100 Ways to Lose Weight 

Diabetes mellitus and pregnancy. Gestational diabetes mellitus (GDM): the danger of a "sweet" pregnancy. Consequences for the child, diet, signs

Recently, there has been an increase in pregnant women with this pathology, which is associated with compensation for the condition of women and the restoration of their fertile function.

Despite the progress made, diabetes still causes a high complication rate for the mother and her baby.

Clinical picture

What doctors say about diabetes

Doctor of Medical Sciences, Professor Aronova S.M.

For many years I have been studying the problem of DIABETES. It is scary when so many people die, and even more become disabled due to diabetes.

I hasten to announce the good news - the Endocrinological Research Center of the Russian Academy of Medical Sciences managed to develop a drug that completely cures diabetes mellitus. At the moment, the effectiveness of this drug is close to 100%.

More good news: the Ministry of Health has achieved the adoption special program, for which the entire cost of the drug is reimbursed. Diabetics in Russia and CIS countries before can get a remedy IS FREE.

Learn more >>

Symptoms of type 2 diabetes

The symptoms of the disease are similar in all types of diabetes. While waiting for the baby, these symptoms may not be too pronounced and even disguise themselves as the usual conditions characteristic of pregnant women. Frequent urination, constant thirst and a strong feeling of hunger are very characteristic of expectant mothers and are not always associated with symptoms of a progressive disease.

The manifestations of type 2 diabetes largely depend on the severity of its complications. With kidney damage in pregnant women, edema appears on the face and limbs. The attached vasospasm leads to the development of arterial hypertension. Blood pressure numbers in pregnant women can go up to 140/90 mm Hg. and above, which has an extremely adverse effect on the condition of the fetus.

It is characterized by damage to the nerve fibers of the upper and lower extremities. There is numbness, tingling, creeping, and other signs of a nervous system disorder. With a prolonged course of the disease, many women complain of leg pains that worsen at night.

One of the most severe manifestations of diabetes is damage to the lens (cataract) and retina (retinopathy). With these pathologies, vision decreases, and even experienced laser surgeons are not always able to correct the situation. Diabetic retinal damage is one of the indications for keserev section.

Source spuzom.com

Principles of pregnancy planning for type 2 diabetes mellitus

be careful

According to the WHO, every year 2 million people die from diabetes mellitus and the complications it causes in the world. In the absence of qualified support for the body, diabetes leads to various kinds of complications, gradually destroying the human body.

The most common complications are: diabetic gangrene, nephropathy, retinopathy, trophic ulcers, hypoglycemia, ketoacidosis. Diabetes can also lead to the development of cancerous tumors. In almost all cases, a diabetic either dies fighting a painful illness or becomes a real disabled person.

What should people with diabetes do? The Endocrinological Research Center of the Russian Academy of Medical Sciences succeeded make a remedy completely curing diabetes mellitus.

Currently, the Federal program "Healthy Nation" is underway, within the framework of which this drug is issued to every citizen of the Russian Federation and the CIS IS FREE... For details, see official website MINISTRY OF HEALTH.

Planning a pregnancy is a way to reduce the potential complications of diabetes. Before the onset of gestation, it is necessary to achieve normalization of glucose levels in order to exclude the influence of an increased level of carbohydrates during embryogenesis.

You need to strive for glucose numbers on an empty stomach with a lower limit of 3.3 and an upper limit of no more than 5.5 mmol / l, and 1 hour after eating no more than 7.8 mmol / l.

It is very important to transfer a woman from tablet forms of drugs to insulin therapy before pregnancy, so that the glucose concentration is under control already at the earliest stages of embryonic development.

The installation of an insulin "pump" is highly effective; it is called an "artificial pancreas"; it automatically releases the required amount of insulin into the bloodstream.

An insulin pump must be installed before pregnancy occurs. The examination should be carried out by many specialists: gynecologist, endocrinologist, nephrologist, geneticist, cardiologist.

An examination by an ophthalmologist with an assessment of the state of the vessels of the fundus is mandatory, if necessary, the use of laser photocoagulation (rupture of blood vessels must not be allowed). It is necessary to start using folic acid, as well as iodine preparations at least 3 months before the onset of the desired pregnancy.

Our readers write

Topic: Defeated diabetes

From whom: Lyudmila S ( [email protected])

To: Administration of my-diabet.ru


At the age of 47, I was diagnosed with type 2 diabetes. In a few weeks, I gained almost 15 kg. Constant fatigue, drowsiness, feeling of weakness, vision began to sit down. When I turned 66, I was already stably injecting myself with insulin, everything was very bad ...

And here is my story

The disease continued to develop, periodic attacks began, the ambulance literally returned me from the other world. All the time I thought that this time would be the last ...

Everything changed when my daughter let me read one article on the Internet. You cannot imagine how grateful I am to her for that. This article helped me completely get rid of diabetes, a supposedly incurable disease. The last 2 years I started to move more, in the spring and summer I go to the dacha every day, grow tomatoes and sell them on the market. The aunts are surprised how I do everything, where so much strength and energy comes from, they still won't believe that I am 66 years old.

Who wants to live a long, energetic life and forget about this terrible disease forever, take 5 minutes and read this article.

Go to article >>>

Source in-waiting.ru

Impact of type 2 diabetes mellitus on pregnancy

Non-insulin dependent diabetes is considered one of the most severe pathologies during pregnancy. This condition leads to the development of many dangerous complications:

  • gestosis;
  • placental insufficiency;
  • placental abruption;
  • polyhydramnios;
  • spontaneous miscarriage;
  • premature birth.

The most severe complication of pregnancy is gestosis. This specific disease develops quite early, and already at a period of 22-24 weeks it makes itself felt with edema and surges in blood pressure. In the future, the kidneys are involved in the process, which in turn only worsens the condition of the expectant mother. Diabetes mellitus gestosis is one of the common causes of premature birth or placental abruption prematurely.

Two-thirds of women with type 2 diabetes develop polyhydramnios during pregnancy. Excess amniotic fluid leads to the fact that the child takes an oblique or transverse position in the womb. In late pregnancy, this condition may require a caesarean section. Spontaneous childbirth with the wrong position of the fetus threatens with serious injuries for both the woman and the child.

Diabetes mellitus also affects the condition of the fetus, leading to the development of serious complications:

  • diabetic fetopathy;
  • chronic fetal hypoxia;
  • delayed development of the child in the womb;
  • fetal death.

Stories from our readers

Defeated diabetes at home. It's been a month since I forgot about the surges in sugar and the intake of insulin. Oh, how I suffered before, constant fainting, ambulance calls ... How many times I went to endocrinologists, but they only repeat one thing - "Take insulin." And now the 5th week has gone, as the blood sugar level is normal, not a single injection of insulin and all thanks to this article. Everyone who has diabetes should read it!

Read the full article >>>

If the pregnancy was planned in advance, then doctors recommend several consecutive hospitalizations until the moment of delivery. The first time is when a diabetic patient is registered with an antenatal clinic. At this stage, all the necessary studies are carried out, tests are taken and insulin therapy is prescribed.

After the pregnant woman is hospitalized only according to the indicators, if at some point the doctor suspects a threat to the life of the mother or child. Reasons for suspicion may be: the appearance of puffiness, increased blood pressure, very severe toxicosis and migraines. If necessary, the insulin therapy regimen is changed, and the woman is prescribed a sparing diet suitable for diabetes mellitus.

Final hospitalization takes place just before childbirth. During her, the woman is additionally examined again, after which a decision is made about the possibility of independent childbirth.

Source diabetis.ru

Treatment: rules for taking drugs at different times

It is necessary to use short-acting insulins (given before meals) and long-acting insulin (given 1-2 times a day to maintain baseline insulin levels). This type of insulin therapy is called basal-bolus therapy.

It is important to know that insulin requirements change during different periods of pregnancy. In the 1st and 3rd trimesters, the sensitivity of receptors to insulin improves, in the 2nd trimester, the blood glucose level rises due to the action of antagonist hormones (cortisol and glucagon), so the dose of insulin injected should be increased.

