Gestational diabetes and obesity can be considered important determinants of postnatal development and offspring health status. This is the conclusion reached by a research team composed of specialists from the departments of physiopathology and obstetrics and gynecology of the Faculty of Medicine of Masaryk University in the Czech Republic, who published the article Morbidity and psychomotor development of the children of women with gestational diabetes: a five-year period -Follow up in BMC Pediatrics.
The main objective of this study was to determine the possible anthropometric abnormalities – increase in cell number and/or cell size – and development and/or morbidity – the number of people who become ill in a given place and time period. in the children of mothers with gestational diabetes (GDM) and how it affects the first five years of their development. The study, whose initial sample consisted of 432 women – only 89 of whom participated over the total five years of the study – also found that the children of women suffering from this pathology had delayed psychomotor development in early childhood , although after five years they gradually reached the results of the control group.
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All participants were recruited from different outpatient prenatal centers in the city of Brno, Czech Republic, and of these, 364 developed GDM and 68 had a pregnancy without GDM. All underwent routine GDM screening with an oral glucose tolerance test using 75 grams of glucose between 24 and 30 weeks of gestation. The normal criteria for sugar during pregnancy are: it should not exceed 95 mg/dL on an empty stomach or before meals; According to the World Health Organization, it is below 140 mg/dL one hour after eating and below 120 mg/dL two hours after eating. Women who exceeded these levels and were diagnosed with GDM were followed up until delivery. During pregnancy, they followed a diet – 27 of them required insulin – and gave birth in the clinics of the Brno University Hospital, which helped to collect all the data of the birth and the health of the newborn up to the time of discharge.
Increased complications during pregnancy
Alejandra Durán, Assistant to the Endocrinology Service at the San Carlos Clinical Hospital in Madrid, Associate Professor at the Complutense University of Madrid (UCM) and member of the Diabetes Group of the Spanish Society of Endocrinology and Nutrition, claims that women develop diabetes mellitus gestational “ suffer greater complications during pregnancy, such as high blood pressure, known as preeclampsia in its most severe form, and a greater number of cesarean sections during childbirth than those who do not develop it.”
In babies born to mothers with this type of diabetes, according to this specialist, “there is a higher percentage of fetuses that are large for their gestational age, which is called macrosomic if they exceed four kilos, but there are also small ones for her gestational age. In addition, as large babies, they may suffer from shoulder dystocia while passing through the birth canal. And he adds: “Neonatal complications such as hypoglycemia or hyperbilirubinemia and a lower Apgar score, which indicates the neonate’s adaptation and vitality after birth, are also observed, which means that more neonates are admitted to the intensive care unit.”
Currently, the incidence of gestational diabetes is increasing mainly due to two factors: the rise in obesity and the age at which pregnancies occur. Numerous studies show that these women triple their cardiovascular risk even if they don’t develop diabetes; and every second person who suffered from it will develop type 2 diabetes in the future.
“After obese patients with metabolic diseases, i.e. those with risk factors such as high blood pressure and hypercholesterolemia, gestational diabetes is the largest cardiovascular risk factor for the development of type 2 diabetes. This is particularly worrying as we are talking about a young population,” she assures Dr. Alejandra Duran.
The importance of early detection
Therefore, early detection and intervention of this type of diabetes during pregnancy is essential to reverse its harmful effects. “It has been shown that early treatment, around 10 or 12 weeks of pregnancy, with a Mediterranean diet enriched with extra virgin olive oil and nuts, not only reduces short-term complications such as performing caesarean sections, but also by 30% reduced. , the possibility of developing gestational diabetes at 24 weeks,” confirms Durán after the research carried out by his team. “It is also advisable, for example, to walk or climb stairs to check blood sugar and weight.”
For her part, María Goya Canino, coordinator of the pregnancy group of the Spanish Society of Diabetes and specialist in obstetrics and gynecology at the Department of Maternal-Fetal Medicine of the Vall d’Hebron University Hospital in Barcelona, considers the implementation of appropriate measures that help to know if a woman can develop this type of diabetes during her pregnancy.
According to this expert, “Gestational diabetes is diagnosed during pregnancy. However, the detection or screening of pregestational diabetes type 1 or 2 and other risk factors for pregnancy can be detected earlier. It’s also important to review and improve habits to promote healthy living with appropriate weight, physical activity, and avoidance of harmful habits and toxic substances. This assessment is key to detecting before pregnancy or minimizing the chance of the disease developing. Furthermore, Goya considers follow-up care of the newborns of these mothers to be necessary and recommends special monitoring for the woman concerned, particularly in the first year after birth, “since she is at increased risk of developing an adverse cardiovascular event five or ten years after birth”.
Although the link between maternal diabetes and changes in the child’s psychomotor development has been described for a long time, Dr points out the mechanism “The most important factor is thought to be glycemic control during pregnancy, but it seems that other factors such as hormonal changes or lipid status (certain fatty acids in the blood) can also have an impact.” For this reason, this expert believes that in order to avoid physical and neurological changes in the newborn, “in addition to maintaining good glycemic control during pregnancy, we know must know that after birth they are children who are at risk of having changes in the neurological development, so you must be particularly careful when assessing psychomotor development. Follow-up can be provided by primary care paediatricians as part of check-ups, but if there is any doubt about their development, the child is quickly referred to early care.”
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