How to manage the gestational diabetes insipidus

There is always a misconception arising between diabetes mellitus and diabetes insipidus. But both are two different things belonging to two different systems. The type of diabetes insipidus saw during gestational periods in pregnancy is called gestational diabetes insipidus. 

 

Here the placenta secretes one hormone called vasopressinase. This enzyme destroys maternal ADH. Because of which the mother produces a large number of diluted urine.

 

What is gestational diabetes insipidus?

 

The gestational diabetes insipidus is also called gestagenic diabetes insipidus. It is mainly seen in the third trimester of pregnancy. And this condition is resolved after 4-6 weeks after delivery.

 

The main reason behind this is the increased amount of vasopressinase. This enzyme makes the kidney less sensitive to ADH. It causes polyuria and polydipsia and is sometimes called water diabetes.

 

What are the causes of gestational diabetes insipidus?

 

The enzyme that is secreted from the placenta is the main cause behind the occurrence of gestational diabetes insipidus. Vassopresinase controls the water retention mechanism of the kidney during pregnancy. It also leads to polyuria and enuresis(bedwetting).

 

It is a very rare disease and sometimes hereditary. In this, your body fails to maintain the body fluid levels. The two hormones like antidiuretic and vasopressin control the number of fluids exerted from the body.

 

Sign and symptoms

 

An antenatal mother suffering from diabetes insipidus is having the following symptoms;

  • Polyuria
  • Polydipsia
  • Excess water in urine form colorless urine
  • Anuresis
  • Dry skin
  • Constipation
  • Muscle weakness
  • Prefer to have cold drinks
  • Muscle pain\
  • Fatigue
  • Dizziness
  • nausea

 

Other reasons include

 

Pregnant mothers are having excess urination due to the pressure of the growing fetus on their bladder. But if it happens abnormally then it could be gestagenic diabetes.

 

Also in the pregnant mother, the amount of prostaglandin secretion is abnormal. It makes the kidney less sensitive to vasopressin and causes excess water loss. Sometimes the symptoms are mild and go away after childbirth. It might appear in another pregnancy.

 

The complication of gestational diabetes insipidus

 

The complications are like;

  • Imbalance of electrolytes
  • Weakness
  • Nausea
  • Vomiting
  • Loss of appetite
  • Muscle cramps
  • Confusion
  • Dehydration
  • Dry mouth
  • Changes in skin elasticity
  • fatigue

How do we identify the gestational diabetes insipidus?

  • Urine Analysis
  • Water deprivation test
  • Magnetic resonance imaging
  • Genetic screening

 

Types of gestational diabetes insipidus?

 

The types of gestational diabetes insipidus are classified into various categories. The preexisting diabetes insipidus are more commonly enhanced during pregnancy.

  • Pregnancy exacerbating symptoms of preexisting diabetes insipidus
  • Transient gestational diabetes insipidus
  • Autoimmune hypophysitis
  • Postpartum diabetes insipidus

 

Pregnancy exacerbating symptoms of preexisting diabetes insipidus

 

In this condition, the pregnant mother previously had diabetes insipidus. It is a very rare condition. The mother is mild symptomatic but, after pregnancy, the placental vasopressinase surpasses the circulatory level of ADH.  

 

The symptoms become intensely visible in the third trimester due to the drastic reduction of antidiuretic hormone. It leads to an imbalance of homeostasis.

 

Transient gestational diabetes insipidus

 

 Increased production of Renal prostaglandins is the victim of transient diabetes insipidus. It is secreted in particular PGE2. and decreases the production of ADH.

 

The increased secretion of vasopressinase enzyme in the circulation will decrease the renal sensitivity of the kidney.

 

What is the function of the liver in GDI?

 

The liver metabolizes vasopressinase. it decreases the secretion of ADH during pregnancy. Indirectly, the liver maintains the circulating level of the Antidiuretic hormone during pregnancy. So, there is a strong interrelation between liver dysfunction and gestational diabetes insipidus.

 

What are the mechanisms?

 

It is suggested the link between gestational diabetes insipidus and pre-eclampsia toxemia and HELLP. The first mechanism says that if there is any hepatic dysfunction that is secondary to the development of PET or HELLP syndrome. It is basically disturbed the mechanism of the vasopressinase enzyme. And it indirectly leads to increased ADH clearance.

 

The secondary mechanism says that the reversible pituitary hypoperfusion associated with vasoconstriction may lead to PET Or HELLP syndrome. This condition leads to a decreased release of ADH from the posterior pituitary. This may contribute to gestational diabetes insipidus.

 

Autoimmune hypophysitis

 

Autoimmune hypophysitis is a rare type of GDI that is secondary to the development of anti-Rabphilin 3A antibodies during the third trimester of pregnancy. Rabphilin 3A is an autoantigen . it is expressed in the ADH neurons in the supraoptic nucleus in the hypothalamus.

 

Postpartum diabetes insipidus

 

It occurs after delivery. Also can lead to permanent diabetes insipidus. Sometimes the placenta abruption is the main reason for the sudden surge of vasopressinase in the maternal blood.it can cause transient diabetes insipidus.

 Peripartum hemorrhagic shock or abnormal bleeding can cause the neuron to extend to the posterior lobe. Also, the increased amount of estrogen during pregnancy can create tumors in the pituitary gland. This can cause pituitary apoplexy after delivery. These are the two reasons for the development of persistent diabetes insipidus.

 

Treatment

 

  • Go for the routine checkup during pregnancy and consult your physician if there are any abnormalities present.
  • Drink and keep a lot of fluid with you. so, you don’t get dehydrated.
  • Use desmopressin to prevent the effect of vasopressinase. 
  • Take medications as directed to correct the osmotic imbalance.
  • It is important to constantly monitor the sodium level as it has to correct the secondary brain swelling and neurological damage.
  • Also, it is safe to use desmopressin during pregnancy. Because it does not increase the chance of fetal malformation.
  • It is safe to use prescribed drugs in the entire gestational period as well as during breastfeeding.

 

 

 

  

 

   

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