The dependence of the dose of insulin on the duration of pregnancy

Pregnancy period Processes in the body Insulin dose
I trimester Improving insulin sensitivity due to the action of hormones: hCG and estrogen. These hormones stimulate insulin production and improve glucose uptake. Decreases
II trimester The level of hormones - insulin antagonists (glucagon, cortisol, prolactin) increases, which increase blood glucose. The need for insulin increases, it is necessary to increase the dose of injected insulin.
III trimester The level of hormones - insulin antagonists decreases, which leads to a decrease in blood glucose levels. Decreases, the dose of insulin administered can be reduced.

With diabetes, blood pressure often rises. You need to know that to correct the pressure it is worth taking the drug "Dopegit", which is allowed for pregnant women.

Drugs from the category of ACE inhibitors ("Enalapril", "Lisinopril", "Captopril", etc.) are strictly prohibited. They have been proven to cause birth defects in the fetus.
Also prohibited to take drugs from the group of statins ("Atorvastatin", "Rosuvastatin", etc.) and angiotensin II receptor inhibitors ("Losartan", "Irbesartan").

Source in-waiting.ru

Vegetable, dairy and fish soups are suitable as first courses. Cabbage soup and borscht can only be eaten vegetarian or in a weak broth.

Second courses are chicken, lean fish, lamb and lean beef. Vegetables are suitable for any and in any quantity.

It is imperative to use fermented milk products (kefir, sour cream, yogurt, cottage cheese).

As snacks, you can use boiled or jellied fish, low-fat ham, homemade pate without adding oil, feta cheese or Adyghe cheese.

Drinks include tea with milk, mineral water, rosehip infusion.

The bread must be diabetic from coarse rye flour. For sweets, sour fruits and berries, jelly with saccharin are suitable.

Glucose control can be achieved with a combination of properly selected insulin therapy and adherence to diet.
You must adhere to the following rules:

  1. the energy calorie content of food should be 2000 kcal (for obesity: 1600-1900);
  2. 55% - carbohydrates (with limited intake of easily digestible carbohydrates - sugar, syrups, grapes, jam), 30% - fats, 15% - proteins;
  3. do not use sweeteners;
  4. a sufficient content of vitamins and minerals in the consumed food is necessary

Source diabethelp.org

Subject to all the doctor's recommendations and good blood sugar control, it is possible to have a baby through the vaginal birth canal. To give birth to a woman suffering from diabetes mellitus should be in a specialized maternity hospital. If this is not possible, you need to enlist the support of an experienced endocrinologist who can help with fluctuations in peripheral blood sugar.

Caesarean section is performed in the following situations:

  • fetal weight over 4 kg;
  • severe preeclampsia or eclampsia;
  • severe fetal hypoxia;
  • placental abruption;
  • severe kidney damage;
  • inability to adequately control glucose.

After the birth of a child, a woman's need for insulin drops significantly. At this time, the endocrinologist must adjust the new dosage of the drug and give the woman recommendations on how to alleviate the condition. If the woman and her baby feel well, breastfeeding is not contraindicated.

Source spuzom.com

Drawing conclusions

If you are reading these lines, we can conclude that you or your loved ones have diabetes mellitus.

We conducted an investigation, studied a bunch of materials and, most importantly, tested most of the methods and drugs for diabetes mellitus. The verdict is as follows:

If all drugs were given, then only a temporary result, as soon as the reception was stopped, the disease intensified sharply.

The only drug that has shown significant results is Dialife.

At the moment, this is the only drug that can completely cure diabetes mellitus. Dialife showed a particularly strong effect in the early stages of the development of diabetes mellitus.

We made a request to the Ministry of Health:

And for the readers of our site there is now an opportunity
get Dialife IS FREE!

Attention! Cases of sale of counterfeit drug Dialife have become more frequent.
By placing an order using the links above, you are guaranteed to receive a quality product from an official manufacturer. Also, when ordering for official website, you receive a money-back guarantee (including travel costs) if the drug does not have a therapeutic effect.

Fast page navigation

Diabetes mellitus is a serious illness that worsens not only the patient's quality of life, but also her ability to bear a child. It is of two types: in one case, the body is not able to produce enough insulin (type 1 diabetes), in the other, the body tissues do not show the proper sensitivity to insulin secreted in a normal volume ().

Since the disease is one of the endocrine diseases, it will have a great influence on both the bearing of the fetus and the well-being of a pregnant woman and require constant medical supervision, up to placement in a hospital for the entire period of pregnancy.

Carrying a child with diabetes of both types puts a huge burden on the body. Often there are miscarriages up to 8 weeks, when the sugar level of a pregnant woman rises to extremely high levels in a short time.

Cases of stillbirth are not uncommon, in which the baby dies in utero during contractions that provoke an increase in sugar. In addition, gynecologists note a number of other dangers that may lie in wait if there is diabetes mellitus during pregnancy:

  • Development of polyhydramnios
  • Increased risk of late toxicosis (gestosis)
  • Fetal anomalies
  • The risk of developing diabetes in a child
  • Cardiovascular complications during long periods of pregnancy.

In some cases, carrying a child is completely contraindicated. For example, if diabetes is difficult to correct with insulin or if both spouses are diabetics.

Type 1 diabetes mellitus implies inadequate insulin production and, as a result, an increase in blood sugar levels. It can be inherited, but if only the mother is sick with it, then the cases of inheritance of the disease do not exceed 2%.

The main feature of pregnancy in type 1 diabetes mellitus should be considered more pronounced changes in carbohydrate metabolism than is the case in women in a normal, non-pregnant state. Another danger may lie in the development of renal failure due to vascular damage to the kidneys.

Such a serious problem is an indication for termination of pregnancy, or for early delivery if the fetus has reached a viable age. To control the functioning of the body, the doctor will prescribe the following diagnostic procedures:

  • General and biochemical blood test
  • Urine analysis (general and daily, for protein)
  • Blood clotting test
  • Ultrasound at least once every 3 weeks
  • Doppler study from 22 weeks, at least 4 times until the end of the pregnancy
  • CTG once a week in the third trimester

Some of these tests may be ordered more frequently than indicated, especially if the woman has a history of miscarriages and stillborn babies.

Influence on the mother's body

Even before conception, the expectant mother should know exactly how a pregnancy burdened with diabetes will affect her body. This will allow some preventive measures to be taken that will help doctors stabilize the condition of the mother's vital organs in the future.

  • Ketoacidosis is a complication resulting from an increase in acetone levels in urine and blood tests.

This condition is caused by the instability of carbohydrate metabolism and can lead to ketoacidotic coma, which develops over several days. Regular urine tests will help control the level of acetone elevation. Coma occurs only in those cases when there was no observation of the dynamics of test indicators, or when the doctor's prescriptions were not followed.

  • Deterioration of the functioning of blood vessels - can affect the organs of vision and kidneys. Moreover, both small vessels and nerves can be damaged.
  • High risk of developing eclampsia - sharp fluctuations in blood sugar can provoke the development of preeclampsia and eclampsia.
  • High risk of rupture during childbirth - an increase in sugar provokes the development of fungal diseases of the vagina. As a result, its mucous membranes become brittle, bleed, and are often subject to a high degree of injury during natural childbirth. A pregnancy pathology such as diabetes mellitus is often an indication for an episiotomy (surgical incision of the vaginal opening to avoid uneven breaks).

Effect on the fetus

During pregnancy, the child's body experiences no less overload than the mother's body. The situation is complicated by the fact that it must grow, and the conditions of intrauterine development are such that this process can be accompanied by various disorders.

