Gestational diabetes

from Wikipedia, the free encyclopedia
Classification according to ICD-10
O24 Diabetes mellitus in pregnancy
ICD-10 online (WHO version 2019)

The gestational diabetes , also known as gestational diabetes , gestational diabetes mellitus (GDM), or Type 4 diabetes referred to, is characterized by high blood sugar levels during pregnancy and defined as a first diagnosed in pregnancy impaired glucose tolerance .

In rare cases, it can be a newly developed type 1 or type 2 diabetes . With typical gestational diabetes, most women return to normal sugar metabolism after delivery . Overall, gestational diabetes is one of the most common pregnancy-accompanying diseases. Overweight, an age over 30 years and a hereditary predisposition to diabetes mellitus are considered risk factors . Gestational diabetes can occur without known risk factors.

causes

The cause is the increased secretion of various pregnancy hormones such as cortisol , the human placental lactogen , estrogen , progesterone and prolactin , which act as antagonists of insulin and in turn lead to an increasingly higher level of insulin resistance during pregnancy. If the pancreas can no longer compensate for this through increased insulin secretion , gestational diabetes with increased blood sugar levels develops.

About 2% of all gestational diabetes cases are based on MODY type 2. A mutation in the glucokinase (GCK) gene (gene variant rs1799884) is characteristic of this autosomal dominant disorder .

Risk factors

  • Overweight ( obesity ) with a pre-pregnancy body mass index > 27.0
  • Type 2 diabetes mellitus in the family
  • maternal age over 30 years
  • Gestational diabetes during a previous pregnancy
  • impaired glucose tolerance before pregnancy
  • an already born child with a birth weight of over 4500 g
  • history of more than 3 miscarriages of unknown cause
  • extreme weight gain during pregnancy

Regardless of these risk factors, a sugar load test (also: oral glucose tolerance test) is recommended for every pregnant woman between the 24th and 28th week of pregnancy .

Symptoms

Affected women often do not notice their illness, since gestational diabetes usually remains symptom-free. Signs such as an increased feeling of thirst ( polydipsia ), urinary tract infections and kidney infections, sugar in the urine ( glucosuria ), changes in the amount of amniotic fluid, growth disorders of the fetus, which the attending gynecologist detects on ultrasound, excessive weight gain and high blood pressure ( arterial hypertension ) can, however occur.

diagnosis

An oral glucose tolerance test (oGTT) is performed to determine gestational diabetes . A distinction is made between a screening test ( 50 g glucose in 200 ml water), which is carried out one hour after drinking the solution , regardless of the time of day and previous food intake with measurement of blood glucose from venous plasma , and the diagnostic 75 g oGTT , the is carried out at the latest when the blood glucose value in the search test is above 135 mg / dl. Other parameters such as the glucose content of the urine, the HbA1c or the fasting glucose are not suitable as a search test. With the 75g-oGTT, which should be carried out under standardized conditions, 75 g of glucose in 300 ml of water are drunk within three to five minutes. If at least one blood glucose value in the venous plasma is above the defined limit values ​​(fasting: 92, after one hour 180, after two hours 153 mg / dl), the diagnosis is confirmed. In Germany, this blood sugar-based test has been part of the maternity guidelines since March 3, 2012 and is therefore a benefit of the statutory health insurance . On this basis, pregnant women can be examined in the 24th to 27th week of pregnancy.

In Austria, this examination was already included in the routine examinations as part of the mother-child passport in 2008.

therapy

In around 9 out of 10 pregnant women, an immediate change in diet (e.g. small but more frequent meals, whole grain products instead of white flour, largely avoiding quickly absorbable carbohydrates such as fruit juices , lemonades ) in conjunction with regular exercise leads to normal blood sugar levels. If this, supported by training in a diabetes center, blood sugar self-monitoring and a diet plan, does not lead to improvement, insulin therapy must be started. An insulin pump therapy will be necessary only in extremely rare cases. Oral diabetes medications such as metformin or sulfonylureas and GLP-1 receptor agonists are contraindicated and must be discontinued in type 2 diabetics when they become pregnant.

