Gestational diabetes (DG) is the number one metabolic complication during pregnancy, with an incidence of 7% in our country and a worrying trend since, according to statistics, it has had an average increase of 32% in recent years. The ideal is to do everything possible to prevent it from before pregnancy, but if the pregnancy is already in progress, keep in mind the precautions that we mention below so that the problem does not get out of control.
What is DG?
It is a specific type of diabetes that can only occur in pregnant women. By definition, it implies an abnormal accumulation of glucose or sugar in the blood, among other alterations, and usually disappears during the puerperium.
Its causes are not entirely known, but experts believe that during pregnancy the placenta produces certain hormones (estrogen, cortisol, and lactogen) that could block the work of insulin (the hormone that is secreted by the pancreas to regulate the level of blood glucose. and thus control the rate at which it is consumed by muscle cells, fat tissue and liver). Normally, the pancreas responds to the effect of these hormones with additional insulin production, but this does not always occur and this is when DG develops.
Problems it can cause
When left untreated, DG affects the health of the woman and the baby she expects. It makes her more susceptible to infections in the urinary tract and to presenting pre-eclampsia, a condition characterized by high blood pressure and fluid retention, among other symptoms, which is potentially dangerous for both maternal life and that of the developing baby. So when it occurs, doctors often terminate the pregnancy.
For their part, babies of mothers with DG can: grow excessively and be born with more than four kilos of weight (macrosomia), which complicates labor and demands more effort from the mother; being born with a pulmonary deficiency that merits their admission to intensive care, until they breathe on their own; suffer hypoglycemia, that is, a drastic drop in your blood glucose levels during birth, with the consequent danger of seizures, and develop jaundice, an excess in the secretion of the hormone bilirubin by the liver, which is easy to remedy, but it can be risky.
How to control it?
Diet. There is no standard diet for DG, so your doctor, supported by a nutritionist, should design an individual regimen based on your weight, height, stage of pregnancy, and laboratory results. In general, your calorie intake should come from 40% to 60%, from complex carbohydrates or slow absorption (whole grains and fruits); 20% to 25%, of proteins (red meat, poultry, fish, milk and derivatives, egg); and 25% to 35%, from unsaturated fats, such as edible olive, sunflower, corn, avocado, walnut, almond, hazelnut, and omega 3 fatty acid oils, available in bluefish. Another guideline is to make three main meals and have two to three snacks that can consist of yogurt, low-fat cheese, fruit or vegetables.
The ideal daily caloric distribution is: 15% at breakfast, 5% at lunch, 30% at lunch, 5% at mid-afternoon snack, 40% at dinner and 5% at night snack. Discard simple or fast-absorbing carbohydrates (they suddenly raise your blood glucose level): sugar and all the products added with it (sweets, chocolates, pastry creams, desserts, ketchup, soft drinks, ice creams, flavored milks, jams, syrups, honey).
Exercise. Exercising will help you to suppress insulin injections and/or the use of anti-diabetic medications, or to reduce the dose as much as possible (it is always good to avoid medicines in pregnancy). In addition, you will reduce your chance of developing type 2 diabetes in the future. Prefer routines that do not involve uterine activity and do use upper body muscles, or just walk for half an hour each day.
Glucose monitoring. Every day you should measure your blood glucose with an easy-to-use glucometer that does not require calibration (to provide accurate results) and that draws a minimum blood sample. Daily monitoring will allow you to observe the adequate control of diabetes, it will involve you more in your treatment, allowing you to detect moments of lack of control (hypoglycemia or hyperglycemia) to make the necessary corrections, either to your diet or level of physical activity, so timely. Your goal should record these values: fasting, less than 95 mg / dL; one hour after eating, less than 140 mg / dL; and two hours after eating, less than 120 mg / dL.
Medical checks
• The appropriate interval between visits is generally every 2-3 weeks up to week 34 and every 1-2 thereafter.
• Between weeks 29 and 33, the doctor measures the fetal abdominal circumference to determine if there is macrosomia (excessive fetal growth). If so, insulin treatment is started.
• Hospitalization is necessary when there are significant repercussions on the mother or fetus (poor metabolic control, severe hypertension or kidney problems, threats of preterm delivery, pyelonephritis…).