Diabetes in pregnancy
Which are the symptoms?
Type 1 and 2 diabetes are already known as pre-pregnancy, while gestational diabetes is generally diagnosed through examinations, but sometimes it can be suspected if the patient has an excessive weight gain or if the fetal growth is at the upper normal limits.
How is it diagnosed?
Patients with type 1 diabetes are already followed-up by their diabetologist with regard to insulin therapy and should tend to glycemic levels as close as possible to normal (95 mg/dl fasting and 120/130 mg/dl 2 hours after a meal) with glycosylated hemoglobin 6.5-7%. Patients with type 2 diabetes are often on hypoglycemic therapy that should be replaced with insulin before pregnancy or at the latest at a positive test. Diagnosis of gestational diabetes is made using loading curve with 75 g of glucose if one or more of the values exceeds the limit of 92 mg/dl baseline, 180 mg/dl after 1 hour and 153 mg/dl after 2 hours. It is recommended that all pregnant women at 24/28 weeks perform the loading curve regardless of the presence of risk factors: in case of risk factors (obesity, previous DG or macrosome, family history of diabetes) it is recommended to perform the curve at 16 weeks and, if negative, to repeat it later. Sometimes, previously undiagnosed diabetes may occur if repeated basal blood glucose values ≥ 126 mg/dl are found at any time of pregnancy.
How is it treated?
Patients with diabetes are followed-up in a multi-specialist outpatient clinic called Diabetes and Pregnancy where there is the simultaneous presence of a gynecologist expert in pathology of pregnancy and a diabetologist. The therapy for type 1 and 2 diabetes is insulin either as conventional subcutaneous therapy or as a pump with the goal of achieving optimal glycemic compensation that allows for regular fetal growth. Intensive glycemic control will be performed through capillary blood glucose possibly associated with subcutaneous sensor. All possible complications of diabetes (hypertension, hypo/hyperthyroidism, retinopathy, nephropathy, celiac disease) should be treated with therapies compatible with pregnancy. On the other hand, gestational diabetes is treated with the setting of an adequate diet, which is based on the fractionation of meals, and an intensive control of capillary glycemia. However, about 20/30% of gestational diabetics require multi-injection insulin therapy in order to maintain target blood sugar levels and normal fetal growth.