Complications

Child complications

The gestational diabetes of the mother increases the premature mortality of the newborn as well as the risk of stillbirth and malformation. There is a higher morbidity during and after childbirth and a higher risk of premature birth. There is also the risk of hypoglycaemia in the child.

On the one hand, there are dangers to the fetus due to the risk of impaired development of the placenta. This can lead to an insufficient supply of the fetus , to impaired maturation of the lungs, liver or other organs, and even to intrauterine fetal death. Newborns have prolonged jaundice ( jaundice ); there is a risk of brain damage ( kernicterus ). A lack of calcium in newborns can also be attributed to it. On the other hand, the fetus or individual organs grow in size ( macrosomia ).

The child tries to compensate for the increased blood sugar level by increasing insulin secretion (which promotes cell growth in the fetus and the newborn is then often excessively large and heavy) and hypertrophy of the pancreas. After the birth, however, the mother's sugar intake is suddenly absent and hypoglycaemia occurs . The hypoglycaemia can make the newborn appear extremely irritable and scream or appear lethargic. In severe cases, seizures or pauses in breathing can occur. As a preventive measure, the newborn should be breast-fed or fed within 30 minutes of birth; A dextrose gel can also be massaged into the child's cheek mucosa.

Due to the early overuse of the child's pancreas, reduced glucose tolerance and a tendency to become overweight can arise even at school age.

Maternal complications

The pregnant woman is at risk of developing high blood pressure and preeclampsia (EPH gestosis) and is more prone to urinary tract infections and vaginal infections . In addition, women suffering from gestational diabetes have an increased rate of caesarean sections due to the fact that their child is too big or because of complications at the end of pregnancy . Another maternal risk is hydramnios . Studies have shown that the uterine muscles of pregnant women with diabetes of all forms have a lower contractility than those of other pregnant women, even after administration of oxytocin to stimulate labor.

The mother has a 50% risk of developing gestational diabetes again if she becomes pregnant again. She also has an increased risk of developing type 2 diabetes mellitus over the next 10 years. (If she breastfeeds her child for at least three months , this risk is reduced.) A glucose tolerance test is therefore one of the follow-up care for women after giving birth.

distribution

13.2% of all pregnant women in Germany develop gestational diabetes. This was shown by a study of the data from the National Association of Statutory Health Insurance Physicians from 2014 to 2015, in which 80% of all pregnancies ending with a birth were evaluated. The frequency is age-dependent: for those under 20 years of age, the GDM frequency was 8%, for those over 45 years of age it was over 26%.

These numbers are significantly higher than any previous estimate and reflect the more recent global data. The International Diabetes Federation estimates that some form of hyperglycaemia can be diagnosed in 16.2% of all pregnancies, which is one of the most important criteria for diagnosing gestational diabetes.

Current study

In 2010 the final results of the HAPO study (= hyperglycemia adverse pregnancy outcome) were published. The study (completed in 2006) included 25,000 pregnant women worldwide. Crucial knowledge was expected about the effects of elevated blood sugar levels in the mother on the unborn child. The guideline was published in 2011 by the specialist societies, the German Diabetes Society (DDG) and the German Society for Gynecology and Obstetrics (DGGG), u. a. updated based on this study.

See also

Guidelines

counselor

  • Heike Schuh: Diabetes in Pregnancy. The guide for pregnant women with gestational diabetes , Kirchheim, Mainz 2007, ISBN 978-3-87409-441-2 .
  • Lois Jovanovic, Genell J. Subak-Sharpe: Hormones. The medical manual for women. (Original edition: Hormones. The Woman's Answerbook. Atheneum, New York 1987) From the American by Margaret Auer, Kabel, Hamburg 1989, ISBN 3-8225-0100-X , pp. 162 ff., 282 ff. And 385.
  • Richard Daikeler, Götz Use, Sylke Waibel: Diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , pp. 128-134.

