Diabetes Mellitus is known as high blood sugar levels and is one of the most common diseases during pregnancy. While diabetes is present before pregnancy in about 0.5% of pregnancies, it occurs during pregnancy in about 4-5%. People with diabetes should be under close control when they decide to become pregnant. Having normal blood sugar levels will reduce the rate of congenital anomalies that may develop in the baby to normal levels (1-2%). The rate of congenital anomalies in the babies of women whose blood sugar levels are high during early pregnancy is about 4-5%.

Why does the risk of diabetes increase during pregnancy?

During pregnancy, major changes occur in a woman's hormonal balance. Especially in the second half of pregnancy, the secretion of diabetogenic hormones that make it difficult for the body to use sugar increases. The most important of these hormones is the "human placental lactogen" hormone. In addition, estrogen, progesterone, cortisol and prolactin hormones also contribute to this effect. The purpose of this change is to meet the baby's increasing growth and energy needs, especially in the second half of pregnancy. Sugar that the mother cannot use will be transferred to the baby. When these natural changes combine with the person's predispositions and increase, gestational diabetes occurs.

Who has an increased risk of gestational diabetes?

Over the age of 25, with a family history of diabetes, weighing more than normal (obese), previously weighing 4000 g. Pregnant women who have given birth to more than one baby, have gestational diabetes in a previous pregnancy, and have a bad pregnancy history such as miscarriage and baby death in the womb are in the high-risk group.

What risks does having diabetes during pregnancy pose?

These risks can be grouped under 3 headings: risks to the mother, the unborn baby (fetus) and the newborn baby.

1. Negative effects on the mother:

a. There is an increase in diabetic coma and related problems in the mother.

b. It has a damaging effect on the cardiovascular system, kidneys, eyes and nervous system.

c. The risk of infectious diseases (urinary tract infections, etc.) increases in the mother.

D. Pregnancy hypertension, the rate of cesarean delivery, injury to the baby during birth, and puerperal infections in the mother increase.

2. Negative effects on the unborn baby:

a. Especially the first in the first three months of pregnancy The anomaly rate increases in pregnancies with high blood sugar levels. These anomalies, in order of frequency, are cardiovascular anomalies, cerebrospinal system anomalies, gastrointestinal system anomalies, skeletal system anomalies and renal-urinary tract anomalies, etc. can be counted as.

b. The risk of miscarriage has increased.

c. Failure in the baby's development in the womb may occur.

d. Early birth The risk has increased.

to. The baby may die suddenly in the womb.

3. Negative effects on the newborn baby:

a. Since the lung maturation of these babies is slightly delayed, the risk of respiratory distress in the neonatal period is high.

b. Jaundice (hyperbilirubinemia), low blood sugar (hypoglycemia), electrolyte disorders (hypocalcemia, hyponatremia) are common.

c. The risk of overweight (macrosomia) and underweight is increased in these babies.

D. Babies who are overweight have a higher risk of injury at birth.

High blood sugar in the mother causes the baby to become overweight.

How is the diagnosis made?

The most important symptoms of diabetes are drinking too much water, eating too much and urinating too much. Additionally, when blood sugar levels drop, tremors, blurred vision, weakness, feeling of hunger, irritability, palpitations, nausea and headache are observed. Weight loss, sugar in the urine and diabetic coma are other symptoms. A person's fasting blood sugar level above 126 mg/dl allows a diagnosis of diabetes to be made. This applies both before and during pregnancy.

In women who do not have diabetes before pregnancy, the 24th-28th week of pregnancy. A screening test is performed between weeks. In this test, the woman is given water containing 50 grams of sugar and her blood sugar is checked 1 hour later. Women with blood sugar levels above 140 mg/dl are considered high risk and 100 grams of blood sugar is required for definitive diagnosis. A sugar loading test is performed. In this test, the woman's fasting blood sugar is first checked and 100 grams is measured. Drink water containing sugar. Blood sugar is checked 1,2, 3 and 2 hours after drinking the liquid. If XNUMX of these four values ​​are found to be higher than normal, gestational diabetes is diagnosed.

How is it treated?

1. Those with pre-gestational diabetes should regulate and control their sugar levels before getting pregnant. This will require diet and insulin therapy.

2. Women with gestational diabetes should first try to control their blood sugar with a diet specially prepared for them. The aim here is to keep fasting blood sugar levels below 95-100 mg/dl and 1st hour post-meal sugar levels below 140 mg/dl. In addition to diet, these people are recommended to walk and exercise every day to increase the body's sugar consumption. Insulin treatment is started in pregnant women whose blood sugar cannot be controlled with diet and exercise. These pregnant women are in the high-risk group. For this reason, it is closer than other pregnant women. they must be followed. In these pregnant women, the HbA1C test, which shows the general course of blood sugar, should be checked at regular intervals.

Along with routine pregnancy tests, women with pre-gestational diabetes should be tested at 19-20 weeks, as the risk of heart anomalies is high. Fetal echocardiography should be performed during the gestational weeks. Pregnant women who are evaluated once a month until the 28th week of pregnancy should be evaluated once a week until the 36th week and then twice a week. Patients whose blood sugar levels cannot be controlled should be hospitalized and blood sugar adjustments should be made. Evaluation methods such as non-stress test and Doppler ultrasonography should be used. In pregnant women who do not experience spontaneous labor pain, artificial pain can be applied for birth after completing the 39th week of pregnancy. If the estimated weight of the baby is 4000 g. If it is above XNUMX%, cesarean section should be preferred as the method of birth. Because in the vaginal birth of these babies, the risk of damage to the baby is high.

Although pregnancies with diabetes are high-risk pregnancies, if they are monitored regularly and their blood sugar levels remain at normal levels, they can have a completely normal pregnancy and have a healthy baby.