In this article we explore how this condition occurs, its implications for health, and as a può be prevented and treated
gestational diabetes, or gestational diabetes mellitus (DMG) is a disease, and represents a growing public health problem that usually occurs in the second halfà of pregnancy.1
When a woman has the DMG, its levels of glucose (sugar) in the blood are raised beyond the norm. Normally, l’the hormone insulin reduces the amount; of glucose in the blood, for example by helping the glucose to enter the cells of muscle, liver and adipose tissue.
During pregnancy, there is a greater needà of insulin, but the hormonal changes can make cells less responsive to’insulin. Usually, when the blood glucose levels rise, the pancreas secretes more insulin.
However, when the pancreas can produce enough insulin to help control blood glucose levels, develops a ‘glucose intolerance’ s, which increases during pregnancy; this is called a DMG.
Implications for medical
The DMG può have the implications of care for the mother and the child. The glucose passes through the placenta and it promotes excessive growth of the fetus.
The macrosomia is a medical condition in which children are the più large with respect to the’età gestational, that is; a typical weight at birth of around 4-4,5 kg, può bring to a complicated delivery, including the dystocia of the shoulder (when the shoulder of the child hangs behind l’pubic bone during birth) and morbidityà related to the birth.2
The DMG is also associated with an increased risk of pre-eclampsia, which canò be deadly if left untreated.3
mothers with DMG are più at risk of developing diabetes later in their life. Although the diabetes usually steps after the birth of the child, the più of the 50% of the women who had the DMG svilupperà the diabetes within 5-10 years after childbirth.4
in Addition, children born to women with DMG will have a greater risk of becoming overweight and develop obesityà and type 2 diabetes in their life.4
If identified in time, the risk of these complications can be reduced through lifestyle interventions.
The prevalence of the DMG varies across european populations, with a range between 1.7% and 11.6%, with rates più high in southern Europe compared to the north and the centre.5
The following factors can increase the risk of a woman developing the DMG:6,7
- with a body mass index greater than 30 kg/m2(obesityà),
- a previous pregnancy with a DGM or a child macrosomico,
- a first-degree relative with diabetes,
- to be of a certain etnicità e.g. the south of’Asia, the Caribbean, or the Middle east.6,7
screening for the DMG is inconsistent in Europe. L’World Organization of the Sanità (WHO) recommended a glucose tolerance test (oral glucose tolerance test, OGTT) to 24–28 weeks for all women with risk factors for gestational diabetes (or a level of plasma glucose in the fasting or casual abnormal).8
In the’ OGTT, the blood is analyzed for fasting blood glucose and two hours after ingesting a sugary drink, usually containing 75 grams of glucose.
L–WHO has recently recommended that the diagnosis of DMG should be performed on the basis of the following values3:
- Levels of fasting blood glucose between 5.1-6.9 mmol/l, mg/dl≥92
- 1 hour after a glucose load of 75 grams, a level of blood glucose ≥10 mmol/l, mg/dl≥180
- 2 hours after a glucose load of 75 grams, a level of glucose levels of 8.5-11 mmol/l mg/dl≥153
Prevention and treatment
There are some ‘modifiable risk factors’ s (the ones that can be controlled) that can help reduce the risk of DMG.
These include l’have a healthy weight before you become pregnant, be physically active and eat a healthy diet, balanced, which includes lots of cereals, lean proteins, oily fish and polyunsaturated and monounsaturated fats in balance.7,9
L’intake of foods and drinks high in the glycemic index (IG) should be kept to a minimum level.
once the DMG has been confirmed by an OGTT, ideally, referral to a dietician would be the first treatment strategy.
While changes in the diet and in the’exercise can help improve the condition, an estimate of 70% of women will requireà additional treatment such as oral agents hypoglycemic or insulin injections.7 women with DMG are usually followed by the professionals of the sanità on how to self-monitor their blood glucose levels.
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- Derbyshire E (2011). Special Cases (pp. 218-240). In Derbyshire E (ed.) Nutrition in the childbearing years. Chichester, UK: John Wiley & Sons.
- Young BC & Ecker JL (2013). Fetalmacrosomia and shoulder dystocia in women with gestational diabetes: risks amenable to treatment? Current Diabetes Reports 13(1): 12018.
- WHO (2013). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy. Geneva, Switzerland: WHO.
- International Diabetes Federation website, Gestational diabetes section.
- Schneider S, Bock C, Wetzel M et al. (2012).The prevalence of gestational diabetes in advanced economies. Journal of Perinatal Medicine 40(5): 511-520.
- International Diabetes Federation website, Risk factors section.
- National Institute for Health Care Excellence (NICE) (2015). Diabetes in pregnancy. Management of diabetes and its complications from preconception to the postnatal period. NICE guideline 3.
- WHO (1999). WHO Consultation: Definition, diagnosis and classification of diabetes mellitus and its complications: Report of a WHO Consultation. Part I: Diagnosis and classification of diabetes mellitus. WHO/NCD/NCS/99.2. Geneva, Switzerland: WHO.
- Zhang C &Ning Y (2011). Effect of dietary and lifestyle factors on the risk of gestational diabetes: review of epidemiologic evidence. American Journal of Clinical Nutrition 94(6 Suppl):1975S-1979S.
1 maggio 2015