  • Large body mass - macrosomia. Such a child looks much larger than an ordinary newborn, his birth weight often reaches five or more kilograms. There is a pronounced swelling, cyanosis of the skin, which does not go away in the first minutes of life.
  • An increase in the size of internal organs - according to the results of an ultrasound scan, an increase in the spleen and liver will be seen.
  • Having a heart defect is a common complication among babies born to mothers with type 1 diabetes.
  • Damage to the central nervous system - high blood sugar levels provoke underdevelopment of the brain and spinal cord. This can lead to a lag in physical development in the first years of a child's life.
  • Immaturity of the lungs - some children born to mothers with type 1 diabetes need artificial ventilation (ALV) immediately after childbirth. This is due to the general immaturity of the body against the background of the child's overweight.

Frequent ultrasound examination, as well as preliminary prenatal administration of dexamethasone injections, will help to avoid serious problems with the development of the fetus and the opening of the lungs, and also allow doctors to respond in time to the deterioration of the child's condition.

Pregnancy and type 2 diabetes

If type 1 diabetes involves high blood sugar and low insulin production, then type 2 is characterized by normal insulin production. However, the tissues of the body are not able to absorb it in the proper amount.

The main danger during pregnancy with type 2 diabetes mellitus is that during the gestation period, the patient can significantly gain weight, which will complicate labor through the natural birth canal (since the fetus itself will also be large).

Throughout the entire period, the pregnant woman must pass the same tests as in type 1 diabetes, but weekly monitoring of body weight is a special item.

Influence on the mother's body

The main difficulties that the expectant mother will experience are the same as in the case of type 1 diabetes. But since with type 2 there is a high risk of gaining excess body weight, special attention should be paid to this.

If the first trimester is associated with severe toxicosis, then even though the tissues are insensitive to insulin, the patient's weight will not increase. It may even decrease against the background of frequent vomiting for a long period of time.

As soon as the time of active growth of the fetus begins (from 20 weeks), the woman will be susceptible to bouts of severe hunger. It usually starts suddenly, develops within a few minutes, the expectant mother experiences weakness and a strong desire to eat something starchy or sweet.

  • It is important to control this desire. If you lie down for 5 - 7 minutes instead of eating, then the attack will go away by itself.

Effect on the fetus

If the mother's weight has increased significantly during pregnancy, then the same thing happens with the baby. This is fraught not only with difficult childbirth, but also with other dangers:

  • Intrauterine fetal hypoxia - occurs due to a decrease in the quality of the functioning of blood vessels located not only in the placenta, but also in the umbilical cord and are responsible for providing the baby with oxygen. That is why the presence of serious vascular diseases in a woman's history is considered an absolute contraindication to pregnancy in diabetes mellitus.
  • High risk of injury to the child - due to the large body weight, the baby's shoulder girdle can get stuck in the birth canal and not turn clockwise as expected, even despite the episiotomy done. Therefore, the most common injury in these children is a fracture of the collarbone.
  • Apnea is one of the leading causes of sudden infant death. In a child born to a mother with type 2 diabetes mellitus, it can occur not only due to a large body weight, but also due to a decrease in blood glucose levels in the first days after childbirth.

In some cases, diabetes occurs directly in the process of carrying a child, despite the fact that previously, before conception, a woman had never been diagnosed with such a diagnosis and her sugar level was normal. This disease is called gestational diabetes mellitus, which spontaneously appears during pregnancy and just as quickly disappears immediately after childbirth.

Pregnancy diabetes should not be confused with cases where a woman's glucose tolerance is first diagnosed only during pregnancy. If after childbirth the disease did not disappear on its own, then this means that the woman is sick with true type 1 or 2 diabetes.

If, before conception or in the first months of gestation, the doctor suspects a violation of glucose tolerance, then the woman is sent to be tested for latent diabetes during pregnancy, the purpose of which is to assess the response of the mother's body to taking a certain dosage of glucose.

  • Some doctors believe that such a procedure is harmful and should not be done unnecessarily.

Treating diabetes during pregnancy

If diabetes is insulin-dependent (type 1), then insulin must be injected during pregnancy, albeit with a slight correction, which must be made by a doctor. In general, with type 1 diabetes, the need for insulin in the first and third trimesters decreases slightly.

If the patient has type 2 diabetes, then from the moment of conception, the question of transferring her to insulin preparations that have not been previously prescribed to her is decided.

The endocrinologist throughout the entire period is obliged to ensure that the exchange of sugars is compensated - this is the key to a successful pregnancy and successful development of the fetus.

The problem with high blood glucose levels concerns not only diabetics, who are struggling with it all their lives: a similar disease has often developed during pregnancy in women. Diabetes mellitus in pregnant women is also called gestational diabetes. Are you familiar with this concept? The instructions below will help you understand the causes, diagnosis, and treatment of this condition.

Reasons for developing diabetes during pregnancy

When diabetes mellitus in pregnant women first appears, it is called gestational, in other words, GDM. It appears as a result of a violation of the metabolism of carbohydrates. Blood sugar levels in pregnant women range from 3.3 to 6.6 mmol / L. It rises for the following reason:

  1. The baby growing inside needs energy, especially glucose, so the metabolism of carbohydrates is disturbed in pregnant women.
  2. The placenta produces an increased amount of the hormone progesterone, which has the opposite effect of insulin, because it only increases blood sugar in pregnant women.
  3. The pancreas is under a heavy load and often cannot cope with it.
  4. As a result, GDM develops in pregnant women.

Risk factors

The average risk group includes pregnant women with the following symptoms:

  • slightly increased body weight;
  • polyhydramnios in a previous pregnancy;
  • the birth of a large child;
  • the child had developmental defects;
  • miscarriage;
  • gestosis.

The risk of gestational diabetes mellitus in pregnant women is even higher in the following cases:

  • high degree of obesity;
  • diabetes in a previous pregnancy;
  • sugar found in urine;
  • polycystic ovary disease.

Symptoms and signs of the disease

A glucose test cannot be ruled out during pregnancy, as mild gestational diabetes is almost invisible. The doctor will often order a thorough examination. The point is to measure sugar in a pregnant woman after consuming a liquid with dissolved glucose. Signs of diabetes in women during pregnancy contribute to the purpose of the analysis:

  • a strong feeling of hunger;
  • constant desire to drink;
  • dry mouth;
  • fast fatiguability;
  • frequent urination;
  • deterioration of vision.

Diagnostic methods

During pregnancy from 24 to 28 weeks, a woman must undergo a glucose tolerance test. The first of the analyzes is performed on an empty stomach, the second - after meals after 2 hours, the last control one - one hour after the previous one. Diagnostics on an empty stomach can show a normal result, therefore, a complex of studies is carried out. Pregnant women need to follow several rules in front of him:

  1. 3 days before delivery, you cannot change your usual diet.
  2. When analyzing on an empty stomach, at least 6 hours should pass after the last meal.
  3. After taking blood for sugar, a glass of water is drunk. Previously, 75 g of glucose is dissolved in it.

In addition to tests, the doctor examines the anamnesis of the pregnant woman and several other indicators. After reviewing this data, the specialist draws up a curve of values ​​by which the weight of the pregnant woman can increase every week. This helps to track possible deviations. These indicators are:

  • body type;
  • abdominal circumference;
  • the size of the pelvis;
  • height and weight.

Diabetes mellitus treatment during pregnancy

With confirmed diabetes mellitus, you do not need to despair, because the disease can be controlled if you perform some measures:

  1. Blood sugar measurements.
  2. Periodic urine analysis.
  3. Compliance with dietary food.
  4. Moderate physical activity.
  5. Weight control.
  6. Taking insulin as needed.
  7. Blood pressure research.

Diet therapy

The basis of treatment for diabetes mellitus during pregnancy is a change in diet, only the principle here is not weight loss, but a decrease in daily calories with the same nutritional level. Pregnant women are advised to divide their meals into 2-3 main and the same number of snacks, it is advisable to make small portions. The following foods are recommended for use with diabetes mellitus:

  1. Porridge - rice, buckwheat.
  2. Vegetables - cucumbers, tomatoes, radishes, zucchini, beans, cabbage.
  3. Fruits - grapefruits, plums, peaches, apples, oranges, pears, avocados.
  4. Berries - blueberries, currants, gooseberries, raspberries.
  5. Meat - turkey, chicken, beef without fat and skin.
  6. Fish - perch, pink salmon, sardine, carp, blue whiting.
  7. Seafood - shrimps, caviar.
  8. Dairy products - cottage cheese, cheese.

