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Gestational diabetes. Quick facts on the most common complication in pregnant women.
Carbohydrate disorders which occur in pregnant women include pre-existing diabetes and hyperglycemia first diagnosed during pregnancy.
Pre-existing diabetes is a condition in which a woman suffering from diabetes gets pregnant, regardless of the type of disease. The group of disorders called hyperglycemia diagnosed for the first time during pregnancy includes gestational diabetes and the so-called diabetes in pregnancy. These two conditions are recognized for the first time during pregnancy, but the difference lies in the criteria for their diagnosis.
Diabetes in pregnancy has the same diagnosis criteria as type 1 and type 2 diabetes, while gestational diabetes has slightly more restrictive glucose values on diagnosis. A characteristic feature of most gestational diabetes cases is normalization of postpartum glucose levels. However, any type of diabetes diagnosed before pregnancy or diagnosed for the first time during pregnancy does not pass once the baby is born (1).
Pregnant women over 35 years of age, burdened with a family history of type 2 diabetes or diagnosed with gestational diabetes in previous pregnancies, are particularly at risk of developing gestational diabetes. Other risk factors for gestational diabetes include multiple births, births over 4 kg in previous cases, births with congenital defects, and a history of intrauterine deaths. Women who are overweight or obese, with hypertension, or polycystic ovary syndrome are also at a higher risk of developing carbohydrate disorders during pregnancy.
The most common symptoms of gestational diabetes include:
- the need to urinate at night
- increased thirst
- unintentional weight loss
- increased drowsiness
- purulent lesions on the skin
- inflammation of the genitourinary organs.
We diagnose diabetes in pregnancy when glycemia values found in the pregnant woman are within the range of values authorizing the diagnosis of clinically overt diabetes, i.e.:
- fasting: ≥ 126 mg/dl (7,0 mmol/l) and/or
- within the second hour after oral load of 75 g of glucose: ≥ 200 mg/dl (11,1 mmol/l) and/or
- random blood glucose level: ≥ 200 mg/dl (11,1 mmol/l).
At the same time, these disorders are accompanied by clinical symptoms typical of hyperglycemia.
Gestational diabetes is diagnosed when gestational glucose values meet at least one of the following criteria (1):
- fasting: 92-125 mg/dl (5,1-6,9 mmol/l)
- within the first after after oral load of 75 g of glucose: ≥ 180 mg/dl (≥ 1 mmol/l)
- within the second hour after oral load of 75 g of glucose: 153-199 mg/dl (8,5-11,0 mmol/l).
Gestational diabetes increases the risk of miscarriages, birth defects, intrauterine deaths, excessive fetal growth, perinatal injuries, hypoglycemia in the baby, and other adaptation problems in the newborn. In order to reduce the risk of developing complications resulting from diabetes in pregnant women with already diagnosed carbohydrate disorders, it is very important to obtain the correct level of metabolic control of the disease (2).
In most cases, the basis for the treatment of gestational diabetes is a change in lifestyle through appropriate dietary management and an increase in the level of physical activity, combined with appropriate patient education. In some cases, insulin treatment may also be necessary. Oral antidiabetic agents are currently not standard treatment for hyperglycaemia during pregnancy because they can cross the placenta.
Gestational diabetes is a common complication that develops in pregnant women. Appropriate lifestyle modification, including a change in diet and increased physical activity, combined in some cases with insulin therapy, can help achieve adequate disease control and prevent the development of complications that accompany the disease.
- American Diabetes Association. 13. Management of Diabetes in Pregnancy: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018; 41(Suppl 1): S137-S143.
- HAPO Study Cooperative Research Group, Metzger B.E., Lowe L.P., Dyer A.R. i wsp. Hyperglycemia and adverse pregnancy outcomes. N. Engl. J. Med. 2008; 358: 1991–2002.