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Current time:0:00Total duration:8:14

Video transcript

diabetes it's certainly not a problem that's unique to pregnancy but it's something we always have to discuss when we're talking about pregnancy because it can really complicate the picture quite a bit so firstly diabetes in pregnancy split up into two two different categories there's the category of women who had diabetes before becoming pregnant and that's called pre gestational diabetes so that categories is referred to as pre gestational diabetes pre for before gestational for pregnancy so before pregnancy diabetes and then there the women who become diabetic during their pregnancy which is called gestational diabetes so that's the second category gestational diabetes in 90% of cases so that's nine of every ten cases of diabetes in pregnancy falls into this category of gestational diabetes and then the other 10% are pre gestational diabetic so there's something about pregnancy that makes women more susceptible to developing diabetes and we'll discuss exactly what that is in just a bit but firstly why do we even split up diabetes into these two different groups well if a woman has pre gestational diabetes that means that her blood sugars may have been poorly controlled at the time that the baby was conceived or even during the first eight weeks of the pregnancy during a period called organo Genesis so the first eight weeks of pregnancy is a period called organo genesis when the when the fetuses organs are made and those high levels of glucose during that really pivotal time can lead to a miscarriage or it can lead to significant anomalies within the fetus however with gestational diabetes that problem with glucose control develops during the pregnancy in some ways because of the pregnancy and usually the glucose control isn't impaired until the second trimester so after the point of conception and after the point of organogenesis so miscarriage and fetal anomalies don't tend to be a problem with gestational diabetes but that's not to say that gestational diabetes doesn't harm the fetus rather diabetes as a whole so regardless of the category can cause preterm labor it can it can cause problems with the growth of the fetus and you can even lead to still birth and one of the complications that we tend to think about a lot that tends to be talked about a lot is fetal macrosomia so fetal macrosomia so let me explain that a little bit all right so if mom has diabetes the basic gist of it all is that her glucose levels tend to run on the high side and glucose can cross the placenta into the bloodstream of the fetus that's like one of the main purposes of the placenta to allow glucose to enter the baby's bloodstream as an energy supply so then when mom has high glucose levels in her blood then the fetus has high glucose levels in its blood and that drives the release of insulin in the fetus because that's a body's primary response to glucose to release insulin insulin is kind of the key that allows cells to open up their doors and take up glucose and use it and so that insulin that's released in the fetus allows glucose to be taken up and an insulin does a few other things it also stimulates fat storage in the body right and it also binds to receptors on different organs such as the heart and the liver and it causes them to grow it causes the organs to actually grow in size and so the end result of it all the end result of the high glucose levels in the mom leading to high glucose levels in the baby leading to high insulin levels in the baby is that the baby grows to a larger size than normal which is called fetal macrosomia macro for large and Soma for body so larger body now another thing that I want to mention is that in pre gestational diabetes so again diabetes before the point pregnancy the impaired glucose control is more long-standing so these women are more likely to have diabetic complications such as kidney damage vascular problems so blood vessel related and damage to the retina and pregnancy can aggravate these complications so I can make it worse so it's really important to monitor these conditions throughout the pregnancy now I want to stop dancing around the issue of why women can become diabetic during pregnancy a lot of it has to do with the hormones that are released during pregnancy so hormones such as HPL that's not one that many people have heard of right it stands for a human since for human placental human placental lack diging right so that's HPL another hormone is cortisol so the body's main stress hormone another one that you may have heard of before is growth hormone it's released in in a large quantity during pregnancy and then finally progesterone progesterone which is which is exceptionally important for the maintenance of a of a healthy pregnancy so these hormones are released during pregnancy and they have lots of important roles and among their many many roles these hormones increase moms production of glucose during pregnancy to make sure that the fetus has enough of the glucose enough of its primary fuel source and and that leads to high glucose levels within the moms blood and you might be thinking well that's no problem because the glucose will cause insulin to be released and that insulin will cause mom cells to take up the glucose and problem solved you don't have high glucose levels in the blood anymore well unfortunately it doesn't really work that way because these same hormones make the mom's body resistant to insulin so that the cells don't respond to insulin and don't take up as much glucose from the blood and this is done for a purpose it's actually done so that you can reduce mom's utilization of the glucose so that more of the glucose is available for the fetus and that's why you can end up with high blood glucose levels and diabetes and pregnancy or if you had diabetes before you became pregnant it can become worse during pregnancy so given that diabetes can cause all of these complications for mom and baby during pregnancy without saying that we do our absolute best to screen for it during pregnancy so for women who have a normal risk of having diabetes we do a routine screen write so for all women Dell average women we do a routine screening around 26 to 28 weeks into the pregnancy and that screening test is usually in the form of a glucose tolerance test so it's the screening test is is often called the glucose tolerance test where the woman is given a very specific amount of glucose and her blood glucose levels are measured at one two or three hours after consuming that very specific amount of glucose and if her blood glucose levels are above the normal range then she's found to be diabetic and if a woman is diagnosed with diabetes during her pregnancy we do our best to control it with diet and if that doesn't work then insulin is kind of our second line of treatment and it's also important to know that gestational diabetes so again diabetes that occurs during pregnancy kind of as a process of pregnancy increases the risk of a woman having overt diabetes after the pregnancy is over so it's really important to followup with all these women after they deliver kind of the setpoint is six weeks after they deliver to test them for diabetes okay so that is just a tional diabetes in a nutshell