Balance your daily menu so that about 50% of carbohydrates, 30% of protein and the remaining amount of fat enter the body. The pregnancy diet for cases with gestational diabetes does not permit the following foods;

  • fried and fatty;
  • sour cream;
  • baked goods, confectionery;
  • fruits - persimmon, banana, grapes, figs;
  • sauce;
  • sausages, wieners;
  • sausages;
  • mayonnaise;
  • pork;
  • mutton.

In addition to avoiding unhealthy foods, it is also necessary to properly prepare healthy foods on a diabetes diet. For processing, use methods such as stewing, boiling, steaming, baking. In addition, pregnant women are advised to reduce the amount of vegetable oil during the cooking process. Vegetables are best eaten raw in a salad or boiled as a garnish for meat.

Physical exercise

Locomotor activity in diabetes mellitus in pregnant women, especially in the fresh air, helps to increase the flow of oxygenated blood to all organs. This is useful for the child, because his metabolism improves. Exercise can help you use up excess sugar in diabetes and help you burn calories so you don't gain more weight than you need to. Pregnant women will have to forget about abdominal exercises for now, but you can include other types of physical activity in your regimen:

  1. Hiking at an average pace for at least 2 hours.
  2. Pool activity, such as water aerobics.
  3. Gymnastics at home.

The following exercises can be performed independently during pregnancy with diabetes:

  1. Standing on tiptoe. Lean on a chair with your hands and rise on your toes, and then lower yourself down. Repeat about 20 times.
  2. Push-ups from the wall. Put your hands on the wall, stepping back from it 1-2 steps. Do push-up-like movements.
  3. Ball rolling. Sit on a chair, put a small ball on the floor. Grab it with your toes and then release it or just roll it across the floor.

Drug therapy

In the absence of the effectiveness of the therapeutic diet and physical activity, the doctor prescribes drug therapy for diabetes mellitus. Pregnant women are allowed only insulin: it is administered according to the scheme in the form of injections. Pills taken for diabetes before pregnancy are not permitted. During the period of gestation, recombinant human insulin of two types is prescribed:

  1. Short-acting - "Aktrapid", "Lispro". It is introduced after meals. It is characterized by fast, but short-term action.
  2. Medium duration - "Isofan", "Humalin". Maintains sugar levels between meals, so just 2 injections per day are enough.

Possible complications and consequences

If there is no proper and correct treatment, both recoverable and serious consequences of diabetes can occur. In most outcomes, a baby born with low blood sugar recovers through breastfeeding. The same happens to the mother - the released placenta, as an irritating factor, no longer releases a large amount of hormones into her body. There are other complications of diabetes in pregnant women:

  1. High sugar during pregnancy leads to overgrowth of the fetus, which is why childbirth is often done by caesarean section.
  2. When a large baby is born naturally, his shoulders may be injured. In addition, the mother can also get birth trauma.
  3. Diabetes mellitus can persist in a woman after pregnancy. This happens 20% of the time.

During pregnancy itself, a woman may experience the following complications of diabetes:

  1. Gestosis in the last stages of pregnancy.
  2. Spontaneous miscarriage.
  3. Inflammation of the urinary tract.
  4. Polyhydramnios.
  5. Ketoacidosis Preceded by ketone coma. Symptoms are thirst, vomiting, drowsiness, and the smell of acetone.

Is it possible to give birth with diabetes? This disease is a serious threat to the kidneys, heart and eyes of a pregnant woman, so there are cases when it is not possible to reduce the risks and pregnancy is included in the list of contraindications:

  1. Insulin-resistant diabetes mellitus with an emphasis on ketoacidosis.
  2. An additional disease is tuberculosis.
  3. Diabetes mellitus in each of the parents.
  4. Rhesus conflict.
  5. Ischemia of the heart.
  6. Renal failure
  7. Severe gastroenteropathy.

Video about gestational diabetes during pregnancy

The future health of her baby depends on the condition of a woman during pregnancy. Diabetes mellitus and pregnancy - this combination is very common, but the disease can be controlled and treated in many ways. To learn more about diabetes during pregnancy, watch a useful video describing the course of the disease.

The pancreas performs both digestive (these are alpha cells) and endocrine functions. The elements of internal secretion are beta cells of the pancreas. They secrete the hormone insulin, which affects all types of metabolism. It is a hormone that promotes the assimilation of glucose by the cells of organs and tissues, the biosynthesis of glucose reserves in the liver - glycogen, fats and proteins. With a lack of insulin, this whole process is disrupted - the absorption of glucose by the tissues, the glucose content in the blood rises, which is called hyperglycemia... This is the main symptom of diabetes.

There is an absolute lack of insulin when there is a defect in beta cells and they produce insufficient amount of the hormone or do not produce it at all. There is also a relative insulin deficiency, when insulin is produced in normal amounts, but the body's tissues are immune to it.

The prevalence of diabetes mellitus (DM) is 0.5% of the total number of births. But this figure is growing every year, due to the increase in the number of diabetes cases in the rest of the population. Approximately 7% of all pregnancies are complicated by pregnancy diabetes (more than 200 thousand), gestational diabetes is diagnosed (gestational - pregnancy). Before the invention of artificial insulin, childbirth in women with diabetes mellitus was rare, pregnancy occurred in only 5% of all patients, threatened the woman's life, fetal and newborn mortality reached 60%. And the deaths of pregnant women and women in childbirth were not so rare! Now the death of women is still high - 1-2%, but the mortality of fetuses and newborns has been reduced to 20. With rational management of pregnancy and childbirth in women with diabetes, when only severe malformations remain the cause of death of the fetus and newborn, mortality will succeed cut to 1-2%.

The problem of managing pregnancy and childbirth in women with diabetes mellitus is relevant all over the world, since with diabetes the frequency of the threat of termination of pregnancy, gestosis, polyhydramnios, genital infections is 5-10 times higher than normal. Fetuses are overweight even with intrauterine hypoxia, placental insufficiency, therefore, birth traumatism of newborns and mothers increases. The frequency of fetuses with increased weight, but affected by hypoxia, injured in childbirth, reaches 94-100%. Complications in the postpartum period - in 80% of newborns, about 12% of children require resuscitation; malformations are found 2-3 times more often than in other pregnant women. The mortality rate of fetuses and newborns, even in specialized maternity hospitals, is 4-5 times higher than this value among normal children.

Therefore, it is important to compensate for diabetes (before normalizing blood glucose levels) within three months before conception and maintaining this compensation throughout pregnancy, during childbirth and in the postpartum period. Women with diabetes who are preparing for pregnancy must go through the so-called diabetes schools on the territory of their residence, have their phone. In such schools, they are taught methods of self-control, the use of rational doses of insulin.

The risk of developing diabetes in pregnancy must be calculated to further optimize pregnancy management.

Low risk groupdiabetes mellitus:

  • under 30 years of age;
  • with normal weight and body mass index;
  • there is no indication of the hereditary factor of diabetes in relatives;
  • there were no cases of violation of carbohydrate metabolism (including glucose was not detected in the urine);
  • there was no polyhydramnios, stillbirth, no children with developmental defects, or this is the first pregnancy.

To classify a woman as a low-risk group for diabetes requires a combination of all of these characteristics.

Medium risk groupdiabetes mellitus:

  • slight excess mass;
  • in childbirth there was polyhydramnios or a large fetus was born, there was a child with a malformation, there was a miscarriage, gestosis, stillbirth.

High risk groupdiabetes mellitus include women:

  • over 35 years old;
  • with severe obesity;
  • with gestational diabetes in a previous birth;
  • with heredity burdened by diabetes (had or have relatives);
  • with cases of violation of carbohydrate metabolism.

