Fitness and healthy lifestyle 

Diabetes and pregnancy. What is the danger of gestational diabetes during pregnancy. Gestational diabetes during pregnancy

Pregnancy is a period of increased functional load on most organs of a pregnant woman. In this case, a number of diseases may decompensate or new pathological conditions may appear. One such pregnancy-related disorder is gestational diabetes mellitus. It usually does not pose a significant threat to the life of the expectant mother. But in the absence of adequate therapy, gestational diabetes negatively affects the intrauterine development of the child and increases the risk of early infant mortality.

What is diabetes mellitus?

Diabetes mellitus is called an endocrine disease with a pronounced violation primarily of carbohydrate metabolism. Its main pathogenetic mechanism is the absolute or relative insufficiency of insulin, a hormone produced by special cells of the pancreas.

Insulin deficiency may be due to:

  • a decrease in the number of β-cells of the islets of Langerhans in the pancreas, responsible for the secretion of insulin;
  • violation of the process of converting inactive proinsulin into a mature active hormone;
  • synthesis of an abnormal insulin molecule with an altered amino acid sequence and reduced activity;
  • changes in the sensitivity of cellular receptors to insulin;
  • increased production of hormones, whose action is opposed to the effects of insulin;
  • discrepancy between the amount of incoming glucose and the level of the hormone produced by the pancreas.

The effect of insulin on carbohydrate metabolism is due to the presence of specific glycoprotein receptors in insulin-dependent tissues. Their activation and subsequent structural transformation leads to an increase in the transport of glucose into cells with a decrease in the level of sugar in the blood and intercellular spaces. Also, under the action of insulin, both the utilization of glucose with the release of energy (the process of glycolysis) and its accumulation in tissues in the form of glycogen are stimulated. The main depot in this case are the liver and skeletal muscles. The release of glucose from glycogen also occurs under the action of insulin.

This hormone affects fat and protein metabolism. It has an anabolic effect, inhibits the process of fat breakdown (lipolysis) and stimulates the biosynthesis of RNA and DNA in all insulin-dependent cells. Therefore, with a small production of insulin, a change in its activity, or a decrease in the sensitivity of tissues, multifaceted metabolic disorders occur. But the main signs of diabetes are changes in carbohydrate metabolism. At the same time, there is an increase in the basic level of glucose in the blood and the appearance of an excessive peak of its concentration after a meal and a sugar load.

Decompensated diabetes mellitus leads to vascular and trophic disorders in all tissues. In this case, even insulin-independent organs (kidneys, brain, heart) suffer. The acidity of the main biological secrets changes, which contributes to the development of dysbacteriosis of the vagina, oral cavity and intestines. The barrier function of the skin and mucous membranes decreases, the activity of local immune defense factors is suppressed. As a result, diabetes significantly increases the risk of infectious and inflammatory diseases of the skin and genitourinary system, purulent complications and impaired regeneration processes.

Types of disease

There are several types of diabetes mellitus. They differ from each other in etiology, pathogenetic mechanisms of insulin deficiency and the type of course.

  • type 1 diabetes mellitus with absolute insulin deficiency (insulin-requiring incurable condition), due to the death of cells of the islets of Langerhans;
  • type 2 diabetes mellitus, characterized by tissue insulin resistance and impaired insulin secretion;
  • gestational diabetes mellitus, with hyperglycemia first detected during pregnancy and usually disappears after childbirth;
  • other forms of diabetes due to combined endocrine disorders (endocrinopathies) or dysfunction of the pancreas due to infections, intoxications, drug exposure, pancreatitis, autoimmune conditions or genetically determined diseases.

In pregnant women, one should distinguish between gestational diabetes and decompensation of previously existing (pregestational) diabetes mellitus.

Features of gestational diabetes

The pathogenesis of diabetes in pregnant women consists of several components. The most important role is played by the functional imbalance between the hypoglycemic effect of insulin and the hyperglycemic effect of a group of other hormones. Gradually increasing tissue insulin resistance exacerbates the picture of relative insular insufficiency. And physical inactivity, weight gain with an increase in the percentage of adipose tissue and the often noted increase in the total calorie content of food become provoking factors.

The background for endocrine disorders during pregnancy are physiological metabolic changes. Already in the early stages of gestation, a metabolic restructuring occurs. As a result, at the slightest sign of a decrease in the supply of glucose to the fetus, the main carbohydrate pathway of energy metabolism quickly switches to the reserve lipid one. This defense mechanism is called the phenomenon of rapid starvation. It ensures constant transport of glucose across the fetoplacental barrier even when the available stores of glycogen and the substrate for gluconeogenesis in the mother's liver are depleted.

At the start of pregnancy, this metabolic rearrangement is sufficient to meet the energy needs of the developing baby. Subsequently, to overcome insulin resistance, hypertrophy of β-cells of the islets of Lagnerhans and an increase in their functional activity develop. The increase in the amount of insulin produced is compensated by the acceleration of its destruction, due to increased kidney function and activation of placental insulinase. But already in the second trimester of pregnancy, the maturing placenta begins to perform an endocrine function, which can affect carbohydrate metabolism.

Insulin antagonists are steroid and steroid-like hormones synthesized by the placenta (progesterone and placental lactogen), estrogens, and cortisol secreted by the adrenal glands of the mother. They are considered potentially diabetogenic, with fetoplacental hormones having the greatest effect. Their concentration begins to increase from 16-18 weeks of gestation. And usually by the 20th week in a pregnant woman with relative insular insufficiency, the first laboratory signs of gestational diabetes appear. Most often, the disease is detected at 24-28 weeks, and a woman may not present typical complaints.

Sometimes only a change in glucose tolerance is diagnosed, which is considered prediabetes. In this case, the lack of insulin manifests itself only with an excessive intake of carbohydrates from food and with some other provocative moments.

According to current data, gestational diabetes is not accompanied by the death of pancreatic cells or changes in the insulin molecule. That is why the endocrine disorders that occur in a woman are reversible and most often stop on their own shortly after childbirth.

Why is gestational diabetes dangerous for a baby?

When gestational diabetes is diagnosed in a pregnant woman, questions always arise about what effect it has on the child and whether treatment is really necessary. Indeed, most often this disease does not pose an immediate threat to the life of the expectant mother and does not even significantly change her well-being. But treatment is necessary first of all to prevent perinatal and obstetric complications of pregnancy.

Diabetes mellitus leads to impaired microcirculation in the tissues of the mother. Spasm of small vessels is accompanied by damage to the endothelium in them, activation of lipid peroxidation, and provokes chronic DIC. All this contributes to chronic placental insufficiency with fetal hypoxia.

Excessive intake of glucose to the child is also by no means a harmless phenomenon. After all, his pancreas does not yet produce the required amount of the hormone, and maternal insulin does not penetrate the fetoplacental barrier. And an uncorrected glucose level leads to dyscirculatory and metabolic disorders. And secondary hyperlipidemia causes structural and functional changes in cell membranes, exacerbates hypoxia of fetal tissues.

Hyperglycemia provokes hypertrophy of pancreatic β-cells in a child or their earlier depletion. As a result, the newborn may experience severe disorders of carbohydrate metabolism with critical life-threatening conditions. If gestational diabetes is not corrected even in the 3rd trimester of pregnancy, the fetus develops macrosomia (large body weight) with dysplastic obesity, splenomegaly and hepatomegaly. In this case, most often at birth, immaturity of the respiratory, cardiovascular and digestive systems is noted. All this applies to diabetic fetopathy.

The main complications of gestational diabetes include:

  • fetal hypoxia with intrauterine growth retardation;
  • premature delivery;
  • intrauterine fetal death;
  • high infant mortality among children born to women with gestational diabetes;
  • macrosomia, which leads to a complicated course of childbirth and increases the risk of birth injuries in a child (clavicle fracture, Erb's palsy, paralysis of the phrenic nerve, injuries of the skull and cervical spine) and damage to the mother's birth canal;
  • , preeclampsia and eclampsia in a pregnant woman;
  • frequently recurrent urinary tract infections during pregnancy;
  • fungal lesions of the mucous membranes (including the genital organs).

