Diabetes in pregnancy | Reproductive system physiology | NCLEX-RN | Khan Academy
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Diabetes in pregnancy | Reproductive system physiology | NCLEX-RN | Khan Academy

August 30, 2019


– [Voiceover] 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
that picture quite a bit. So firstly, diabetes
and pregnancy split up into two different categories. There’s the category of women who had diabetes before becoming pregnant, and that’s called
pre-gestational diabetes. So that category is referred
to as pre-gestational diabetes. Pre for before, gestational for pregnancy, so before pregnancy diabetes. And then there are the
women who become diabetic during their pregnancy, which is called gestational diabetes. So that’s the second category,
gestational diabetes. And 90% of cases, so that’s
nine of every 10 cases of diabetes in pregnancy
falls into this category of gestational diabetes. And then the other 10% are
pre-gestational diabetics. 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 organogenesis. So the first eight weeks of pregnancy is a period called organogenesis, when the fetus’ 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 cause problems with
the growth of the fetus. It can even lead to stillbirth. 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. Alright, 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 the 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 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 of pregnancy, the impaired glucose control
is more long-standing. So these women are more likely to have diabetic complications
such as kidney damage or vascular problems, so
blood vessel related problems, and damage to the retina. And pregnancy can aggravate
these complications, so it can it make 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 stand for human placental, human placental lactogen. Alright, 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, that’s released in a large
quantity during pregnancy. And then finally, progesterone. Progesterone, which is
exceptionally important for the maintenance 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 mom’s production of glucose during pregnancy to make sure that the fetus has enough of the glucose, enough of its primary fuel source. And that leads to high glucose levels within the mom’s 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’s cells “to take up the glucose
and problem solved. “You don’t have high glucose
levels in the blood any more.” 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 in 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, it goes 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. So for all women, all average women, we do a routine screen
around 26 to 28 weeks into the pregnancy. And that screening test
is usually in the form of a glucose tolerance test. So the screening test 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 follow up with all these women after they deliver. Kind of the set point, six
weeks after they deliver to test them for diabetes. Okay, so that is gestational
diabetes in a nut shell.

Only registered users can comment.

  1. Correction: the OGTT is first a screening test of 50g of glucose and checked one hour later. IF it is over 140mg/dL, THEN they will do a diagnostic screening of 100g @ 3 hours or 75g @ 2 hours to diagnose. A result of at least two of the hour checks is diagnostic of GDM.

  2. Very nicely done, with the basic principles. Thank you. 😀

    btw screening is done at 26-28 weeks because that's when the diabetogenic hormones are at their peak levels. 🙂

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  4. You need to consider handling diabetes by following the right eating pattern. I have spent enough time and money to realize that drugs ain't going to be the answer for this kind of sickness.

  5. Thanks so much for breaking these pregnancy topics down to be so easy to understand.
    – Sincerely, A nursing student

  6. Actually, the first test is the Glucose Challenge. Then if you fail that, its the Glucose Tolerance test. Done over a 3 hour period.

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  8. Correction- Gestational diabetes mellitus- woman without diabetes develop glucose intolerance with its onset during pregnancy usually around the 20-24th week (depending on your text book )or first detected in pregnancy.

  9. Would anyone be able to provide a credible source for the "hormone theory" as the causative agent in development of GDM?

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