Diabetes occurs when the body is unable to produce enough insulin. Insulin is a hormone produced in the pancreas and regulates the sugar balance in the body. Blood sugar serves as energy for the body. The hormonal changes associated with pregnancy lead to an increased need for inuslin in the expectant mother. If the mother’s pancreas does not produce enough insulin for this purpose, blood glucose levels will rise, leading to gestational diabetes. When the mother’s blood sugar level is elevated, the sugar passes through the placenta (placenta) to the fetus. The latter reacts to this by increasing its own insulin production. However, unlike sugar, this insulin cannot cross the “placental barrier”. Therefore, in the fetus, increased insulin levels stimulate growth and increased fat formation. This leads to oversized and heavy babies.
Risk
There is an increased risk of gestational diabetes in:
- Overweight (BMI over 25)
- Diabetes in the family (parents or siblings)
- Gestational diabetes in a previous pregnancy
- Women of African, Asian or Latin American origin
- Age over 30
- Repeated miscarriages
- Earlier birth with birth weight over 4000 grams
These at-risk individuals should be tested as early as the first pregnancy checkup. If the oral glucose tolerance test (oGTT) described below is normal, it should be repeated between weeks 24 and 28 of gestation. 30 bis 50 Prozent aller Schwangeren haben jedoch keinen der genannten Risikofaktoren. Therefore, it is recommended that all women be tested between the 24th and 28th week of pregnancy.
Symptoms
In most cases, the mother has no symptoms, i.e., the typical signs of diabetes (e.g., severe thirst, frequent urination) are not present. Often, only nonspecific symptoms indicate diabetes, such as increased susceptibility to urinary tract infections, elevated blood pressure, increased amniotic fluid, or increased urinary sugar excretion.
Untreated gestational diabetes can have the following effects on the baby:
- Stronger growth in size and higher birth weight (over 4000 grams)
- Organ maturation disorders (the lungs are particularly affected)
- Birth complications
- Child hypoglycemia after weaning
- Increased bilirubin levels in the blood (infantile jaundice)
Risks for the mother are:
- Pregnancy toxicity (so-called preeclampsia/HELLP) with high blood pressure, edema, multi-organ failure.
- Birth complications (including frequent cesarean section).
Diagnosis by us (glucose tolerance test)
Glucose tolerance test means blood glucose determination in the mother’s blood fasting and 1 and 2 hours after ingestion of a glucose solution (75 grams). If a value is above the limits, gestational diabetes is diagnosed (fasting: > 5.1 mmol/l, 1 hour: > 10 mmol/l, 2 hours: >8.5 mmol/l).
Fasting means you may do the night before the exam starting at midnight:
- eat nothing
- Do not drink sweetened drinks
- do not drink fruit juices
- also no chewing gum or so-called “sero-drinks
(water is allowed)
Treatment
Gestational diabetes can be treated very well for a long time in 85 percent of cases by changing the diet. Regular physical activity that is easy for pregnant women to perform without risk, such as swimming, walking, and climbing stairs, makes the body’s cells respond better to the body’s own insulin.
If an adapted diet and exercise no longer have any effect, insulin must be injected. Oral antidiabetic drugs (blood glucose tablets) are usually not allowed.
Gestational diabetes usually disappears shortly after the placenta is expelled. In some women, the metabolic disorder persists after birth. 25 to 50 percent of all mothers develop type 2 diabetes mellitus within five to ten years after giving birth, so experts recommend blood glucose monitoring about six weeks after birth and once a year thereafter.