Experts agree that it is very useful to have a glucose challenge test done during the 24th and 28th weeks of pregnancy to diagnose diabetes during pregnancy. In addition to these, it is also very important to have a glucose challenge test done during pregnancy so that the pregnancy is problem-free for both the mother and the baby.
During pregnancy, many hormonal changes occur in expectant mothers in order to meet the different needs of the fetus in the womb and to ensure that it passes through the development period without any problems. Even if the mother is not negatively affected by these different changes, it is very important for both the expectant mother and the baby to experience this period in a controlled manner.
During pregnancy, the mother's body creates insulin resistance to meet the baby's glucose needs. After a healthy pregnancy, this condition disappears on its own. This condition does not require treatment.
What is a Pregnancy Glucose Loading Test and How is it Done?
The pregnancy sugar loading test is a diabetes test performed on the expectant mother between the 24th and 28th weeks of pregnancy. In this test, a 50-gram sugar loading is performed. This test can be performed on an empty stomach or with food. The results of this test may be normal. However, expectant mothers with a family history of diabetes, in other words, expectant mothers with risk factors, are subjected to a second pregnancy sugar loading test.
In the pregnancy sugar loading test, blood is taken from the expectant mother and she is given sugar water. After this stage, it is forbidden to consume or drink anything for 1 hour. Then, blood is taken again and if the sugar level in the blood taken is 140 and above, it is revealed that the expectant mother has diabetes. If the expectant mother is diagnosed with diabetes, a diet is first applied and this situation is tried to be corrected. If there is no response to this treatment, insulin can be started.
Gestational Diabetes Risks
Diabetes during pregnancy carries various risks for the mother and the baby. In expectant mothers with diabetes, the sugar level should be monitored continuously during pregnancy with a pregnancy glucose tolerance test. The more regular the sugar levels are during pregnancy, the lower the risks that the disease brings.
Expectant mothers who had diabetes in their previous pregnancy, who have diabetes in their family, who were overweight before getting pregnant, and who are over 35 years old are at a higher risk. Expectant mothers in this risk group should not ignore the risk of this disease, have a sugar loading test during pregnancy, and be examined by a specialist doctor. The importance of the sugar loading test for the diagnosis of diabetes during pregnancy is quite high. A 50-gram glucose loading test, or sugar water test, is performed between the 24th and 28th weeks of pregnancy to screen for gestational diabetes. The sugar water test is performed in extremely obese expectant mothers, those with a history of large babies, those with a first-degree blood relative, and those with risky conditions such as gestational diabetes, and examinations and tests are required at earlier stages. The test may be negative, but this test should be repeated in the 24th week.
How is the sugar loading test done?
In the health test called sugar loading test, 50 grams of sugar water is given to the expectant mother. After drinking the water, she is not allowed to eat or drink anything for 1 hour. At the end of 1 hour, the values in the blood are examined. If the values are above a certain level, the expectant mother is suspected of gestational diabetes. A second sugar loading test is applied to the expectant mother who is suspected of having this suspicion. This time, 100 grams of sugar water is given and a total of 4 blood samples are taken at the 1st, 2nd and 3rd hours. If the values are higher than expected in 2 or more of these blood tests, the diagnosis of gestational diabetes is definite. If 1 test result is high, it is decided that there is only suspicion of gestational diabetes.
Diabetic pregnant women should be careful to keep their fasting and postprandial blood sugar levels at normal levels during pregnancy. Here's what needs to be done to do this:
Diabetic pregnant women need to talk to their doctors more often about their blood sugar levels and insulin treatment doses; they need to apply intensive insulin treatment 4 times a day. If these treatments are not interrupted, are continued properly, and blood sugar controls are not neglected, the risk of any metabolic complications is reduced and the pregnancy process is terminated without harming the baby.
However, if there are organ problems such as heart and kidneys due to diabetes, more frequent general check-ups are needed. It is important not to skip prenatal blood tests. Especially if there is organ failure, frequent urine tests should be performed to evaluate whether there is protein loss from the kidneys, high blood pressure, water accumulation in the lungs due to heart valve or heart muscle problems, and heart failure.
Normal values for the 100 g oral glucose tolerance test (OGTT):
Fasting >95mg/dl
>180mg/dl at 1st hour
>155mg/dl at 2nd hour
>140mg/dl at 3rd hour
If 2 or more of the 4 values we mentioned are different from normal, gestational diabetes is diagnosed.
If only one of these results is high, the test is repeated after one month. If the 50-gram glucose tolerance test result is more than 190 mg/dl, there is no need to perform a 100-gram OGTT and the fasting glucose level is checked. If the fasting blood glucose is over 95 mg/dl as a result of the test, the mother is considered to have gestational diabetes and the appropriate treatment method is determined.
Who develops diabetes during pregnancy?
Diabetes can occur in approximately 5% of expectant mothers during pregnancy. 90% of the diabetes that develops during this period is gestational diabetes.
Expectant mothers with a high risk of gestational diabetes:
-Having had a stillbirth before, -Having given birth to a baby with anomalies,
-Having given birth to a baby weighing more than 4 kilos
-Expectant mothers who have had multiple miscarriages are in the risk group.
-Expectant mothers who had diabetes in their previous pregnancies
-Expectant mothers who are overweight before pregnancy,
-Expectant mothers who are over 35 years old,
-Expectant mothers who have a blood relative with diabetes in their family,
-Expectant mothers who gained too much weight during pregnancy,
-Increase in amniotic fluid during pregnancy,
-In case the baby dies in the womb,
-If glucose is detected in the urine of the expectant mother, and in these risk situations, the expectant mother is at risk for diabetes.
Risks of Diabetes in Gestational Age
Diabetes, even if it occurs during pregnancy or starts before pregnancy, carries various risks for the mother and the baby. In pregnant women with diabetes, the more regular the sugar levels are during pregnancy, the less the risks of diabetes. The risks that may arise in diabetes that occurs during pregnancy are less than in diabetes that already exists before pregnancy. Pregnant women with diabetes are more at risk of high blood pressure (hypertension), pregnancy poisoning, miscarriage and premature birth during pregnancy than a mother without diabetes.
In diabetes that occurs before pregnancy, the risk of developing various anomalies in the baby increases. However, gestational diabetes that occurs during pregnancy does not cause anomalies in the baby. The risk rates increase due to the development of a larger than normal baby, namely macrosomic babies, and the necessity of cesarean delivery that occurs due to diabetes that occurs before or during pregnancy.
In patients with pre-existing diabetes before pregnancy, the more normal the blood sugar levels remain in the first few months before pregnancy and throughout pregnancy, the lower the risk of developing anomalies in the baby. This risk is higher in pregnancies where blood sugar levels are consistently high and controls are neglected.
For this reason, HbA1C and glucose monitoring is very important.
Risks that may develop in babies during diabetic pregnancies:
Respiratory distress that may occur after birth:
The baby is large: macrosomia
The baby is smaller than normal: SGA
Hypoglycemia, i.e. low blood sugar, polycythemia, hypocalcemia, hyperbilirubinemia in the baby after birth: jaundice
Heart anomalies: VSD, TGA, cardiomyopathy
Brain and central nervous system anomalies: Anencephaly, spina bifida, caudal dysplasia
Kidney anomalies
Digestive system anomalies
Ear anomalies
What are the symptoms of diabetes during pregnancy?
Sensation of thirst,
Weight loss,
The need to eat a lot of food,
Urinating much more frequently than normal,
Symptoms such as persistent fatigue may occur.
However, diabetes may not usually show any symptoms during pregnancy. It is diagnosed through screening tests or tests performed on the expectant mother.
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