To classify a woman as a high-risk group for developing diabetes mellitus, 1-2 of these signs are sufficient.

There are 3 main typesdiabetes mellitus:

  1. Type I diabetes mellitus - insulin dependent (IDDM);
  2. Type II diabetes mellitus - independent insulin (NIDDM);
  3. Gestational diabetes is gestational diabetes (HD) that develops after 28 weeks of gestation and is manifested by a transient disorder of carbohydrate metabolism during pregnancy.

Type I diabetes is an autoimmune disease in which antibodies destroy the B cells of the pancreas. It manifests itself in children or adolescents with a corresponding absolute insulin deficiency, a tendency to accumulate acidic metabolic products and glucose peroxidation to acetone (this is called ketoacidosis), with rapid damage to the small vessels of the retina, resulting in blindness and kidney tissue. In their blood, auto-antibodies to the beta cells of the pancreas are detected.

The risk of developing diabetes mellitus in offspring with a disease of the mother is 2-3%, for the father - 6%, for both parents - 20%. The average life expectancy of such patients who developed IDDM in childhood does not exceed 40-45 years.

Type II diabetes mellitus develops after 35 years, most often against the background of obesity. Insulin deficiency is relative, but the tissues do not respond to their insulin, and the response is weak to the injected response, which is why it is called NIDDM - insulin resistance (tissues are immune to insulin) and hyperinsulinemia - an increased amount of insulin in the blood. At the same time, late onset diabetes with mild violations in the vessels and metabolism, the state of the reproductive system is almost not disturbed. But the risk of inheritance of diabetes mellitus in offspring is very high - genetic overwhelming inheritance.

There are three degrees of diabetes severity:

  • Grade I (mild) - fasting glucose<7,7 ммоль/л, не возникает кетоз. Нормализация глюкозы может быть достигнута одной только диетой;
  • Grade II (medium) - fasting glucose< 12,7 ммоль/л. Нет признаков кетоза. Нормализация уровня глюкозы может быть достигнута с помощью диеты и инсулина в дозе до 60 ед./сут.;
  • Grade III (severe) - fasting glucose> 12.7 mmol / L. Severe ketoacidosis, violation of small vessels in the retina and kidneys. Normalization of glucose levels can be achieved with doses of insulin in excess of 60 units / day.

With IDDM, there is a moderate or severe form of diabetes mellitus. And with NIDDM - mild or moderate diabetes.

Pregnancy diabetes (HD) is a transient abnormality in blood glucose that was first identified during pregnancy. In the first trimester, HD is detected in 2%; in the II trimester - in 5.6%; in the third trimester, HD is detected in 3% of pregnant women.

The main consequence of HD is diabetic fetopathy (fetus - fetus; patia - disease), i.e. fetal malformations, which include increased body weight (4-6 kg), with immaturity of lung tissue for spontaneous breathing - a high frequency of malformations, impaired adaptation to extrauterine life, in the neonatal period - high fetal and newborn mortality.

There are 2 main forms of fetopathy, which forms in 94-100% of fetuses of patientsmaternal diabetes mellitus:

  • hypertrophic - high body weight with normal body length, large in area and thick placenta;
  • hypoplastic - fetal-placental insufficiency and IUGR (intrauterine growth retardation) of the fetus, the placenta is thin and smaller. More severe course of intrauterine hypoxia and asphyxia during childbirth.

Symptoms and signs of diabetes during pregnancy

During normal pregnancy, significant shifts occur in blood glucose levels, and insulin secretion levels also change, which has a manifold effect on several metabolic factors. Glucose is a source of energy for fetal development. The need for glucose is provided by glucose in the mother's blood. Fasting blood glucose decreases as pregnancy progresses. The reason is the increased absorption of glucose by the placenta. In the first half of pregnancy, due to a decrease in blood glucose, the sensitivity of maternal tissues to insulin increases.

In the second half of pregnancy, the level of placental hormones increases significantly, which suppress the absorption of glucose by the mother's tissues, which ensures a sufficient level of glucose supply to the fetus. Therefore, pregnant women have higher postprandial blood glucose levels than non-pregnant women. A constantly slightly elevated blood glucose level in pregnant women leads to an increase in the amount of insulin secreted. In parallel, tissue insensitivity to insulin is formed, due to placental hormones, as mentioned above. And this insensitivity of maternal tissues and cells to insulin increases its amount in the blood.

An increase in blood glucose inhibits the formation of a store of glucose in the liver - glycogen. As a result, a significant part of glucose passes into soluble fats - triglycerides - this is a light depot of fat, its reserve for the development of the brain and nervous system of the fetus. An increased level of glucose in the mother's blood also increases the amount in the fetal blood, which stimulates the release of insulin.

In the third trimester of pregnancy, under the influence of placental lactogen, which prepares the mother's mammary glands for future lactation (milk production), fat breakdown increases. Drops of soluble fats are the basis of milk. Therefore, the amount of glycerol and free fatty acids in the mother's blood increases.

As a result, the level of so-called ketone bodies - oxidized residues of fatty acids - increases. The cells of the maternal liver also take part in the formation of these ketone bodies. These ketones are needed by the fetus to form the liver and brain, as a source of energy.

This is a description of the physiological picture of changes in the amounts of glucose and insulin in a pregnant woman and a fetus during pregnancy, although it may seem that this is a picture of diabetes mellitus. Therefore, many researchers regard pregnancy as a diabetogenic factor. In pregnant women, urinary glucose may even be detected, which is caused by decreased kidney function rather than abnormal blood glucose.

Complications of pregnancy in diabetes mellitus begin from the earliest stages of embryonic development. Transmission of chromosomal mutations is possible, subsequently causing diabetes in the fetus and newborn. A genetic mutation leads to the death of the zygote (the earliest stage of division of a fertilized egg), and the already mentioned menstrual abortion occurs.

Diabetes mellitus in a pregnant woman with impaired metabolism and assimilation of glucose in organs and tissues of the body, with pronounced vascular disorders, especially in small vessels of the liver, kidneys, retina, cannot but affect the processes of embryogenesis, the formation of the embryo. A teratogenic effect is possible (see the chapter on the development of the embryo and fetus), incorrect laying of individual organs and systems (the occurrence of fetal malformations). In addition, an increased level of glucose in the blood of a pregnant woman causes the same increase in it in a fetus that does not yet have its own insulin. As a result, the metabolism of the fetus is disrupted, including increased lipid peroxidation with the formation of an increased amount of ketone bodies that freely penetrate into the blood of a pregnant woman. Ketones in the mother's blood can cause ketoacidosis - acidification of body fluids, which sharply worsens the condition of the pregnant woman, causing ketoacidotic shock, which threatens the life of the pregnant woman. A shift to the acidic or alkaline side of the fluids and environments of the human body is a severe violation of cellular respiration (assimilation of oxygen in cells). Therefore, the death of a woman may follow.

The first half of pregnancy in patients with diabetes mellitus proceeds only with the threat of termination of pregnancy. If there is a high degree of damage to the vessels of the uterus and contact with the forming placenta is disturbed, a late miscarriage occurs, on the verge of premature birth, at 20-27 weeks in 15-30% of pregnant women.

