Glucose curve: diabetes in pregnancy

Glucose is the fundamental energy source of the fetus, and nature causes that during pregnancy a greater volume of blood glucose is promoted so that the fetus can access it easily without problems. The hormonal changes of pregnancy also generate a transient state of insulin resistance and other changes similar to those in diabetes.

This, which in principle is good for the development of the fetus, can make a mother - if she has a certain genetic predisposition or certain habits of life not too healthy - can develop a gestational diabetes. And if this happens, the risk of alterations occurring at the end of pregnancy and at delivery is statistically greater because of how these changes affect the baby.

Why it is important to control the level of blood sugar

1. Gestational diabetes can later lead to adult-onset diabetes with all the problems that this disease produces in the body, ranging from alterations in blood pressure, to problems in the kidney, in the eyes * that are very harmful to women.

2. It can affect the development of the baby. They are usually children of greater weight than their due for their time of pregnancy and, however, at birth may have some complications of low glucose or poor control of it, which makes them less vital.

3. Metabolic alterations can be produced that are transmitted to the fetus, which may have a lower heart rate and require a much stricter control of babies.

For all these reasons, a control is carried out that allows us to know the glucose figures of the mother in pregnancy and to detect any incidence early and to distinguish if there is a prior hidden diabetes before pregnancy or if, on the contrary, it appears during pregnancy. gestation.

In general, to know which pregnancies may present this problem, one or more glucose overload tests are done. The basic test is called O 'Sullivan test or "test of the hour", which is usually done between week 24 and 28 of pregnancy and consists of giving a glucose dose of 50 grams fasting and make a glucose determination basal (that is to say nothing else to take the preparation) and another determination of glucose in blood after one hour.

When are glucose tests done during pregnancy?

As we have said, in a normal situation it is carried out in those weeks of pregnancy, but it can be anticipated and done in the first trimester in cases that are considered risky, either because there are family factors -such as diabetes in parents or siblings-, or either because the body mass index - the measure used to know the degree of overweight - is high, or if in previous pregnancies there has already been gestational diabetes.

The fact of having had gestational diabetes previously does not mean that in the next one it has to be repeated, although it is estimated that the recurrence is 40%.

If the test gives a blood glucose figure at the time of 140 mg / dL or higher, a second test is performed, in which the glucose dose is increased to 100 grams and the measurements are made on an empty stomach, before the take glucose at the time, at two hours and three hours. In this case, the fasting blood glucose should be below 105mg / Dl, the determination at the time must be below 190mg / DL, at two hours below 165 mg / DL and at three hours below 140 mg / DL.

We should not be scared and our gynecologist is the one who should tell us how things are and the measures that must be taken to have everything under control.

Control measures for glucose in pregnancy

In the event that there are two values above these figures, it is considered that the pregnant woman has gestational diabetes and will have to follow a specific treatment and, if there is only one value altered, what is called a glucose intolerance appears. In those cases the tests are repeated at three weeks to see the evolution.

If in this third test, after three weeks, the curve is normal or there is only one value altered, it indicates that we are dealing with a case of glucose intolerance during pregnancy and the prevention of associated problems is done only through dietary measures, which they consist, fundamentally, of:

- Eliminate glucose from the diet:
- Sugar is replaced by sweeteners
- Sweetened drinks, industrial pastries and sweets are eliminated
- Precooked food is also eliminated

During this stage, dietary control is accompanied by regular blood glucose checks before and after meals, but it is the doctor who must establish the frequency.
- Reduce the intake of calories, which should be distributed throughout the day in three main meals and some snacks. With which it will be necessary to be a little more aware of the meals that there is to do and take care that they do not have added sugar.
- Perform soft exercise, such as walking an hour 4 or 5 days a week or as long as possible depending on the physical situation.

In most cases, these measures will be enough to control gestational diabetes. Therefore, do not be scared: with a good follow-up, gestational diabetes is handled perfectly.

However, there will be cases in which blood glucose can not be adequately controlled with these measures and insulin treatment will be needed. The dose will be adjusted according to the glycemia controls that are made during pregnancy. Although this may seem very complicated, because of the experience you have, women often learn to control blood glucose levels and, depending on that, to adjust the insulin dose.
If the woman already had diabetes before pregnancy, she should continue with the same controls she had before and see if there is a need to adjust the insulin dose.

Diabetes at the time of delivery

For both gestational and pregestational diabetes, the baby's controls will be stricter during the rest of the pregnancy and high resolution ultrasounds will be performed for a strict fetal control of the size, estimated weight and development of the organs in the last phase of pregnancy .
Depending on the development of the baby and the control of maternal glycemia, the time and manner of finalizing the pregnancy will be decided. Whenever possible, one should try to reach a term because, although these children are large in size and weight, they may be more immature after birth.

Likewise, if possible, you should try a vaginal delivery, but considering that they are large babies, which can make it difficult to deliver.

After giving birth, the mother should continue to perform glucose checks and in most cases will have normalized a few days after delivery.

Dr. José Luis Prieto. Gynecology and Obstetrics Service of the Hospital Nuestra Señora del Rosario, Madrid.