Some doctors also include early spontaneous abortion as a complication of gestational diabetes. But most likely the cause of miscarriage is decompensation of previously undiagnosed pregestational diabetes.

Symptoms and Diagnosis

Pregnant women suffering from diabetes rarely show complaints characteristic of this disease. Typical signs are usually mild, and women usually consider them physiological manifestations of the 2nd and 3rd trimesters. Dysuria, thirst, pruritus, insufficient weight gain can occur not only in gestational diabetes. Therefore, laboratory tests are the main diagnostics of this disease. And obstetric ultrasound helps to clarify the severity of fetoplacental insufficiency and identify signs of fetal pathology.

A screening study is the determination of the level of glucose in the blood of a pregnant woman on an empty stomach. It is carried out regularly starting from the 20th week of gestation. Upon receipt of the threshold indicators of glycemia, a test is prescribed to determine glucose tolerance. And in pregnant women from a high risk group for the development of gestational diabetes, it is advisable to carry out such a test at the first appointment and again at a period of 24-28 weeks, even with a normal fasting glucose level.

Glycemia from 7 mmol / l on an empty stomach in capillary whole blood or from 6 mmol / l on an empty stomach in venous plasma are diagnostically reliable laboratory indicators for gestational diabetes. Also a sign of the disease is the detection of hyperglycemia above 11.1 mmol / l with random measurement during the day.

Conducting a glucose tolerance test () requires careful compliance with the conditions. Within 3 days, a woman should follow her usual diet and physical activity, without the restrictions recommended for diabetes. Dinner on the eve of the test should contain 30-50 g of carbohydrates. The analysis is carried out strictly on an empty stomach, after 12-14 hours of fasting. During the test, smoking, taking any drugs, physical activity (including climbing stairs), food and drink are excluded.

The first sample is blood taken on an empty stomach. After that, the pregnant woman is given a solution of freshly prepared glucose to drink (75 g of dry matter per 300 ml of water). To assess the dynamics of glycemia and identify its hidden peaks, it is advisable to take repeated samples every 30 minutes. But often, only the determination of the level of glucose in the blood is carried out, 2 hours after taking the test solution.

Normally, 2 hours after a sugar load, glycemia should be no more than 7.8 mmol / l. A decrease in tolerance is said at rates of 7.8-10.9 mmol / l. And gestational diabetes mellitus is diagnosed with a result of 11.0 mmol / l.

The diagnosis of gestational diabetes cannot be based on the determination of glucose in the urine (glucosuria) or the measurement of glucose levels with home glucometers with test strips. Only standardized laboratory blood tests can confirm or exclude this disease.

Treatment Issues

insulin therapy

Self-monitoring of glucose levels in peripheral venous blood with the help of glucometers is necessary. A pregnant woman analyzes herself on an empty stomach and 1-2 hours after a meal, recording the data along with the calorie content of the food taken in a special diary.

If a hypocaloric diet in gestational diabetes did not lead to normalization of glycemia, the doctor decides to prescribe insulin therapy. In this case, short-acting and ultra-short-acting insulins are prescribed in the mode of multiple injections, taking into account the caloric content of each meal and the level of glucose. Sometimes intermediate-acting insulins are used additionally. At each appointment, the doctor adjusts the treatment regimen, taking into account self-monitoring data, the dynamics of fetal development and ultrasound signs of diabetic fetopathy.

Insulin injections are carried out with special syringes subcutaneously. Most often, a woman does not need outside help for this, training is carried out by an endocrinologist or the staff of the School of Diabetes. If the required daily dose of insulin exceeds 100 units, a decision may be made to install a permanent subcutaneous insulin pump. The use of oral hypoglycemic drugs during pregnancy is prohibited.

As an auxiliary therapy, drugs can be used to improve microcirculation and treat placental insufficiency, Hofitol, vitamins.

Diet for gestational diabetes

During pregnancy, the mainstay of treatment for diabetes and impaired glucose tolerance is diet therapy. This takes into account the body weight and physical activity of the woman. Dietary recommendations include correction of the diet, food composition and its calorie content. The menu of a pregnant woman with gestational diabetes mellitus should, in addition, ensure the supply of essential nutrients and vitamins, and contribute to the normalization of the gastrointestinal tract. Between 3 main meals, snacks should be arranged, and the main caloric content should be in the first half of the day. But the last snack before bedtime should also include carbohydrates in the amount of 15-30 g.

What can you eat with diabetes in pregnancy? These are low-fat varieties of poultry, meat and fish, fiber-rich foods (vegetables, legumes and grains), greens, low-fat dairy and sour-milk products, eggs, vegetable oils, nuts. To determine which fruits can be included in the diet, you need to evaluate the rate of rise in blood glucose levels shortly after eating them. Apples, pears, pomegranates, citrus fruits, peaches are usually allowed. It is acceptable to consume fresh pineapple in small quantities or pineapple juice without added sugar. But it is better to exclude bananas and grapes from the menu, they contain easily digestible carbohydrates and contribute to the rapid peak growth of glycemia.

Delivery and prognosis

Childbirth in gestational diabetes can be natural or by caesarean section. Tactics depends on the expected weight of the fetus, the parameters of the mother's pelvis, the degree of compensation of the disease.

With independent childbirth, glucose levels are monitored every 2 hours, and with a tendency to hypoglycemic and hypoglycemic conditions - every hour. If a woman was on insulin therapy during pregnancy, the drug is administered during childbirth using an infusion pump. If she had enough diet therapy, the decision to use insulin is made in accordance with the level of glycemia. For caesarean section, glycemic monitoring is necessary before surgery, before removal of the baby, after removal of the placenta, and then every 2 hours.

With the timely detection of gestational diabetes and the achievement of stable compensation for the disease during pregnancy, the prognosis for the mother and child is favorable. Nevertheless, newborns are at risk for infant mortality and require close monitoring by a neonatologist and pediatrician. But for a woman, the consequences of gestational diabetes can be revealed several years after a successful birth in the form of type 2 diabetes or prediabetes.

If many of us have heard about ordinary diabetes mellitus, few people know what gestational diabetes is. Gestational diabetes is an increase in blood glucose (sugar) that is first noticed during pregnancy.

The disease is not so common - only 4% of all pregnancies - but, just in case, you need to know about it, if only because this disease is far from harmless.

Diabetes during pregnancy can adversely affect the development of the fetus. If it arose in the early stages pregnancy, the risk of miscarriage increases, and, even worse, the appearance of congenital malformations in the baby. Most often, the most important organs of the crumbs are affected - the heart and brain.

Gestational diabetes onset in the second and third trimesters pregnancy, causes overfeeding and overgrowth of the fetus. This leads to hyperinsulinemia: after childbirth, when the child will no longer receive such an amount of glucose from the mother, his blood sugar levels drop to very low levels.

If this disease is not detected and treated, it can lead to the development diabetic fetopathy- a complication in the fetus that develops due to a violation of carbohydrate metabolism in the mother's body.

Signs of diabetic fetopathy in a child:

  • large sizes (weight more than 4 kg);
  • violation of body proportions (thin limbs, large belly);
  • swelling of tissues, excessive deposits of subcutaneous fat;
  • jaundice;
  • respiratory disorders;
  • neonatal hypoglycemia, increased blood viscosity and risk of blood clots, low calcium and magnesium in the blood of the newborn.

How does gestational diabetes occur during pregnancy?

During pregnancy, not just a hormonal surge occurs in the female body, but a whole hormonal storm, and one of the consequences of such changes is violation of the body's tolerance to glucose Some are stronger, some are weaker. What does this mean? The blood sugar level is high (above the upper limit of normal), but still not enough to make a diagnosis of diabetes mellitus.

In the third trimester of pregnancy, as a result of new hormonal changes, gestational diabetes may develop. The mechanism of its occurrence is as follows: the pancreas of pregnant women produces 3 times more insulin than other people - in order to compensate for the action of specific hormones on blood sugar levels.

If she does not cope with this function with an increasing concentration of hormones, then there is such a thing as gestational diabetes mellitus during pregnancy.

