The body's energy needs increase with pregnancy. Under the influence of pregnancy hormones estrogen, progesterone, cortisone and milk hormones, sensitivity to the insulin hormone, which plays an important role in the mother's sugar metabolism, decreases. Thus, sugar molecules (glucose), which are restricted for use in the expectant mother, pass to the baby and are used in the growth and development of the baby.
During pregnancy, the blood sugar of the expectant mother is normally low. Insulin resistance, which develops under the influence of pregnancy hormones in healthy individuals, is supported by the use of body stores. The glucose needed by the baby is provided before the blood sugar rises. In the presence of some risk factors such as the presence of familial diabetes, advanced maternal age and obesity, the expectant mother's blood glucose levels tend to increase. The rising glucose level in the blood passes to the baby, causing the baby to release the hormone insulin. Increased insulin hormone in the baby may cause problems in the baby's development by affecting the growth hormone in the baby. These are heart anomalies in babies, excess water, depending on the degree of high blood sugar; For expectant mothers, it brings risks such as unexplained miscarriages, premature birth, difficult birth of a large baby or stillbirth.
The incidence of diabetes during pregnancy varies according to race, but is between 5-10%. There are two types of diabetes during pregnancy. Pregestational diabetes (existing before pregnancy) and gestational diabetes (emerging during pregnancy)
One is a known diabetes disease that already exists before pregnancy, and the other is gestational diabetes, which occurs after the 20th week of pregnancy. If there is pre-gestational diabetes, the risks are higher. The expectant mother should be under strict control at least 3 months before pregnancy in order to ensure the appropriate health and development of the baby. It is appropriate to stop oral medications taken before pregnancy with pregnancy and start insulin instead.
Diabetes that occurs in the second half of pregnancy is usually more benign. This condition, called Gestational Diabetes, usually resolves at the end of pregnancy. Often, people with a family history of diabetes, over 30 years of age, and overweight pregnant women are at risk for gestational diabetes.
Pregnant The ideal fasting blood sugar level of expectant mothers is 65-90mg/dl, and the postprandial blood sugar level is 120-130 mg/dl. Variable glucose measurements are made depending on the type of diabetes and the blood sugar control of the expectant mother. These measurements can be frequent, such as fingerstick blood sugar measurements taken many times a day, or less frequent checks, such as weekly fasting and postprandial blood sugar measurements.
If blood sugar control can be achieved with diet in patients with gestational diabetes, treatment is continued with diet compliance checks. It is recommended to consume high-fibre, green foods, avoid carbohydrates and pastries and sugary foods, and consume a protein-based diet. Regular brisk walking or light sports such as swimming or pilates can be done. Insulin treatment should be started without delay in expectant mothers whose blood sugar control is not at an ideal level due to diet regulation and physical activity.
Total weight gain during pregnancy should not exceed 10-13 kg. While the expectant mother's excess weight gain increases the risk of diabetes during pregnancy, it also brings with it the risk of increased blood pressure.
Fasting blood sugar evaluation is performed at the first application during pregnancy, this test is important to detect patients in the first group who do not know that they have diabetes before. Patients with fasting blood sugar (FBG) over 126 mg/dl or postprandial blood sugar over 200 mg/dl should be considered diabetic. In these patients, the HbA1c test, which shows the blood sugar level of the last three months, can provide information about the duration of high blood sugar.
If the expectant mother does not have any risk factors, gestational diabetes can be diagnosed with sugar loading tests, the ideal time of which is 24-28 weeks. For expectant mothers with advanced maternal age, obesity, and a history of diabetes in previous pregnancies, it is recommended to perform a sugar loading test at the beginning of pregnancy.
Diabetic pregnant women can preferably give birth starting from the 38th week. If the period exceeds 40 weeks or the baby's estimated weight is over 4000 grams, birth is preferably done by cesarean section.
Diabetes in expectant mothers&nb sp; Advanced age brings a high risk in uncontrolled patients with organ disorders such as eye, nervous system or kidney functions. In patients with uncontrolled diabetes, pregnancy may not be allowed to continue as it may negatively affect maternal health.
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