personal notes and reflections of the dr. Claudio
Italiano
We remind our kind sailors that the information on this page is only for scientific information about the problem of gestational diabetes. If the pregnant woman has found by chance that her blood sugar levels, after or before meals, have increased, as explained below, she must immediately contact her doctor, obstetrician-gynecologist and the diabetologist for the treatments to be carried out. Remember that under no circumstances can you practice or practice diets following our instructions, especially during pregnancy! Gestational diabetes may also occur in non-diabetic women in the second trimester of pregnancy and ends with childbirth, affecting up to 7% of women, with greater risk of developing hypertension and therefore fetal mortality and morbidity.
We remind our kind sailors that the information on this page is only for scientific information about the problem of gestational diabetes. If the pregnant woman has found by chance that her blood sugar levels, after or before meals, have increased, as explained below, she must immediately contact her doctor, obstetrician-gynecologist and the diabetologist for the treatments to be carried out. Remember that under no circumstances can you practice or practice diets following our instructions, especially during pregnancy! Gestational diabetes may also occur in non-diabetic women in the second trimester of pregnancy and ends with childbirth, affecting up to 7% of women, with greater risk of developing hypertension and therefore fetal mortality and morbidity.
It's performed using OGTT at the 24th-28th week
Blood sugar and glucose concentration threshold values
FGP (ie fasting plasma glucose) <92 mg / dl
after 1 hr PG up to 180mg / dl but the target is <140 mg / dl
after 2 hr PG <153 mg / dl but the target is <120 mg / dl
Glucose load.- it is recommended to administer 100 grams of anhydrous glucose dissolved in 300 ml of water.
If these values are disregarded, treatment with diet and, if necessary, with
insulin should be instituted as soon as possible; after delivery, the woman
should be followed because she can develop diabetes.
Which women can develop gestational diabetes?
There are women who are constitutionally predisposed:
The incidence of gestational diabetes (4-6% of pregnancies) increases:
- with age,
- with overweight at the beginning of pregnancy,
- with a familiarity with diabetes and previous pregnancies with gestational
diabetes.
- A previous pregnancy without gestational diabetes does not protect against the risk of developing it
Gestational diabetes is manifested because the placenta, which we know is the
organ that allows the child to relate with the mother and to exchange the
respiratory gases and nutrients, secretes hormonal substances that go to
counteract the action of insulin produced normally from our pancreas: this
abnormal behavior causes an increase in blood sugar. Our body, to cope with the
sudden hyperglycemia, increases the production of insulin but it is not enough.
However, the opposite is also true; in fact, nature has caused the placenta,
during pregnancy, to produce the placental lactogen that works in the opposite
direction. A large number of growth factors have shown increased beta cell
proliferation, mass and their function. Growth factors include placental
lactogen hormone (PL), growth hormone (GH) and prolactin (PRL), which belong to
a family of homologous polypeptide hormones and common to different primate
species to teleostal fish. . PL is produced by the placenta exclusively during
pregnancy and is the main factor responsible for increasing the mass of the
pancreatic islets and their function. PL exerts a greater mitogenic activity on
pancreatic beta cells than GH and PRL, therefore, it could have a potential role
in the survival and function of islands before and / or after transplantation.
Our interest has turned to the possible biological role of hPL-A hormone in cell
differentiation.
It's highly specialized and makes use of the combined counseling of the
gynecologist and the diabetologist.
We start with only diet and moderate exercise, consistent with the conditions of women. It's very important for pregnant
women to walk 30 to 60 minutes, at least 3 times a week so as not to gain weight
and to control blood sugar levels. The diet should favor the intake of fiber (cereals,
these unknown nobility) and proteins, indeed it must be slightly hyper-protein (eggs,
milk, yogurt and cheese: nutritional value) limiting instead the intake of
carbohydrates, lipids, and carbohydrates. The saturated fats must be reduced to
the maximum and the sugary fruit and vegetables are preferred, avoiding the most
chemicals. The rapidly absorbing sugar must be avoided in all its forms (sweets,
honey, jams, sugary drinks, etc.). Even foods labeled "sugar free" will have to
be temporarily eliminated, as they still contain sugar substitutes not indicated
during pregnancy.
Alcohol and smoking should also be avoided and adequate hydration preferred. It is important to perform a careful home glycemic
self-control because in some cases the future mother must resort to the help of
insulin therapy: insulin, in fact, is one of the few drugs without
contraindications during pregnancy, preferring medication to meals with similar
fast insulins ; in particular it would seem that novorapid is the first
analogous insulin to be used according to studies in women with type 1 diabetes.
It also compares the management of diabetes during pregnancy. The trial, which
involved 322 women with type 1 diabetes in pregnancy that lasted more than 4
years, showed that this insulin significantly improves postprandial glycemic
control in the first and third trimesters when compared to human insulin. The
risk of major episodes of hypoglycaemia was 28% lower for patients treated with
Rapid insulin compared to human insulin. The risk of major episodes (nocturnal and
diurnal) of hypoglycaemia was 52% and 15% lower respectively with Rapid Insulin than
with human insulin. When compared to human insulin, the rapid insulin trial has
shown better results for both the mother and the baby:
- Less premature parts (p <0.053)
- Reduced risk of neonatal hypoglycemia requiring treatment
- Less significant hypoglycaemia (in 24 hours, at night and during the day)
- Lower risks for the fetus, with results overlapping at least those obtained
from human insulin.
Diabetes is still a serious problem for many women who want to become mothers.
Historically, the results of pregnancies in diabetic women have been poor. The
population studied shows that the children of women with diabetes 1 continue to
have a higher risk of perinatal death and greater congenital anomalies than the
general population. In the absence of interventions it is probable that a fetal macrosomia will occur. The fetus will have an abdominal circumference and a
weight exceeding the norm (> 4.0 kg) and this can be associated with major
problems or risks at the time of delivery. For example, dislocations of the
unborn child's shoulder during birth can occur, polydramnios (abnormal increase
in amniotic fluid) in the last weeks of gestation and a greater incidence of
caesarean sections.
Gestational diabetes "disappears" a few hours after delivery
but in the absence of interventions, 90% of women with gestational diabetes
develop true type 2 diabetes within 20 years of pregnancy; of these, 20% already
within two or three years. Gestational diabetes should induce women to improve
their lifestyle and undergo frequent checks.