In the second half of pregnancy, the frequency of gestosis is high, it develops in 30-70% of pregnant women with diabetes. The development of gestosis is associated with a pronounced violation of the vessels of the kidneys - nephropathy. Therefore, gestosis in diabetes is expressed by hypertension - increased blood pressure as a result of impaired blood supply to the kidneys and the involvement of the renin-angiotensin system of vasospasm. As a result, kidney hypoxia increases even more, and circles of vascular and hypoxic disorders are twisted. Kidney filtration is damaged, a second characteristic feature of diabetic gestosis occurs - edema, increased glucose in the urine. A tendency to accumulate tissue fluid can cause acute polyhydramnios. On the part of the fetus, urinary excretion increases in order to "dilute" high glucose in the amniotic fluid. Edema of tissues and vasospasm in the placenta can cause intrauterine fetal death. The risk of stillbirth with gestosis reaches 18-45%. It is caused not only by hypoxia, but can occur due to malformations, mechanical compression by amniotic fluid, with polyhydramnios and a complete cessation of oxygen supply. Polyhydramnios is diagnosed in 20-60% of pregnant women with diabetes. Intrauterine fetal death in diabetes occurs most often at 36-38 weeks of pregnancy, with the highest permeability of the placenta for glucose - in particular, but also for ketones, peroxidized fats. Because of this, delivery of diabetic patients is often performed at 35-36 weeks. A newborn baby, although premature, is easier to help by normalizing glucose levels in the first place.

Due to diabetic vascular lesions in pregnant women with diabetes mellitus, chronic DIC is formed. Therefore, often combined gestosis has a severe course, up to eclampsia. The danger of maternal mortality is sharply increasing. Large violations are observed during the formation of the placenta: the so-called annular placenta is formed, underdeveloped by stripes, with additional lobules. Violations of the fundamental features of the placental circulation are possible: only one umbilical artery is formed instead of two. In the uterine arteries of mothers with diabetes, there are no changes characteristic of normal uteroplacental circulation. This causes an insufficiency of the uteroplacental circulation, germination of placental vessels into the uterine muscle, the vascular lumens are narrow, cannot provide the proper increase in the uteroplacental circulation in the II and III trimesters of pregnancy. This is the cause of fetal-placental insufficiency and chronic fetal hypoxia.

At the same time, an increased blood sugar level of the fetus causes an increase in growth hormone, therefore, at the level of placental insufficiency, starting from the second trimester, bone tissue increases and muscle mass grows, a large fetus can form. The frequency of birth of children weighing more than 4 kg in patients with diabetes mellitus is three times higher than the frequency of large fetuses in other women. Diabetes mellitus in the mother causes the accumulation of adipose tissue with still normal bone thickness and muscle mass. The internal organs of the fetus (heart, liver, kidneys, pancreas) increase in accordance with the increase in the size of the fetus. A typical picture of hypertrophic diabetic fetopathy arises. Along with the growth of a large body weight and fetal organs, there is a significant failure of the functions of these organs, a lack of enzymes.

But sometimes placental insufficiency overpowers, and a hypoplastic type of diabetic fetopathy occurs. With this form, the risk of death of an immature and hypotrophic fetus increases from insufficient production of surfactant, which straightens the lungs at the first inhalation of the newborn. This is also the reason for the syndrome of respiratory disorders (respiratory distress syndrome) in newborn diabetic children, large, but with immature hormonal and enzyme systems, their organs are not able to function normally, therefore more than 12% of newborns require resuscitation.

The clinical picture of diabetes mellitus is due to an increase in blood sugar. This explains dry mouth, increased thirst, drinking more than two liters of fluid a day, itching of the skin, especially in the genitals, in the anus, since glucose crystals irritate the mucous membranes and subcutaneous tissue. Violation of the vessels of the eyes causes periodic, transient changes in vision, weight loss. Violation of immunity explains the increased tendency to pustular skin lesions of pyoderma, furunculosis, and in the genitals - to candidal colpitis (inflammation of the vagina).

The course of pregnancy in the first trimester, if it is possible to maintain it, proceeds without significant changes. Sometimes even the blood sugar level is normalized due to an improvement in glucose tolerance, its absorption by tissues, since even some hypoglycemia occurs. This should be taken into account by doctors, since a decrease in insulin doses is required. The decrease in the amount of glucose in the mother is also explained by the increased absorption of glucose by the fetus. Strict control of levels of glucose, ketones, acid-base balance is required to prevent the development of hypoglycemic or ketoacidosis coma.

In the second trimester, due to the increased production of placental hormones that counteract insulin, glucose in the blood of a pregnant woman rises, typical diabetic complaints appear (dryness, thirst, itching), and glucose appears in the urine. Again, ketoacidosis threatens. Therefore, it is required to increase the dose of insulin.

In the third trimester, with the manifestation of placental insufficiency, the amount of hormones that oppose insulin decreases, the sugar level decreases again, this is due to the production of its own insulin by the fetus. Therefore, the amount of insulin administered must be reduced.

In childbirth, there is a great lability (mobility, changes) in the sugar content. The stress of childbirth (fear and pain) creates an increase in glucose levels and the possibility of acidosis. But the work done on the birth of a large fetus, trauma and blood loss can quickly lead to a sharp decrease in glucose levels and hypoglycemic coma.

In the postpartum period, hypoglycemia (low glucose level) is also observed, by the 4th-5th day, the sugar level gradually increases. Insulin doses should be increased or decreased accordingly. By 7-10 days after birth, the glucose level reaches the level that was observed before pregnancy.

We can say that diabetes and pregnancy mutually burden each other. Pregnancy requires increased functions, and organs and systems are significantly undermined by the existing disease. Therefore, vascular disorders progress significantly, retinal vascular disorders are observed in 35% of pregnant women. Diabetic nephropathy leads to gestosis. There is a combination of vascular disorders in the kidneys and the addition of infections, in 6-30% of pregnant women - pyelonephritis and bacteriuria.

In childbirth, weakness of labor is often formed, due to overstretching of the uterus with a large fetus. Prolonged labor worsen the picture of fetal hypoxia, asphyxia may begin. Due to a large fetus, injuries to the mother and the fetus increase. The fetus has a fracture of the collarbones or humerus bones, possibly a skull injury. And the mother has ruptures of the cervix, the walls of the vagina, the perineum, often making her dissection (lerineotomy).

The incidence of postpartum complications in diabetes mellitus is five times higher than in healthy puerperas. The number of infectious, wound, and respiratory disorders is increased. Due to a decrease in placental lactogen, lactation of the mammary glands is reduced.

The course of pregnancy and childbirth, the severity of complications depends on the type of diabetes.

Pregnancy management in patients with diabetes mellitus

Monitoring of pregnant women suffering from diabetes mellitus is carried out in the conditions of both an outpatient clinic and a hospital, departments of specialized maternity hospitals. Women with an established diagnosis of diabetes mellitus before pregnancy, when planning it, should undergo an examination, in which the type of diabetes and the degree of compensation for it, the presence of vascular damage characteristic of diabetes are specified.

Antibodies to beta cells of the pancreas, antibodies to insulin are being investigated. The “School of Diabetes” provides training in self-control techniques for insulin therapy. During pregnancy, regardless of the type of diabetes, everyone is transferred to the introduction of appropriate doses of insulin to compensate for the increased level of glycemia (high blood sugar). Oral sugar-lowering drugs should be discontinued due to the embryotoxic and teratogenic effects of these drugs. After a detailed examination, the question of the admissibility of the onset of pregnancy, the risk of carrying it, is decided.

Pregnancy is contraindicated when:

  • the presence of rapidly progressing or existing severe vascular disorders of the retina of the eyes, threatening blindness, or nephropathy, which can pose a threat to life, with severe gestosis;
  • insulin resistance, the presence of antibodies to insulin. Labile (variable) diabetes course;
  • the presence of diabetes in both parents, which dramatically increases the risk of fetal disease;
  • a combination of diabetes mellitus and Rh sensitization in the expectant mother, significantly worsening the prognosis for the fetus;
  • a combination of diabetes mellitus and active pulmonary tuberculosis, which threaten with a severe exacerbation of the process during pregnancy.

The question of the possibility of prolonging pregnancy is decided by a collegium of doctors - an obstetrician-gynecologist, endocrinologist, therapist and sometimes a phthisiatrician.

A case from practice. Pregnant M.O., 35 years old, with type II diabetes, 8 weeks of pregnancy, the threat of recurrent miscarriage. Before the current pregnancy, there were 3 miscarriages in the first trimester and stillbirth at 25 weeks of gestation. The diagnosis revealed severe microcirculation disorders, the threat of blindness and nephropathy. The College of Physicians recommended M.O. terminate pregnancy due to difficult prognosis for herself and the fetus.

