“The prevalence of gestational diabetes[2] exceeds 10% of pregnancies”has indicated the Dr. Fernando Gómez Peralta, coordinator of the Diabetes Area of the Spanish Society of Endocrinology and Nutrition (SEEN)at the Round Table ‘Use of closed-loop systems in diabetes in special situations’organized within the framework of the 64th Congress of the Spanish Society of Endocrinology and Nutrition (SEEN), which is being held at the Barcelona International Convention Center (CCIB) on October 18, 19 and 20.
The endocrinologist has also warned that “The application of the new diagnostic criteria proposed by the International Association of the Diabetes and Pregnancy Study Groups (IADPSGC) can increase the cases diagnosed in pregnancies that require specific attention by up to 35%”.
Likewise, Dr. Gómez Peralta has recommended that the pregnant woman follow an optimal diet appropriate to her needs, as well as self-monitoring of capillary blood glucose. “Insulin therapy is only used in cases with insufficient control”, he has clarified. The endocrinologist has explained that gestational diabetes is caused by a decreased tolerance to carbohydrates that is diagnosed for the first time during pregnancy: “It is produced by increased peripheral insulin resistance mediated by high plasma levels of diabetogenic hormones (prolactin, placental lactogen, progesterone and cortisol)”. Thus, This specialist has insisted that ““As it is an asymptomatic situation, specific screening measures are required.”. A high percentage of women with a history will develop type 2 DM, “which also requires postpartum monitoring and screening”.
The closed loop system optimizes glycemic control in pregnant women
In relation to the benefits of gestational diabetes control systems, the doctor specializing in Endocrinology and Nutrition has highlighted that “Closed-loop systems integrate an insulin pump, a real-time continuous glucose monitor, and a control algorithm that determines insulin infusion by the pump, based on interstitial glucose readings by the sensor. with the aim of maintaining blood glucose at stable values close to normal.”. Dr. Gómez Peralta has argued that this technology has revealed improvements in glycemic control “with increases in time in target range (TIR) greater than 10% compared to the multiple injection regimen, as well as evident reductions in the number and time of hypoglycemia”. In the words of the endocrinologist, the closed-loop system is essential for women with type 1 diabetes, since it can optimize glycemic control by adapting insulin therapy to real needs at each moment of the day.
Regarding the possible risks of gestational diabetes, the coordinator of the Diabetes Area of the SEEN has pointed out preeclampsia, macrosomia or large fetus for gestational age, polyhydramnios -excessive accumulation of amniotic fluid-, neonatal morbidity (hypoglycemia, hyperbilirubinemia, hypocalcemia, hypomagnesemia, polycythemia, respiratory distress and cardiomyopathy), fetal organomegaly (hepato or cardiomegaly), as well as risk of abortion and congenital anomalies.
On the other hand, the Dr. Javier Santamaría, specialist in Endocrinology and Nutrition at the Cruces University Hospital in Barakaldo (Vizcaya) and member of the Thyroid Area of the Spanish Society of Endocrinology and Nutrition (SEEN)he pointed out, at the Round Table ‘Dissecting thyroid dysfunction in pregnancy’that “pregnancy represents a significant overload of activity for the thyroid, so its hormone production increases by around 50%”. In this sense, the endocrinologist has stressed the importance of the pregnant woman increasing the nutritional intake of iodine, “indispensable for the synthesis of thyroid hormone”. However, this specialist has warned that the shortage of this micronutrient in our geographical area and the increase in its consumption for other needs “causes more or less severe thyroid hormone deficiencies to be common in pregnant women”.
Thyroid dysfunction ‘worsens’ reproductive prognosis
Dr. Santamaría has specified that thyroid hormone production needs normally return to basal levels after childbirth, however, “Sometimes, the effort that the thyroid gland has had to make during pregnancy aggravates a previous deficiency and remains after childbirth”. Thyroid dysfunction worsens the reproductive prognosis since “it is more difficult to achieve pregnancy and, if it is achieved, its loss (abortions) is more frequent, as well as various types of complications during pregnancy and childbirth (placenta abruption, preterm birth, postpartum hemorrhage, intrauterine fetal death, low birth weight, etc.)”. In addition, It can have an impact on fetal development, since thyroid hormones are essential for the neurological development of the fetus, so its deficiency during pregnancy can lead to a decrease in the baby’s IQ. “However, it must be noted that this decrease in IQ only appears in severe thyroid hormone deficiencies in the pregnant woman.”.
A screening between weeks 9 and 11 of gestation, fundamental
Thyroid hormone deficiency during pregnancy is usually moderate, so the symptoms in pregnant women are nonspecific and usually go unnoticed. For this reason, Dr. Santamaría has recommended systematically screening thyroid function between weeks 9 and 11 of gestation, or even earlier, if the woman has a high obstetric risk or a known pre-existing thyroid pathology.
The endocrinologist has stressed that thyroid pathology “It is very frequent” in the population: “The data collected in the national di@bet study, published in 2017, show a prevalence of thyroid disorders in women of childbearing age of between 2% and 4.5% for clinical hypothyroidism, 5% and 7% for subclinical hypothyroidism, 0.5% and 1% hyperthyroidism and between 5% and 10% positive thyroid autoimmunity”.
Regarding the recommendations, Dr. Santamaría maintains that Pregnant women must rigorously follow obstetric controls, which include thyroid dysfunction, indicated by their specialist. Likewise, the member of the SEEN Thyroid Area once again emphasizes the importance of iodine intake During pregnancy: “In general terms, the intake of foods rich in iodine (especially dairy products) and iodized salt is recommended and, in some cases, pharmacological iodine supplements may even be indicated..
Finally, the member of the Thyroid Area of the SEEN has insisted on the importance of gynecologists and endocrinologists having the same protocols for action in the face of this pathology. For this reason, the SEEN has published, together with the Spanish Society of Gynecology and Obstetrics (SEGO), a document set that includes recommendations for health professionals who care for pregnant women for the detection, prevention and treatment of thyroid dysfunction in pregnant women.
Source: Spanish Society of Endocrinology and Nutrition (SEEN)