Diabetes And Pregnancy. Gestational Diabetes

Description

During normal pregnancy, metabolic adaptations occur, aimed at correcting the imbalance that occurs when you need a higher nutritional content to the fetus. One of these imbalances is that the body needs more insulin intake to require a greater use of glucose.

A proof of this change is experienced by all pregnant women, usually in the morning to note the unpleasant symptoms of hypoglycemia: nausea, drowsiness, fatigue, weakness, etc..

With advancing gestation, metabolic adaptation intensifies, reaching great importance during the last 20 weeks of pregnancy.

All these metabolic changes lead to a number of considerations when they occur in a diabetic woman:

• In some patients, Diabetes first appears during pregnancy.
• The conventional criteria for diagnosing diabetes are not applicable in pregnancy.
• With advancing gestation there is an increase in insulin requirements.
• The usual criteria of metabolic control are not applicable during pregnancy.

Screening For Gestational Diabetes Mellitus (GDM)

The data suggest the possibility of DMG are:

• Family history of diabetes, especially among first-degree relatives.
• Glycosuria (glucose in urine) in a second fasting urine sample (see below).

• A story of:
• Unexplained abortions.
• Infants large for gestational age.
• Malformations in the newborn.
• Important maternal obesity (90 kg or more).
Some minor data are: multiparity, toxemia of pregnancy recurrent preterm birth repeated.
The presence of more than one data increases the probability of a disorder in glucose metabolism.
Glycosuria (glucose in urine) is a common finding, as 15% of pregnant women have it, so the search for cases based on this information alone is ineffective. The validity of this test can be increased when using a second fasting urine: the urine passed on waking is neglected and collected a second sample 15 minutes later when the patient is still fasting.
Suspected cases of gestational diabetes mellitus DMG should be seen every 15 days by the endocrinologist, working together this and the obstetrician. It should take the usual prenatal measures. There should be special emphasis on weight control.
At each visit must make a blood glucose after eating. If this test does not exceed 120 mg / dl), proof of an oral glucose tolerance should be deferred until the week 37 th -38 th of gestation, at which time more likely to test positive. If at any visit after eating glucose exceeds 120 mg / dl, should be tested for glucose tolerance without delay.
If the test is negative in early pregnancy does not exclude, however, diagnosis, and the test should be repeated at 37-38 weeks, before making a final decision.
Patients who have a negative tolerance test at 37-38 weeks is considered normal.
If the test is positive you can make the diagnosis of gestational diabetes and gives the patient a diet and was controlled in the same way a diabetic clinic.
If the ideal criteria of glycemic control are not reached soon, you begin treatment with insulin. In cases well controlled and uncomplicated spontaneous delivery is expected.
The existence of an increased need for insulin during pregnancy does not necessarily indicate that diabetes persists after birth.
Monitoring DMG Gestational Diabetes Mellitus
After the puerperium should be repeated glucose tolerance. If the test is still positive, the patient has a diabetes clinic (which was demonstrated for the first time during pregnancy).
If not, the correct diagnosis of gestational diabetes mellitus.
Because some patients with gestational diabetes develop diabetes mellitus DMG clinic then should be advised to maintain a normal body weight and advised to attend to review annually, or immediately if they become pregnant again.
Problems Of Pregnancy In Diabetic Women
The particular problems in diabetic pregnancy may be considered under several headings:

Maternal problems

• Hypoglycemia

Hypoglycemia is common in the first half of pregnancy, especially in the first quarter. Fortunately, the fetus tolerates hypoglycaemia well.

• Diabetic ketoacidosis

It is a real danger and contrary to what occurs with hypoglycemia, is fatal to the fetus

• Retinopathy (damage to the retina)

Retinopathy is already present in many women at the beginning of pregnancy, and may progress as it progresses. Regular ophthalmoscopy is therefore important. Paradoxically, the progression of retinopathy may be related to the start of a strict metabolic control. When neovascularization occurs can be controlled with photocoagulation, and it is therefore an indication for abortion.

• Nephropathy (kidney damage)

Diabetic nephropathy in pregnant women is defined as the presence during the first half of gestation with proteinuria (protein in urine), persistent, more than 400 mg in 24 hours, in the absence of infection.
Many patients also have high blood pressure and other complications of renal injury. These cases require careful monitoring and control of hypertension and diabetes mellitus , quickly realizing hospitalization and inducing labor.
Patients with functioning kidney transplants often have successful pregnancies.

FETAL PROBLEMS

• Intrauterine death (Death of the fetus in the uterus)

It may occur unexpectedly and inexplicably

• Malformations

Congenital malformations occur in 6-8% of the children of diabetic mothers: they are three times more frequent than in the general population. The type of malformations covers a wide spectrum, but the neural canal defects and cardiac lesions are quite common.
Therefore, you should advise diabetic women to plan their pregnancy and warn in advance, in order to achieve the best possible control before conception takes place. Compliance with this advice may reduce the number of malformations
• Macrosomia (birth-large)
• Infants who were small for gestational age
Although usual in children of diabetic mothers is macrosomia, some infants are small for gestational age due to intrauterine growth retardation. This is more common in patients with longstanding DM with vascular complications.

DEATH IN THE NEWBORN

• Respiratory distress syndrome (RDS) or hyaline membrane disease

When patients routinely gave birth at 36-37 weeks of gestation, due to lack of maturation of the baby's lungs, a respiratory disturbance occurred numerous times was deadly. Today this problem can be anticipated in time to avoid numerous deaths from this cause.

• Hypoglycemia

Neonatal hypoglycemia is frequent, especially in macrosomic infants. Metabolic control of the mother and newborn in the postpartum decreases the frequency and severity of neonatal hypoglycemia.

• Hyperbilirubinemia

Can occur in association with preterm delivery.

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