But not only M.O., but also many women with diseases of internal organs that threaten a worsening of their condition or even death during pregnancy, neglect the advice of doctors and prolong pregnancy with a manic idea of ​​having a child even at the cost of their own lives.

Accordingly, M.O. refused to terminate the pregnancy and began to carry it.

We managed to keep the pregnancy. But there was a deterioration in the state of the vessels of the retina. At 22 weeks, combined preeclampsia with nephropathy, edema and hypertension began. M.O. was urgently hospitalized. Long-term intravenous treatment of preeclampsia and placental insufficiency, the introduction of corticoid hormones to accelerate the maturation of surfactant in the lungs of the fetus were started.

This was done due to insufficient treatment effect. There was a sharp deterioration in the patient's vision, she was practically blind. The destabilization of the blood glucose level began, and hypoglycemic states began to appear.

Therefore, a premature delivery was undertaken at 28-29 weeks.

Due to chronic fetal hypoxia, a cesarean section was performed. A girl with a weight of 3000 g, signs of prematurity and functional immaturity of organs (and this at 29 weeks), a hypertrophic form of diabetic fetopathy, was retrieved. The mother sacrificed her eyesight for the birth of her daughter.

Diabetes mellitus treatment during pregnancy

The severity of pregnancy complications in diabetes necessitates repeated hospitalizations as the pregnancy progresses. The purpose of these hospitalizations is to prevent possible complications of pregnancy and diabetes.

The first hospitalization is carried out at the first visit of a pregnant woman to an antenatal clinic. The tasks of this hospitalization are the precise determination of the gestational age, genetic counseling with carrying out, according to indications, amniocentesis, cordocentesis, and chorionic biopsy. An ultrasound scan is performed to detect diabetic embryopathy. Insulin doses are being adjusted. Information is provided on the control of not only the level of glycemia, but also glucosuria (the appearance of glucose in the urine), acetonuria - the appearance of ketones in the urine. The particulars of the diet required regardless of the type of diabetes are explained. An in-depth examination of the urogenital infection and treatment of the identified infections are carried out. The only possible type of correction of the immune system for pregnant women is the introduction of rectal suppositories Viferon or Kipferon.

The second hospitalization is at a period of 8-12 weeks. At this time, a correction of insulin doses is required due to the onset of relative hypoglycemia (a decrease in blood sugar). A repeated ultrasound scan is performed, fetal size control, identification of malformations, the amount of amniotic fluid. An examination by an ophthalmologist, identification of the state of the retinal vessels is required. Symptoms of the threat of termination of pregnancy are identified, and treatment is prescribed if necessary.

The third hospitalization is at 20-24 weeks. Another correction of insulin doses.

Control for the presence or development of small vessel lesions characteristic of diabetes. Signs of the development of combined preeclampsia are revealed. Ultrasound control - clarification of the state of the placenta, the correspondence of the size of the fetus to the gestational age, signs of diabetic fetopathy, the amount of amniotic fluid. A course of metabolic therapy (metabolism - metabolism) is carried out for three weeks to prevent placental insufficiency and fetal hypoxia.

The next hospitalization is at 30-32 weeks of pregnancy. The next correction of insulin doses, determination of the presence or occurrence of lesions of small vessels. Assessment of the condition of the fetus and placenta using ultrasound, Doppler study of blood flow in the placenta and in the fetus. A study of the fetal heart rate is also carried out - CTG recording. Control of blood clotting, placental hormones. Prevention of insufficient production of surfactant in the lungs of the fetus. The timing and method of delivery are determined

Childbirth is carried out as close as possible to full-term pregnancy, but the risk of intrauterine fetal death, fetal loss during childbirth is taken into account. In case of impaired presentation of the fetus, severe diabetes, high risk of fetal loss in childbirth, a cesarean section is performed at 36-37 weeks of pregnancy. Delivery is possible at an earlier stage of pregnancy. It all depends on the compensation of diabetes, the severity of complications, the condition of the pregnant woman and the fetus. It is necessary to take into account the sharp drops in blood glucose levels during labor and the early postpartum period.

A case from practice. Patient O.N., 32 years old. Type I diabetes mellitus, congenital, the presence of antibodies to the beta cells of the pancreas. Was admitted for delivery at 34 weeks of gestation with severe gestosis, hypertension and acute polyhydramnios. Intravenous administration of antihypoxants (drugs for the treatment of hypoxia) and micronized heparin was started, this was the prevention of DIC.

When compensating for the level of blood pressure, blood glucose, a careful amniotomy (opening of the fetal bladder) was performed with a gradual release of fluid.

CTG monitoring revealed severe fetal hypoxia, a hypoplastic form of diabetic fetopathy.

According to the sum of severe diabetic and obstetric risks, the delivery plan was changed to an operative one. A cesarean section was performed - a living, premature, hypotrophic boy with asphyxia, weighing 1300 g was extracted. Subsequently, the child was found to have a congenital heart defect, fusion of the fingers. The postoperative period on the 2nd day was complicated by severe hypoglycemia, ketoacidosis, hypoglycemic coma. An immediate jet injection of 40% glucose was started, but this did not help, death occurred. Autopsy revealed cerebral edema with wedging of the cerebellum into the foramen magnum - the cause of death. It was about the automation of the actions of the doctors. After the operation, a zero table is assigned - only water, a weak broth. And insulin doses were not adjusted on time. The sugar-lowering effect of insulin, starvation, and early postoperative (fear, blood loss) hypoglycemia converged. The sugar level dropped to zero. Therefore, even an intravenous jet injection of 250 ml of 40% glucose did not help.

The time when doctors considered diabetes mellitus as an indication for terminating pregnancy is long gone, because modern pharmacies can buy a very effective medicine that will help maintain the health of a woman with diabetes mellitus in position, and a pocket glucometer so that you can measure glucose levels at any time in blood. Today, hospitals are provided with all the necessary equipment in order to leave a baby born to a mother with diabetes mellitus. However, it is impossible to say unequivocally that no risks and dangers will arise during pregnancy. Still, there are a number of features that all pregnant women with diabetes need to take into account.

Diabetes mellitus is a chronic disease that occurs due to a lack of pancreatic hormone insulin in the blood. This hormone is responsible for ensuring that glucose from food is supplied to all cells of the human body in a timely and correct manner. If there is not enough insulin in the blood, then the level of glucose in the blood rises, which is very dangerous.

Diabetes mellitus can occur for the following reasons:

  1. Due to heredity.
  2. Due to obesity.
  3. Due to diseases of the pancreas, which produces insulin (pancreatitis, cancer, and so on).
  4. Due to viral infections in the blood.
  5. Due to frequent nervous breakdowns.
  6. Due to age (this reason may be additional to the above).

This endocrine disorder can have many negative health consequences:

  • A glycemic coma may occur (when the patient's nerve cells are affected, and he is in a state of complete lethargy).
  • Swelling of the extremities (most often the feet).
  • Unstable blood pressure (it can be low or high).
  • Severe pain in joints and feet.
  • Ulcers appear on the legs, which can become large and increase in number.
  • Gangrene may develop on the legs, which ends with the amputation of the limb.

Types of diabetes

The disease can take two forms:

  1. Insulin-dependent diabetes mellitus. It occurs in thin young people who have not yet reached the age of 40. Such people cannot live without an additional dose of insulin from a syringe, as their body produces antibodies to the cells of insulin, which is produced by the pancreas. It is impossible to recover from this form of diabetes, but it is possible to restore the function of hormone production by the pancreas if you eat only raw food.
  2. Non-insulin dependent diabetes mellitus. Obese elderly people suffer from it due to the fact that the cells of their body lose their sensitivity to insulin due to an excess of nutrients in them. Sometimes a doctor will prescribe such people to take sugar pills and follow a strict diet that will help them lose weight.

