During pregnancy, it is especially important to monitor blood sugar levels because high blood sugar can lead to gestational diabetes. Therefore, being aware of diabetes during pregnancy will help you handle it properly.
Types of Diabetes
Diabetes in pregnant women is divided into 2 types, which are
1) Diabetes diagnosed before pregnancy (Pregestational / Overt DM) is a condition of diabetes that has been present before pregnancy.
It is reported that women who had diabetes before pregnancy are at risk for pregnancy complications such as
- Preeclampsia 27%
- Miscarriage 24%
- The baby being larger than normal 13%
- Preterm birth 6%
- Baby death during and after birth 6%
2) Gestational DM (Diabetes Mellitus diagnosed for the first time during pregnancy) is diabetes diagnosed for the first time during pregnancy, which accounts for 90% of diabetes in pregnant women. It may be diabetes that existed before pregnancy but was undiagnosed or may be diabetes that emerged for the first time due to pregnancy.
Risk groups for gestational diabetes include
- Patients with a family history of diabetes
- Patients who have a history of giving birth to a large baby
- Patients who have a history of stillbirth without known cause
- Patients who are overweight or obese
Risks from diabetes during pregnancy
- The risk of high blood pressure and the rate of cesarean delivery may increase
- Macrosomia, which means the baby has a weight of more than 4,000 grams, occurs because of high blood sugar in the mother, which often occurs in the second half of pregnancy and also causes the baby’s sugar to be high, stimulating the pancreas to produce more insulin
Diagnosis
- Medical history
- Family history of diabetes
- Risk history for diabetes as mentioned above, such as giving birth to a baby weighing more than 4,000 grams, history of stillbirth or unknown cause death during pregnancy
- Physical examination
- Weight measurement, height measurement, and BMI calculation
- Pregnancy check for larger than normal pregnancy or hydramnios
- Check for abnormalities from diabetes, high blood pressure during pregnancy
- Laboratory tests
- Detecting sugar in urine
- Blood sugar level test by OGTT method
Screening and Risk Assessment
Current screening and diagnosis in pregnant women, several organizations have proposed screening methods. The choice depends on the appropriateness and cost-effectiveness, but most adhere to the practices of the World Health Organization (WHO) in 1999 and the American College of Obstetricians and Gynecologists (ACOG) in 2001. Screening can be done in all pregnant women (Universal Screening) or only in those at risk, depending on the prevalence of diabetes in each location. High prevalence locations should screen everyone, using a 2-step screening process, starting from risk assessment as follows
Patients in the high-risk group should be screened as soon as possible. If normal, repeat the test between 24-28 weeks of pregnancy, including
- Obesity
- History of gestational diabetes
- Sugar in urine
- Direct relatives with diabetes
2-step Examination
Two Step Screening method includes
- Screening with a 50 gram Glucose Challenge Test Take 50 grams of glucose at 24-28 weeks of pregnancy, regardless of the previous meal. If the Plasma glucose level equals or exceeds 140 mg/dL, it is considered abnormal. If abnormal, proceed to diagnosis with a 100 gram OGTT
- Diagnosis with a 100 gram Oral Glucose Tolerance Test (OGTT) by drawing blood while fasting and after taking 100 grams of glucose at 1, 2, and 3 hours consecutively The criteria for diagnosis are
- Fasting before ingesting 100 grams of sugar should be less than 95 mg/dL
- After ingesting 100 grams of sugar at 1 hour should be less than 180 mg/dL
- After ingesting 100 grams of sugar at 2 hours should be less than 155 mg/dL
- After ingesting 100 grams of sugar at 3 hours should be less than 140 mg/dL
***If abnormalities are found in >= 2 values of the 100 gram-OGTT, the patient will be diagnosed with gestational diabetes
Care for Diabetes When Pregnant
Pregnant women are advised to see a dietitian, consuming protein-rich foods, reducing starchy foods, increasing fiber intake, and consuming milk and milk products.
Additionally, it is recommended to monitor blood sugar levels before and after meals, with pre-meal levels should be less than 95 mg/dL, and 2-hour post-meal levels should be less than 120 mg/dL to prevent future complications.
Diabetes after Pregnancy
After childbirth, patients diagnosed with gestational diabetes have about a 3 – 20% risk of developing diabetes. It is advised to consume a high-protein diet, reduce starchy foods, and exercise regularly, which can prevent the development of diabetes in the future.
