Gestational diabetes, or in other words diabetes that occurs during pregnancy, is the inability of the pancreas organ to respond to insulin resistance. Gestational diabetes is also referred to as abnormal glucose (sugar) tolerance that first occurs during pregnancy. Physiologically, the pregnancy period is accompanied by insulin resistance. This situation is caused by diabetogenic hormones secreted from the placental tissue that nourishes the baby; It is through growth hormone (GH), corticotropin-releasing hormone (CTRH), placenta lactogen (PL) and progesterone hormones. If glucose (sugar) metabolism is disrupted due to insulin resistance during pregnancy and continues this way without taking precautions, among the consequences that may occur are; increased risk of preeclampsia (pregnancy poisoning), macrosomia (large baby) and therefore increased cesarean delivery rate, fetal organomegaly (hepatomegaly, cardiomegaly), operative delivery, birth trauma in mother and baby, respiratory problems in the newborn and metabolic complications (hypoglycemia, hyperbilirubinemia). In addition, if the mother has hyperglycemia (high blood sugar level) due to known or unknown overt diabetes in the 6-8th week, which we call the organogenesis period, the risk of miscarriage and congenital anomalies increases. In patients who have gestational diabetes during pregnancy and are not treated, the risk of developing type 2 diabetes and cardiovascular disease in the future increases. The children born to these women are also at risk of diseases such as obesity, abnormal glucose tolerance and metabolic syndrome, which are called long-term effects. An increased risk of autism has also been identified in children born to mothers with diabetes combined with gestational diabetes and obesity (gestational or non-gestational).
The term gestational diabetes is used for pregnant women diagnosed in the second half of pregnancy. It tastes. Insulin resistance during pregnancy is more evident in those who first appear during pregnancy but are probably predisposed to diabetes.
WHO IS AT RISK FOR GESTATIONAL DIABETES?
1) gestational diabetes in a previous pregnancy. Women with diabetes or impaired glucose intolerance
2)Those with a family history of diabetes, especially in their first-degree relatives
3)Those whose pre-pregnancy BMI is higher than 30kg/square meter, during adolescence or between pregnancies Women who gained significant weight during pregnancy, women who gained excess weight between the 18th and 24th weeks of pregnancy
4) Those whose maternal age is over 25
5) A history of unexplained pregnancy loss or stillbirth in a previous pregnancy or women with a history of malformed (anomaly) babies
6)Those who are predisposed to the development of diabetes; Those with metabolic syndrome, polycystic ovary syndrome; those who use steroids, those with hypertension
7) Those who have multiple pregnancies (twin, triplet pregnancy)
As preventive approaches to reduce risk, losing weight before pregnancy, applying regular exercise programs, and diet recommendations in overweight patients. can be done.
SCREENING AND DIAGNOSTIC TESTS
Screening and diagnostic tests for diabetes are used to reveal the pregnant woman with diabetes and then give appropriate treatment, mascrosomy, baby's shoulder at birth. It is performed to prevent implantation and reduce maternal and fetal morbidities such as preeclampsia.
Mostly, screening and diagnostic tests are blood glucose measurements performed after drinking solutions containing glucose (sugar), andnone of these tests are performed on the mother and baby. It does not have any negative or damaging effects.
If gestational diabetes is diagnosed, the first approach is to make changes in diet, close blood sugar and weight monitoring, appropriate drug treatment and close mother-baby monitoring. takes it. The aim of screening tests is to identify asymptomatic individuals who are at risk of developing this disease. Screening tests are divided into 1-step and 2-step tests.
2-Step approach: It is often a screening test. The 50gr OGTT test identifies women with glucose intolerance (impairment in sugar metabolism). Those whose test results are high are taken to the 2nd step, 100gr OGTT (fasting blood sugar, 1st, 2nd and 3rd hour postprandial blood sugar measurement) test. The 100gr OGTT test is also a diagnostic test for gestational diabetes.
One-step approach; It is known as 75 g OGTT. It includes 1st and 2nd hour postprandial blood sugar measurements. Screening and diagnosis go together.
Who is a candidate for screening tests?
90% of pregnant women have at least one risk factor for deterioration in blood glucose levels during pregnancy. However, almost 20% of women are diagnosed with gestational diabetes without any risk factors.
When should the screening test be performed?
In early pregnancy, only those with suspected unidentified type 2 diabetes ( Those with a BMI over 30kg/square meter, a history of gestational diabetes in a previous pregnancy, or known impaired glucose metabolism such as polycystic ovary syndrome) may be tested. Early diagnosis of overt diabetes can be made at the first prenatal visit by checking the hemoglobin A1c level in the blood (hemoglobin A1c level above 6.5). However, it is not successful in detecting mild glucose intolerance.
If there is no early period test or it is negative, the screening test is performed during the 24-28 week pregnancy period, which is applied worldwide. The 50gr OGTT test is the blood sugar level measured 1 hour after drinking a liquid containing 50g of glucose, regardless of the meal.
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