Gestational diabetes (gestational diabetes)
What is gestational diabetes?
Gestational diabetes is characterized by the first appearance of a glucose tolerance disorder during pregnancy. With some certainty, so-called gestational diabetes is one of the most common pregnancy-related illnesses.
The gestational hormones estrogen, prolactin, progesterone and placental lactogen, which provide the female body with the necessary glucose during pregnancy, are probably responsible for the onset of gestational diabetes.
In some women, however, the pancreas can not produce enough insulin to also channel this glucose into the body's cells (true insulin deficiency). Or, although the pancreas can produce more insulin, the cells are no longer responsive (relative insulin deficiency).
Many pregnant women with already diagnosed gestational diabetes are sure to wonder why it has just hit them. This question is certainly justified, but can not be answered in all cases one hundred percent.
A not to be underestimated risk factor is usually the body weight. With a body mass index of> 27, there is an increased risk of developing gestational diabetes.
Hereditary factors (type 2 diabetes mellitus in the family) and over 30 years of age are equally problematic. Past pregnancies and births are also in the focus of interest. If all the following questions can be answered with a "yes", the pregnant woman should immediately consult a gynecologist:
Has a child of over 4500 g birth weight been born? Did more than three abortions take place? Did you have gestational diabetes in your last pregnancy? Nevertheless, the cause of gestational diabetes can not always be clearly defined. Sometimes it just happens to women without the risk factors mentioned above.
Symptoms, complaints & signs
Although gestational diabetes is not uncommon, in many cases it remains undetected. This is due to the fact that the course of the disease usually proceeds asymptomatic. As a rule, he remains completely undetected until the 24th week of pregnancy. In addition, the signs of gestational diabetes are quite unspecific, if they occur only sporadically.
In pregnancy, the specific symptoms of diabetes are usually not perceived as such. Because the frequent urination, the constant tiredness or a feeling of weakness can also be typical side effects of a pregnancy. However, in pregnancy there are also abnormalities that speak for diabetes.
These include high blood pressure, sudden rapid weight gain of the pregnant woman and / or the unborn baby due to the conspicuously high blood sugar level and rapid increase in the amount of amniotic fluid (this can be found in an ultrasound examination).
If several of the named signs of illness are noticeable, then the disease is much easier to diagnose. Increased infections of the urinary tract and vaginal inflammation, however, clearly indicate gestational diabetes. These infections are caused by the high amount of sugar in the urine, because sugar favors the formation of fungi and bacteria.
Many women get along well with the complaints of gestational diabetes, but the disease is sometimes associated with grave consequences for mother and child. If no necessary medical measures are taken, the disease may also go back beyond the pregnancy.
Diagnosis & History
Gestational diabetes can only be reliably detected with a so-called "oral glucose tolerance test". The good news is that the examination costs for the test have been taken over by all health insurances since 3 March 2012.
From the 24th week of pregnancy, the doctor measures the fasting blood sugar of the patient, gives her a glucose solution to drink and waits three times an hour until the next measurement. Thus, the blood sugar is measured every hour, with each time there is a limit that must not be exceeded under any circumstances.
After fasting for 8 hours, the fasting value should not exceed 95 mg / dl, 180 mg / dl should not be exceeded after 1 hour, 2 hours after drinking the glucose solution, the value should be less than 155 mg / dl and after 3 hours Blood sugar levels have returned to levels below 140 mg / dl. If only one upper limit is exceeded, it may already be a gestational diabetes.
In the case of gestational diabetes there is a risk of complications for both the mother and the unborn child. The risk increases if the gestational diabetes is not treated. One of the biggest risks of maternal gestational diabetes is preeclampsia. This is too high a blood pressure, which is accompanied by an increased protein concentration within the urine.
At the same time, the risk of seizure (eclampsia) increases. In addition, the pregnant woman is more susceptible to inflammation of the vagina and urinary tract infections. Women who suffer from gestational diabetes also have to undergo caesarean section more often, due in part to their complications or size.
If the mother becomes pregnant again later, the risk of another gestational diabetes is about 50 percent. Furthermore, the risk of developing diabetes mellitus type 2 increases.
Complications from gestational diabetes also threaten the child. So it is possible that there is a faulty development of the placenta, which has an insufficient supply of the fetus result. Furthermore, maturation disorders may occur on organs such as the liver or lungs. In the worst case, the intrauterine fetal death takes place.
