Diabetes during pregnancy can bring complications to the baby – 10/05/2023 – Balance and Health

The diagnosis of gestational diabetes can come as a shock to an expectant mother. And now? Can’t I eat sweets anymore? Do I need to worry about the baby’s health?

This reality may become increasingly common, as the prevalence of gestational diabetes mellitus (GDM) has grown in the country and in the rest of the world. According to data gathered by the SBD (Brazilian Diabetes Society) for the year 2021, it is estimated that 16% to 18% of live births in Brazil are generated by women who had some form of hyperglycemia during pregnancy.

Worldwide, prevalence varies from 3% to 25%. 200 to 300 million babies are expected to be born annually to mothers with some type of hyperglycemia.

Gestational diabetes mellitus is defined as hyperglycemia of varying degrees, detected for the first time during pregnancy, with a glycemic level that does not meet the diagnostic criteria for diabetes mellitus (above 92 milligrams per deciliter and below 126), according to the Opas definition. WHO (Pan American Health Organization linked to the World Health Organization).

The diagnosis of diabetes mellitus during pregnancy is defined as a patient without a previous diagnosis of diabetes, with hyperglycemia (fasting blood glucose greater than or equal to 126 mg/dL or greater than or equal to 200 mg/dL two hours after consuming 75 g of glucose) detected during pregnancy and with glycemic levels that meet the WHO criteria for diabetes in the absence of pregnancy.

Finally, there are also those women who already had a diagnosis of diabetes mellitus (type 1 or type 2) and who become pregnant, thus being cases of pregnancy in diabetic patients. According to Brazilian data compiled by SBD, these correspond to approximately 8% of cases of gestational diabetes in the country.

This distinction is important because during pregnancy, a woman’s body produces hormones that naturally alter insulin production, explains doctor Cristina Figueiredo Façanha, from Sbem (Brazilian Society of Endocrinology and Metabology).

“The woman could have had her blood sugar levels under control before pregnancy, she could even eat a sweet here and there, the glycemic index would go up a little, but in general everything was fine. But, when she gets pregnant, the pregnancy hormones lead to development of glucose intolerance.”

According to the doctor, the amount of insulin needed to metabolize the same amount of glucose increases six times during pregnancy. In short, it would be as if before pregnancy, after ingesting, for example, 15 grams of carbohydrate (one bagel), she needed six units of insulin produced by the pancreas to metabolize glucose. With pregnancy, for the same amount of carbohydrates, she needs to produce 36 units of insulin (six times more).

In general, the detection of hyperglycemia can be done during a routine examination of pregnant women, even in the first trimester, with a fasting blood glucose test. If there are any changes at the beginning of pregnancy, the doctor can recommend treatment, which may be diet or insulin, considered the elective treatment for diabetes during pregnancy.

However, if the blood sugar level is within the expected range (below 92 mg/dL), the pregnant woman undergoes a new oral glucose tolerance test between the 20th and 24th week of pregnancy for the definitive diagnosis of gestational diabetes (glycemia). equal to or greater than 200 mg/dL two hours after consuming 75 g of glucose). This is because, due to the hormones produced during pregnancy, the body experiences a peak in blood sugar levels from the 20th week onwards.

As this change in sugar tolerance is, in general, asymptomatic, the woman does not discover that she has GDM unless a specific test is carried out. “And we have in the SUS [Sistema Único de Saúde] only the fasting blood glucose test, the oral glucose tolerance test is not available. Therefore, prenatal screening is essential,” he adds.

The correct diagnosis is important since hyperglycemia during pregnancy can cause complications for the mother and baby, according to obstetrician Natália Filaretti.

The doctor monitors the pregnancy of her sister, businesswoman Isabella Filaretti, 33, who was diagnosed with gestational diabetes at the beginning of her pregnancy. “I was very scared, especially with the need to take insulin daily, thinking that the medication could pose some risk or affect my baby,” she said.

According to Filaretti, the complications that the baby may have as a result of GDM are, in the first trimester, the risk of malformation of the baby, heart disease (changes in the heart) and the risk of intrauterine fetal death. In the second and third trimesters, the main risks are fetal macrosomia (baby weighing more than 4 kg at birth), due to metabolic changes occurring in the womb due to hyperglycemia. “And a risk for a very high baby is also a risk for the mother, as she may have some difficulty during the birth,” she explains.

Another concern with gestational diabetes is that about 7 in 10 women diagnosed with diabetes during pregnancy become diabetic later, says Façanha.

Isabella says she has always been active and tried to exercise, but there is a history of gestational diabetes in her family. “My grandmother had diabetes during pregnancy and became diabetic afterwards”, she says, who is close to going into labor to give birth to her first daughter, Manoela. “Fortunately, in my case I managed to keep it under control, I didn’t even need to change the insulin dosage, and I don’t think I will have the post-pregnancy risk.”