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Predisposing impact of pregnancy on diabetes is well-known, since due to hormonal changes and reduction of insulin sensitivity during pregnancy the insulin demand can increase either 3-4-fold. If the maternal system cannot meet this increased insulin demand, then carbohydrate metabolism will be disturbed and the level of blood sugar will rise.

Frequency of diabetes-complicated pregnancies in our country is estimated to 6- 8 %, and clinical experience shows that the incidence of the disease is more and more frequent The primary causes include unfavourable changes in lifestyle, e.g. the increasing number of overweight women due to over-nutrition, reduced physical activities, as well as shifting of childbearing to older age

Women at risk are considered those, who are over 35, with overweight and multigravidas as well as those women whose family history showed diabetes or who gave birth to a baby over 4000 grams.

Due to the fact that gestational diabetes generally has no symptom or only a few, the majority of the cases can be diagnosed by active screening. Complete screening of gestational diabetes is obligatory in Hungary since 2004; it means that oral glucose tolerance test OGTT-test is performed in 22-28th week of the pregnancy with each expectant woman (in case of risk factors the test is performed earlier) with 75 grams of sugar in the framework of obstetric care. The test includes determination of blood sugar level before consuming the sugar solution (so called fasting value) and the presentation of two-hour blood sugar level. We can speak of gestational diabetes if the fasting value is over 6 mmol/l and/or the two-hour level is 7,8 mmol/l or more.

Diagnosis of gestational diabetes is very important because high blood sugar level can affect pregnancy output. Extreme growth, developmental abnormalities, birth injuries mean risk to the fetus, and later complication can be the increased risk of overweight and abnormalities in carbonhydrate metabolism in child- and young adulthood. In respect of the maternal organism - in addition to the direct effects of glycemic imbalance it must also be accounted for that type 2 diabetes developed in 20-50 % of women suffering from gestational diabetes after 5-10 years of delivery, meaning 3-4-fold increase of risk as compared to women with normal carbonhydrate metabolism during their pregnancy.

However it is proved that each risk can be significantly reduced by normalizing of the maternal blood sugar level, even to the level of pregnancies characterized by healthy metabolism. In the course of the primary treatment of gestational diabetes native, sugar-free diet is started; in case it fails to achieve and maintain the normal level of blood sugar, the diet is added with insulin administration. Diabetes-complicated pregnancy requires more attention both from the mother and the family, because in addition to observing the diet, regular blood sugar self-checking and regular care by the physician and diabetologist is needed.

Reduced insulin sensitivity and sugar metabolism significantly improve after delivery; therefore each gestational diabetes has to be re-assessed by repeating the tolerance/loading test – 6 weeks after delivery at the earliest, but by the time of finishing lactation at the latest. In majority of the cases we notice normal carbonhydrate metabolism that time, but in case of any deviation further changes in lifestyle or medical treatment may be needed. Nevertheless the importance of repeated tests after delivery is important because it provides the possibility for calling the attention of women who previously suffered from gestational diabetes that early diabetologic care is needed before the next pregnancy (prior to conception).

Dr. Krisztina Lukács

Dr. Krisztina Lukács
Head of the consultancy of internal medicine.

 

Phone number: +36(06)1-213-4222

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Pregnant women and their children first of all