Diabetes mellitus in pregnancy

                  Gestational diabetes

• First diagnosed during pregnancy and associated with an increase in adverse outcomes.  

• Resolves after delivery, may persist postpartum  

• increased risk of type 2 diabetes in later life. 

Definition: 

gestational diabetes occurs when your body can't make enough insulin during your pregnancy

                                                                or

gestational diabetes is high blood sugar (glucose) that develops during pregnancy and usually disappears after giving birth

Causes of Gestational Diabetes:

• Gestational diabetes occurs when your body can’t make enough insulin during your pregnancy. Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy.

• During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin.

• All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant. They start pregnancy with an increased need for insulin and are more likely to have gestational diabetes.

Symptoms and Risk Factors:

Gestational diabetes typically doesn’t have any symptoms. Your medical history and whether you have any risk factors may suggest to your doctor that you could have gestational diabetes, but you’ll need to be tested to know for sure.

                                       Complications of gestational diabetes

• Most women who have gestational diabetes deliver healthy babies. However, untreated or uncontrolled blood sugar levels can cause problems for patient and her baby.  

• Complications for baby, including:  

• Macrosomia (Excess growth). Extra glucose can cross the placenta, which triggers baby's pancreas to make extra insulin. This can cause baby to grow too large. Very large babies are more likely to require a C-section birth.  

• Hypoglycemia: babies may develop hypoglycemia shortly after birth because their own insulin production is high. Prompt feedings and an intravenous glucose solution can return the baby's blood sugar level to normal.  

• Type 2 diabetes later in life. Babies of mothers who have gestational diabetes have a higher risk of developing obesity and type 2 diabetes later in life.  

• Death. Untreated gestational diabetes can result in a baby's death either before or shortly after birth.  

• Complications for the mother, including: 

• Preeclampsia. This condition is characterized by high blood pressure, excess protein in the urine, and swelling in the legs and feet. Preeclampsia can lead to serious or even life-threatening complications for both mother and baby.  

• Subsequent gestational diabetes. Once patient had gestational diabetes in one pregnancy, she is more likely to have it again with the next pregnancy. She is also more likely to develop diabetes  typically type 2 diabetes in elderly

Prevention :

Before you get pregnant, you may be able to prevent gestational diabetes by losing weight if you’re overweight and getting regular physical activity.

Don’t try to lose weight if you’re already pregnant. You’ll need to gain some weight—but not too quickly—for your baby to be healthy. Talk to your doctor about how much weight you should gain for a healthy pregnancy.

                                                Treatment 

You can do a lot to manage your gestational diabetes. Go to all your prenatal appointments and follow your treatment plan, including:

• Checking your blood sugar to make sure your levels stay in a healthy range.

• Eating healthy food in the right amounts at the right times. Follow a healthy eating plan created by your doctor or dietitian.

• Being active. Regular physical activity that’s moderately intense (such as brisk walking) lowers your blood sugar and makes you more sensitive to insulin so your body won’t need as much. Make sure to check with your doctor about what kind of physical activity you can do and if there are any kinds you should avoid.

• Monitoring your baby. Your doctor will check your baby’s growth and development.

NB :

If healthy eating and being active aren’t enough to manage your blood sugar, your doctor may prescribe insulin, metformin, or other medication.