Gestational Diabetes – Overview (signs and symptoms, pathophysiology, diagnosis, treatment)
Gestational Diabetes – Overview (signs and symptoms, pathophysiology, diagnosis, treatment)
Hello in this video we’re, going to talk about gestational, diabetes mellitus or gdm for short. Gestational diabetes is a common condition that occurs during pregnancy, specifically diagnosed roughly in the third trimester of pregnancy. As the name suggests it essentially is similar to diabetes Mellitus type 2, in that you have hyperglycemia and you have problems with insulin. So let’s look at what normally happens during pregnancy.
The pancreas is an organ responsible for producing the hormone insulin, and here is the target cell, which insulin will target eventually, and here is the fetus which is inside the uterus of the pregnant lady. During pregnancy there is betta cell hyperplasia, fetus cells or B cells or cells in the pancreas, that produces and secretes the hormone insulin. When a pregnant lady eats, their blood glucose rises, there is hyperglycemia.
Hyperglycemia will stimulate the beta cells of the pancreas to release the hormone insulin into circulation. The increase in insulin in the circulation will go around the body and then target specific cells telling these cells to take up glucose from the blood in the attempt to reduce blood glucose.
There is still enough blood glucose available in circulation to enter fetal circulation. The fetus requires glucose in order to gain energy and to grow, and so the fetus will receive adequate glucose, and so there will be normal fetal growth.
The fetus will always receive glucose because of several reasons. The first is that during pregnancy, insulin, sensitive decreases. This means that the effects of insulin on maternal tissue is reduced because the effects of insulin is reduced.
There will be more glucose in the blood vita cell hyperplasia in the maternal pancreas occurs because of reduced insulin, sensitivity in maternal tissue, and this also is a cause of the factors released by the foetus telling the maternal body to feed it.
What happens in gestational diabetes is that, instead of a small decrease in insulin, sensitivity and maternal tissue, there is a lot of insulin, sensitivity, decreasing and thus also insulin. Resistance here is a pancreas of the mother with gestational diabetes, and here is a target cell of insulin, and here is the fetus in uterus.
After a mother eats blood, glucose increases, there is hyperglycemia hyperglycemia stimulates the beta cells of the pancreas to release the hormone insulin into circulation. Insulin aims to target cells to increase glucose uptake in maternal tissue, but in just a tional diabetes, there is insulin resistance and therefore, blood glucose is not taken up into maternal tissue as efficiently the result of insulin.
Resistance is hyperglycemia of the maternal circulation with hyperglycemia. This also traveled into fetal circulation, and so there is an increase in blood glucose in the fetus because of hyperglycemia in fetal circulation.
The fetus, the beatle pancreas, thus will work by producing its own insulin with more fetal insulin. The fetal tissue will take up more glucose that is available, and so there will be more growth of the fetus, the growth of the fetus increases and you get a big baby.
Similarly, the increase in blood glucose in maternal circulation means that the mother can have symptoms of diabetes, which are the 4ps polyuria polyphagia paresthesia, which is not actually common, but it’s more so in chronic diabetes and polydipsia.
These symptoms are not very specific for gestational diabetes. Instead, gestational diabetes is rather asymptomatic. The reason for a big decrease in insulin, sensitivity and the development of insulin resistance in gestational diabetes is thought to be because of plus the placenta producing hormones such as growth hormones, CRH and placental lacta gene a central hormone caused a decrease in insulin, sensitivity to try To tell the mother to feed it with more glucose risk factors for gestational diabetes, mellitus include pregnant lady’s, age, greater than 35 years old obesity, family history of gdm, polycystic, ovarian syndrome, certain ethnic groups, including South East Asian, and also having a previous History of gdm, the diagnosis of gestational diabetes, is actually done during screening at 24 to 28 weeks, roughly gestation, and this is done with a fasting blood glucose or with the oral glucose tolerance test.
A fasting blood glucose is measured between weeks 24 to 28 weeks. A fasting blood glucose of greater than 5.1 millimoles per liter can help diagnose gdm. The diagnosis of gdn can also be done with an oral glucose tolerance test if blood glucose is greater than ten millimoles per liter.
After one hour of taking our glucose or greater than eight point, five million milliliter okay, two hours of taking our glucose, these values normally should be lower because insulin should be lowering blood glucose but with insulin resistance or sensitivity.
Blood glucose takes a lot longer to go down after eating glucose. On a side note, diagnosing diabetes is different. What I mean is diagnosing diabetes type 2 in non pregnant woman. You can think of diagnosing diabetes type 2 as the seven-eleven rule 7 in 11 rule, meaning a fasting glucose, greater than 7 million moles per liter or a random blood glucose.
Greater than 11 million moles per liter with symptoms of diabetes can help the diagnosis of diabetes type 2. The complications of gestational diabetes can be divided into maternal Convocation, fetal complications and infant complications.
Maternal complications or mother complications of gestational diabetes include hypertensive disorders. Increased risk of infection for zarion section is a 50 % risk of developing future diabetes type 2.
Maternal can also be a treatment complication where you get insulin, late, related, hypoglycemia feature. Complications occurs as a consequence of feature hyperglycemia with fetal hyperglycemia you get fetal hyperinsulinemia, fetal hyperinsulinemia means that there will be more glucose uptake by fetal tissues, causing macrosomia or a big baby.
Fetal hyperglycemia means fetal, osmotic, diuresis occurs, which, which means that the fetus will pee more because of the diuretic effects of glucose, because the fetus pee is more more fluid will be within the amniotic sac, causing polyhydramnios fetal hyperglycemia may lead to congenital abnormalities and even still Birth, infant complications or baby complications tend to occur during delivery or right after delivery, and this is because the fetus is larger than normal.
There is macrosomia and thus birth trauma can occur, and this can be trauma to the baby or to the mother’s, genital tract after delivery. The fetus will not receive any more glucose from the mother, because the umbilical cord is clamped keep in mind that there is still fetal hyperinsulinemia present, and this means that glucose will be taken up still, but with no more supply of glucose in the baby.
This means that there is hypoglycemia later after delivery. The baby will also have subsequent hyperbilirubinemia hypocalcemia and increased risk of respiratory distress syndrome, which is a respiratory problem which is manageable.
There’s, also a long-term risk of the baby, developing child hood obesity. The management of gestational diabetes can be divided into managing the pregnancy itself and managing the baby after delivery.
The maternal management or pregnancy management involves a multidisciplinary team where the obstetrician plays a vital role. As a woman with gestational diabetes is a high-risk patient. The management first line is diet and exercise.
Use of diabetic medication, including metformin, can also be used if this fails or if the mother prefers insulin injections can be used during this period of managing gestational diabetes, which again is diagnosed roughly between 24 to 28 weeks, which is a screening process.
The pregnant woman needs to continuously monitor their blood glucose with a finger prick test, for example at least four times a day further. It is important to monitor the fetus inside the uterus, using an ultrasound to detect any anatomical changes to check for fetal size to check for fetal blood flow and also checking a fetal heart rate.
The management of the baby occurs postpartum after delivery and includes oxygenation because of the risk of respiratory distress syndrome, because the baby is also in hypoglycemia there. There can be also administration of extras.
It is finally also important to monitor the bilirubin levels. The glucose levels continuously and also the calcium levels you
