Online consultation on diabetes and pregnancy
Gestational diabetes means a violation of carbohydrate metabolism - that is, a woman has an increased level of sugar in her blood. Causes of gestational diabetes? The development is often attributed to excessive consumption of sugary foods and a change in a woman's hormonal profile.
The function of insulin is affected by the growing placenta producing hormones that in some cases do not keep the sugar level in the bloodstream at standard values. The child then grows unnaturally fast and has a higher birth weight and larger organs, which can affect the child's development after birth.
The symptoms of gestational diabetes are not clear cut. It can cause more frequent urination.
The examination of gestational diabetes takes place between the 24th and 28th week of pregnancy. The examination is called an oral glucose tolerance test (oGTT).
Your most frequent questions are answered by MUDr. Radka Bažantová:
1. Your question:
Do you recommend watching my diet before the oGTT (oral glucose tolerance test) for example for a week or can I eat normally for the whole time?
MD Radka Bažantová: At least three days before the oGTT examination, it is desirable that you have your usual eating habits (do not limit the intake of carbohydrates), it is also generally recommended to exclude increased physical exertion the day before the test.
2. Your question:
Are babies born bigger with diabetes?
MD Radka Bažantová : If diabetes is adequately treated (regular checks of glycemic values are within the normal range), babies are of "normal" size. Macrosomia (baby's birth weight over 4000 g) is the result of repeatedly increased sugar (glucose) levels in the mother's blood. Glucose freely passes through the placenta into the baby's bloodstream, which reacts with an increased production of its own insulin. The baby therefore has an excessive amount of energy (from glucose) and an increased level of insulin, which has a growth effect. Thanks to this, the baby grows faster and gains weight.
3. Your question:
The baby had hypoglycemia after birth, can this have consequences in the future?
MD Radka Bažantová : Here it depends on the circumstances, especially how severe and long-term the hypoglycemia was. A baby can develop without any consequences. In general, however, there are increased risks of neuropsychological development, which can be manifested by attention disorders and hyperactivity of the child. In the future, there may be a higher tendency to obesity, type 2 diabetes...but this can be influenced by guiding the child to a rational diet and regular exercise :-).
4. Your question:
Before pregnancy, my fasting glucose values were higher (5.9 mmol/l). Should I expect problems during pregnancy?
MD Radka Bažantová: If a certain disorder of glucose tolerance appears before pregnancy, the risk of developing gestational diabetes is higher. I would follow a rational diet (limit refined sugars) and maintain regular exercise, just walking in the fresh air :-).
5. Your question:
I have nausea in the 1st trimester, I only eat pastries, sweets, etc. Before pregnancy, I ate rather low-carb. Is there a high risk of gestational diabetes? I also have to eat more often than before when I only ate 3 times a day.
MD Radka Bažantová: Here I would advise listening to your body. I would definitely not stress about the fact that you are now eating more carbohydrates than you used to 🙏🏼.
Risk factors for the development of gestational diabetes are age (over 30 years), occurrence of diabetes in the family, or if you yourself had gestational diabetes or elevated fasting blood glucose in a previous pregnancy. Other risk factors are overweight or obesity and a diet rich in foods with a high glycemic index.
Pregnancy is a great stress situation for the organism. Try to include some movement in the fresh air :-). I would also add that dividing the food into several portions per day is, on the contrary, beneficial.
6. Your question:
I didn't pass the oGTT stress test, then the doctor in the dia consultation called me off due to low long-term sugar – 28 mmol/mol. My fasting blood sugar was 5.2 mmol/l and the second time was 5.1 mmol/l. So I don't follow a diet, but I try to eat healthy. Do you think it's OK?
MD Radka Bažantová : Glycated hemoglobin (long sugar) reflects glycemic values in the last 3 months. You have it all right. I would continue to eat rationally, I would also add regular exercise. If there were any other doubts, your gynecologist would then take blood and solve the situation.
7. Your question:
How common is gestational diabetes?
MD Radka Bažantová : Gestational diabetes is detected in approximately every 10th pregnancy.
8. Your question:
Is it necessary to undergo an oGTT? It was stressful for me in my first pregnancy.
MD Radka Bažantová : I am very sorry that you had such a bad experience. However, an oGTT needs to be done. In most cases, gestational diabetes does not appear until the second half of pregnancy, when there is a high level of pregnancy hormones acting against insulin. You yourself do not recognize the problem and the risk of complications is high, for you and the baby, with unrecognized gestational diabetes.
9. Your question:
Should I have a follow-up oGTT half a year after giving birth if I am fully and heavily breastfeeding? Or should I wait until after breastfeeding?
MD Radka Bažantová : If you are fully breastfeeding, the oGTT should be postponed until it can be performed without breastfeeding (before the test and during the test).
10. Your question:
How to reduce sugar? I follow a healthy diet and exercise enough. Can higher sugar negatively affect the baby?
MD Radka Bažantová : If there is an increase in blood sugar (gestational diabetes), you need to be taken care of by a specialist – a diabetologist. It is important to follow a rational diet with carbohydrate restriction, regular exercise and regular control of blood glucose levels, in most cases this regime is sufficient. If this is not enough, therapy should be included. A long-term increase in blood sugar can negatively affect the baby. Glucose (sugar) freely passes through the placenta into the baby's bloodstream, which responds by increasing its own insulin production. The baby therefore has an excessive amount of energy (from glucose) and an increased level of insulin, which has a growth effect. Thanks to this, the baby grows faster and gains weight (the baby's birth weight is over 4000 g), which can complicate childbirth. A baby grows quickly, but organ development may lag behind - especially the lungs. There is also a risk of hypoglycemia (low blood sugar) in the baby after birth.
Many thanks to MUDr. Councilor Bažantová for exhaustive answers. You can look forward to the next online consultation (on Polycystic Ovary Syndrome) with the doctor at the usual time, on Thursday 14 November 2021 from 5-7 pm on our Instagram.