28 Week Pregnancy Diet

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The term gestational diabetes is used to describe intolerance to carbohydrates that occurs during pregnancy or existed previously but that is recognized for the first time during pregnancy.

The only condition for gestational diabetes to develop is that the woman is pregnant. Only one in four pregnant women present risk factors that allow the disease to suspect, for this reason it is advisable to make a screening of all the pregnants in order to be able to detect the disease.

The incidence of gestational diabetes oscillates 3-6% according to population groups studied.

Risk factors are considered to be able to have a gestational diabetes:

• Maternal age over 35 years.
  
• Background of a child’s birth with a weight greater than 4,000 grams (macrosome).

• Background of fetal deaths without a known cause.
  
• Gestational diabetes in previous pregnancy.
  
• Family history of diabetes mellitus or gestational diabetes.
  
• obesity, generally weight greater than 90 kilograms.
  
• Previous analytics with fasting glucose determination greater than 140 mg / dl (7.8 mm) or random glycemia determination greater than 200 mg / dl (11 mm).
  

  In women with risk factors, the ideal would be to verify correct blood glucose figures before pregnancy. It would also be advisable to take folic acid and be in the ideal weight before getting pregnant.
  

  Diagnosis
  

  When there are risk factors start the screening at the first pregnancy visit, then controls between 24-28 weeks and later, between 32-35 weeks. If there are no risk factors, only a test is performed between 24-28 weeks.

  For the screening of gestational diabetes, the test of O’Sullivan , which is to determine the venous blood glucose figure 1 hour after taking 50 grams of oral glucose . It can be done at any time of the day, it is not necessary to be fasting and it is not necessary to determine basal blood glucose.

  The O’Sullivan test is pathological when blood glucose is greater than 140 mg / dl or 7.8 mm.

  When the result of the O’Sullivan test is altered, the study must be completed with a glucose overload test (glucose curve) . To make the glycemic curve correctly it must be taken into account:

  • You should not restrict the diet the 3 previous days.
    
  • The diet must have a carbohydrate content greater than or equal to 150 grams.
    
  • The test must be done in the morning with a pre-fast of 8-14 hours.
    
  • should remain seated and without smoking during the test.
    

    The reference limits of the venous blood curve are the following:

    • fasts: 105 mg / dl.
      
    • 1 hour: 190 mg / dl.
      
    • 2 hours: 165 mg / dl.

    • 3 hours: 145 mg / dl.
      

      A pathological glycemia curve is considered when there are two or more values ​​above the aforementioned values. An altered value of the curve forces to repeat it in 3 weeks, if the alteration is repeated, it is considered to be a gestational diabetes.
      

      Monitoring and control
      

      Pregnant with gestational diabetes should have a positive attitude, and maintain great communication with your doctor. The doctor will advise pregnant adapting the diet of it, recommending adequate physical exercise and eventual paying the necessary treatments according to the peculiarities of each case.

      The gestational diabetes gesture should visit the doctor (obstetrician and / or diabetologist) to establish an adequate diet in which fast absorption sugars (sugar, chocolate, candies, jams) will be avoided. The diet will have a caloric content around 2000-2500 cal / day (35 kcal / kg of ideal weight / day). The diet should be varied, maintaining the following proportions: 45-50% of carbohydrates (fruits, bread, pasta, rice vegetables), 20% proteins and the rest of fat. Taking into account the individual characteristics and features the total daily intake will be distributed in about 6 meals.

      A complementarily have to control glycemias in capillary blood 1 hour after meals (must be less than 140 mg / dl or 7.8 mm). If the diet and strictly fulfilled the glucemias will not be controlled, it will probably be a candidate pregnant to be treated with insulin.

      From the obstetric point of view it will be controlled every 2-3 weeks until week 34-35 and then weekly.Fetal growth will be established at 28-30 weeks and, subsequently, at 34-36 weeks, a biophysical profile will be carried out to assess fetal well-being, trying to end the delivery at term if the metabolic controls are correct.

      Routine tests will be expanded with monthly urine cultures and determinations of fructosamine and glycosylated hemoglobin.

      Likewise, care should be taken not to exceed a weight gain of about 11-12 kilograms during pregnancy.

      With all these controls, in general, optimal perinatal results are achieved.

      Consequences

      When gestational diabetes is not properly controlled, the risk of a fetus dying is slightly increased compared to non-diabetic women, however if properly controlled this risk almost disappears. < / p>

      When gestational diabetes is not controlled, there are risks for the mother of urine infection, excessive weight gain, premature delivery and, to a lesser extent, complications similar to those of non-gestational diabetes.

      Regarding the fetus, the risks are macrosomia, hyperbilirubinemia, polykethemia, hypocalcemia, hypoglycemia, respiratory distress (hyaline membrane). Blood glucose levels above 150 mg / dl can lead to fetal acidosis and loss of fetal well-being.

      During childbirth there are only small differences compared to a pregnant woman who does not have gestational diabetes. Glucose solutions, betamimetics and corticosteroids should be avoided, as well as controls of glycemic levels. If the pregnant woman is treated with insulin, a specific protocol must be applied. On the other hand, it is advisable to have gross fetuses diagnosed to try to prevent possible shoulder dystocia during delivery.

      The follow-up of patients with gestational diabetes shows that around a third may develop diabetes in the following years. However, after delivery, the vast majority of gestational diabetes disappears, except in those pre-existing diabetics in which it will remain. Between 6 weeks and 6 months after delivery, it is advisable to carry out a glucose tolerance test with 75 grams and glucose determination at 2 hours in order to confirm the normalization of the process.

      If you have suffered from gestational diabetes in a pregnancy, it usually occurs with a high frequency in subsequent pregnancies.

      Frequently Asked Questions

      Will the baby have diabetes or underweight if the mother has gestational diabetes?
      The fact that gestational diabetes has been diagnosed does not necessarily mean that the child is born with diabetes. On the other hand, the weight of the baby at birth should not be worrying, since if the established controls are followed, a proper diet and is controlled by a specialist, the baby will be born with the weight that corresponds to it.

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