Risk group for developing gestational diabetes during pregnancy

There are certain risk factors that make a woman more likely to develop gestational diabetes during pregnancy. However, the presence of even all these factors does not guarantee that diabetes will still occur - just as the absence of these adverse factors does not guarantee 100% protection against this disease.

  1. Overweight observed in a woman before pregnancy (especially if the weight exceeded the norm by 20% or more);
  2. Nationality. It turns out that there are certain ethnic groups in which gestational diabetes is observed much more often than others. These include Blacks, Hispanics, Native Americans, and Asians;
  3. High blood sugar on urinalysis;
  4. Violation of the body's tolerance to glucose (as we have already mentioned, the sugar level is above normal, but not enough to make a diagnosis of "diabetes");
  5. Heredity. Diabetes is one of the most serious hereditary diseases, its risk is increased if someone close to you in your line was diabetic;
  6. Previous birth of a large (over 4 kg) child;
  7. Previous birth of a stillborn child;
  8. You have already been diagnosed with gestational diabetes during a previous pregnancy;
  9. Polyhydramnios, that is, too much amniotic fluid.

Diagnosis of gestational diabetes

If you find yourself with several signs that are at risk, tell your doctor about it - you may be prescribed an additional examination. If nothing bad is found, you will be tested again along with all the other women. All others pass screening examination for gestational diabetes between the 24th and 28th weeks of pregnancy.

How would this happen? You will be asked to do a test called an oral glucose tolerance test. You will need to drink a sweetened liquid containing 50 grams of sugar. After 20 minutes, there will be a less pleasant stage - taking blood from a vein. The fact is that this sugar is quickly absorbed, after 30-60 minutes, but individual indications vary, and this is what doctors are interested in. In this way, they find out how well the body is able to metabolize the sweet solution and absorb glucose.

In the event that in the form in the column "analysis results" there is a figure of 140 mg / dl (7.7 mmol / l) or higher, this is already high level. You will be given another test, but this time after several hours of fasting.

Treatment of gestational diabetes

The life of diabetics, frankly, is not sugar - both literally and figuratively. But this disease can be controlled if you know how and strictly follow medical instructions.

So, what will help to cope with gestational diabetes during pregnancy?

  1. Blood sugar control. This is done 4 times a day - on an empty stomach and 2 hours after each meal. You may also need additional checks - before meals;
  2. Urinalysis. Ketone bodies should not appear in it - they indicate that diabetes mellitus is not controlled;
  3. Compliance with a special diet that the doctor will tell you. We will consider this issue below;
  4. Reasonable physical activity on the advice of a doctor;
  5. Control over body weight;
  6. Insulin therapy as needed. At the moment, during pregnancy, only insulin is allowed to be used as an antidiabetic drug;
  7. Blood pressure control.

Diet for gestational diabetes

If you have been diagnosed with gestational diabetes, you will have to reconsider your diet - this is one of the conditions for the successful treatment of this disease. Weight loss is usually recommended for diabetics (this contributes to increased insulin resistance), but pregnancy is not the time to lose weight, because the fetus must receive all the nutrients it needs. So, you should reduce the calorie content of food, while not reducing its nutritional value.

1. Eat small meals 3 times a day and 2-3 more snacks at the same time. Don't skip meals! Breakfast should be 40-45% carbohydrates, the last evening snack should also contain carbohydrates, about 15-30 gr.

2. Avoid fried and fatty, as well as foods rich in easily digestible carbohydrates. These include, for example, confectionery, as well as pastries and some fruits (banana, persimmon, grapes, cherries, figs). All these foods are quickly absorbed and provoke a rise in blood sugar levels, they are few in nutrients, but high in calories. In addition, to offset their high glycemic effect, they require too much insulin, which is a luxury in diabetes.

3. If you feel sick in the morning, keep a cracker or cracker on your bedside table and eat a few before you get out of bed. If you're on insulin and feel sick in the morning, make sure you know how to deal with low blood sugar.

4. Don't eat fast foods. They are industrially pre-processed to reduce their preparation time, but their effect on increasing the glycemic index is greater than that of their natural counterparts. Therefore, exclude freeze-dried noodles, soup-lunch “in 5 minutes” from a bag, instant porridge, freeze-dried mashed potatoes from the diet.

5. Pay attention to foods rich in fiber: cereals, rice, pasta, vegetables, fruits, whole grain bread. This is true not only for women with gestational diabetes - every pregnant woman should eat 20-35 grams of fiber per day. Why is fiber so good for diabetics? It stimulates the intestines and slows down the absorption of excess fat and sugar into the blood. Also, fiber-rich foods contain many essential vitamins and minerals.

6. Saturated fat in the daily diet should not be more than 10%. In general, eat less foods containing "hidden" and "visible" fats. Eliminate sausages, wieners, sausages, bacon, smoked meats, pork, lamb. Lean meats are much preferable: turkey, beef, chicken, and also fish. Remove all visible fat from meat: lard from meat, and skin from poultry. Cook everything in a gentle way: boil, bake, steam.

7. Cook food without fat, but in vegetable oil, but it should not be too much.

8. Drink at least 1.5 liters of fluid per day(8 glasses).

9. Your body does not need such fats like margarine, butter, mayonnaise, sour cream, nuts, seeds, cream cheese, sauces.

10. Tired of bans? There are also products that you can have no limit They are low in calories and carbohydrates. These are cucumbers, tomatoes, zucchini, mushrooms, radishes, zucchini, celery, lettuce, green beans, cabbage. Eat them in the main meals or as snacks, preferably in the form of salads or boiled (boil in the usual way or steamed).

11. Make sure your body is provided with a full range of vitamins and minerals needed during pregnancy: ask your doctor if you need extra vitamins and minerals.

If diet therapy does not help, and blood sugar remains at a high level, or if ketone bodies are constantly detected in the urine at a normal sugar level, you will be prescribed insulin therapy.

Insulin is only injected because it is a protein, and if you try to put it in tablets, it will be completely destroyed by our digestive enzymes.

Disinfectants are added to insulin preparations, so do not wipe the skin with alcohol before injection - alcohol destroys insulin. Naturally, you need to use disposable syringes and follow the rules of personal hygiene. All other subtleties of insulin therapy will be told to you by your doctor.

Exercise for gestational diabetes in pregnancy

Do you think it's not needed? On the contrary, they will help maintain good health, maintain muscle tone, and recover faster after childbirth. In addition, they improve the action of insulin and help not to gain excess weight. All this contributes to maintaining optimal blood sugar levels.

Engage in the usual activities that you enjoy and enjoy: walking, gymnastics, exercising in the water. No stress on the stomach - for now, you will have to forget about your favorite “abs” exercises. You should not engage in sports that are fraught with injuries and falls - horseback riding, cycling, skating, skiing, etc.

All loads - according to well-being! If you feel bad, there are pains in the lower abdomen or in the back, stop and catch your breath.

If you are on insulin therapy, it is important to be aware that hypoglycemia can occur during exercise, as both exercise and insulin lower blood sugar levels. Check your blood sugar levels before and after your workout. If you started exercising an hour after eating, you can eat a sandwich or an apple after class. If more than 2 hours have passed since the last meal, it is better to have a snack before training. Be sure to bring juice or sugar with you in case of hypoglycemia.

Gestational diabetes and childbirth

The good news is that gestational diabetes usually goes away after childbirth – it only develops into diabetes in 20-25% of cases. True, the birth itself due to this diagnosis can be complicated. For example, due to the already mentioned overfeeding of the fetus, the child may be born very large.

Many, perhaps, would like a “hero”, but the large size of the child can be a problem during labor and childbirth: in most such cases, it is carried out, and in the case of natural delivery, there is a risk of injury to the child’s shoulders.

Children with gestational diabetes born with low levels blood sugar, but this is fixable simply by feeding.

If there is no milk yet, and the child does not have enough colostrum, the child is supplemented with special mixtures to raise the sugar level to a normal value. Moreover, the medical staff constantly monitors this indicator, measuring the glucose level quite often, before feeding and 2 hours after.

