Diabetes is a chronic disease characterized by high blood glucose levels, a condition known as hyperglycemia. Diabetes occurs when the body is unable to produce enough insulin*, or is unable to use it properly. This hormone's main function is to allow glucose** to enter cells so it can be used as an energy source. When this doesn't happen, glucose builds up in the blood in large amounts. If hyperglycemia persists, it leads to the onset of various complications.

There are several types of diabetes mellitus, but three are the main ones.

  • Type 1 diabetes is an autoimmune disease in which hyperglycemia is linked to the progressive destruction, by the immune system, of the beta cells in the pancreatic islets, which are responsible for insulin production. Type 1 diabetes usually affects children or young adults, but it can appear at any age and accounts for about 5-10% of all cases. Its main treatment is subcutaneous insulin injection.
  • Type 2 diabetes is a metabolic disorder resulting from the body's inability to properly use insulin. It is the most common form, responsible for about 90-95% of diabetes cases. It occurs mainly in adulthood. Its treatment, at least in the early stages, may not require insulin, and can instead be based on diet, exercise, and medications that stimulate insulin secretion or make peripheral tissues more sensitive to its action.
  • Gestational diabetes is a temporary condition in which high blood glucose levels appear during pregnancy, in a woman with no previously known diabetes. It occurs in about 4-7% of pregnant women. After delivery, blood sugar returns to normal. However, 30-60% of these women may go on to develop type 2 diabetes within the following 10-20 years. It is particularly common in the last trimester of pregnancy and in women giving birth at an older age. Very often, the baby is born above-average weight (macrosomia).

Pre-existing Diabetes (Type 1 and Type 2) and Pregnancy

Pregnancy in women with diabetes, whether type 1 or type 2, is often associated with a high frequency of maternal and fetal complications, with increased neonatal mortality and rates of malformation. Optimal blood sugar control, from the moment of conception through to the end of pregnancy, is the key measure for reducing miscarriages and the incidence of illness in the baby. This suggests it is worth planning the pregnancy, so as to reach conception with ideal glycemic control already in place.

Gestational Diabetes

In pregnant women, the placenta supplies the fetus with all the substances needed for its growth and also produces a wide variety of hormones that help maintain the pregnancy. Some of these hormones interfere with the action of insulin. For this reason, toward the end of pregnancy, a pregnant woman's insulin requirement is about three times higher than that of a woman who is not pregnant, for the same calorie intake. As a rule, the endocrine pancreas is able to produce an additional amount of insulin suited to offsetting this insulin resistance. However, some women, due to particular genetic characteristics, are unable to meet this extra insulin demand and therefore cannot compensate for the insulin-blocking effect of placental hormones. This insufficient insulin supply leads to a rise in blood glucose levels, which is the pathological condition known as gestational diabetes. Blood sugar imbalances must be monitored very carefully to avoid problems for both the mother and the developing fetus.

Conclusion

Pregnancy in women with pre-existing diabetes can carry an increased risk of complications for both mother and fetus. Carefully planning the timing of conception helps reduce both the risk of congenital malformations and, more generally, the incidence of diabetes-related maternal and fetal conditions. For a woman with diabetes, pregnancy should always be a period of constant blood sugar monitoring.

For women who develop gestational diabetes during pregnancy, it is essential that they follow all the necessary precautions recommended by their gynecologist, so they can carry the pregnancy forward with peace of mind, minimizing the risks for both mother and baby.

* Insulin is a polypeptide hormone, that is, a chain of amino acids, produced by the endocrine component of the pancreas, made up of the beta cells of the islets of Langerhans.

** a six-carbon sugar, a fundamental compound in our metabolism.