What is Diabetes During Pregnancy?
Diabetes mellitus is defined as a condition of persistently high blood sugar due to lack of production and / or action of insulin. Insulin is a hormone that helps keep blood sugar levels at the right level. Pregnancy diabetes occurs due to the effects of pregnancy on the body.
- In type 1 diabetes, insulin is required from the outside as the body cannot produce insulin.
- Type 2 diabetes is primarily treated with healthy eating and exercise habits and possibly blood sugar lowering drugs. At a later stage, insulin treatment is often required.
About 2% of all pregnant women develop gestational diabetes. The total number of pregnant women with diabetes is on the rise, which is mainly explained by the increased incidence of type 2 diabetes.
Pregnancy diabetes usually goes unnoticed without any obvious symptoms. Therefore, some type of test is required to detect that you have pregnancy diabetes.
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Type 1 diabetes is caused by the immune system destroying the cells of the pancreas that produce insulin. Type 2 diabetes is because the body produces too little insulin in relation to the need and the insulin has poor effect.
When a woman is pregnant, the body becomes less sensitive to insulin, which increases the need for insulin. If the body is unable to produce enough insulin, the result is that blood sugar levels rise and are too high. They talk about pregnancy diabetes. Some factors increase the risk of developing gestational diabetes. This applies, among other things, to the incidence of type 1 and type 2 diabetes in parents or siblings, obesity and obesity, or previous pregnancy diabetes. Pregnancy diabetes is more common in women from countries outside Europe.
The diagnosis of pregnancy diabetes is made using a sugar load, a so-called glucose load test. The test means that you are allowed to drink a sugar solution containing 75 grams of glucose and that the blood sugar level is measured at a certain number of times during the test. If your blood sugar is outside established limits, you have pregnancy diabetes.
The approach, who is offered the glucose load test, may differ. An alternative is to offer pregnant women with an increased risk of the pregnancy diabetes test, or if randomly taken blood glucose values have exceeded a certain limit during pregnancy. Examples of risk factors are:
- That you have had pregnancy diabetes in the past.
- That you have previously given birth to a big child.
- That you have a body mass index (BMI) over certain limits.
- That you have someone close to diabetes.
Another alternative is to offer all the pregnant test.
Elevated sugar levels in the urine often occur in pregnant women without diabetes. This is because the blood sugar level of the kidneys that releases sugar into the urine is lowered during pregnancy. Therefore, a urine test is not a good test for assessing the risk of pregnancy diabetes.
The aim of the treatment is to make blood sugar levels normal. Measuring your blood sugar yourself is the most important step in determining the appropriate treatment and the correct dosage of any medication. Blood glucose values between 4 and 8 mmol / L are sought throughout the day. Multivitamin and folic acid supplements should be taken from the time when you are planning to become pregnant up to and including pregnancy week twelve. This reduces the risk of diabetes-related malformations and neural tube defects in the child.
Basic for all forms of diabetes during pregnancy are:
- Custom diet.
- Daily physical activity.
- To refrain from tobacco use.
As physical activity increases insulin sensitivity, the need for insulin simultaneously decreases. Tobacco use lowers insulin sensitivity and increases the risk of complications in both mother and child. Tobacco use is therefore not suitable for diabetes and especially not during pregnancy.
- Women with type 1 diabetes can continue with their previous treatment. Women with type 2 diabetes can continue with metformin (anti-diabetic drug) while all other treatment is replaced with insulin.
- The majority of women with gestational diabetes can achieve satisfactory blood sugar control through changing lifestyle habits, while in principle everyone with type 2 diabetes needs the addition of drugs.
- In women with obesity / obesity, metformin can be considered as starting therapy when treatment with diet and exercise does not produce enough results. At a later stage, supplemental therapy with insulin may be required.
- Insulin therapy is the first choice for women who are not overweight / obese or for other reasons not relevant to metformin.
The majority of women with gestational diabetes have a normal pregnancy course and the pregnancy can usually continue until pregnancy is complete. In type 1 and type 2 diabetes, the risk of complications towards the end of pregnancy is relatively higher and it may then be relevant to start the delivery.
Type 1 and 2 diabetes are persistent diseases. Pregnancy diabetes usually disappears after childbirth, but up to 50% of all women with gestational diabetes develop diabetes within a 10-year period after childbirth (primarily type 2 diabetes).
Therefore, it is important to:
- Get back to normal weight after pregnancy.
- To maintain a healthy lifestyle.
- To regularly engage in physical activity.
Since children of women with diabetes during pregnancy have an increased risk of developing obesity and diabetes later in life, it is important to involve the whole family in healthy living habits.
Diabetes during pregnancy can cause problems in both mother and child. The sugar easily passes the placenta. When the blood sugar is high in the mother, it also becomes high in the fetus. High blood sugar levels early in pregnancy mean an increased risk of fetal malformations. In pregnancy diabetes, blood sugar levels have usually been normal early in pregnancy and the risk of malformations is very small.
There is a relationship between how much sugar values are elevated and the risk of malformations. In women with known diabetes, there are data that indicate that the risk of giving birth to children with malformations increases to double that of women who do not have diabetes. The most common deformities are in:
- Central nervous system
Such malformations can in many cases be detected with ultrasound around week 20.
High blood sugar levels later in pregnancy can lead to increased insulin production in the fetus. Since the effects of insulin are to introduce sugar into the cells, the baby risks growing abnormally. If the child becomes very large it can be damaged in connection with the birth and get stuck with the shoulders in the birth canal. Increased insulin levels in the fetus are also the reason why the baby may suffer from low blood sugar immediately after birth.
More rare complications are oxygen deficiency, difficulty breathing and jaundice in the newborn baby.
In women with type 1 diabetes, bleeding in the retina of the eye has been associated with rapidly lowered blood glucose levels and elevated blood pressure. During the latter part of pregnancy, the risk of rising blood pressure and pregnancy poisoning increases. This also applies to women with type 2 diabetes and pregnancy diabetes.