As a rule, no special measures to normalize the blood sugar level of the mother and child will be needed: in the child, as we have already said, sugar returns to normal thanks to feeding, and in the mother - with the release of the placenta, which is the “irritating factor”, because produces hormones.

The first time after childbirth still have to follow for nutrition and periodically measure the level of sugar, but over time everything should return to normal.

Prevention of gestational diabetes

There is no 100% guarantee that you will never encounter gestational diabetes - it happens that women who, according to most indicators, fall into the risk group, do not get sick when they become pregnant, and vice versa, this disease happens to women who, it would seem, did not have no preconditions.

If you already had gestational diabetes during a previous pregnancy, the chances of it coming back are very high. However, you can reduce your risk of developing gestational diabetes during pregnancy by maintaining a healthy weight and not gaining too much during those 9 months.

Physical activity can help keep your blood sugar at a safe level, as long as it's regular and doesn't cause you discomfort.

You also remain at risk of developing a permanent form of diabetes called type 2 diabetes. You will have to be more careful after childbirth. Therefore, it is undesirable for you to take drugs that increase insulin resistance: nicotinic acid, glucocorticoid drugs (these include, for example, dexamethasone and prednisolone).

Please note that some birth control pills may increase the risk of diabetes - for example, progestin, but this does not apply to low-dose combination drugs. In choosing a contraceptive after childbirth, be guided by the recommendations of your doctor.

Answers

The number of cases of developing diabetes in pregnant women is constantly growing. According to the latest data, its frequency averages 7%. In addition, gestational diabetes mellitus during pregnancy (GDM) is one of the main predictors of the further progression of type 2 diabetes mellitus (DM). In accordance with the results of clinical studies, 4 out of 100 women with a history of GDM are diagnosed with non-insulin-dependent diabetes mellitus within six months after birth.

Under gestational (it is also sometimes called gestational) diabetes understand the occurrence of signs of hyperglycemia, identified for the first time during pregnancy. The process of bearing a child is accompanied by certain changes not only in glucose metabolism.

During this period, the functional load on the β-cells of the islets of Langerhans of the pancreas increases significantly, the degree of their secretory activity increases threefold to compensate for the increasing metabolic changes.

Due to increased breakdown and an increase in the concentration of fatty acids in the systemic circulation, the sensitivity of insulin receptors in tissues decreases.

Despite the development of medical technology, doctors still cannot accurately predict how impaired glucose tolerance will affect the further course of pregnancy. This complicates the selection of an adequate treatment regimen and the prediction of postpartum adverse reactions.

GDM not only aggravates the course of pregnancy and increases the likelihood of developing eclampsia. Such a disease becomes the cause of the disorder of all functions of the placenta, which in turn affects the condition of the child and sometimes causes irreversible and life-incompatible complications.

Diabetes mellitus is a disease, the main manifestation of which is a pathological increase in blood sugar levels. There are several forms of the disease.

With the exception of extremely rare types of pathology (due to congenital and other severe disorders), the most common types of diabetes are:

  • Diabetes of the first type. Occurs against the background of a decrease in insulin secretion by β-cells of the pancreas. The causes of such changes are autoimmune diseases, viral infections and other pathologies. The main method of treatment is the constant administration of the required doses of insulin.
  • Diabetes of the second type. It develops with reduced tissue sensitivity to insulin secreted in the body, although its concentration remains within the normal range. As the disease progresses, a kind of chain reaction occurs: the lack of a “response” from insulin receptors in tissues causes a state of hyperglycemia. An increase in glucose levels stimulates even more insulin release. Sooner or later, the functional reserve of β-cells is depleted, and the production of this hormone decreases.

Gestational diabetes, according to the pathogenetic mechanism of development, has a certain similarity with type 2 diabetes. However, unlike it, it occurs only in pregnant women under the influence of fetal development and related metabolic disorders. The basis of the pathogenesis of gestational diabetes is a decrease in the sensitivity of tissues to the action of insulin. As a result, the β-cells of the islet apparatus of the pancreas inadequately "perceive" the level of glycemia and react by additional release of insulin into the blood.

These pathological changes develop especially brightly in the third trimester. There is a kind of "vicious circle". Everything happens in an ascending spiral: an increased level of sugar provokes the release of insulin, which in turn increases the resistance of tissues to the action of this pancreatic hormone. In addition, the progression of gestational diabetes is affected by the acceleration of the destruction of insulin in the kidneys, an increase in the concentration of steroids.

There is a group of predisposing facts that can provoke GDM. Let's list them:

  • age exceeding thirty-five years;
  • obesity (body weight over 90 kg or 120% of normal physiological weight) before pregnancy, especially if the woman is over 25 years old;
  • the presence of DM in a family history;
  • the development of a similar condition in a previous pregnancy;
  • doubtful indicators in blood tests for glucose, carried out in compliance with all the rules;
  • the presence of recurring glucosuria during the current pregnancy;
  • too large fetus;
  • the birth of a previous child weighing more than 4 kg;
  • the birth of a stillborn or a child with congenital malformations;
  • spontaneous abortion.

Based on these factors, pregnant women are divided into risk groups for developing gestational diabetes:

  • high-risk group - the presence of more than two of the listed factors;
  • medium-risk group - the presence of 1-2 factors;
  • low-risk group - the complete absence of risk factors.

For early diagnosis and prevention of the development of GDM, it is necessary to carefully collect anamnesis in the early stages of pregnancy. Based on the data obtained, they build further tactics for maintaining and monitoring a woman, prescribing appropriate examinations and tests.

Gestational diabetes mellitus: causes, clinic, diagnostic methods

Doctors call obesity caused by metabolic, endocrine disorders or nutritional errors one of the main reasons for the development of GDM. Not the last role is played by hereditary predisposition. The first symptom of gestational diabetes is rapid weight gain without major changes in diet and lifestyle.

A woman may also be concerned about:

  • constant thirst combined with a feeling of drying out of the oral mucosa;
  • general deterioration of well-being;
  • frequent urge to urinate and an increase in the daily volume of urine separated;
  • weakness and constant drowsiness;
  • persistent thrush;
  • long-term non-healing wounds on the skin.

Diagnosis of disorders of carbohydrate metabolism is carried out in two stages.

At the first visit of a woman to a doctor at any time up to 24 weeks, the following studies are necessary:

  • determination of the level of glucose in venous blood on an empty stomach (after the last meal, at least 8 hours should pass, but not more than 14 hours);
  • measurement of glycated hemoglobin;
  • determination of glucose concentration at any time of the day, regardless of food.

The diagnosis of gestational diabetes mellitus is made if the level of sugar in the venous plasma on an empty stomach is in the range of 5.1-7.0 mmol / l. If the value exceeds 7.0 mmol/l, manifest diabetes mellitus is diagnosed and then its type is determined.

An additional examination is carried out at 24-28 weeks in women at risk or when violations are detected during the initial examination. An oral glucose tolerance test with 75 g of glucose is required. It is completely safe, the results are easy to interpret, in addition, such an analysis is highly specific.

Conduct research as follows:

  • on an empty stomach take blood from a vein and immediately measure the level of sugar;
  • within the next 5 minutes, a woman is given a glucose solution consisting of 75 g of dry matter diluted in a glass of warm non-carbonated water;
  • after 60 minutes and after 2 hours, blood tests are repeated.

The diagnosis of gestational diabetes mellitus is made if the glucose level exceeds 10.0 mmol/l after 1 hour and 8.5 mmol/l after two hours. Due to the high risk of complications, treatment for GDM is started as soon as a positive blood test is obtained.

GDM during pregnancy: principles of treatment, diet, exercise, herbal medicine, medications

Since conservative therapy for gestational diabetes mellitus is fraught with complications and side effects, treatment begins with the appointment of a strict diet, dosed physical activity.

Indications for the use of drugs are the lack of results for 2 weeks of dietary restrictions and ultrasound signs of fetopathy, these are:

  • too large fruit;
  • polyhydramnios;
  • too large neck fold;
  • thickening of the fat layer.

