Diabetes and Pregnancy
What are the changes in carbohydrate metabolism during pregnancy?
During pregnancy, the body's energy needs have increased. More glucose is needed to provide the necessary energy for the child's development. Therefore, blood sugar levels in pregnant women are lower than normal. If sufficient glucose cannot enter the cell as a result of a decrease in carbohydrate intake, energy is primarily supplied from fats and ketone bodies are seen in the urine. Pregnancy, ketosis susceptibility increases due to the lack of sufficient insulin hormone in the blood, but the need for glucose. Ketosis is a condition that has dangerous consequences for both the development of the child and the health of the pregnant woman. In addition, the increase in progesterone, estrogen, cortisone, lactogen, etc. hormones during pregnancy causes resistance to insulin.
What is the effect of pregnancy on diabetes?
The most important difference between diabetic and non-diabetic pregnant women is the increased risk of ketoacidosis in diabetes, and may further aggravate the current insulin resistance. Insulin requirement is higher in pregnant women than non-pregnant women. Insulin requirement increased in diabetic pregnant women compared to pre-pregnancy period, especially after the first 3 months. In diabetic pregnant women, it is important to balance the increased glucose and insulin requirements of the organism for both mother and child. Otherwise, the risk of cardiac skeletal anomalies in infants and preterm birth, miscarriage, large birth or stillbirth in pregnant women increases.
What is gestational diabetes?
Pancreatic cells, which can secrete sufficient insulin before pregnancy, cannot secrete enough insulin with the progression of pregnancy, so blood sugar may increase during pregnancy even if there is no sign of diabetes before. The so-called 'gestational diabetes' usually improves at the end of pregnancy. Overweight pregnant women over the age of 30, who usually have a large number of diabetic people in their family, are at risk for gestational diabetes.
How should birth planning be done in diabetes?
Diabetic mothers who do not have a life-threatening risk of conception should undergo strict control at least 3 months before conception in order to ensure proper health and development of the fetus. The risk of achieving metabolic control in diabetes and preventing or stopping the progression of complications is low in young mothers with low age of diabetes and without diabetes-related organ disorders. Diabetes is older, people with an initial diagnosis of disorders such as the eye or nervous system, or older mothers are at high risk. In diabetic patients with advanced organ disorders, pregnancy is not allowed as pregnancy increases these disorders.
How should blood sugar be monitored during pregnancy?
The ideal fasting blood sugar level is 60-90mg / dl, and the satiety blood sugar level is 120-130 mg / dl. During pregnancy, blood glucose levels should be measured at least 2 times a week before breakfast and 2 hours later, before lunch and dinner and at 11.00 pm. During pregnancy, blood sugar may rise in the urine before it rises (renal glycosuria). Therefore, daily urine glucose monitoring and acetone monitoring should be performed. If acetone is detected in the urine for two consecutive days, the patient should immediately see his doctor.
What should be the treatment of diabetes during pregnancy?
If the metabolic control can be achieved by diet in gestational diabetic patients, treatment is continued with dietary compliance controls. Insulin therapy should be initiated immediately in patients with poor metabolic control but with slightly higher blood glucose values and diabetic patients with poor metabolic control. Pregnant women cannot use oral antidiabetic drugs. Total weight gain during pregnancy should not exceed 10-13 kg.
What should be considered before and after birth in diabetic pregnant women?
Diabetic pregnant women can be delivered preferably from the 38th week. If the duration exceeds 40 weeks or if the fetus is estimated to be over 4000 gr, caesarean section should be preferred.
The baby who is exposed to hyperglycemia in the womb starts to secrete insulin and continues to secrete insulin after birth. Therefore, the most common metabolic disorder in newborn children is low blood sugar. Measurement of blood sugar of the baby following birth and strict blood sugar monitoring for at least two weeks is important for the detection and treatment of hypoglycemia. If hypoglycemia is detected in the baby, it should be taken into an early feeding program or if hypglycemia is heavy, serum containing dextrose should be given.
What should be done to prevent pregnancy?
Although contraceptive methods are not different from diabetic, non-diabetic contraceptives may interfere with the hormonal balance of diabetes and therefore blood sugar control. In a diabetic woman, it is very important that the intrauterine devices (spirals), which are at risk of developing infections, are placed under sterile conditions. The tube fixation technique is the most reliable method.
18AXX
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