What is gestational (pregnant) diabetes and what effect does it have on a fetus?

In the interview, you will be informed about the following:

• Gestational diabetes;
• Causes;
• Method of diagnosis;
• Possible risk-factors.

It’s a disorder of any degree primarily developed in pregnancy or diagnosed glucose tolerance (glucose tolerance test determines how the body responds to glucose, i.e, sugar solution).

What is gestational  (pregnant) diabetes?

It’s worth mentioning that we encounter two types of diabetes in pregnant women – gestational (when it primarily manifested during pregnancy) and pregestational (when a woman was affected by diabetes type I or type 2 before the pregnancy as well).

An optimal date for diabetes screening in pregnant women is a 24-28^th week of pregnancy, whereas, in the case of certain risk factors related to the development of this pathology, screening should be conducted as soon as possible during the first antenatal visit to the obstetrician-gynecologist.

For reference, unlike diabetes mellitus,  clinical symptomatic might not be present in pregnant diabetes. A woman, rarely, but might still has the following complaints: excessive urination, visual deterioration, increased thirst, fatigue. 

Endocrinologist of the clinic “New Life” of National Center of Surgery Ana Kopaleishvili discusses the topic.

– What causes gestational diabetes?

–Risk-factors for development are:  

• Family history of diabetes mellitus;
• Body mass index more than 30 kg/m2;
• Childhood obesity;
• Pregnancy age (over 25 years old);
• History of childbirth with a large (4 kg or more) fetus;
• History of glucose tolerance disorder;
• History of stillbirth;
• Fetal malformation;
• Mother’s birth weight (4,1 kg and more or 2,7 kg and less);
• Polycystic ovary syndrome;
• Use of glucocorticoids;
• Chronic or pregnancy-induced hypertension.

–What are the methods of diagnosis?  

– Per our country's protocol, there's two-step diabetes screening for pregnant women. A pregnant woman is given a liquid solution with a certain level of glucose at the laboratory, after which fasting venous blood glucose level is determined in 1, 2 and 3 hours. 

– How does it affect pregnant woman, what are the risks for the mother and fetus?

– Possible risks for a mother are:

• Polyhydramnios (excessive amniotic fluids);
• Complications caused by hypertension;
• Relapse of genitourinary infectious diseases;
• Childbirth trauma;
• Development of diabetes mellitus in the future;

Possible risks for a fetus are:

• Macrosomia (excessive birth weight);
• Intrauterine fetal death;
• Birth trauma;
• Postnatal mortality;
• Possible complications in childhood or adolescent age, etc. 

In the period of 6^th to 12^th weeks after the pregnancy, it's recommended to conduct a 2-hour oral glucose (75 g) test or determine fasting glucose blood level and respond appropriately for all the women affected by gestational diabetes.

In case of hyperglycemia (on an empty stomach = 140-125 mg/dL or in 2 hour oral glucose (75 g) test = 144-199 mgdL), a person must consult with endocrinologist.

If the screening tests after the childbirth is normal, it’s recommended to restest once in 3 years.

– What can you tell us about childbirth, is obstetrician responsible for something peculiar?

–The method,  physiological birth or c-section (cesarean section) depends on fetal and mother's condition. 

Also, glucose blood level should be measured every 2 hours during childbirth, whereas it's optimal level is 70-90 mg/dL (3,9-5,0 mmol/L).

–Should the mother's gestational diabetes be taken into consideration when planning future pregnancy and is it possible for a disease to relapse?

–Next pregnancy must be planned. Also, of course, it's possible for diabetes to relapse during the next pregnancy. That’s why endocrinologist’s consultation is recommended during pregnancy planning in order to asses the risk of development and for the woman to receive respective recommendations. 

Wish you health!