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Gestational diabetes - what's important to know

The problem, which affects between 3% and 25% of women, usually appears after the second trimester of pregnancy; Healthy eating is the best prevention

It is known that diabetes happens when the pancreas is unable to produce enough of the hormone called insulin or when this hormone is unable to act satisfactorily. But when this happens for the first time during pregnancy, the condition is called gestational and usually develops in the second half of pregnancy.

According to the Brazilian Society of Diabetes (SBD), during pregnancy there are adaptations in maternal hormone production to allow the baby to develop. The placenta is an important source of hormones that reduce the action of insulin, which is responsible for the uptake and utilization of glucose by the body. The pancreas consequently increases insulin production to compensate for this resistance to its action.

In some women, however, this process does not occur and they develop gestational characterized by an increase in the level of glucose in the blood. When the baby is exposed to large amounts of glucose while still in the womb, there is a greater risk of excessive fetal growth (fetal macrosomia) and, with this, traumatic births, neonatal hypoglycemia and even obesity and diabetes in adulthood.

As it rarely presents symptoms, it is necessary to carry out regular tests to detect the condition from the 24th week (beginning of the 6th month). The most common tests are fasting glucose and the oral glucose tolerance test (OGTT). When symptoms appear, the most common are increased thirst and hunger, increased urination and blurred vision.

Treatment

According to Dr. Lenita Zajdenverg, an endocrinologist and nutritionist responsible for monitoring pregnant women with pregnant women at the Maternity School Hospital of the Federal University of Rio de Janeiro (in an interview with the website www.bebe.abril.com.br), only 20% of women with gestational insulin, which is a safe treatment and doesn't affect either the mother or the baby. Depending on the degree of the problem, if sugar levels are little altered, diet may be the only form of treatment. "Most women who have gestational can control their sugar levels with diet alone and, if there are no contraindications, with physical activity," she explains.

What are the risks for the baby?

In an interview, Paulo Nader, president of the Neonatology Department of the Brazilian Society of Pediatrics, says that two thirds of the mother's sugar goes to the baby. In addition, the insulin produced to process the blood also promotes the growth of certain organs and tissues. "In this way, high levels of this substance will directly interfere with the development of the fetus, which can become a baby with an above-average size.

Nutritional therapy and prevention

A successful prevention strategy is to adopt a healthy diet and engage in regular physical activity.

According to the SBD, pregnant women diagnosed with diabetes should receive individualized dietary guidance and the diet should contain the essential nutrients for the baby's proper development, taking into account the body mass index (BMI), the frequency and intensity of physical exercise, the fetal growth pattern and aiming for adequate weight gain.

According to the Institute of Medicine, 2009, the expected weight gain during pregnancy should take into account the pre-pregnancy BMI, as shown in the table below:

Diabetes type 2 diabetes (DM2) after gestational gestational

According to endocrinologist Josiane Cristine Melchioretto Detsch, in an interview on the Centro de Diabetes Curitiba, women with a history of gestational diabetes have an increased risk of developing type after giving birth, on average a risk of 20 to 40% over a period of ten to 20 years.

Still according to the doctor, there are other risk factors for the onset of DM2 after childbirth: early onset of diabetes in pregnancy (before 24 weeks), use of high doses of insulin during pregnancy, excessive weight gain during pregnancy and a family history of diabetes.

"Reclassification of maternal glycemic status should be carried out six weeks after delivery, with a new oral glucose tolerance test. Women with altered fasting glucose or glucose intolerance should be retested for diabetes test every year. These patients should receive advice on lifestyle changes and be placed on an individualized exercise program, due to the high risk of developing type type 2 diabetes," he explains.


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References:

https://www.diabetes.org.br/publico/diabetes-gestacional
https://www.diabetes.org.br/profissionais/images/pdf/diabetes-gestacional/002-Diretrizes-SBD-Diabetes-Gestacao-pg323.pdf
https://www.diabetes.org.br/profissionais/images/pdf/diabetes-gestacional/001-Diretrizes-SBD-Diabetes-Gestacional-pg192.pdf
https://www.minhavida.com.br/saude/temas/diabetes-gestacional
https://bebe.abril.com.br/gravidez/20-questoes-sobre-o-diabete-gestacional/
http://www.centrodediabetescuritiba.com.br/artigos/diabetes-gestacional-e-o-risco-futuro-de-diabetes-tipo-2/

Institute of Medicine, National Research Council. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: The National Academies Press; 2009.

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