Gestational Diabetes Mellitus

The increase of blood sugar levels during pregnancy shows the development of gestational diabetes mellitus. Gestational diabetes can be explained as a violation of carbohydrate metabolism that occurs in the second half of pregnancy. Its peculiarity lies in the fact that after delivery it goes away in most cases, although, some women are not excluded of its transition to type 2 diabetes and very rarely to type 1 diabetes. Gestational diabetes is a risk factor for the development of a large fetus that makes it difficult to go through the birth canal. It may result in birth trauma of the fetus and the mother, and even the danger of a child’s death. Therefore, it is sometimes necessary to resort to caesarean section. It is also possible that metabolic disorders might develop in newborns. However, a child’s risk of malformations of individual organs is low, since diabetes almost always develops in the second half of pregnancy, and all the organs of a fetus are laid in the first half of pregnancy. The current study aims to prove that pregnant women with gestational diabetes require special attention from the doctors and should stay under the supervision of an obstetrician-gynecologist.

Pathophysiology

During pregnancy, the placenta, as ripening, gradually increases insulin resistance. The main role in this process is played by placental and mother’s hormones (cortisol, estrogen, and prolactin), whose concentration in blood also increases with gestational age. This process is compensated by an increase in production and a decrease in clearance of endogenous insulin of a mother. Insulin resistance is exacerbated by an increased amount of food, reduced physical activity, and weight gain. The complications during pregnancy depend on microcirculation disorders due to spasm of peripheral vessels in patients with diabetes. According to Petry (2014), insulin deficiency violates all types of metabolism that occur with hyperlipidemia and lead to severe structural and functional changes in cell membranes. All this aggravates hypoxia and microcirculatory disturbances, underlying the complications of pregnancy.

Cellular Level

The hormone insulin is produced in certain cells (beta cells) of the pancreas and acts as a key, opening a pathway of glucose into the cell. If insulin is insufficient or its interaction with cell receptors is disrupted, the glucose does not get into the cells as it should and it is excreted from the body through the kidneys. As a result, cells lack energy. Petry (2014) report that starting from the 20th week of pregnancy, a woman’s body increases the levels of pregnancy hormones, which partially block the action of insulin. In order to keep blood sugar within a normal range, the pancreas of a healthy pregnant woman develops high amounts of insulin – 2-3 times more than a non-pregnant woman. If the beta cells of pancreas cannot cope with the increased workload for them, a relative or absolute insulin deficiency occurs and develops into gestational diabetes.

An activation of lipids leads to the formation of toxic free radicals, damaging cell membranes. Insulin deficiency violates all types of metabolism that occur with hyperlipidemia, leading to severe structural and functional changes in cell membranes. All these factors aggravate hypoxia and microcirculatory disturbances, resulting in pregnancy complications.

Clinical Manifestations

In moderate and severe cases of gestational diabetes, such symptoms as strong hunger, great thirst, blurred vision, and frequent and copious urination may occur (Gupta, Kalra, Baruah, Singla, & Kalra, 2015). Since pregnant women often experience thirst and increased appetite, the appearance of these symptoms is not yet talking about diabetes. Only the regular delivery of tests and medical examinations will help to prevent it on time. High blood sugar can cause problems for a mother and her baby. A child may grow too large, causing difficulties in labor. In addition, the fetus often lacks oxygen, leading to hypoxia. It was found that those who had high blood sugar levels during pregnancy often develop diabetes with age (Gupta et al., 2015). This risk can be greatly reduced with the help of weight control, healthy diet, and regular physical activity.

Sequelae of Disease Process

Pregnant women with gestational diabetes mellitus have high frequency of spontaneous abortions, hypoglycemia, and ketoacidosis progression of vascular complications of diabetes, such as retinopathy, nephropathy, neuropathy, and ischemic heart disease. They also experience more frequent pregnancy complications, such as late preeclampsia, infection, and polyhydramnios. Many studies assert that doctors often observe the excessive growth of fetus and its excess weight (Yang, Li, Wang, & Ma, 2015). High mortality during childbirth, congenital malformations, and complications in the first weeks of life are also inherent.

Diagnostic Tests

A woman should pass several tests, in order to estimate the probability of a successful pregnancy outcome. They include a blood test to glycated hemoglobin and the measurement of blood sugar 5-7 times a day (Yang et al., 2015). It is necessary to keep the blood pressure tonometer at home to be able to determine whether there is postural hypotension. Doctors require passing tests to check kidneys and to collect daily urine to determine creatinine clearance and protein content in it. Furthermore, blood tests on plasma creatinine and urea nitrogen. If protein is found in the urine, it is necessary to pass the tests for urinary tract infections. Petry (2014) suggest checking the condition of retina. It is desirable that a text description will be accompanied by colored photographs. They help to visually compare and evaluate the changes in subsequent re-examinations. If a woman with diabetes has reached 35 years of age and suffers from hypertension, kidney disease, obesity, high cholesterol levels in the blood or has a problem with peripheral vessels, it is necessary to pass an electrocardiogram.

Treatment

Fortunately, with proper and timely treatment, most expectant mothers with diabetes have a good chance to give birth to a healthy child. One of the conditions for successful treatment is diet therapy. Restriction on the menu of certain foods can help maintain blood sugar levels within the normal range and get all the necessary vitamins and minerals from food. Pregnant women with gestational diabetes mellitus should avoid foods that are rich in carbohydrate, such as confections that contain a significant amount of sugar, baked goods, and some fruits. Yanget et al. (2015) believe that it is important to choose foods with a high content of fiber because it stimulates the intestines and delays absorption of sugar and fat in blood. In addition, fiber-rich foods contain large amounts of vitamins and minerals that are necessary for a woman and her baby. Admittedly, the use of small amounts of food every 3 hours avoids a significant increase in blood sugar level after a meal.

If diet background during the first week does not show the desired results, doctors prescribe insulin preparations that are administered only by injection that helps to keep the blood sugar level within the normal range. In order to simulate normal secretion of insulin by the pancreas during the day, it is necessary to combine several different insulin types: short, acting as food, and long, acting to maintain a constant blood level between meals and during the night (Gupta et al., 2015). Moreover, daily exercise can help women maintain good health during pregnancy, muscle tone, and quickly restore the shape and lose weight after giving birth. In addition, exercise improves the action of insulin and helps to not gain the extra weight. All this maintains normal blood sugar levels.

Conclusion

Gestational diabetes mellitus creates many problems to pregnant women and encourages them to be more careful about their health. Thus, they should stay under the special supervision of an obstetrician-gynecologist. Moreover, dieting and physical exercise should become their norm. Although gestational diabetes is a risk factor for the development of a fetus’ health, proper and timely treatment can maintain an expectant mother with diabetes and give her a chance to give birth to a healthy child.