Planning a pregnancy with diabetes

If a woman knows for sure that she has diabetes mellitus, then it is strictly forbidden for her to become pregnant without prior planning, since a woman's high blood sugar will affect the health and full development of the fetus in utero from the first days of conception. Doctors recommend that women with diabetes who dream of experiencing the joy of motherhood start preparing for pregnancy 3-4 months in advance. During this time, specialists will conduct diagnostics in order to determine the risk assessment and contraindications for pregnancy with diabetes. What this diagnosis will be like:

  1. Take a blood test for diabetes mellitus to plan pregnancy (A normal level is 3.3-5.5 mmol. An amount of sugar from 5.5 to 7.1 mmol. Is called a pre-diabetic state. If the sugar level exceeds 7.1 mmol. , then they are already talking about one or another stage of diabetes mellitus).
  2. Use a pocket meter to check your blood sugar up to 10 times every day to track your glucose rise and fall throughout the day.
  3. Measure blood pressure daily (preferably several times a day).
  4. Pass a urine test to detect kidney disease.
  5. Visit the ophthalmologist's office to assess the state of the vessels of the eye tissue.
  6. Make an ECG if the woman is over 35 years old, and she suffers from arterial hypertension, nephropathy, obesity, high blood cholesterol, has problems with peripheral vessels.
  7. Check the sensitivity of the nerve endings on the legs and feet (tactile, pain, temperature and vibration).
  8. Take blood tests for thyroid hormones.
  9. Visit the gynecologist's office, who will collect material for the detection of genitourinary infections.
  10. Register with an endocrinologist who will accompany the entire pregnancy if it occurs.

Features of the course of pregnancy in diabetes mellitus

Now let's take a closer look at how the course of pregnancy with diabetes mellitus will differ from the usual one. First of all, in the first weeks of pregnancy, a woman's indicators of carbohydrate tolerance will improve. Therefore, the level of insulin that a woman consumed before conception should be reduced. It will return to normal in the second trimester of pregnancy, when the placenta is already fully formed and begins to produce counterinsulin hormones such as prolactin and glycogen.

In the fourth month of pregnancy, the doctor will strengthen control over the blood sugar level in the pregnant woman, since the baby's pancreas is already starting to work, which begins to respond to the mother's blood. If there is a lot of sugar in the blood of a pregnant woman, then the fetal pancreas will respond with an injection of insulin, as a result of which glucose will break down and be converted into fat - the child will actively gain weight and be born with diabetes.

In the third trimester of pregnancy, the intensity of the production of counterinsulin hormones will decrease, therefore, the endocrinologist will reduce the dosage of insulin for the expectant mother, who, because of her problem, will have to visit the gynecologist's office every week during pregnancy and several times lie in the hospital at the day hospital under the supervision of doctors:

  • The first hospitalization will be shown to the pregnant woman in the first trimester (at 8-10 weeks), where diagnostics will be carried out, which will reveal contraindications to pregnancy, if any;
  • The second hospitalization will be indicated in the second trimester (5-6 months of pregnancy), when all kinds of fetal pathologies due to diabetes of the expectant mother will be revealed;
  • The third hospitalization is carried out in the third trimester of pregnancy (8 months before delivery). Here it must be decided when and how the birth will take place.

Pregnancy with type 1 diabetes

Women face insulin-dependent diabetes mellitus most often. They will need to take insulin in different dosages for 9 months, which will be prescribed by an endocrinologist. As a rule, these are:

  • In the first trimester, the need for insulin in a pregnant woman decreases by about 25-30%.
  • In the second trimester, on the contrary, the need for insulin increases - the average daily dose of insulin can reach 80-100 units.
  • In the third trimester, the situation of the first stage of pregnancy is repeated.

Pregnancy with type 2 diabetes

Diabetes mellitus type 2 in pregnant women is much less common due to the fact that it occurs in people after 40 years, when women are no longer fertile due to the onset of menopause.

Gestational diabetes mellitus during pregnancy

This type of diabetes occurs exclusively during pregnancy. After giving birth, he always disappears without a trace. Why might it arise? Most often, the reason lies in the increasing load on the pancreas after the release of hormones into the bloodstream, the action of which is opposite to insulin. What are the symptoms of gestational diabetes during pregnancy:

  • Very intense thirst;
  • Constant hunger;
  • Frequent urge to urinate;
  • Deterioration of vision.
  • Changes in blood sugar levels in gestational diabetes during pregnancy:

Due to the fact that these symptoms are often found in all expectant mothers who are not sick, they do not even realize that latent diabetes mellitus is already developing in their blood during pregnancy. The most susceptible to the occurrence of gestational diabetes are women with:

  • obesity;
  • polycystic ovary syndrome;
  • sugar in urine before pregnancy or at the beginning;
  • the presence of diabetes mellitus in one of the relatives;
  • diabetes in previous pregnancies.

According to medical statistics, 4% of women who are expecting a baby are faced with pregnancy diabetes. Most often, gestational diabetes mellitus during pregnancy is treated with a diet.

Contraindications to pregnancy with diabetes mellitus

At the 12th week of pregnancy at the first hospitalization, doctors reveal how dangerous diabetes mellitus during pregnancy is for a woman. Unfortunately, some women are forbidden to give birth and are sent to terminate their pregnancies. This can happen if, in addition to diabetes mellitus, a pregnant woman has the following diseases:

  • ischemia;
  • renal failure;
  • gastroenteropathy;
  • Rh negative blood.

Diabetes mellitus treatment during pregnancy

The essence of the treatment of diabetes during pregnancy is insulin therapy and a balanced diet. Only an endocrinologist can recommend the dose of insulin to each woman, but we will tell you in detail what diet for diabetes mellitus during pregnancy should be followed.

The diet includes:

  • a reduced amount of carbohydrates (200-250 g), fats (60-70 g) and an increased amount of proteins (1-2 g per 1 kg of body weight);
  • the energy value of the daily consumed food should be 2000-2200 kcal, and in case of obesity - 1600-1900 kcal;
  • food intake should coincide in time with the action of insulin (one and a half and 5 hours after the administration of insulin, as well as before bedtime and upon awakening);
  • the use of sugar, sweets, jams, honey, ice cream, chocolate, cakes, sweet drinks, grape juice, semolina and rice porridge is prohibited;
  • meals should be fractional, preferably 8 times a day;
  • you need to take vitamins A, groups B, C, and D, folic acid (400 mcg per day) and potassium iodide (200 mcg per day).

In addition to following the diet of a pregnant woman with diabetes, herbal teas are prescribed:

  • boiled blueberry leaves;
  • boiled beans without seeds, blueberry leaves, chopped oat straw, flaxseed, chopped burdock root.

Expectant mothers with diabetes mellitus benefit from physical activity in the form of walking before bedtime.

Delivery in diabetes mellitus

During the last third hospitalization, doctors will determine how the labor will go. If it is decided that a woman will give birth on her own, and not by caesarean section, then, as a rule, delivery will take place like this:

  • the birth canal will be prepared for childbirth (the amniotic sac will be pierced);
  • the necessary hormones (oxytocin or insulin) and pain relievers are administered;
  • the blood sugar level and fetal heart rate are monitored with the help of KGT. With the attenuation of the labor of the pregnant woman, oxytocin is injected intravenously, and with a sharp jump in sugar - insulin.

The consequences of diabetes during pregnancy

  1. Miscarriages are common in early pregnancy.
  2. Preeclampsia develops sharply - blood pressure rises, edema appears, protein appears in the urine, kidneys may fail, the child may die in utero.
  3. Toxicosis is much more common in late pregnancy.
  4. Polyhydramnios may develop, which will lead to fetal malformations and may provoke premature birth.

Pregnancy in any case is a serious test for any woman, especially for one who has diabetes. To avoid negative consequences, the expectant mother with diabetes will need to scrupulously follow all the recommendations of an endocrinologist and gynecologist.

Video: "Pregnancy with diabetes"