Even after birth, the sequelae of diabetes notice. Not infrequently the affected babies suffer from prolonged jaundice. Likewise, a lack of calcium, hypoglycaemia or brain damage are possible. In severe cases, the neonatal breath or seizures.
When should you go to the doctor?
In case of gestational diabetes should definitely be consulted a doctor. Only by proper treatment of the disease can an ordinary child development be guaranteed. If the gestational diabetes is not treated, it can lead to severe malformations in the child, which must be treated after delivery. The sooner the patient is visited for gestational diabetes, the better the progression of the disease. As a rule, a doctor should be consulted if the pregnant woman suffers from low blood pressure and significant weight gain. The increase in weight exceeds the usual increase in pregnancy.
Furthermore, inflammation at various parts of the body may indicate gestational diabetes and should be examined by a physician. Especially when sudden onset of these symptoms, a doctor should be consulted. The urine of those affected can smell sweet and indicates gestational diabetes. In gestational diabetes, a general practitioner or a gynecologist can be visited. Usually, the disease can be treated well, so that the life expectancy of the mother and the life expectancy of the child are not reduced by this disease.
Treatment & Therapy
In a diagnosed gestational diabetes is usually the referral to the diabetologist, who analyzed the diet of the patient in detail and has suggestions for improvement ready. If the patient refrains from now on the so-called "short-chain carbohydrates", such as sugar, white bread and sweets, the blood sugar values can be adjusted well in over 80% of the patients.
From now on there are whole grains, lots of vegetables and fewer fruits with fruits such as berries or apples on the menu. Once a week, the diabetologist checks the patient's blood glucose levels, which records her values at least three times a day from the time of the first nutritional consultation:
In the morning after getting up, at noon and in the evening. With low blood glucose levels and few "outliers", the low-carbohydrate diet is completely adequate to prevent excessive maternal weight gain and developmental delays in the infant. An insulin dose is then unnecessary and gestational diabetes leads to no further complications, such as an excessive birth weight, which can lead to a problematic childbirth.
Gestational diabetes can not always be avoided. Hereditary factors, obesity and the increasing gestational age of patients take their toll. It is not crucial during pregnancy to "eat a lot", but just healthy and varied. In this way, some gestational diabetes may not even develop and existing gestational diabetes can be treated well.
In the case of gestational diabetes, the patient has in most cases only a few and even limited measures of direct follow-up care available. For this reason, the person suffering from the disease ideally should consult a doctor at an early stage to prevent the onset of other symptoms or complications.
There can be no self-healing, so that treatment by a doctor should be initiated in time. Only then can different malformations of the child be prevented. In most cases, the symptoms of gestational diabetes can be relieved relatively well if the diet is changed accordingly. The person concerned should refrain from sugar and white bread and generally pay attention to a healthy lifestyle with a healthy diet.
Regular checks and examinations by a doctor are very important to detect further complaints early. In some cases, the insulin can be completely cured, so that no special follow-up care is needed after that. Gestational diabetes does not reduce the life expectancy of the patient and usually does not limit them.
You can do that yourself
Often, the blood sugar level in gestational diabetes can be normalized with a change in diet and physical activity. An individual dietary advice should necessarily take pregnant women with this diagnosis.
For gestational diabetes, the daily amount of energy should be between 1, 800 and 2, 400 kilocalories, depending on eating habits, daily routine and body weight. When dieting pregnant women should ensure that the daily carbohydrate intake is 40 to 50 percent and consists mainly of slowly absorbable carbohydrates (eg whole grains). On white flour products, fruit juices and confectionery, expectant mother should abstain from gestational diabetes, because the food increases blood sugar excessively fast and strong. To avoid this, it still makes sense to consume about 30 grams of fiber daily in the form of whole grains, fruits, vegetables and legumes.
Furthermore, it is advised to eat preferably vegetable fats and to cover the protein requirement with low-fat milk and dairy products and low-fat meat and sausage products. To avoid blood sugar spikes after a meal, five to seven smaller meals are recommended throughout the day. For overweight pregnant women applies - with or without gestational diabetes - a diet ban.
In addition to diet, regular exercise is the A & O. Sport in moderation can help to lower elevated blood sugar levels in a natural way.