Maternal diabetes mellitus – known in medicine as embryofetopathia diabetica – causes an increased risk of prenatal and postnatal complications in the child during pregnancy. The extent of the blood sugar imbalance and its onset during pregnancy are of particular importance.
What is Diabetic Embryofetopathy?
According to HEALTHKNOWING.COM, Embryofetopathia diabetica is a prenatal developmental disorder of the unborn child, which is caused by poorly adjusted, unrecognized or derailed diabetes mellitus in the mother during pregnancy. Depending on when the increased blood sugar levels occur, various complications can arise in the child.
Organs are created in the child during the embryonic period (early pregnancy). In addition, arm and leg buds are formed. If sugar-related disorders occur during this time, severe malformations can be the result. This is also known as embryopathia diabetica. Two thirds of diabetes-associated malformations affect the cardiovascular and nervous systems.
During this period, miscarriages also occur more frequently in mothers with poor metabolism than in healthy pregnant women. Fetopathia diabetica, on the other hand, describes the consequences of increased maternal glucose levels in the unborn child during the fetal period (from the 9th week after fertilization). In the fetus, too, the placenta leads to increased blood sugar levels with subsequent increased insulin production.
Causes
In the metabolic disorder of the mother can be, mellitus firstly pre-existing diabetes. A distinction is made between type 1 and type 2. While type 1 diabetes mellitus is an autoimmune disease with gradual destruction of the insulin-producing cells in the pancreas, type 2 is based on insulin resistance.
The insulin actually present in sufficient quantities no longer has a sufficient effect. On the other hand, embryo fetopathia diabetica can also be caused by diabetes that appeared for the first time during pregnancy, known as gestational diabetes. This usually occurs from the 24th week of pregnancy and with increasing frequency.
Regardless of the cause, the increased blood sugar levels in pregnant women also lead to increased glucose levels in the fetal blood via the placenta. The fetus produces a lot of counter-regulating insulin. In addition to its blood sugar lowering effect, this also has a growth-promoting effect. This leads to disproportionate growth in the unborn child.
Birth injuries are thus favored. Further consequences of the so-called hyperinsulinemia can include impaired or delayed lung maturity or an increased production of red blood cells in the child with subsequently abnormally increased blood viscosity. Furthermore, the risk of premature birth is increased.
Symptoms, ailments & signs
Typical symptoms of diabetes mellitus are severe thirst, dry skin, increased urination and fatigue. Sometimes there is also weight loss or an increased susceptibility to infections. The symptoms can vary in severity.
Often, however, the diabetes remains undetected for a long time due to the lack of pain. Sonographic evidence of embryo fetopathia diabetica can be increased amniotic fluid formation (polyhydramnios), enlarged or comparatively rapidly increasing fetal abdominal circumference, and the presence of diabetes-associated malformations.
Diagnosis
Pregnancy care with regular blood, urine and ultrasound examinations is therefore of particular importance. Before the 24th week of pregnancy, manifest diabetes mellitus should be specifically ruled out if risk factors are present. Furthermore, an oral glucose tolerance test standardized with 75 grams of glucose should be carried out between the 24th and 28th week of pregnancy in every pregnant patient who has not yet suffered from diabetes.
Complications
Embryofetopathia diabetica is one of the prenatal developmental disorders. The causes of the symptom are either undetected diabetes mellitus in the expectant mother or a poorly controlled variant of diabetes. Because the blood sugar level is too high, the placenta also increases insulin production in the unborn child.
If the signs of the symptom, such as extreme tiredness, constant feeling of thirst, dry, tight skin and constant need to urinate, as well as inexplicable weight loss and susceptibility to infections, are not medically clarified by the expectant mother, serious pregnancy complications will arise. During the embryonic period, malformations of the arm and leg buds as well as organ damage to the heart, liver and kidneys can occur.
Neonatal adjustment disorders, delayed lung maturity and increased red blood cell production are not uncommon. In addition to the risk of miscarriage or stillbirth, newborn mortality is higher. If the newborn does not show any visible malformations, it is still carefully monitored in the first days of life, as the metabolism slows down.
Another complication of a diabetic embryofetopathy are birth injuries, where the newborn can get stuck with one shoulder in the birth canal during the birth process and threatens to suffocate. If diabetes is diagnosed during pregnancy or if it is known beforehand, the mother-to-be, the birth process and the subsequent follow-up examinations are monitored in a diabetic clinic.
When should you go to the doctor?
If an expectant mother has a vague feeling of a health disagreement, she should see a doctor. If the perception of unusual changes in yourself or the unborn child cannot be explained rationally, it is generally advisable to discuss the concerns openly with a doctor or an obstetrician. If fears, panic behavior, insecurities or brooding thoughts arise, a doctor’s visit is necessary. This is especially true if the symptoms persist unabated or increase in intensity over a long period of time.
If there is a sudden strong sensation of thirst, persistent tiredness despite adequate and healthy sleep or an unexplained need to urinate, a medical examination should be initiated. If an unwanted loss of weight occurs despite sufficient and substantial food intake, this is considered worrying. A doctor should be consulted to clarify the cause of this development. If the pregnant woman’s waist increases in an atypical way for the development of pregnancy, a doctor should be consulted.
