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There was gestational diabetes. Gestosis diabetes mellitus in pregnant women: symptoms, menus, consequences. Causes of Gestational Diabetes Mellitus

Gestational diabetes mellitus during pregnancy is not a common condition, however, occurs in 5% all women waiting for the baby. Such a small percentage of the prevalence of this disease does not at all mean its easy course and the absence of risks for both the child and the expectant mother. It is also worth distinguishing between gestational diabetes and diabetes mellitus, which occurs not only in the female population, but also in men. All of the above parameters for considering the concept of "gestational diabetes mellitus" must be borne in mind when studying this serious pathology.

This pathological condition of a pregnant woman is characterized by changes in metabolic processes in her body with a violation, primarily of carbohydrate metabolism.

The pancreas, which normally secretes the amount of insulin necessary for carbohydrate metabolism, fully regulates the peripheral blood of a person. During pregnancy there is a "hormonal explosion"leading to a change in the intensity and amount of hormones, in particular, insulin.

In connection with the formed insulin deficiency an excess amount of glucose circulates in the peripheral blood, hyperglycemia develops. In addition, cells that perceive glucose with their specific receptors lose their sensitivity and become less responsive to it, which also leads to a hyperglycemic blood picture.

Unlike normal type 1 or type 2 diabetes, gestational diabetes is that diabetes in which hyperglycemia is detected during gestation.

Without timely and adequately selected therapy the disease does not pass without a trace neither for the mother, nor for the expected baby. There are a number of undesirable complications, some of which are completely dangerous to the health and life of the fetus or can lead to the formation of congenital malformations of the structure, growth and development.

Diabetes risks for a child:

  • The developing pancreas of the baby, which normally functions within the physiological level of glucose received from a healthy mother, releases excess insulin with hyperglycemia. Over time, the body adapts to such high levels of insulin and blood glucose. But after childbirth there is a risk of a sharp drop, since the excess intake of carbohydrates from the mother is no longer carried out, and the pancreas still secretes a lot of its hormones.
  • In connection with the above pathological mechanism, the child has a risk of disturbances in the functioning of the respiratory system, the functioning of the brain (since glucose is the main substrate for his normal activity).
  • Intrauterine weight gain and growth.
  • The development of diabetic fetopathy after birth, the manifestations of which include overweight with an increase in the abdomen relative to the limbs, pastiness, yellowness of the skin and sclera, respiratory dysfunction and an increase in platelet count in the blood with the risk of increased blood clots formation in the vascular bed.

Diabetes risks for the mother:

  • Development of renal failure.
  • Deterioration of the visual analyzer.
  • Late birth due to a large baby.
  • Impossibility of giving birth naturally.
  • With reference to this, it can be argued that early diagnosis and properly selected therapy for gestational diabetes mellitus is extremely important for the affected pregnant woman.

Causes of gestational diabetes in pregnant women

The etiological basis in relation to this pathology is not fully studied at the present period of the development of science. However, a certain role is given to such possible reasons, as:

  • genetic predisposition;
  • autoimmune processes;
  • carriage of a viral infection;
  • unfaithful and lifestyle.

Also highlighted risk factors, under the influence of which the development of gestational diabetes mellitus of pregnant women is possible. These include:

  • smoking;
  • abuse of alcoholic beverages;
  • age over 30;
  • increased body weight both before pregnancy and during it;
  • a history of common diabetes mellitus.

Exist special risk groups for gestational diabetes mellitus of pregnant women, which include women who have:

  • excess body weight;
  • burdened heredity for diabetes;
  • special ethnicity (blacks, Asians, Latinos, Americans);
  • a previously diagnosed gestational diabetes;
  • hyperglycemia in the biochemical blood test and glucosuria according to the results of a general urinalysis;
  • early birth of a child with high body weight;
  • a history of stillbirth.

Symptoms of gestational diabetes during pregnancy

The entire clinical picture related to this pathological condition in a woman is not specific to this particular type of diabetes.

There is only a number of general somatic signs health problems and diabetes mellitus: general fatigue and decreased performance, fatigue, decreased visual acuity, constant or incoming thirst and a feeling of dryness in the mouth, frequent urge to urinate with the release of a large amount of urine (polyuria).

Assessment of symptoms by pregnant women themselves very often complicates diagnostic measures, since usually women do not pay attention to all the signs diseases and refer their appearance to the fact of pregnancy.

The first activity that absolutely must be carried out by the pregnant woman herself is constant monitoring of her daily condition and an indispensable seeking help from a leading obstetrician-gynecologist if the first signs appear. It is the timely appearance of a woman at an appointment with a specialist in a situation with a set of complaints that is the starting point for the doctor's further diagnostic tactics.