A woman is prescribed only insulin preparations:

  • short-acting - Actrapid, Insuman Rapid, Humulin R;
  • long-acting - Protafan, Humulin NPH, Insuman Bazal, Levemir (appointed most often);
  • ultrashort action - Novorapid, Humalag.

When prescribing insulin therapy, a woman is recommended to purchase a portable home glucometer and measure blood glucose levels at least 8 times a day: on an empty stomach, before and 60 minutes after meals, at night, at 3 o'clock in the morning and at the slightest deterioration in well-being. The appointment of insulin is not the reason for hospitalization. Stay in the hospital is possible only for medical reasons.

However, the main therapy for GDM during pregnancy is a diet that should provide the optimal combination of nutrients for the fetus and the expectant mother. According to doctors, most women with a similar disease gain approximately 0.9-1 kg per week. And if it is possible to reduce this figure to 450 grams, we can talk about successful control of glucose metabolism.

To date, there is no consensus on what diet should be followed by a pregnant woman with a similar disease. Doctors offer three options:

  • Up to 40% carbohydrates, 25% protein food and 35-40% lipids. Moreover, carbohydrates should be evenly distributed throughout the day, which will ensure proper glycemic control throughout the day.
  • More than half (55%) of carbohydrates, the rest of the diet is equally divided between proteins and fats.
  • About 60% carbohydrates with a low glycemic index, at least 17-19% protein and up to 25% fat.

However, regardless of the appropriate diet option, the menu can be varied. There are many easy-to-follow recipes for delicious dishes on various culinary forums. Unsweetened fruits, vegetables, herbs, walnuts, cashews are very useful.

In addition, it is necessary to avoid the appearance of hunger, completely abandon sweets and "fast" carbohydrates, snacks, fried and fatty foods. Particular attention should be paid to the drinking regime - it is necessary to consume at least 1.8 liters of ordinary water per day.

Of the physical activities, walking is allowed (at least 30 minutes daily), swimming is very useful, yoga classes for pregnant women. Performing more intense exercises must be agreed with the doctor.

A good result is provided by various decoctions and teas based on medicinal plants. According to traditional healers, the following herbs lower blood sugar well:

  • leaves and flowers of wild strawberries;
  • lingonberry leaves;
  • centaury grass;
  • mulberry leaves;
  • horsetail grass;
  • viburnum berries;
  • nettle leaves;
  • mint grass;
  • chicory herb;
  • stigmas of corn.

They can be brewed separately according to the standard recipe (a tablespoon per glass), or mixed in fees of 3-4 ingredients and drunk ¼ cup 4 times a day. However, with an increase in blood sugar levels, you should consult a doctor and, if necessary, switch to insulin therapy.

Diabetes mellitus during pregnancy: danger to the fetus, possible complications, tactics of childbirth and prevention

Against the background of GDM, fetal diabetic fetopathy often develops, due to impaired functioning of the placenta, metabolic disorders, and sharp fluctuations in hormonal levels. Hypertrophy of some organs is characteristic (especially the heart, adrenal glands, in rare cases, the liver and kidneys), sometimes a decrease in the thymus gland and the brain develops.

In newborns, complications associated with impaired lung development are often noted. Laboratory tests show a decrease in sugar levels, an increase in the concentration of bilirubin, and a variety of mineral metabolism disorders. In addition, diabetes mellitus during pregnancy often causes placental insufficiency, which causes a variety of hypoxic disorders up to intrauterine fetal death.

With regard to childbirth, uncomplicated GDM is not an indication for caesarean section. With satisfactory blood tests and the absence of serious intrauterine complications of the fetus, independent physiological delivery is quite possible. Surgical intervention is indicated for eclampsia in the last trimester, progressive placental insufficiency and other life-threatening conditions for the child and the patient.

After 6-12 weeks after childbirth, a woman must be re-analyzed to determine the concentration of glucose in the blood. If the result is within the normal range, further monitoring and regular testing is indicated to exclude the latent course of diabetes mellitus. If the values ​​are positive, you need to consult an endocrinologist, in some cases - a histological examination of pancreatic tissues.

With hereditary predisposition and other aggravating factors, diabetes during pregnancy is very difficult to prevent. However, the main preventive measure is to maintain a normal weight, and you should think about this even in the period preceding conception.

It is necessary to adhere to an appropriate diet, exercise, give up bad habits. Moreover, the correct lifestyle should be maintained after the onset of pregnancy.

Many people are familiar with type 1 or type 2 diabetes either directly or indirectly. But few people have heard of the third variety of sweet disease. This is gestational diabetes mellitus, which is diagnosed only in a woman when she is carrying a long-awaited baby.

The causes of the appearance, the impact on the development of the fetus and the condition of the mother, the method of diagnosing, how to treat gestational diabetes during pregnancy should be known to every woman who is of childbearing age.

Differences between gestational diabetes and other types

Violation of blood sugar levels is always indicative of diabetes. It is only important to determine the type of this disease. If type 1 is mainly a disease of the young, and type 2 is the result of an improper diet and lifestyle, then type 3 of the disease can appear only in a woman, and only during pregnancy. More precisely, he can be diagnosed in this juicy position.

The specificity of gestational diabetes is such that glucose surges occur until the baby is born.

In the future, a woman can live in her usual way and not be afraid for her health. But there is no full guarantee of a positive outcome if the expectant mother does not follow the doctor's recommendations.

Diabetes in pregnancy occurs due to hormonal changes, which are normal in most cases. The mechanism of the natural process is as follows:

  1. After fertilization of the egg increases the activity of progesterone - a hormone that guards the safety of the fetus and its successful development. This hormone partially blocks the production of insulin. But the pancreas, receiving a signal of a deficiency of a substance, begins to produce it in greater quantities and can overstress. Hence the symptoms of diabetes.
  2. The placenta conducts its work, rebuilding the inner life of the expectant mother, so that the baby is properly formed, gains the necessary weight and is born safely.
  3. During pregnancy, elevated levels of cholesterol and glucose are acceptable, because it is required to provide energy, nutrition for two organisms - mother and baby.

But gynecologists have a medical scale, which determines what can be considered normal during pregnancy, and what should already be called pathology.

And also the situation with the sugar content and the amount of insulin in a pregnant woman.

In a certain period, increased numbers in the analysis do not cause alarm, but if the content of sugar or insulin in the blood is higher than acceptable, then there is a reason to assume the development of diabetes in pregnant women. Due to the increased production of hormones, there is a failure in the absorption of glucose or insufficiency in the production of insulin by the pancreas.

Period of diagnosis of gestational diabetes

Despite the fact that the percentage of pregnant women without pathology and expectant mothers with gestational diabetes is small (about 5% out of 100), there is a pattern of how long a hormonal failure can develop. Twenty-two weeks is the period when the gynecologist can diagnose the first changes in the screening that is given to pregnant women. The activity of the placenta is enhanced to preserve intrauterine life and the full development of the fetus.


If the patient has no prior complaints or symptoms indicating that the pregnant woman belongs to a risk group, screening is carried out in the period of 24-28 weeks. On an empty stomach, blood is taken from a vein and its composition is checked.

With an elevated glucose level, a pregnant woman is sent for an additional analysis - a test for the ratio of body cells to insulin, the ability to absorb glucose. The patient is offered to drink a liquid containing 50 grams of sugar. After a certain interval, intravenous blood sampling is done and the extent to which glucose is absorbed is studied.

The liquid is usually converted into usable glucose and absorbed by the cells within 30 minutes to an hour. But if the metabolic process is disturbed, the indicators will be far from the standards. The figure of 7.7 mmol / l is the reason for the appointment of another blood sample, only after a few hours of fasting.

Such testing can accurately determine whether a woman has diabetes during pregnancy.

There are circumstances when gestational diabetes is diagnosed at the initial stage of pregnancy. Hidden diseases of the pancreas, the initial stage of failure of carbohydrate metabolism can be enhanced by hormonal changes in a pregnant woman. Therefore, when registering with a antenatal clinic, a future mother needs to be told in detail about any diseases.

