with diabetes, the risk of premature birth is increased by about 30%, and the newborn can be very weak.
  • Propensity to obesity: According to recent studies, children born to mothers with gestational diabetes have an increased risk of developing juvenile obesity. Although the mechanism is not yet fully understood, it seems that the increased blood sugar level in the mother strongly affects the future of the child and increases the risk of overweight or obesity at the age of 5 to 7 years.

Complications for the mother

Gestational diabetes can also provoke many serious complications in the mother. Even if the prognosis is favorable after birth and the diabetes has completely disappeared, in some cases it can recur after years as type 2 diabetes. There are also other short-term complications:

Gynecological complications: A cesarean section may be necessary to prevent the passage of the macrosomic child through the birth canal from causing vaginal tears.

Endocrinological complications: Women with gestational diabetes are at risk of developing subclinical (or not yet specifically symptomatic) hypothyroidism and autoantibodies directed against the thyroid gland. However, the mechanism is not clear.

Diagnosis of gestational diabetes and examinations

In order to make the diagnosis of gestational diabetes, laboratory tests must be carried out, which are usually carried out during the second pregnancy period, around the 24th week of pregnancy. Diagnosis is made by specific tests:

  • Basic screening: It is the first examination and it is called small blood sugar curve or criteria of Carpenter. This is a test that is done in pregnant women around the 26th – 28th week (and around the 16th – 18th week in women at increased risk). The woman must drink a glucose-enriched solution (50 g) and 2 examinations are carried out at intervals of 1 hour, one before taking the solution and one after taking the solution. Before taking the solution, the reference values must not exceed 110 mg/dl, while after taking the solution normal blood glucose levels may not exceed 140 mg/dl. If the test shows values above 140 mg/dl, it is positive and a further examination is carried out. If the value is higher than 198 mg/dl, the woman has gestational diabetes.
  • Oral glucose load test: This test is similar to the previous one, with the difference that the drinking solution contains twice the amount of glucose with about 100 g and the control tests for blood glucose measurement are four this time, one measurement again before taking the solution and the other 3 measurements at intervals of one hour, two hours and three hours after taking the solution. Diabetes is diagnosed in this case when blood glucose levels exceed 95 mg/dl before taking the solution, exceed 180 mg/dl after one hour, 155 mg/dl after two hours and exceed 140 mg/dl three hours after ingestion.
  • Two blood values are examined: glycated hemoglobin and fructosamine to determine when the diabetes started.
  • The urine test may show glucosuria, which is the presence of sugar in the urine (which should be absent).

If gestational diabetes has been detected, it is advisable to conduct examinations related to controlling the growth of the fetus and its state of health, such as:

  • Fetal well-being monitoring: This is used to assess whether the unborn child suffers from macrosomia, i.e. whether it is larger than normal.
  • Screening of congenital malformations: This checks whether fetal malformations are present during organ development. It is a simple ultrasound examination that is performed from the 16th week.
  • Non-stress test: This is an examination in which the fetal heartbeat and fetal movements are measured to check whether they meet the norm. The amount of amniotic fluid is also evaluated. It is an examination in which the child’s heartbeat is determined by means of ultrasound. Usually, the test is performed towards the end of pregnancy and close to the due date, but in the case of high-risk pregnancies, this examination is also carried out in the months before birth.

Symptoms of gestational diabetes

Gestational diabetes is a disease that in most cases is asymptomatic and is discovered during routine examinations during pregnancy. Sometimes there may be few specific symptoms such as nausea, headache and vomiting (typical in pregnancy) or typical symptoms of diabetes such as polyuria (frequent urination), glucosuria (evidence of sugar in the urine), an increase in amniotic fluid detected by echography, polydipsia (increased thirst), fatigue and rapid weight gain.

Prevention and treatment: how to prevent gestational diabetes through diet and proper nutrition

The prevention of gestational diabetes includes a healthy diet without excessively sugary foods and rich in fiber and vegetables, as well as a proper lifestyle with moderate physical exercise.

Helpful is a course for gentle gymnastics during pregnancy. A diabetes diet for gestational diabetes must be prescribed by a specialist. It must be normocaloric and must not affect the growth of the unborn child, but the intake of primary and secondary sugars must be reduced.
Blood glucose must be constantly monitored (glucose test strips) to track the effectiveness of therapy.