Of the additional research methods, conducting general blood test, general urine test, biochemical blood test.

Highly informative specialized oral glucose tolerance test... A woman needs to drink a glass of sweet water containing 50 grams of glucose. After 15-20 minutes, blood is taken from the vein to determine the level of sugar in the peripheral blood. According to the obtained glucose level, experts assess the utilization capacity of the human body in relation to carbohydrates. An elevated blood glucose level means a prerequisite for identifying a pathological condition.

Upon delivery of all tests a pregnant woman should live in her usual rhythm of life and eat in accordance with her usual menu in order to eliminate false negative or false positive results of diagnostic tests.

Treatment of gestational diabetes during pregnancy

All therapeutic measures are reduced to eliminating symptoms and possible complications for the woman and the unborn baby, that is, symptomatic therapy is carried out. It certainly includes nutritional correction, the implementation of specially designed physical exercises, the use of drugs and the control of laboratory parameters of biological fluids of the body (primarily, glucose levels).

Optimal diet for gestational diabetes during pregnancy

A woman in a position should not direct her diet towards reducing body weight, since a new life is developing in her body.

A child requires a sufficient amount of nutrients for the implementation of plastic and energy metabolism in his cells of various organs and systems. But, as you know, a decrease in body weight increases the body's resistance to a pathologically increased glucose content in the peripheral blood. Therefore, a woman is advised to consume those foods that are not high in calories and depleted in all essential nutrients.

What is the menu for gestational diabetes during pregnancy? You should eat regularly in small portions, excluding fried and too fatty foods, carbohydrate foods. Reception is limited confectionery, sweets, bananas, persimmons, grapes, figs and cherries. Instant meals (custard purees, noodles, soups) are also excluded from the diet.

The intake of fiber (vegetables, fruits, cereals, pasta, bread) is recommended due to its stimulating effect on the intestines and a slowing down effect on the absorption of carbohydrates in the small intestine. It is absolutely shown to pay special attention to the intake of everyone in your daily diet for pregnancy diabetes.

Physical exercises

Doing a number of physical exercises not only helps in reducing a woman's overweight, but also strengthens her muscular system. In some research papers, physical activity is attributed to those factors that stimulate the normal work of insulin and help to reduce the excess amount of insulin in the peripheral blood, which reduces the symptoms of gestational diabetes mellitus. Physical activity must be dosed in accordance with your state of health, exclude all abdominal exercises (directly due to pregnancy).

Drug therapy

Insulin therapy is applicable with the help of parenteral (intradermal) administration of insulin preparations. The dosage and type of the drug is selected individually for each pregnant woman with gestational diabetes mellitus. Insulin is not used in pill form, since, being a protein, it is broken down in the gastrointestinal tract under the action of the body's enzymatic systems.

Childbirth is the point at which gestational diabetes usually disappears. However, complications of this pathology, which have already been mentioned above, may appear.

Complications of diabetes can manifest themselves not only in the postpartum period, but also immediately before it, which will radically change the course of the birth process. For example, in the case where the child has developed large, natural childbirth is contraindicated due to the risk of trauma when passing through the birth canal, and cesarean section is used.

Of course, adherence to the diet of a pregnant woman after childbirth and careful monitoring of the baby's condition is an unquestioning requirement for the management of such clinical cases by doctors. Special blood glucose measurement is important mother and child.

Prevention of gestational diabetes

It is impossible to completely eliminate the likelihood of gestational diabetes with the help of preventive measures. But any pregnant woman can follow a set of rules, which will provide some help in preventing this pathology.

  • A woman should be guided, especially during the entire period of pregnancy.
  • Regular ones are not excluded, which do not cause discomfort to the pregnant woman.
  • With special interest it is worth looking at your contraceptive pills (if they are taken) - some drugs can contribute to the development of the disease.

Gestational Diabetes Videos

For better familiarization with the problem of gestational diabetes we suggest watching a video, from which you can once again learn about the possible causes of this disease, symptoms, ways of timely diagnosis and its adequate treatment. The video also talks about preventive measures for diabetes in pregnant women, which is equally important for a pregnant woman or a woman planning a pregnancy.

Gestational diabetes mellitus - one of the variants of diabetes that occurs or is first diagnosed during pregnancy. At the heart of the disease is a violation of the metabolism of carbohydrates of varying degrees, namely, a decrease in glucose tolerance in the body of a pregnant woman. It is also called diabetes pregnant.

