Why does sugar increase during pregnancy?
In the second half of pregnancy, the placenta produces hormones that reduce tissue sensitivity to insulin. This is necessary to ensure that the child receives enough glucose. A healthy pancreas responds by increasing insulin production. If its reserves are limited, for example due to heredity or excess weight, the mother's blood sugar rises. Glucose passes freely through the placenta, but the mother's insulin does not, so the fetal pancreas is overloaded.
- Gestational diabetes - sugar is above normal, but below the thresholds for overt diabetes
- Manifest diabetes - overt diabetes diagnosed for the first time during pregnancy
- Pre-pregnancy type 1 or 2 diabetes is a separate situation
Risk factors and consequences
Gestational diabetes can occur in women without risk factors, so all pregnant women have their glucose levels checked. With high sugar, the fetus stores more fat and grows large, which complicates childbirth and increases the likelihood of cesarean section and birth injuries. After birth, the baby's sugar may drop sharply. The mother has a higher risk of preeclampsia and polyhydramnios. In the future, both mother and child are more likely to become obese and have type 2 diabetes.
- Overweight and obesity
- Diabetes mellitus in close relatives
- Gestational diabetes in a previous pregnancy
- Birth of a child weighing 4 kg or more
- Polycystic ovary syndrome
- Age over 35 years
How to make a diagnosis
At the first pregnancy visit, fasting venous blood glucose is determined for everyone. A value from 5.1 to 6.9 mmol/l indicates gestational diabetes, and 7.0 and above or glycated hemoglobin from 6.5% indicates overt diabetes. If at the beginning of pregnancy the indicators are normal, at 24–28 weeks a glucose tolerance test is performed with 75 g of glucose: blood is taken on an empty stomach, after 1 and 2 hours. The diagnosis is made if at least one value reaches the threshold: on an empty stomach 5.1, after an hour 10.0, after two hours 8.5 mmol/l. A glucometer is not used to make a diagnosis.
- Fasting venous plasma glucose
- Glucose tolerance test at 24–28 weeks
- Glycated hemoglobin in cases of suspected overt diabetes
- Urine ketone test
- Ultrasound of the fetus to assess the size and amount of water
Treatment and self-control
The basis of treatment is nutrition: exclude sugary drinks, sweets, white bread and pastries, distribute complex carbohydrates into 3 main meals and 2-3 snacks, add vegetables and protein foods. You cannot go hungry or completely give up carbohydrates. Daily walks and moderate activity are helpful if there are no contraindications. A woman measures her glucose with a glucometer on an empty stomach and an hour after meals and keeps a diary. If the target values are not achieved, the endocrinologist prescribes insulin - it is safe for the child. Tablets to lower sugar during pregnancy are used only in certain cases, as decided by the doctor.
- Fractional meals without fast carbohydrates
- Daily physical activity
- Diary of self-monitoring of glucose and nutrition
- Insulin when goals are not achieved
- Weight control, blood pressure, fetal ultrasound
- Choosing the date and method of childbirth with an obstetrician-gynecologist
After childbirth
After the birth of the placenta, the need for insulin drops sharply, and in most women, sugar levels return to normal in the first days. Insulin is stopped, glucose is monitored in the maternity hospital. The newborn's sugar level is checked and breastfeeding early. A glucose tolerance test should be taken 4–12 weeks after birth to ensure that the disorder has resolved. Since the risk of type 2 diabetes remains elevated, glucose levels are subsequently checked regularly, and breastfeeding, a normal weight and activity reduce this risk.
- Glucose control in mother and baby after childbirth
- Glucose tolerance test after 4–12 weeks
- Breastfeeding
- Reducing weight to original
- Check your glucose at least once every 1–3 years
- Planning your next pregnancy with an endocrinologist
