January 17, 2018
Gestational diabetes is the most common metabolic complication during pregnancy. Between 2% and 20% of pregnant women present this disorder, caused by the resistance to insulin that is produced by the elevation of hormones during gestation.
Insulin is a substance secreted by the pancreas that allows the body to convert the food it consumes into energy, which is stored in the form of sugar or glucose. During pregnancy, the placenta produces hormones that enter the bloodstream and affect the body's ability to use that substance, whose action is further altered in obese mothers, as fat cells are highly resistant to insulin.
Dr. María Inés Silva de Casanova, an endocrinologist at La Trinidad Teaching Medical Center, explained that when this happens the cells fail to metabolize glucose and there is an increase in blood sugar levels in the mother.
That high blood glucose passes to the fetus through the placenta, forcing it to produce a lot of insulin, which increases its growth, fat percentage and turns it into a macrosomic newborn (weighing more than 4 kilograms at birth).
"This complicates delivery, and it is generally possible that a cesarean delivery will not be completed or necessary. These infants are at risk for low blood sugar levels (below 50 mg / dl) due to circulating high insulin," she said.
Problems for mother and baby
Babies whose mothers have had gestational diabetes also have an increased risk of developing type 2 diabetes throughout their lives. To prevent this, Casanova recommends starting with exclusive breastfeeding for 6 months, teaching them to eat well and encourage sports.
Mothers may have complications such as: elevated blood pressure, loss of protein through the urine, and edema in the lower limbs. "This is called pre-eclampsia and is quite risky for both the mother and the fetus," she said.
Fortunately, this disease can be well controlled and most mothers have healthy and normal babies. Women who are at increased risk of having it are those who are overweight or during pregnancy, with a family history of type 2 diabetes, and those who lead a sedentary life and who have polycystic ovaries.
Diagnosis and treatment
To diagnose gestational diabetes, at week 24 of pregnancy, an oral glucose load test (75 grams) is performed, and fasting glucose is measured (whose normal value should be less than 92 mg / dl), and another intake (Less than 180 mg / dl), and at 2 hours (less than 153 mg / dl). One of these high values indicates the existence of diabetes.
The endocrinologist explained that, in these cases, a treatment is indicated to maintain a normal level of glucose in the mother's blood. This should be monitored with the glucometer before, one and two hours after each meal, with the following control goals: less than 95 mg / dl before eating, less than 140 mg / dl an hour later, and less than 120 mg / Dl within two hours.
The mother should also follow an appropriate meal plan and exercise 150 minutes per week. In cases where it does not present the expected results it would be necessary to resort to insulin.
Dr. María Inés Silva said that feeding can be hypocaloric to lose weight at the beginning of pregnancy; Then normocaloric to increase the adequacy (6 to 7 kilos) during the 39 weeks of gestation. Iron and folic acid supplements are also recommended for mothers.
Gestational diabetes usually appears or is diagnosed for the first time, around the 24th to 28th week of gestation and, at the end of pregnancy, it should return to normal. However, the risk of developing type 2 diabetes is increasing, so it is necessary for both mother and child to have a lifetime medical follow-up and to check blood sugar at least once a year.
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