Gestational diabetes mellitus (GDM) is various degrees of carbohydrate intolerance that begins during pregnancy or is first diagnosed during pregnancy. Those at high risk for GDM are those who are obese, people with GDM in a previous pregnancy, and those with a family history of diabetes. Those with a history.
PATHOPHYSIOLOGY
A normal pregnancy consists of growth hormone secreted from the placenta, corticotropin-releasing hormone, placental lactogen, tumor necrosis factor-α (TNF-α). It is a condition characterized by insulin resistance, hyperinsulinemia and mild postprandial hyperglycemia due to the effect of diabetogenic hormones such as ) and progesterone. This situation prepares the mother to meet the fetus's increasing need for amino acids and glucose, especially in the second half of pregnancy. It is thought that there is a subclinical metabolic dysfunction in women who had normal glucose tolerance before pregnancy but developed GDM in late pregnancy. The 60% decrease in insulin sensitivity that occurs during normal pregnancy leads to clinical hyperglycemia/GDM in these women. Maternal obesity, which is frequently associated with gestational diabetes, is associated with increased inflammation in maternal white adipose tissue and placenta.
The screening test is performed by OGTT with 75 g glucose between the 24th and 28th weeks of pregnancy. If "delayed fasting glucose" is 140-199 mg/dl at the 2nd hour of loading and is above 200, DM is diagnosed.
RISK FACTORS
If you have any of the mentioned features. The risk of developing GDM is increased in pregnant women with diabetes.
- Previous impaired glucose tolerance or history of GDM in a previous pregnancy
- Hispanic-American, African-American, Native
Belonging to an ethnic group with a high prevalence of type 2 DM, such as American, South or East Asian, Pacific Islands
Being a member of an ethnic group with a high prevalence of type 2 DM
- Having a history of diabetes in the family, especially in first-degree relatives (30 )
- Pre-pregnancy body weight ≥110% of the ideal body weight, or BMI >30 kg/m²
, or excessive weight gain in early adulthood and between pregnancies, or Excessive weight gain during pregnancy
Weight gain (31.32)
- Advanced maternal age (>25 years)
- Having given birth to a >4.1 kg baby before
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- Previously unexplained perinatal loss or m giving birth to an already formed baby
- Maternal birth weight >4.1 kg or <2.7 kg
- Detection of glycosuria at the first prenatal visit
- Metabolic syndrome, Presence of metabolic conditions that may be associated with the development of diabetes, such as polycystic ovary syndrome, glucocorticoid use and hypertension
TREATMENT
The aim of treatment is to reduce morbidity and The aim is to provide close to normal metabolic control to minimize mortality. Glycemic control goals during pregnancy; FPG was determined as < 95 mg/dl, 140 mg/dl in the 1st hour after the meal and < 120 mg/dl in the 2nd hour. Initial treatment for GDM is nutrition regulation, glucose monitoring and exercise. If glycemic targets are not achieved within 1-2 weeks with lifestyle changes, pharmacological treatment is started. Blood glucose monitoring is important in evaluating treatment. It is recommended that the patient self-monitor glycemic levels by measuring fasting glucose before three main meals, postprandial glucose at the 1st hour, and at bedtime. Glycemic monitoring with 4-7 points should be performed at least 3 days a week.
Medical Nutrition Treatment
Medical nutrition treatment should be given by a nutritionist in pregnant women with GDM. The aim is to protect the mother from ketosis, to provide normoglycemia and the energy required for appropriate weight gain according to maternal BMI, and to contribute to the continuation of the well-being of the fetus and the mother. Total daily calories are adjusted for ideal body weight. In clinical practice, the energy need in women is generally 1800-2500 Kcal/day.
Insulin
Approximately 15% of pregnant women with GDM cannot achieve glycemic targets with nutritional treatment alone and require pharmacological treatment with insulin. Apart from not reaching the glycemic target values, the fetal abdominal diameter being above the 70th percentile after the 29th-30th weeks of gestation can also be used as a criterion to determine the need for pharmacological treatment.
Oral Hypoglycemic Agents
Oral hypoglycemic agents are known to be contraindicated during pregnancy because they may cause fetal anomalies or cause fetal and maternal hypoglycemia.
TREATMENT DURING LABOR
Good glycemic control before and during labor It is important in reducing fetal complications. In pregnant women who are on a diet, regular glucose monitoring along with IV saline infusion at a rate of 100-150 cc/hr is recommended during this period. In pregnant women receiving medical treatment, an IV infusion of 5% dextrose or saline at a rate of 100-150 cc/hr along with a short-acting insulin IV infusion of 1-2 u/h per hour is recommended. Blood glucose is monitored hourly and the aim is to keep it between 70-130 mg/dl. After birth, insulin resistance disappears and maternal glucose metabolism returns to normal. Since some women may have undiagnosed overt diabetes, it is recommended to continue blood glucose measurements in the postpartum days
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