Candidates for Diabetes in Pregnancy

There are some criteria by which the gynecologist understands that the pregnant patient is at risk, enhanced monitoring of the general condition of the woman and the fetus is required. Ladies who are preparing for pregnancy or are already expecting a baby, it will be useful to pay attention to this.

  • The presence of a diagnosis of diabetes in someone in a family line.
  • Excess weight in the expectant mother even before conception. If the body mass index exceeds the permissible norm by 20%, then it is better to pay attention to diet and physical activity in order to reduce the likelihood of a failure in the absorption of glucose by cells.
  • The age of the expectant mother. It is believed that after 30 years in the body of a woman there are processes that can affect the course of pregnancy. By this age, cell tolerance to insulin may be impaired. Having such a problem before conception, the lady risks getting even more cell insensitivity.
  • The previous pregnancy ended in miscarriage, fetal fading and the birth of a dead baby.
  • The weight of the woman herself at her birth was 4 kg or more.
  • Previous children were born weighing more than 4 kg.
  • Polyhydramnios throughout the entire pregnancy cycle.
  • Urine examination revealed elevated levels of sugar.
  • Gestational diabetes was already present in previous pregnancies, but did not develop into a serious disease after delivery.

If at least one of the listed factors is present in the woman's history, monitoring of the patient's health and the development of pregnancy should be enhanced.

But do not think that only those ladies who have precursors of gestational diabetes are at risk. Cases are often diagnosed with one hundred percent health of the expectant mother. The birth and development of a new life is a complex process that can violate any rules of medicine and nature.

Why is gestational diabetes dangerous?

Diabetes in pregnant women is a rare phenomenon, but it does not give a woman a reason to be skeptical about it. If there is an imbalance in the absorption of glucose by the body of the mother and baby, serious problems will appear:

  • In the early stages, pregnancy may stop developing. The fetus will experience oxygen starvation, the cells will not receive the necessary energy for development. The result may be a miscarriage or fading of the fetus.
  • With late development of diabetes, the embryo will receive an excess of glucose, which usually contributes to rapid weight gain. A child in utero can gain weight more than 4 kg. This will affect the ability of the embryo to turn around for a smooth delivery. If the baby enters the birth canal with a booty or legs, complications can be serious, up to death or impaired brain activity.
  • In babies, after birth, the sugar level is usually lowered, which requires more medical attention for the health of the newborn.
  • Sometimes failures in the absorption of glucose lead to the development of intrauterine pathologies of the fetus - the development of the brain, the respiratory system, the formation of the pancreas. Insufficiency of maternal insulin can provoke an increase in the function of the pancreas in the baby, which by nature is not ready for this. Hence there are problems with the production of enzymes after the birth of the crumbs.
  • In a woman, uncompensated diabetes causes preeclampsia. Blood pressure rises, severe swelling occurs, and the work of the vascular system is disrupted. The child may experience oxygen and nutritional starvation.
  • Gestational diabetes is closely associated with the formation of a large amount of amniotic fluid (polyhydramnios), which causes discomfort to both the mother and the embryo.
  • Thirst and copious urination can also be triggered by high glucose levels.
  • Hyperglycemia increases the risk of genital infections in a pregnant woman due to a decrease in local immunity. Viruses, bacteria can enter the birth canal, reach the placenta and lead to infection of the crumbs. A woman will need additional therapy, which may affect the course of pregnancy.
  • A lack of insulin in the mother's body can cause ketoacidosis, a serious disease that can put a woman in a diabetic coma. The child often dies in utero.
  • Due to the decrease in the process of glucose utilization in the usual way, the kidneys and the circulatory system experience a greater load. Renal failure occurs or visual acuity is severely reduced.

The listed consequences and complications in the presence of gestational diabetes occur only due to the inaction of the pregnant woman. If you approach temporary inconveniences with knowledge of the matter and compliance with the recommendations of the gynecologist, you can normalize the course of pregnancy.

Gestational diabetes must be controlled

This feature in pregnant women is not new to medicine. Despite the fact that the causes of the pathology during the bearing of a baby are not 100% determined, the mechanism for compensating for sugars and making a woman's life easier has been studied and worked out. You need to trust the gynecologist and follow a number of rules:

  1. The first task of the patient is to normalize the level of glucose in the blood. As with any type of diabetes, proper nutrition will help, which is based on the exclusion or reduction of simple carbohydrates in the diet.
  2. But the nutrition of a pregnant woman in any case should be complete, so as not to deprive the baby of nutrients, the right fats, vitamins, proteins. You need to diversify the menu, but monitor the glycemic index of products.
  3. Moderate physical activity has a positive effect on insulin production and prevents the deposition of excess glucose in fat.
  4. Continuous monitoring of blood glucose levels. You need to buy a glucometer and measure the indicators 4 times a day. The doctor will tell you more about the monitoring method.
  5. An endocrinologist and a nutritionist should be involved in the management of pregnancy. If there are psychological outbursts in a woman, you can consult a psychologist.

The sensitive attitude of the expectant mother to her health will help normalize the carbohydrate process and approach childbirth without complications.

Diet for gestational diabetes

When seeing a woman with diabetes, the doctor does not have much time for a detailed nutritional consultation. General instructions or a referral to a nutritionist are given. But a pregnant woman herself can develop a diet and a list of acceptable foods if she studies information about how people with type 1 and type 2 diabetes eat. The only exception is the fact that the benefits of food should be not only for the mother, but also for the fetus.

  • Emphasis should be placed on observing the meal interval. The main servings should be consumed 3 times (breakfast, lunch, dinner). In between should be snacks up to 3-4 times.
  • The energy value is also important, because two organisms feed at once. Excessive consumption of carbohydrates is replaced by proteins (from 30 to 60%), healthy fats (30%), fiber (up to 40%).
  • Nutrition should be comprehensive, any mono-diet and starvation are excluded. Porridges, soups, salads, meat, fish dishes should be the basis. Snacks use vegetables, fruits, allowed desserts, low-fat dairy products.
  • For the entire duration of pregnancy, bakery products, cakes, sweets, some fruits, pasta, potatoes should be canceled. Even rice can be banned due to its high glycemic index.
  • When choosing products in the store, you need to pay attention to the composition, energy value, study in advance and make a list of cereals, vegetables, fruits with a low glycemic index.
  • Dishes should not be complex, so as not to create a load on the pancreas and not deceive yourself.
  • We need to change the way we prepare food. You can not fry, preserve food. Any fast food, to which pregnant women are often not indifferent, is excluded. Semi-finished products from the category of dumplings, sausages, sausages, meatballs and other mass-produced products should remain on the shelves. Relatives should be in solidarity in refusal so as not to injure already vulnerable women during pregnancy.
  • You should pay attention to frozen vegetable smoothies, which will allow you to whip up a meal and give a lot of benefits. The range is large, but you need to monitor the correct storage of goods.

If at first there are difficulties with the correct menu for gestational diabetes in pregnant women, you can focus on recipes for soups, salads, main courses, desserts for type 1 and type 2 diabetics. Moms who are faced with a similar diagnosis often unite on forums and share their recipes.

The diet in this case does not differ in the type of sweet disease, because it is focused on the normalization of carbohydrate metabolism in the body of the mother and fetus.

A nutritionist or endocrinologist will definitely give a recommendation on the caloric content of food. The daily rate should not exceed 35-40 kcal per 1 kg of the pregnant woman's weight. Suppose a woman weighs 70 kg, then the total daily ration should have an energy value of 2450 to 2800 kcal. It is advisable to keep a food diary so that by the end of the day you can see if there were any violations.

