Where does gestational diabetes come from?
Underlying gestational diabetes is the phenomenon insulin resistance (among others, as a result of diabetogenic effects of pregnancy hormones, or increased availability of glucose needed for fetal development), i.e. reduced sensitivity of the body's cells (in this case mother's) to this hormone. Its effect is compensatory increase in insulin production, which in some cases may be insufficient, which in turn can lead to a collapse of the carbohydrate balance of the body (in pregnant women this is manifested by an uncontrolled increase in glucose, which leads to the development of GDM). The occurrence of insulin resistance, and thus the development of gestational diabetes, is favored by certain factors, including:
- Gestational diabetes in previous pregnancies - the first episode of GDM is about 5 to 10 percent pregnant. Of these, up to 30 percent will experience a recurrence of diabetes in their next pregnancy.
- Birth in a previous pregnancy of a child with a malformation or body weight exceeding 4 kg - it may be evidence of undiagnosed GDM.
- Family history of type 2 diabetes - significantly increases the risk of GDM as well as type 2 diabetes not related to pregnancy.
- Age over 35 years - age is an independent risk factor for gestational diabetes as well as diabetes with unbound pregnancy.
- BMI over 27 kg / m2 before pregnancy - overweight and obesity increase the body's insulin resistance.
Complications of gestational diabetes, or why GDM should always be treated?
As we have already mentioned, untreated carbohydrate disorders are particularly dangerous for the fetus because they can cause, among others:
- macrosomia - fetal macrosomia is a condition when the baby's weight is too high in relation to his gestational age (above 4,000 grams on the day of delivery). This may result in difficulties during childbirth, perinatal injuries to the baby and mother, and the need for a Caesarean section.
- Postpartum hypoglycemia - excessive pregnancy stimulation of the toddler's pancreas (the result of continuous high blood glucose in the mother and thus the fetus) can lead to episodes of hypoglycaemia that occur after delivery.
- Increased likelihood of overweight, obesity or type 2 diabetes later in life - children of mothers who have undergone GDM (especially if untreated or under-treated) have an increased risk of the abovementioned disorders.
- Birth defects - the increased likelihood of their occurrence concerns the children of mothers who had diabetes before pregnancy (GDM does not increase this probability).
Treatment of gestational diabetes - diet or also insulin therapy?
Gestational diabetes can be treated with a diet, but if it turned out to be ineffective or ineffective (control after 5-7 days of dietary treatment - fasting glucose determination), it is necessary to start insulin therapy, which should be continued throughout pregnancy.
Diet of women suffering from GDM - basic assumptions
The diet of a pregnant woman who has GDM should be based on several assumptions. These include:
- The caloric content of the diet depends on the weight, period of pregnancy and level of physical activity - on average, for women with a BMI within the norm it should be about 35 kcal / kg (on average from 1800 kcal at the beginning of pregnancy to about 2400 kcal in the third trimester).
- The amount of carbohydrates at 40-45% of daily caloric demand - complex carbohydrates (vegetables or whole wheat bread) are most recommended. Simple sugars derived, for example, from sweets should be avoided.
- The amount of protein is 20-30% of the daily caloric demand - full-value proteins containing a set of amino acids (animal proteins) will work best here.
- The amount of fat is 20-30% of the daily caloric demand - polyunsaturated fats (also called omega acids) should prevail. They can be found in vegetable oils and seafood.
Daily food ration spread over 6 meals - the last meal, containing about 25 grams of complex carbohydrates (example one slice of bread), should be consumed about an hour before falling asleep.
To sum up, GDM is a very dangerous disease for the unborn child and hence, it should be actively explored and effectively treated throughout the pregnancy.