Web links

Wiktionary: Gestational diabetes  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. ↑ a b S3 guideline gestational diabetes mellitus (GDM), diagnostics, therapy and follow-up care of the German Diabetes Society (DDG). In: AWMF online (as of 2011)
  2. ↑ Freathy et al. Diabetes. 2010; 59 (10): 2682-9
  3. ↑ [1] (PDF; 255 kB) G-BA, guidelines on medical care during pregnancy and after delivery (maternity guidelines): Introduction of screening for gestational diabetes, December 15, 2011.
  4. ↑ Screening for gestational diabetes for all pregnant women. In: aerztezeitung.de. March 4, 2012, accessed November 20, 2019 .
  5. ↑ How is gestational diabetes diagnosed? In: Gesundheitsinformation.de. Institute for Quality and Efficiency in Health Care (IQWiG), November 20, 2018, accessed on November 20, 2019 .
  6. ↑ ÖDG press release December 2008: Great success with gestational diabetes! The ÖDG welcomes the inclusion of the glucose tolerance test in the mother-child pass (PDF; 11 kB).
  7. ↑ Richard Daikeler, idols Use, Sylke Waibel: diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , pp. 130-134.
  8. ↑ Richard Daikeler, idols Use, Sylke Waibel: diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , p. 128.
  9. ↑ Gestational diabetes: newborns often have hypoglycaemia! In: Diabetes Journal. German Diabetes Society, November 28, 2013, accessed June 12, 2014 .
  10. ^ Diabetes and Pregnancy, Section: "Childhood Complications in Diabetic Pregnancy". In: www.diabetes-heute.uni-duesseldorf.de. August 2001, accessed March 7, 2017 .
  11. ^ P Weiss, W Walcher, H Scholz: The neglected gestational diabetes: Risks and consequences . In: Birth of Frauenheilk 1999; 59: 535-44.
  12. ↑ Richard Daikeler, idols Use, Sylke Waibel: diabetes. Evidence-based diagnosis and therapy. 10th edition. Kitteltaschenbuch, Sinsheim 2015, ISBN 978-3-00-050903-2 , p. 128.
  13. ^ S. Al-Qahtani, A. Heath, S. Quenby, F. Dawood, R. Floyd, T. Burdyga, S. Wray: Diabetes is associated with impairment of uterine contractility and high Caesarean section rate . In: Diabetologia . tape 55 , no. 2 , 2012, p. 489-498 , doi : 10.1007 / s00125-011-2371-6 . Quoted from: N. Heslehurst, R. Vieira, L. Hayes, L. Crowe, D. Jones, S. Robalino, E. Slack, J. Rankin: Maternal body mass index and post-term birth: a systematic review and meta -analysis . In: Obesity Review . tape 18 , no. 3 , 2017, p. 293-308 , doi : 10.1111 / obr.12489 .
  14. ↑ Breastfeeding reduces the risk of type 2 diabetes. www.heilpraxisnet.de, October 30, 2012, accessed on February 2, 2013 .
  15. ↑ Screening reveals gestational diabetes. Doctors newspaper, November 10, 2016, accessed March 7, 2017 .
  16. ^ Deutscher Ärzteverlag GmbH, editorial office of the Deutsches Ärzteblatt: The prevalence of gestational diabetes (16.06.2017) . doi : 10.3238 / arztebl.2017.0412 ( aerzteblatt.de [accessed on June 23, 2017]).
  17. ^ International Diabetes Federation. Retrieved June 23, 2017 .
  18. ↑ Dr. med. Ute Schäfer-Graf: Diabetes Portal DiabSite - Abstract PD 11/2008
  19. ^ Hyperglycemia and Adverse Pregnancy Outcomes . The HAPO Study Cooperative Research Group In: The New England Journal of Medicine , Volume 358: 1991-2002 May 8, 2008