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Frequent questions | |
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He asks the doctor | |
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Beginning | |
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DIABETES AND PREGNANCY | |
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 DESCRIPTION DETECTION PURSUIT PROBLEMS TO SEE TO CONSULT |
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During the normal pregnancy there take place metabolic adaptations, directed to correct the imbalance that takes place on having needed a major nourishing contribution for the fetus. One of these imbalances consists of the fact that the organism needs a major insulin contribution on having needed a major use of the glucose. A clear test of this change is the experienced one by every pregnant woman, who usually notices in the mornings the unpleasant symptoms of the hypoglycemia: morning sickness, drowsiness, weariness, weakness, etc.
The same way as it advances the gestation, the metabolic adaptation is intensified, reaching big importance during the last 20 weeks of the pregnancy. All these metabolic changes lead to a series of considerations when they take place in a diabetic woman:
The information that suggest the possibility of a DMG is:
Some information with minor importance is: multiparity, toxemia of the pregnancy appellant and repeated premature childbearings. The presence of more than one fact increases the probability of which there is a disorder in the metabolism of the glucose. The glucosuria (glucose in urine) is a frequent find, since 15 %, of the women gestantes has it, for which the cases search basing on this isolated fact is fruitless. The validity of this test can increase when the second urine sample is used on an empty stomach: the urine expressed, on having woken up, is despised and the second sample is gathered 15 minutes later, when the patient still remains on an empty stomach. The suspicious cases of DMG should be seen every 15 days by the endocrinologist, working together this one and the obstetra. The habitual prenatal measures must be taken. It is necessary to do special emphasis on the control of weight. In every visit it is necessary to realize a glycemia after eating. If this examination does not overcome 120 mg/dl), the test of oral tolerance to the glucose must be deferred up to the week 37ª-38ª of the gestation, moment in which it is more probable that it gives positive. If in any visit the glycemia, after eating, overcomes 120 mg/dl, it is necessary to do a tolerance test to the glucose without delay. If the test is negative at the beginning of the pregnancy it does not exclude, nevertheless, the diagnosis, and the test must recur at the age of 37-38 weeks, before taking a definitive decision. The patients who have a test of negative tolerance at the age of 37-38 weeks are considered to be normal. If the test is positive it is possible to realize the diabetes diagnosis gestacional and a diet is offered to the patient and he is controlled likewise to a clinical diabetic. If the ideal criteria of control of the glycemia are not reached soon, the treatment is begun with insulin. In the well controlled and not complicated cases, it is waited for the spontaneous childbearing. The existence of a high need for insulin during the gestation does not indicate necessary that the diabetes persists after the childbearing. After the puerperio the tolerance test must recur to the glucose. If the test is still positive, the patient has a clinical diabetes (that was revealed for the first time during the gestation). If it is negative, the correct diagnosis is of diabetes mellitus gestacional. As some patients with DMG develop a clinical DM later, it is necessary to recommend to them to support a normal corporal weight and to advise to come annually to review, or immediately if they remain pregnant women again.
The particular problems of the gestation in the diabetic can be considered under several titles: MATERNAL PROBLEMS
The hypoglycemia is frequent in the first half of the pregnancy, especially in the first trimester. Fortunately the fetus tolerates well the hypoglycemia.
This is a real danger and what happens with the hypoglycemia, it is mortal for the fetus
The retinopatía is already present in many women to the beginning of the gestation, and can progress the same way as this one advances. The regular oftalmoscopia is, therefore, important. Paradoxically, the progression of the retinopatía can be related to the beginning of a strict metabolic control. When it appears neovascularización, it can be controlled by photocoagulation, and it is not, therefore, an indication for the interruption of the pregnancy.
The nefropatía in the diabetic gestante is defined as the presence during the first half of the gestation of proteinuria (presence of proteins in the urine) persistently, of more than 400 mg in 24 hours, in infection absence. Many patients also will have the high tension and other complications derived from the renal injury. These cases need a meticulous supervision and the control of the hypertension and of the diabetes mellitus, realizing quickly the hospitable revenue and inducing the childbearing. The patients with renal transplants funcionantes usually have gestations successfully. FETAL PROBLEMS
It can take place of unexpected and inexplicable form
The congenital malformations happen in 6-8 % of the children of diabetic mother: they are three times more frequent than in the general population. The type of malformations covers a wide bogey, but the defects of the channel neural and the cardiac injuries are quite frequent. Therefore, it is necessary to advise to the diabetic woman to plan his gestation and to warn in advance, to be able to obtain the best possible control before the conception takes place. The fulfillment of this advice can diminish the number of malformations
Although the habitual thing in the children of diabetic mother the macrosomía is, some neonatos are small for the age gestacional, due to a delay in the growth intrauterino. This is more frequent in patients with DM of long evolution with vascular complications. MORTALITY IN THE NEWBORN BABIES
When the patients were giving birth of routine form to 36-37 weeks after gestation, due to the absence of maturation of the lungs of the neonato, an alteration respiratory was taking place that numerous times it was mortal. Nowadays this problem can be foreseen on time numerous deaths being avoided by this cause.
The hypoglycemia neonatal is frequent, especially in the children macrosómicos. The strict metabolic control of the mother and of the neonato in the postchildbearing diminishes the frequency and gravity of the hypoglycemia neonatal.
She can turn out to be associated with a premature childbearing. |
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