Gestational diabetes is detected only during pregnancy and warns by the elevation of blood glucose levels during pregnancy.It can cause the weight gain of the baby, premature delivery and greater indication of caesarean sections.

High levels of blood blood glucose (hyperglycemia) during pregnancy generate increased insulin in the fetus which could produce immaturity of some organs and weight gain in the fetus.

It is necessary to distinguish between women who have diabetes (type 1 or type 2) who seek pregnancy from those who develop the pathology during pregnancy.“Gestational diabetes is usually diagnosed after the 20th week.If it is detected at an earlier stage, you may have had this diabetes before becoming pregnant, ”explains Carolina Fux Otta, specialist in Endocrinology and Head of the Department of Endocrinology and Diabetes of the University Hospital of Maternity and Neonatology of Córdoba.

- Who can suffer from this pathology?

- Gestational diabetes can occur in a pregnant woman without previous risk factors.Patients who are most likely to develop gestational diabetes are those who are more than 30 years old, have had other children over four kilos at birth, a history of diabetes in previous pregnancies, first -degree relatives with diabetes, obesity, ovary syndromepolycystic or increased blood pressure.However, and as it can also be triggered in women without any of these factors, the obstetrician requests in the first consultation a blood glucose analysis.And repeat the order during the second half of the pregnancy.

- What are the symptoms?

–The gestational diabetes is generally asymptomatic unless the sugar levels (blood glucose) are very high.

In that case, a lot of thirst, appetite can be presented, urinating a lot or having infections.In ultrasound controls, signs such as increased amniotic fluid, growth and fetal well -being can be found.

- How is it detected?

–With a glucose oral tolerance test that consists of ingesting 75 grams of glucose diluted in water.Blood extraction is carried out before and two hours after intake to measure blood glucose levels.This study is requested between week 24 to 28 of pregnancy and if the woman presents risk factors for diabetes is repeated between week 31 to 33 of gestation.

In pregnant women with obvious risk factors for diabetes, the test can be performed before.

- What is the treatment?

- Once the diagnosis of gestational diabetes is made, it is important to educate the patient to achieve adequate metabolic control, fundamental to the health of the mother and her baby.Clinical controls consist of making a weight curve, blood pressure control and evaluating the presence of edema in lower limbs.

The patient will perform the glycemic and ultrasound controls to assess well -being and fetal growth.

- What is the relationship between weight gain during pregnancy and this pathology?

–We suggest adequate weight gain during ambazo depending on the previous nutritional status, why?In a normal pregnancy there are hormonal and metabolic changes to ensure the proper arrival of nutrients to the fetus.During the second half of pregnancy there is a greater diabeotogenic effect since it increases insulin resistance;This generates that beta cells of the pancreas secrete 1.5 to 2.5 times more insulin to maintain normal blood glucose levels.

When the secrete capacity of the beta cell is reduced, gestational diabetes is installed.In patients with obesity, who already have insulin resistance, pregnancy exacerbates it generating a greater risk of triggering diabetes.YeahMetabolic control is not optimal, an increase in amniotic fluid, premature birth and greater indication of caesarean sections can be generated.

Mother's hyperglycemia generates fetal hyperglycemia and compensatory fetal hyperinsulinism.This increase in insulin in the fetus can generate hypertrophy of liver tissues, adipose tissue and heart and can cause macrosomia (large babies) with the consequent complications in childbirth.

In addition, if there was no adequate metabolic control, the increase in insulin in the fetus can generate immaturity of some organs generating consequences at birth as respiratory problems, decreased levels of calcium, blood glucose and jaundice.

Hypocaloric diets are contraindicated in pregnancy.Control with a nutritionist to follow the evolution of the mother's weight is essential.

It is recommended to perform physical activity that mainly involves the muscles of the trunk and arm, low impact aerobics for 30-45 minutes, at least three times a week.Of course, there are situations where physical activity is contraindicated as in cases of contractions, arterial hypertension, uterine bleeding and all the obstetricians consider that it should avoid.

In those patients who use insulin, it is indicated to measure glycemia before performing physical activity.Regarding medication, only insulin use is approved during pregnancy and will be recommended in those pregnant women with gestational diabetes that fail to specify the blood glucose levels considered desirable.

Should the control continue after pregnancy?

- Yes, since it has a greater risk of presenting gestational diabetes in an upcoming pregnancy and throughout life.In children born of mothers with diabetes that did not have adequate metabolic control, a greater incidence of obesity and metabolic alterations such as diabetes and high blood pressure was observed.

It is important to identify and correct metabolic alterations before pregnancy.But once achieved it we recommend that you continue with a healthy life to avoid excessive weight gain.Complications during pregnancy (such as hypertension and diabetes) predict the risk of suffering in the future more diabetes and cardiovascular disease for the mother and, probably, for the fetus in the adult stage.

- Do the diabetic women should plan their pregnancies?

–Yes, patients with pre -war diabetes should program their pregnancies.In the University Hospital of Maternity and Neonatology the "preconception consultation" works very well.It is an interdisciplinary team in which the obstetrician, the endocrinologist and the neonatologist participate.

Planning pregnancies, having healthy lifestyles and making preconception consultation are the best strategies for both those that were already diagnosed and diabetic (type 1 and 2) before getting pregnant and for those that are already pregnant.

For the mother to arrive in the best conditions, it requires glycemia controls, cholesterol, adequate weight, check with the ophthalmologist.Also, evaluating the functioning of the kidneys since renal failure can affect the health of the mother and that of the child to be born.

In addition, cardiological checking is important and consider whether certain drugs that cannot be used during pregnancy are suspended or changed because they could damage the baby's health.

Polycystic ovary syndrome

In December 2015, a scientific work carried out by the Department of Endocrinology and Diabetes, the Chair of Applied Pharmacology and Human Physiology of UNC.The work, which Carolina Fux Otta is one of its main authors, addressed the issue of pregnant women with ovary syndromepolycystic and it was detected that the presence of gestational diabetes was three times greater in women with polycystic ovary syndrome than in the control group without the presence of this pathology.That syndrome is considered one of the risk factors for the development of gestational diabetes.The research "Polycystic Ovary Syndrome: Impact on Reproductive and Maternal Health" received the prize for the best work in the clinical area of ​​that specialty.

Prevalence
In an investigation carried out at the University Hospital of Maternity and Neonatology in Córdoba, the prevalence of diabetes during pregnancy was 8 percent.A few years ago, in Argentina the prevalence of this pathology was determined by 5 percent.At present, although multicenter studies are being developed to update these figures.