Menu option for pregnant women with gestational diabetes

Meal stage/Day of the week Mon Tue Wed Thu Fri Sat Sun
Breakfast buckwheat porridge on the water, 1 toast with butter, herbal tea b/s oatmeal with milk, boiled egg, black tea Omelette with boiled chicken breast and vegetables, b/s tea cottage cheese casserole, rosehip broth b / s oatmeal on the water, low-fat cheese or cottage cheese, a slice of rye bread, weak coffee. millet porridge in meat broth, toast, herbal tea rice on the water with vegetables or herbs, a piece of rye bread, low-fat cheese, weak unsweetened coffee.
2nd breakfast baked apple, water orange, low fat yogurt seasonal vegetable salad dressed with lemon juice or vegetable oil. fruit salad from the permitted list, seasoned with low-fat yogurt without filler. cottage cheese casserole, water Cheese with a slice of oatmeal, unsweetened tea. drinking yogurt.
Dinner Vegetable soup with chicken meatballs, a piece of boiled chicken breast, vegetables, dried fruit compote. Fish soup, boiled brown rice, steamed lean fish, boiled beetroot salad, tea. Veal borsch without potatoes, boiled buckwheat with steamed veal cutlet, compote. Chicken noodle soup without potatoes, vegetable stew, herbal tea Turkey pea soup, lazy cabbage rolls with minced turkey in the oven, jelly. Shrimp soup with vegetables, squid stuffed with vegetables and baked in the oven, freshly squeezed vegetable juice. Lean beef pickle, stewed cabbage, boiled beef, b/s berry juice
afternoon tea small handful of nuts cottage cheese, slice of whole grain bread baked apple (any fruit from the list) assorted raw vegetables according to the season dried fruits from acceptable yogurt Vegetable Salad
Dinner boiled cabbage (cauliflower, broccoli), baked fish, tea stuffed turkey peppers with 15% sour cream, tea vegetable stew, low-fat cheese, freshly squeezed fruit juice veal pilaf, vegetable salad, tea seafood salad, tea. turkey baked in the oven with vegetables, berry juice boiled potatoes with fresh cabbage salad
late dinner Kefir 200 ml Ryazhenka 200 ml Low-fat cottage cheese 150 g. Bifidoc 200 ml drinking yogurt Cheese, toast, green tea Milkshake

This is a sample menu for every day for pregnant women with a history of gestational diabetes. The diet can be varied, it all depends on the season and personal taste preferences. If there is a feeling of hunger between the planned meals, you can drink plain water in small sips. The diet should contain up to 2 liters of ordinary water, not counting other liquid foods.

In the treatment of gestational diabetes in a pregnant woman, dieting is not enough if the lifestyle is generally passive. Energy must be spent, oxygen must be supplied to the body in sufficient quantities, weakening of the muscles of the abdominal cavity and other parts of the body is unacceptable.

Physical activity improves the production and absorption of insulin, excess glucose can not be converted into fat.

But a lady in "special status" should not run to a sports club to get this load. It is enough to make daily walks, go to the pool or sign up for a special fitness for pregnant women.


Sometimes it is necessary to compensate for sugar with the help of insulin injections. In such a situation, it must be remembered that active physical activity can lower the level of glucose and the hormone in the blood as much as possible, which leads to hypoglycemia.

Monitoring of sugar levels should be both before and after training. You need to take some snacks with you to make up for the deficit. Sugar or fruit juice can prevent the effects of hypoglycemia.

Childbirth and the postpartum period in gestational diabetes

Even a woman with type 1 or type 2 diabetes can get pregnant, bear a baby and give birth long before conception.

Therefore, with diabetes that occurs during pregnancy, there are no contraindications for delivery. The main thing is that the preliminary stage should not be complicated by the inaction of the patient.

If the pregnancy proceeds according to a certain algorithm, the attending physician prepares a special mother in advance for the birth process.

The main risk in such childbirth is considered to be a large fetus, which can lead to complications. A caesarean section is usually recommended. In practice, independent childbirth is also acceptable if there is no preeclampsia in the pregnant woman or the situation has not worsened in recent days.

They monitor the general condition of both the woman and the unborn baby. A pregnant woman enters the maternity hospital earlier than women without such complications. The gynecologist writes out a referral with a birth mark at 38 weeks, but in reality the process can begin at 40 weeks and later if there are no complications according to ultrasound and tests.

They begin to stimulate contractions only in the absence of natural contractions, if the pregnant woman is overstaying the due date.

Caesarean section is not mandatory for all women diagnosed with gestational diabetes, but only at risk to the fetus and to the woman in labor. If there is a special department for the delivery of people with diabetes, then the gynecologist, if there are all indications, will refer the patient to such an institution.

After giving birth, the baby may have low sugar levels, but this is compensated by nutrition. Medical therapy is usually not required. The baby is under special supervision and diagnostics are carried out for the absence of pathology due to gestational diabetes in the mother.

In a woman, after the release of the placenta, the condition returns to normal, there are no jumps in sugar levels. But do not neglect the diet that was followed before childbirth, at least in the first month.

It is better to plan a subsequent pregnancy no earlier than 2 years, so that the body recovers and no more serious pathologies arise. But before conception, you need to undergo a complete examination and warn the gynecologist about the fact of complications during a previous pregnancy.

In ancient times, when there were no hospitals and pharmacies, humanity already knew about the existence of diabetes. The first mention of this disease dates back to the 15th century BC. Already in that distant era, it was noticed that diabetes mellitus adversely affects the condition of a pregnant woman and interferes with the normal development of her baby. How does the disease manifest itself in expectant mothers and what threatens its appearance during pregnancy?

Types of gestational diabetes

Diabetes mellitus is a metabolic disease accompanied by an increase in blood glucose levels. The pathological process can develop as a result of absolute or relative insufficiency of insulin. During pregnancy, one of the types of pathology can make itself felt:

  • diabetes mellitus type 1 or 2 that existed before pregnancy;
  • gestational diabetes.

Gestational diabetes is a condition that first occurs during a real pregnancy. Before conceiving a child, a woman did not notice any changes in her body and did not make any special complaints. It also happens that the expectant mother simply did not know about her disease, because before pregnancy she was not examined by an endocrinologist and a therapist. It is possible to unequivocally understand whether diabetes mellitus is gestational or is a manifestation of true diabetes only after the birth of a child.

Before talking about the features of the course of the disease in expectant mothers, it is necessary to understand how diabetes manifests itself outside of pregnancy. The causes, mechanisms of development and principles of treatment are determined by the type of diabetes mellitus. In this case, the symptoms of the disease will be similar, and only targeted diagnostics can distinguish the varieties of this pathology.

Type 1 diabetes is a typical autoimmune disease. In most cases, it occurs against the background of infection with one or another virus. Inflammation develops, leading to the destruction of thyroid beta cells. It is these cells that produce insulin, a hormone involved in all metabolic processes in the body. When more than 80% of the thyroid cells are affected, symptoms of type 1 diabetes appear.

Type 2 diabetes arises from a genetic predisposition. The factors that provoke its appearance include:

  • obesity;
  • violation of the diet;
  • sedentary lifestyle;
  • stress.

In type 2 diabetes, insulin levels remain normal, but the cells of the body are not able to perceive this hormone. Insulin resistance develops, leading to numerous health problems. Characteristic for patients with type 2 diabetes is overweight. Obesity in this form of the disease is associated with a violation of lipid metabolism as a result of high levels of insulin in the blood.

Gestational diabetes mellitus essentially similar to type 2 diabetes. High levels of female sex hormones and cortisol (adrenal hormone) during pregnancy lead to the development of physiological insulin resistance. In other words, in anticipation of a child, all women, to one degree or another, develop insensitivity of body cells to insulin. At the same time, in 5-10% of expectant mothers, this condition leads to the formation of gestational diabetes mellitus, while in other women the development of the disease does not occur.

Symptoms of Diabetes During Pregnancy

Gestational diabetes mellitus is usually asymptomatic. The woman does not make any special complaints, and only a routine examination during pregnancy reveals an elevated blood glucose level. Typical symptoms of diabetes in expectant mothers are rare.

Signs of gestational diabetes include:

  • polydipsia (constant thirst);
  • polyuria (frequent urination);
  • polyphagia (increased appetite up to constant insatiable hunger).

All these symptoms are not too specific and can be mistaken for the usual manifestations of pregnancy. Many women in anticipation of the baby feel severe hunger and notice a significant increase in appetite. Thirst often occurs in expectant mothers in the later stages, especially if this period occurs in spring and summer. Finally, frequent urination occurs in all pregnant women, and it is not possible to distinguish it from the symptoms of diabetes.

