Gestational Diabetes

Gestational Diabetes

2022-05-20 10:53:57/ Kategori : Gynecology and Obstetrics, Internal Medicine (Internal Medicine)

Facts About Gestational Diabetes 

What is gestational diabetes and why is it important?

Gestational diabetes, known as pregnancy or gestational diabetes, is a disease that first appears during pregnancy and resolves with birth, but insulin resistance persists after birth. Pregnant women with well-controlled gestational diabetes, who are noticed at an early time, give birth and give birth to a healthy baby, no different from other pregnant women without gestational diabetes. However, if high blood sugar due to gestational diabetes is not noticed and treated, it can lead to negative consequences for both the expectant mother and her baby. It may lead to the delivery of heavier, overweight and large (macrosomal) babies than expected, and accordingly, damage to both the mother and the baby that will affect their later lives during birth. Early birth, Respiratory difficulties, low blood sugar, prolonged jaundice can be observed in newborns after birth, and newborn intensive care treatment may be required for these reasons. Gestational hypertension (pre-eclampsia) can be seen in the mother, which can threaten the life of both the baby and the mother.

The frequency of gestational diabetes is between 2-20%, this rate varies according to the prevalence of diabetes in the community. Its prevalence in the Turkish population is estimated to be around 15%. As in other societies where the diabetes prevalence is very high, in our society, all pregnant women are given the opportunity to reach their pregnant women between the 24th and 28th days of their pregnancy. gestational diabetes screening is recommended.

Due to the changing hormone profile due to pregnancy, insulin resistance and hyperinsulinemia (excessive insulin in the blood) occur from the second trimester (second trimester). Here, the effects of insulin in the tissues are not sufficient, so there is a “relative insulin deficiency”.

Feeding pregnant women only with natural proteins and fats and avoiding all carbohydrates leads to the inability to meet the basic needs of our body, vitamins and minerals from natural sources. Such a diet prevents pregnant women from consuming vegetables, fruits and whole grain foods. In this way, nutrition by excluding carbohydrates completely will lead to the re-emergence of problems such as vitamin C and B deficiency, magnesium and calcium deficiency in the 21st century. According to current guidelines, the daily carbohydrate requirement of a healthy adult woman is 130 grams, and this requirement is recommended as 175 grams during pregnancy and 210 grams during lactation.

Today, pregnant women diagnosed with pregestational or gestational diabetes are already given limited carbohydrates to meet 35-40% of daily energy. It is recommended to reduce the amount of carbohydrates at breakfast to prevent hyperglycemia caused by hepatic insulin resistance, especially in the morning.

Proteins are already given as high (1.1 g/kg/day) in order to meet the increased protein requirement during pregnancy. But even higher amounts of protein can have harmful effects on the kidneys.

For all these reasons, it would be appropriate to follow a dietitian together with close endocrinological follow-up in patients diagnosed with gestational diabetes.

How is it diagnosed? “Is it necessary to LOAD SUGAR to pregnant women?

In the last 3 years, there has been an increase in the tendency of pregnant women not to have it, especially in our country, due to opinions stating that it is harmful and harmful.

World Health Organization, International Diabetes Federation, American Diabetes Society, American Society of Gynecology and Obstetrics, American Endocrine Society, American National Institutes of Health, European Endocrine Society; Diabetes, Endocrine and Gynecology authorities of British, German, French, Swedish, Finnish, Canadian, Dutch, Australian and Turkish and all institutions, including the Ministries of Health, accept a phenomenon called “Gestational Diabetes” and say that a diagnosis must be made, He states that it is necessary to perform the “SUGAR LOADING TEST (OGTT)” for diagnosis. A suitable nutrition program is organized for the pregnant woman diagnosed with gestational diabetes and it is recommended to increase her physical activity. However, in the following weeks, 20-25% of pregnant women have to control their blood glucose level. not possible. These women and their babies can have serious health problems. Such an undiagnosed patient will naturally be faced with these problems.

For the screening of Gestational Diabetes during pregnancy, it is recommended to perform OGTT by drinking 75 grams of glucose. This test is done only once (in a single step).


24-28 in pregnancy. Although many smaller studies have previously proven that the glucose tolerance test, which is performed once every week, is reliable and useful in the diagnosis of gestational diabetes, it has been clearly demonstrated by a study called HAPO, in which 25,000 pregnant women from nine countries who did not have diabetes before, participated. . This research was published in the May 8, 2008 issue of the “New England Journal of Medicine”, which is read by scientists and those interested in the field of health all over the world (N Engl J Med 2008; 358:1991-2002May 8, 2008).

About 10% of pregnant women diagnosed with gestational diabetes are actually “type 2 diabetes” cases that started before pregnancy but could not be diagnosed before. In addition to diet and exercise, these patients will need to be treated with insulin at the time of diagnosis or within a few weeks. Glyburide, which is not available in our country as an oral drug, can be used in mild forms of gestational diabetes. It is a pregnancy category B drug. While metformin has been accepted as pregnancy category C and used carefully during pregnancy in the last 10 years, it has now been evaluated in category B and used in appropriate patient groups.

Some patients (around 1-2%) have gestational diabetes, on the other hand, actually has “type 1 diabetes” that first appears during pregnancy. For this reason, it is vital for both mother and baby to start insulin therapy without delay.

Screening for gestational diabetes will enable these two types of patients to be diagnosed and to start treatment without delay.

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