Gestational Diabetes, High Risk for Baby

This type of diabetes or elevated blood sugar can occur between weeks 24 and 28 of pregnancy and disappear after delivery. However, it is very important to receive timely treatment, as otherwise it may cause serious problems for the mother and baby.

Source
Although it is unclear why it develops gestational diabetes, "is believed to be associated with increased production of hormones in the placenta (the organ that serves the needs ephemeral breathing and excretion of the fetus during its development) that can generate insulin resistance in the mother's body, "said the specialist.

It should be clear that the placenta provides nutrients and water to the growing fetus, and produces several hormones to maintain pregnancy, some of which (estrogen, cortisol and lactogen) can block the effect of insulin.

As the placenta grows, produces more hormone secretion and, consequently, the mother increases resistance to insulin, resulting in inability to absorb glucose in the tissues. In most pregnant women, the pancreas is able to regulate this situation, however, when its action is not enough to offset the effect of placental hormones, the result is gestational diabetes.

Moreover, research is needed if the modern diet, rich in calories, modifies the adaptation of the pancreas to pregnancy and the possible influence of prior administration of certain drugs.

Impact
Gestational diabetes means that the mother is more susceptible to infectious disease and of hypertension (high blood pressure with risk of preeclampsia, which causes complications during pregnancy and childbirth). In turn, the placenta is injured and edema (fluid accumulation) that hinder its role in maternal-fetal exchange.

In terms of complications for the baby, unlike type 1 diabetes, gestational usually does not cause birth defects, since they generally originate in the first trimester of pregnancy, i.e. before week 13. However, the insulin resistances caused by the hormones of the placenta and usually occur until 20 weeks making the product vulnerable to several chemical imbalances and two major problems: macrosomia and hypoglycemia.

Macrosomia occurs in the case of a baby larger than expected, because all the nutrients you get when you come directly into the uterus of the mother's blood. The liquid contains too much glucose vital and this is detected by the pancreas of the fetus, so that body produces more insulin in response to use that glucose, which becomes excess fat.

At birth, the product has too much insulin and, as we do not receive the supply of glucose from the mother, comes lack of this nutrient, i.e., hypoglycemia.

Control and management
Care prior to delivery in women with gestational diabetes should include possible confirmation of normal blood glucose concentrations and an indication of proper diet and controlled.

While there is no consensus regarding the type of food and adequate calories for these patients, dietary control should be guided and supervised by the nutritionist. However, broadly speaking we can say that consumption is recommended 35 to 40% of carbohydrates per day (normally should represent 50% of nutrients).

Additionally, we recommend the practice of regular exercise as this improves glucose control. According to the specialist, the treatment is complemented by the combined application of ultra-fast acting insulin and ultralente, because together provide better control for simulated effect similar to that normally occurs.

Treatment with oral hypoglycemic agents is not recommended, since these agents have the ability to cross the placenta and fetus hypoglycemias keep for long periods, leading to impaired growth.

Obstetric Resolution:
The perinatal assessment (which happens just before and after childbirth) should start at 32 weeks gestation, with close monitoring, especially in patients who had inadequate glucose control; hypertension associated and did not use insulin in an orderly manner.

The vaginal delivery is not contraindicated, although to avoid complications may terminate the pregnancy via cesarean section, depending on the background of the weight of previous children (if any) and the characteristics of the bony pelvis. Do not interrupt the pregnancy before 40 weeks in patients with good control, unless there is a maternal or fetal complication.

The patient had gestational diabetes, usually no need to continue medication in the postpartum period, as the insulin resistance disappears quickly, but you must make determinations of glucose before hospital discharge. Either way, it is very important to continue with weight management, follow proper diet and exercise regularly.

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