Diabetes is the most common medical complication of pregnancy. Pregnancy is a diabetogenic period characterized by insulin resistance, compensatory β-cell increase and hyperinsulinemia that begins in the second trimester. Insulin sensitivity decreases by 80% during pregnancy. Gestational diabetes (GDM) is a glucose tolerance disorder that first appears or is diagnosed during pregnancy. While GDM complicates approximately 4% of pregnancies, the incidence of pregestational diabetes is approximately 1-3 in 1000 pregnancies. The American Diabetes Association reports that GDM is detected in 4% of pregnant women, that is, approximately 135,000 women per year. However, this rate varies between 1% and 14% in different societies. Studies conducted in different regions in Turkey have found that the prevalence of GDM varies between 3-8%.
Diabetes present before and during pregnancy increases perinatal morbidity and mortality in the mother and newborn. Maternal hyperglycemia has decreased today due to careful monitoring during pregnancy. Despite this, morbidity in the baby of diabetic mothers (DAB); It still continues to a significant extent. The incidence of DAB is 5%. Approximately 93% are babies of mothers diagnosed with gestational diabetes (GD) and 7% with insulin-dependent diabetes (IDDM). Preventing congenital malformations in babies of diabetic mothers is an important problem. The frequency of major anomalies in live-born babies is between 1-4%. Maternal IDDM is a risk factor for congenital anomalies. Structural defects in the babies of these mothers increased 3-5 times. Malformations were detected at a rate of 8-8.6% in babies of diabetic mothers and 3.8% in babies of non-diabetic mothers. While the frequency of structural heart disease is 2.8% in controlled DAB, it has been reported to be 3.2% in uncontrolled DAB. Perinatal mortality in diabetic pregnancies is 2.2-5.9%. Hypoparathyroidism, hyperphosphatemia, low magnesium and vitamin D metabolism disorders have been reported in babies of diabetic mothers. Bone mass in DAB is significantly higher than in normal infants of the same weight. Increased bone mass increases the need for calcium. Hypocalcemia is common in DAD. Hypoglycemia is observed in 25-50% of babies of diabetic mothers in the first 24 hours, especially within 30-90 minutes following birth. It is often asymptomatic and resolves spontaneously.H Hypertrophic cardiomyopathy is a generally benign and transient condition identified in DAB. HCM was observed in 38% of the cases, especially hypertrophy of the interventricular septum. Cases in which fetal death occurred due to hypertrophic cardiomyopathy have been described.
Gestational Diabetes (GD) is a glucose tolerance disorder detected for the first time during pregnancy. Timely recognition of GD is important for protecting pregnant and fetal health. Although there are disagreements about who should be screened for GD, it seems safe to screen all pregnant women considering the importance of GD. The ideal period for screening is the 24th-28th day of pregnancy. weeks. However, if there are significant symptoms and findings that raise suspicion of diabetes, screening can be performed at the first prenatal visit.
WHAT IS OGTT?
The most commonly used method for screening is the 50-g oral glucose tolerance test. Taking the 1st hour post-load glucose level as 130 mg/dl increases the sensitivity of the test. Nowadays, 100 g glucose tolerance test is frequently applied to cases that are positive in the screening. However, the 75 g glucose tolerance test can also be used for this purpose and it even seems to replace the 100 g glucose tolerance test in the future. GD can be diagnosed if two or more of the following serum glucose conditions are met during a 100 g glucose load: Fasting >95 mg/dL; first hour >180 mg/dL; second hour >155 mg/dL; Third hour >140 mg/dL.
Glucose loading test during pregnancy is at 24-28 weeks of pregnancy. It is applied in weeks. Liquids containing 50 grams of sugar are given to the expectant mother and measurements are taken. The aim of applying the sugar load test, also known as OGTT, during pregnancy is to reveal whether the glucose level is kept in balance in the mother's body.
If pregnancy-related diabetes is diagnosed after the sugar load test, different treatment methods can be applied. If precautions are not taken; Serious problems may arise, such as the baby being born earlier, serious health problems for the mother, babies being born larger than they should be, and the baby being born with extremely low sugar syndrome, that is, hypoglycemia, right after birth.
Sugar overload during pregnancy. take the test Is it useful?
Whether the sugar challenge test in pregnant women is harmful to the health of the mother and baby is a highly debated issue. The most undesirable situation during pregnancy in terms of mother and baby health is diabetes during pregnancy.
Sugar during pregnancy causes risks for the baby and mother. In order to take precautions against this situation, a sugar loading test should be performed in 24-28 weeks of pregnancy. . This test is an internationally accepted test and the 50-75 grams of sugar given for the test will not cause any harm to the baby.
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