If you feel sick, change your mood or have behavioral problems that cannot be explained by the normal course of the pregnancy, a doctor should be consulted. If the expectant mother suffers from a high susceptibility to infections despite adequate protection and appropriate precautionary measures, these observations should be discussed with a doctor.
Treatment & Therapy
Once the diagnosis has been made, it is important to normalize the maternal glucose metabolism as the cause of the embryo-fetal disorder as quickly as possible. The type of therapy depends on the type of maternal diabetes. Type 1 diabetics always have to inject insulin in addition to an optimal diet.
For type 2 diabetics and mothers suffering from gestational diabetes, a purely dietetic treatment can initially be attempted, depending on the severity of the sugar derailment. If the effect is insufficient, insulin therapy is also indicated here. The sonographically measured abdominal circumference is used to monitor the success of the therapy in the child.
Common to all diabetes diseases is the essential diabetes education for mothers. In this, they should learn how to monitor their own blood sugar levels with the help of sugar measuring devices and learn the basics of a balanced diet. The birth of diabetic women on a diet should take place in a clinic experienced in the treatment of diabetic mothers and their children.
According to current guidelines, pregnant women with diabetes requiring insulin must be delivered in a level 1 or 2 perinatal center. The delivery should take place by the appointment at the latest. Primary caesarean section should be recommended for macrosomal children with an estimated weight of 4500 grams.
The aim here is to avoid birth injuries such as shoulder dystocia and fetal oxygen deficiency caused by a birth arrest. The treatment of the newborn is in addition to routine neonatal therapy according to the complications that arise. The most common in quantitative terms is hypoglycaemia (low blood sugar).
Newborns from diabetic mothers must therefore be closely monitored. If necessary, intravenous glucose must be given in addition to consistent application or early feeding. If symptoms of calcium or magnesium deficiency occur, these must also be treated with calcium or magnesium substitution.
Newborns with increased blood viscosity should be monitored and given adequate fluids. Depending on the severity, infusion therapy may be necessary. Any cardiomyopathy that may occur should also be monitored and, if symptoms occur, treated with fluids and drug therapy.
Outlook & forecast
Embryofetopathia diabetica is not a curable disease. It only occurs in expectant mothers and must be closely supervised and monitored by doctors. With adequate medical care, a good prognosis can emerge. The development of the unborn child is closely monitored until delivery is usually planned in advance. This is followed by multiple check-ups of the baby so that action can be taken immediately in the event of any abnormalities.
During pregnancy, the expectant mother must take various precautionary and safety measures. Drug treatment takes place over the entire period. The therapy depends on the severity of the disease. Various impairments in the way of life occur and an early admission of the pregnant woman to hospital is often recommended. A special diet is necessary for a good prospect of further developments.
If complications occur during gestation, the prognosis worsens. Organ damage, premature birth or birth injuries are possible. A lack of oxygen in the infant can occur, which leads to irreparable damage. In severe cases, the child dies.
If no or inadequate medical care is used, the prognosis is poor. The risk of a miscarriage is significantly increased. In addition, malformations are possible, which further reduce the quality of life.
Prevention
Embryofetopathia diabetica is caused by poorly controlled, pregnancy-related derailed or previously undiscovered diabetes mellitus in the mother. The severity of the consequences correlate with the extent and duration of the elevated blood sugar levels.
Consistent therapy of pre-existing diabetes as well as targeted and early gestational diabetes screening with subsequent adequate treatment can reduce the risk of secondary diseases in the child. Pregnancies with pre-existing diabetes mellitus should be planned if possible. Preconception, blood glucose values close to normal should be achieved for at least three months.
Aftercare
In the case of diabetic embryofetopathy, the person concerned is usually always dependent on intensive medical treatment first, so that there are no further complications or further complaints. The earlier the disease is recognized and treated, the better the further course of the disease will usually be. However, a complete cure of the diabetic embryo fetopathia cannot be achieved in every case, so that the children often suffer from malformations or other defects that have to be treated after birth.
The focus of this disease is therefore on the early detection and subsequent treatment of the child’s defects. The symptoms themselves are treated with the help of medication and other therapies, depending on their severity. In many cases, those affected depend on regular examinations to prevent complications.
The women are dependent on the support of their partner and family in their everyday life so that there is no depression or other psychological upsets. The child should also be monitored after birth and regularly examined by a pediatrician. No general predictions can be made about the life expectancy of the child in the case of embryofetopathia diabetica.
You can do that yourself
If the expectant mother has a vague feeling that something is wrong with her or her unborn child, she should consult a doctor immediately. A check-up is then advisable.
A balanced and healthy diet is also important. Despite a possible weight loss in embryo fetopathia diabetica during pregnancy, the food intake should not be too sugary or fatty. It is helpful if the food ingested is well controlled and documented. This can be easily implemented using digital programs and shows irregularities more quickly.
With a good diet and compliance with a recommended fluid intake is striking changes can be detected more easily. The waist circumference should be regularly checked independently and compared with the normal values for the progress of pregnancy.
An expectant mother has to protect herself more strongly against an infectious disease. Contact with sick people during the incubation period should be avoided. The clothing should be selected and worn according to the weather conditions. The precautionary measures against infections should be optimized and strengthened. If the pregnant woman observes these precautionary measures and an infection nevertheless occurs, this should be classified as a warning.
