Gestational diabetes mellitus is defined as a carbohydrate intolerance that occurs for the first time during pregnancy or is determined by multiple tests during pregnancy. In addition to the first occurrence during pregnancy, the patient can also suffer from glucose intolerance such as type I or type II diabetes before pregnancy. However, if diabetes occurs for the first time or if the risk is established during pregnancy, it is referred to as gestational diabetes. It is not known whether the glucose intolerance persists after pregnancy or whether the administration of insulin is necessary for gestational diabetes, but it is determined solely by the course of pregnancy. The incidence of gestational diabetes is around 3-5%, although studies show mixed results.
Although there is no diabetes before pregnancy, an increase in blood sugar, that is, the sugar level, can occur during pregnancy. First of all, it is recommended that all pregnant women measure their fasting blood sugar or HbA1C at the beginning of their pregnancy. If the measured values are found high, the exercise test is performed immediately. If these tests prove normal, the provocation test should be done within the 24th and 28th week of pregnancy.
The sugar load occurs in the 24th and 28th week of pregnancy. Because it is known that the insulin resistance increases between these weeks. As a result of the scans to be performed, it was found that 10% of women diagnosed with gestational diabetes developed diabetes within 7 years, 18% within 10 years, 40% within 17 years, and 60% within 20 years. When assessed for perinatal mortality; Although mortality did not change significantly, women diagnosed with gestational diabetes were given diet, insulin therapy, and close monitoring, so the reality of this finding should be viewed with suspicion. The presence of causes such as perinatal morbidity (fetal macrosomia, neonatal hypoglycemia, hyperbilirubinemia, and polycythemia) in gestational diabetes (gestational diabetes) is one of the factors that exacerbate gestational diabetes. However, because the 100 g glucose load test cannot be used for diagnosis in every pregnant woman, screening methods and tests have been developed. “In the past, 100 g glucose exposure tests were only performed in risk groups after a clinical examination and anamnesis of the patient. “
Likewise; It should be remembered that diseases such as obesity, glucosuria, history of macrosomia, fetal or neonatal loss, a history of a baby with congenital abnormalities, the presence of diabetes in the family, and preeclampsia in the current pregnancy can all lead to the The patient is included in the risk class.
Gestational diabetes is diagnosed with 100 g of OGTT tests. However, there are theories that some people don’t need OGTT tests and can be diagnosed based on their fasting blood sugar level (plasma> 140mg / dL). Oral glucose tolerance test; It is used in the morning after 8-14 hours of fasting on an empty stomach without any diet containing less than 150 grams of glucose and for results by adding 100 grams of oral liquid with glucose in more than 400 ml of liquid. The first approach that should be used in patients with a diagnosis is regulation of diet therapy.
Hyperglycemia paves the way for the development of some chronic diseases (cardiovascular system). There are studies showing that congenital heart problems in the fetus of a diabetic mother occur as a result of exposure to adverse effects in the very early stages of heart formation in these children. Examples of these heart problems (transposition of the great arteries, mitral atresia, pulmonary atresia, double outlet of the right ventricle, Fallot tetralogy, and fetal cardiomyopathy).
One study looked at the characteristics of diabetic mothers; The mother’s age, type of diabetes (type 1, type 2, and gestational diabetes) and duration were classified according to the mother’s medical history. It was found that there was a positive correlation between the presence of an eight-hour fasting sound, cyanosis and high blood pressure during pregnancy, and congenital heart defects during the night. It was concluded that insulin use, as well as genetic disorders and the presence of high blood pressure during pregnancy, increase the risk of congenital heart disease.
Another study carried out at the same time showed that education is the most important factor in the level of knowledge of pregnant women about prenatal care; It was noted that as the level of education increases, the prenatal period will be healthy. A management system should be established for their applicability and advice, and public health programs should be implemented that provide information to the expectant mothers.
As a result; There is a significant relationship between genetic factors, chronic comorbidities and the level of knowledge and the occurrence of gestational diabetes. However, it should aim to prevent problems that can develop in both the mother and the fetus through nutrition, that is, dietary precautions. Although it is a controversial issue, it is decided to continue with the two-step diagnostic approach (50g glucose pre-screening followed by 75g glucose OGTT) until evidence-based results are available in our country. Particularly risk groups (overweight people, people with GDM in previous pregnancies, people with glucosuria, people with a family history of intense DM) should be re-examined from the first 3 months (1st trimester).
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