Enf.ª Helena Bettencourt

Enfermeira Especialista
Saúde Materna e Obstetrícia

I have Gestational Diabetes.
What now?

HPA Magazine 18

You are pregnant and were informed during the consultation with your doctor that you have gestational diabetes (GD)? This unexpected information can result in a whirlwind of doubts, insecurities and feelings that are sometimes difficult to digest.
If this is your case, believe that you are not alone. In fact, the prevalence of GD in 2018 was 8.8% of the Portuguese pregnant population. However, it appears that this prevalence tends to increase with the age of pregnant women, and in women over 40 years of age, the incidence rises to 17.7%.
In this article, we will attempt to demystify this topic, so that the pregnant woman knows what to expect and the possible implications related to this diagnosis for the mother and the baby.
 

DEFINITION
GD is defined by a carbohydrate intolerance that is diagnosed or recognized for the first time during pregnancy. It can occur in pregnancy during any month, however it is more frequent in the second half of pregnancy, namely from the 24th week of pregnancy and ends up solving itself after delivery (except in cases of where diabetes were identified before pregnancy).

RISKS FOR MOTHER AND BABY
The risks associated with GD are indeed substantial, which could be 'scary' for the pregnant woman and her family. However, and before mentioning them, it is important to mention that it has been proven that maternal complications, perinatal mortality and morbidity is directly related to glycaemic control.  The sooner the diagnosis is reached and metabolic control is carried out, the greater the benefits achieved.
What are the risks associated with poor blood glucose control?
• Miscarriage.
• Congenital anomalies.
• Large foetus (macrosomia), which can cause complications in labour and delivery, namely lead to induction of labour, caesarean section, shoulder dystocia or other.
• Excess amniotic fluid.
• Pre eclampsia.
• Premature birth.
• Complications in childbirth.
• Caesarean Section.
• Hypoglycaemia (low blood sugar) in the new-born infant in the first hours after birth.
• Jaundice in the new-born infant (increased bilirubin in the blood).
• Foetal death.
GD is also associated with an increased risk of a pregnant woman later developing Type 2 Diabetes.

TREATMENT
The treatment of GD is multifactorial, which is why monitoring by a multidisciplinary team is essential. This team should include the Obstetrician, Endocrinologist or Internist with experience in diabetology, Specialist Nurse in Maternal Health, Dietician or Nutritionist, Paediatrician and Psychologist.
Treatment is based on non-pharmacological control measures (in all cases) but in some cases pharmacological control measures may also be used.
//Non-pharmacological treatment:
• As mentioned before, it is essential to control blood glucose levels, which implies daily assessment of blood glucose levels by capillary puncture (finger prick) until the end of pregnancy. Your nurse will provide blood glucose monitoring equipment along with an assessment plan. In general, capillary blood glucose assessments should be performed daily, when fasting and also 1 hour after the beginning of the 3 main meals, but can be adjusted if necessary. Don't forget to register the results. This will be an essential part of the process.
• Regular foetal monitoring through biophysical profile and cardiotocographic monitoring (CTG) to assess foetal well-being.
• Adhering to a balanced and personalized meal plan.
• Physical exercise adapted to pregnancy (if there is no medical contraindication).
• Psychological support.
//Pharmacological treatment:
• If these measures are not sufficient in achieving adequate blood glucose levels, it will be necessary to resort to pharmacological treatment with medication of oral antidiabetic drugs (tablets) and/or subcutaneous insulin. However, for the success of the pharmacological treatment, it is essential to associate the non-pharmacological measures described above.

TO REMEMBER 
The diagnosis of GD can be a frightening for a woman due to the numerous lifestyle changes, both physically, in terms of food or fear of "pricks", but above all because of the risks associated with pregnancy and the foetus, related to this diagnosis. 
However, with the support of a competent and sensitive multidisciplinary team with experience in this area, this process can become less painful. A timely diagnosis as well as the control and treatment of pregnant women is essential for a positive obstetric and perinatal outcome.