Diagnosis of gestational diabetes

During pregnancy, all women have their blood sugar levels checked. This analysis is taken from a vein on an empty stomach twice during pregnancy: at the first appearance and for a period of 30 weeks. This approach allows you to identify the disease in time and take all measures to prevent its complications in expectant mothers.

When interpreting a blood test for glucose, the following results are possible:

  • from 3.3 to 5.5 mmol / l - the norm;
  • from 5.6 to 7.0 - impaired glucose tolerance;
  • more than 7.1 - diabetes mellitus.

Impaired glucose tolerance is called prediabetes. This condition is on the verge of normal and pathological, and the expectant mother needs to make every effort to maintain health in this situation. When determining a blood sugar level of more than 5.6 mmol / l, a pregnant woman should definitely see an endocrinologist.

If diabetes is suspected, a glucose tolerance test is performed. The analysis consists of two stages. First, blood is taken from the patient from a vein strictly on an empty stomach, after which the woman is offered to drink 75 ml of a sweet drink (glucose diluted in water). After 1-2 hours, blood is taken again to determine the level of sugar. Based on the results of the test, the following conclusions are made:

  • up to 7.8 mmol / l - the norm;
  • from 7.9 to 11.0 mmol / l - impaired glucose tolerance;
  • more than 11.1 mmol / l - diabetes mellitus.

Simultaneously with the determination of blood glucose levels, pregnant women take a urine test. When sugar is found in the urine, they talk about the development of gestational diabetes. Also, with this pathology, acetone (ketone bodies) can be detected in the urine. By itself, acetone cannot be the basis for making a diagnosis, since this element is found in many pathological processes (for example, with toxicosis in early pregnancy).

Complications of pregnancy in gestational diabetes

In the first trimester of pregnancy against the background of diabetes, spontaneous miscarriage can occur. Such a complication most often occurs after 6 weeks and is due to pathological processes occurring in altered vessels. It is worth noting that this complication is more characteristic of true diabetes mellitus, which existed even before the onset of pregnancy.

Gestational diabetes is often complicated by placental insufficiency after 20 weeks. This complication is also associated with impaired microcirculation, which ultimately leads to an insufficient supply of oxygen and nutrients to the baby. In the third trimester of pregnancy, gestational diabetes very often leads to the development of fetal hypoxia and intrauterine growth retardation.

One of the most serious complications of pregnancy due to gestational diabetes is placental abruption. All the same microcirculation disorders resulting from vasospasm are to blame for the occurrence of this pathology. In turn, the narrowing of the lumen of the vessels is explained by numerous metabolic disorders against the background of developed insulin resistance.

All of these mechanisms lead to the fact that the placenta moves away from the uterine wall ahead of schedule. Normally, a fetal place is born immediately after the birth of a child. Placental abruption during pregnancy can cause massive bleeding and even death of the fetus.

70% of women with gestational diabetes develop preeclampsia. This specific complication of pregnancy is characterized by high blood pressure and impaired renal function. With diabetes, preeclampsia manifests quite early, and already at 24-26 weeks, many women notice the first symptoms of this disease. The combination of preeclampsia and diabetes is quite unfavorable and provokes multiple problems throughout pregnancy.

In most expectant mothers, gestational diabetes leads to the development polyhydramnios. With this pathology, the volume of amniotic fluid increases to 2 liters for a period of 36-37 weeks. Polyhydramnios adversely affects the condition of the fetus, disrupting its normal position in the uterus. Often, excess amniotic fluid leads to the fact that the fetus takes an oblique or transverse position, and it will be possible to remove it from the uterus only with the help of a caesarean section.

Effects of gestational diabetes on the fetus

Throughout pregnancy, the baby suffers from a lack of oxygen and essential nutrients. Constant hypoxia primarily affects the development of his nervous system. The lack of oxygen affects the brain, which results in perinatal encephalopathy and other serious diseases that develop immediately after the birth of a child.

A specific complication of gestational diabetes is diabetic fetopathy. Children born to mothers with this pathology have a characteristic appearance:

  • large weight (more than 4 kg at birth);
  • purple or bluish skin tone;
  • a large amount of cheese-like lubricant on the skin;
  • swelling of the skin and soft tissues;
  • puffiness of the face;
  • petechial rash (small hemorrhages under the skin).

Despite their large size, babies are born weak. Many children experience shortness of breath and even apnea (breathing stops) in the first hours of life. Characterized by prolonged jaundice associated with pathological changes in the liver of the newborn. Most babies develop various neurological disorders (decrease in muscle tone, adynamia or hyperexcitability, inhibition of reflexes).

A particularly dangerous condition that occurs in a newborn in the first days of life is hypoglycemia (low blood glucose). The thing is that in utero the baby received a large amount of sugar from the mother's blood. The fetal pancreas is used to working in an enhanced mode, and cannot always quickly switch to a different rhythm. After birth, the supply of maternal sugar to the baby stops, while insulin levels remain high. Hypoglycemia develops - a sharp decrease in blood sugar levels. This condition threatens with serious consequences up to coma and death.

Treatment of gestational diabetes

When gestational diabetes is detected, a woman is transferred under the supervision of an endocrinologist. It is recommended to visit a doctor every two weeks (in the absence of complications). In the event of the development of adverse effects of diabetes, the treatment of a pregnant woman can be continued in a hospital.

Therapy of diabetes during pregnancy is aimed at preventing various complications associated with metabolic disorders. Treatment begins with the selection of an optimal diet, balanced in essential nutrients. At the same time, dietary recommendations should take into account the real needs of the mother and fetus in accordance with the duration of the present pregnancy.

In gestational diabetes from a woman's diet easily digestible carbohydrates are excluded:

  • cakes, pastries and other sweets;
  • jam;
  • products made from white flour;
  • sweet fruits;
  • juices and syrups;
  • carbonated drinks.

To prevent excessive weight gain in the diet of a pregnant woman, fats are also limited. Nutrition in gestational diabetes should be frequent, up to 5-6 times a day, but in fairly small portions. This scheme avoids the burden on the digestive tract and prevents the development of hyperglycemia (increased blood glucose levels) after eating.

A sharp restriction of the diet and fasting is prohibited. The nutrition of a pregnant woman should be balanced, containing the optimal amount of vitamins and minerals. The total weight gain during pregnancy should be no more than 12 kg for women with normal weight and no more than 8 kg in case of obesity.

The criterion for the effectiveness of diet therapy is determination of blood sugar levels. Normally, glucose should be no more than 5.5 mmol / l on an empty stomach and no more than 7.8 mmol / l two hours after eating. If these indicators are exceeded, the issue of insulin therapy is decided.

The selection of insulin and the determination of its dosage is carried out by an endocrinologist. It is worth considering that most women with gestational diabetes mellitus retain the ability to synthesize their own insulin. To maintain a normal metabolism for such women, a very small dose of the hormone daily is enough. The need for insulin may increase with increasing gestational age.

Birth management in gestational diabetes mellitus

The optimal delivery time for gestational diabetes is 37-38 weeks of pregnancy. It makes no sense to delay beyond this period. By 37 weeks, the fetus is already fully formed and can safely exist outside the womb. Further prolongation of pregnancy can be quite dangerous due to the insufficient functioning of the placenta and the depletion of its resources after 38 weeks.

Experts recommend that women give birth to a child in a specialized obstetric hospital. Such maternity hospitals have all the necessary equipment to care for a newborn. Also, experienced therapists and endocrinologists work here around the clock, able to solve any problems associated with the progression of diabetes.

Childbirth in women with gestational diabetes usually occurs through the natural birth canal. Indications for caesarean section are the very large size of the fetus, as well as preeclampsia, nephropathy and other complications of pregnancy. In many cases, insulin therapy is given during childbirth or during surgery.

Gestational diabetes after childbirth goes away on its own without additional treatment. It is possible that the situation will recur in the second and subsequent pregnancies. The persistence of a high blood glucose level after childbirth indicates the development of true diabetes mellitus. In this case, a woman is recommended to undergo a complete examination by an endocrinologist and begin treatment of the disease as soon as possible.