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Pregnancy-specific illnesses & illnesses in the puerperium

If a glucose metabolism disorder is found in the mother during pregnancy, one speaks of "gestational diabetes" (gestation = pregnancy) - regardless of whether there is already a known diabetes mellitus, which is only diagnosed during pregnancy, or whether the diabetes is a consequence the pregnancy arose.

Basically, with a frequency of around 2% - 8%, it is the most common concomitant disease in pregnancy, which can lead to serious complications for the mother and, above all, for the child before and at birth. The disease results in recurring, briefly elevated blood sugar levels in the mother and, ultimately, in the child. Pregnant women therefore have an increased risk of infections, high blood pressure and premature births. Further health risks can arise for the child, such as malformations or so-called fetal macrosomia. Too much of the growth hormone insulin can lead to weight gain and, in some cases, enlargement of the skull and bones, which make delivery difficult, make a caesarean section necessary and can lead to birth injuries. Affected newborns later often become overweight children and adults and are more prone to diabetes and the long-term damage associated with the metabolic disease. It is therefore very important that the disease is identified and treated as early as possible.

Insulin plays a crucial role in the development of gestational diabetes. It is responsible for the fact that sugar (glucose) gets from the blood into the cells and thus ensures a lowering of the blood sugar level. During pregnancy there is usually an increase in the blood sugar level, which can be caused on the one hand by various pregnancy hormones (e.g. estrogen, human placental lactogen (HPL)) and on the other hand often due to diet (malnutrition and overeating). This also increases the maternal organism's increased need for insulin. If the pancreas cannot supply this increased need for insulin, diabetes develops. After the birth, the mother needs less insulin again, which is why the disease disappears in most cases. In a small proportion of those affected, diabetes persists even after pregnancy or leads to diabetes mellitus after five years.

Between the 24th and 28th week of pregnancy, all pregnant women who have not already been diagnosed with overt diabetes can have a blood sugar-based addiction test for the early detection of gestational diabetes (GDM for short).
Risk factors for developing gestational diabetes include:

  • Malnutrition and the resulting overweight or obesity
  • Type 2 diabetes mellitus in the family
  • Gestational diabetes during a previous pregnancy
  • excessive weight gain during pregnancy
  • impaired glucose tolerance (precursor of type II diabetes) before pregnancy

In pregnant women who are at increased risk of diabetes, an addiction test for increased blood sugar levels can be carried out as early as the first trimester of pregnancy. However, it should be repeated in risk patients with negative results in the 24th to 28th week of pregnancy and, if the results are negative again, in the 32nd to 34th week of pregnancy.

Even if the child is significantly larger than its developmental age after the 20th week, it should be checked whether gestational diabetes may be present.

A mild form of gestational diabetes can be treated with diets, with several small, low-calorie meals per day and sufficient exercise. Above all, quickly available sugars, such as those found in white flour products, confectionery or lemonades, should generally be avoided as they lead to a rapid rise in blood sugar. Instead, whole grain products should be preferred as a source of carbohydrates. In 85% of all cases, a wholesome, healthy diet is sufficient for therapy; in 15% of cases, additional insulin must be given.
If a good adjustment of the blood sugar values ​​is not possible from a dietary point of view, medication must be used. This treatment takes place in specialized diabetological practices in cooperation with the gynecologist. In most cases, gestational diabetes regresses after pregnancy, but those affected should have their blood sugar levels checked regularly by their gynecologist even after delivery.

Because of the possible complications, it is advisable for women with gestational diabetes to give birth in a clinic with intensive neonatal care. It is not uncommon for their babies to have an increased birth weight of over 4kg, which can make it necessary to have a caesarean section or a forceps or suction bell birth.

To be on the safe side, the blood sugar level should also be checked again after the birth - ideally at regular intervals in the future. Studies have shown that more than half of all women with gestational diabetes develop diabetes within 10 years. The prognosis is even worse for pregnant women with diabetes that requires injecting insulin - 61% of them will develop type II diabetes within the next three years. In expectant mothers who were adequately treated by changing their diet alone, only 15% later became ill. This form of diabetes can also be controlled well with medication and a change in diet.

thrombosis

The risk of deep leg or pelvic vein thrombosis in pregnant women and women who have recently given birth is around 6 times higher than in non-pregnant women. The cause are the physical changes during pregnancy: The composition of the blood and the hormone balance change, the vein walls become more elastic and widen due to the increased formation of the corpus luteum hormone progesterone. This will slow down the flow of blood. In addition, changed pressure conditions in the veins - especially in the last months of pregnancy, when the growing fetus and the uterus increasingly press on the veins in the abdomen - promote the formation of blood clots.

In a thrombosis, a blood clot (thrombus) forms in a healthy or damaged blood vessel and narrows or blocks the vessel. Such blood clots can develop when "used", low-oxygen blood no longer flows sufficiently towards the heart.
The most common thromboses are in the veins and, here, preferably in the veins of the lower half of the body (deep leg veins, not infrequently also pelvic veins). Basically, the frequency of thrombosis in the veins is significantly higher than in the arteries. The more delicate anatomical structure of the vein walls and the lower flow velocity of the venous blood compared to the arteries are responsible for this.

If a thrombosis has already occurred in a previous pregnancy, the risk of a new thrombosis is considerably increased. If other risk factors are added, these multiply with each other and dramatically increase the risk of thrombosis. In addition, the risk of thrombosis after a caesarean section is significantly higher than after a vaginal delivery. Only consistent thrombosis prevention can help here. In order to support the vein function and prevent secondary diseases, it can be helpful to administer heparin and to wear well-fitted compression stockings.

Expectant mothers should always consult a doctor if a leg swells painfully, turns bluish and the superficial veins are more filled with blood. The doctor is able to detect a thrombosis by palpating the thrombosis pressure points and with the help of ultrasound or magnetic resonance imaging and, if necessary, treat it with blood-thinning medication.

Ectopic pregnancy