Nutrition for gestational diabetes

Very important in the prevention and even more so in the treatment of gestational diabetes is the woman’s diet. It is the first treatment prescribed by the doctor when this form of diabetes is detected. Now let’s see what foods to avoid and how to create a balanced diet for this form of the disease. Care must be taken to ensure that the values of 1800 – 2000 kcal are never undercut in order to ensure proper nutrition for mother and child. All forms of fasting are not recommended, such as therapeutic fasting, which can be helpful in the case of type 2 diabetes.

to avoid and allowed 
In order to keep blood sugar under control through the diet, the consumption of carbohydrates and sugary foods must be limited. We can structure food intake in the following ways:

Avoid processed foods and dairy products such as cakes and ice cream. The consumption of high-fat foods and animal protein should also be restricted: cheese, meat, crustaceans, eggs, etc.

Carbohydrates should be limited, but not completely avoided. They should cover 45% of daily calories.
Allowed foods are whole wheat bread and pasta, legumes and rice.

Allowed, even increasingly recommended, are fruits and vegetables and all fiber-rich foods.
Vegetables should preferably be eaten raw.

For protein intake, the consumption of fish and legumes is particularly recommended, unlike red meat, which should be avoided because of the increase in cholesterol. This is crucial for fat reduction in the diet, because obesity favors the occurrence of diabetes.
Fat intake must also be limited by avoiding too much cheese.
As a dressing, extra virgin olive oil is most suitable.

Nutritional example

The recommended diet during pregnancy, even with gestational diabetes, should be about 1800 – 2000 kcal and can be divided into five meals, three main meals and two snacks.

Breakfast – to choose from:

  • coffee sweetened with aspartame, a slice of wholemeal bread of about 50 g and an apple;
  • coffee sweetened with aspartame, 2-3 slices of wholemeal rusks and a peach;
  • Coffee or tea sweetened with aspartame, 2-3 slices of wholemeal rusks or 3 slices of honeydew melon.

Snack in the morning and afternoon, alternating the following suggestions between morning and afternoon:

  • A slightly sweet fruit (for example, apple or orange).
  • A little sweet fruit (for example, apple or orange) and 2-3 slices of wholemeal rusks.

Lunch – choose from the following options:

  • A portion of wholemeal pasta or whole grain rice (50 g) mixed with vegetables as desired, one fruit or one serving of vegetables.
  • A 200 g serving of legumes (chickpeas, beans or peas), 50 g of wholemeal bread and one fruit or serving of vegetables.
  • One serving of 250 g of fish (any type of fish is possible), 50 g of wholemeal bread and one fruit or one serving of vegetables.

Dinner – choose one of the options:

  • Strained vegetables or broth with 20 g of pasta or rice, two fruits and a portion of vegetables.
  • One serving of fish (250 g) or a small can of tuna (80 g), 50 g of wholemeal bread, one fruit or one serving of vegetables.
  • One serving of nuts or pistachios (50 g), 50 g of wholemeal bread, one fruit or one serving of vegetables.

Drug therapy

The doctor may prescribe oral blood sugar-lowering medications, which are usually taken for type 2 diabetes and are not recommended for gestational diabetes because they can cause damage to the fetus.

There are three types of insulin that can be used to treat this type of diabetes:

  • zinc insulin, to be administered three times a day, with medium – long-acting daily effect,
  • normal insulin, to be administered one to three times a day, half an hour or an hour before eating,
  • Isophane insulin, a type of insulin of medium action, the dosage of which depends on the severity of the disease.

Natural remedies and alternative medicine

There are some homeopathic remedies that can be used after changing your diet.
The herbal products that are taken into account are herbal teas, for example, based on walnut leaves, which contain slightly hypoglycemic substances, and dietary supplements based on fiber, such as psyllium seeds, which reduce sugar absorption.
Also, some plants such as eucalyptus and myrtle appear to have blood sugar-lowering properties.
Eucalyptus contains substances that inhibit the absorption of sugar, while myrtle inhibits the enzymes that serve the absorption of sugar, while honeysuckle rue enhances insulin action.

Frequently Asked Questions

Can gestational diabetes be prevented by early detection?
People at risk should take routine tests to prevent diabetes before anyone else.

Is it possible to control gestational diabetes through food?
Yes, gestational diabetes can be influenced by diet. If nutrition alone is not enough, one should contact a gynecologist or endocrinologist to conduct appropriate insulin therapy.

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