The results of epidemiological studies conducted in the United States have shown that gestational diabetes mellitus develops in 4% of all pregnant women. European researchers have voiced data according to which prevalence of gestational diabetes mellitus fluctuates in the range of 1-14% of the total number of pregnancies. About 10% of women after childbirth remain with signs of the disease, which subsequently transforms into type 2 diabetes mellitus. According to statistics, half of women who underwent gestational diabetes mellitus during pregnancy develop type 2 diabetes mellitus over the next 10-15 years.

Such high prevalence rates of this pathology and possible complications indicate a low awareness of women about the possible risks of developing gestational diabetes mellitus and its consequences, and, as a result, late seeking diagnosis and qualified help. For the timely detection of the disease in reproductive family planning centers and antenatal clinics, active educational work is currently being carried out, which allows maintaining the health of women and contributing to the birth of healthy offspring.

What is the threat of diabetes during pregnancy?

First of all, in a negative impact on the growth and development of the fetus. With the onset of gestational diabetes mellitus in the early stages of pregnancy, there was a significant increase in the risk of spontaneous abortion and the appearance of congenital malformations of the heart and brain structures of the fetus. If diabetes mellitus begins later in pregnancy (2-3rd trimesters), it leads to excessive fetal growth (macrosomia) and hyperinsulinemia, and after birth it can be complicated by diabetic fetopathy. Signs of diabetic fetopathy of a newborn are overweight of the child (over 4 kg), body imbalance, excess subcutaneous fat, respiratory distress, hypoglycemia, increased blood viscosity with a risk of thrombus formation.

How is gestational diabetes during pregnancy different from other types of diabetes?

Diabetes mellitus is a disease characterized by a gross violation of carbohydrate metabolism due to a deficiency of the pancreas hormone insulin in the blood, which can be absolute or relative. Diabetes mellitus is almost always accompanied by an increased blood glucose - hyperglycemia and the detection of sugar in the urine - glucosuria. According to the WHO, there are several types of diabetes mellitus.

Type 1 diabetes occurs in childhood and adolescence as a result of the autoimmune breakdown of specific cells in the pancreas that produce insulin, which leads to a decrease or complete cessation of its production. Type 1 diabetes mellitus occurs in 15% of all patients with diabetes mellitus. The disease is detected when a high starting level of glucose is detected in the blood at a young age, while antibodies to β-cells and insulin can also be detected in the blood. The level of insulin in the blood in these patients is reduced. For the treatment of patients with type 1 diabetes mellitus, insulin injections are used - unfortunately, there are no other ways.

Type 2 diabetes mellitus often develops in overweight people in the second half of life against the background of genetic defects, previous infectious diseases, acute and chronic pancreatitis, taking certain medications and chemicals. The disease is characterized by a hereditary predisposition. In laboratory diagnostics, an increase in glucose levels (\u003e 5.5 mmol / l) is noted in the blood of patients. Treatment of such patients consists of the appointment of a special diet, physical activity and taking medications that lower blood glucose levels.

Causes of Gestational Diabetes Mellitus

Gestational diabetes mellitus during pregnancy develops as a result of a decrease in the sensitivity of cells and tissues of the body to its own insulin, that is, insulin resistance develops, which is associated with an increase in blood levels of hormones produced by the body during pregnancy. In addition, in pregnant women, the glucose level decreases more rapidly due to the needs of the fetus and placenta, which also affects homeostasis. The consequence of the above factors is a compensatory increase in the production of insulin by the pancreas. That is why insulin levels in the blood of pregnant women are most often increased. If the pancreas cannot produce insulin in the amount required by the pregnant body, gestational diabetes mellitus develops. The deterioration of the β-cell function of the pancreas in gestational diabetes mellitus can be judged by the increased concentration of proinsulin.

Often, immediately after delivery, the woman's blood sugar level returns to normal. But it is not necessary to completely exclude the possibility of developing diabetes mellitus in this case.

Who is most susceptible to developing diabetes during pregnancy?

Gestational diabetes mellitus during pregnancy develops in the case of a genetic predisposition, realized under the influence of a number of risk factors, such as:

Overweight, obesity with signs of metabolic syndrome;

Other disorders of carbohydrate metabolism;

Increased sugar levels in the urine;

Type II diabetes mellitus in direct relatives;

The woman's age is over 30;

Arterial hypertension and other diseases of the cardiovascular system;

A history of severe toxicosis and gestosis;

Hydramnios, birth of a previous overweight child (over 4.0 kg), stillbirth in previous pregnancies;

Congenital malformations of the cardiovascular and nervous systems in previous children;

Chronic miscarriage of previous pregnancies, characterized by spontaneous abortion in the first two trimesters;

Gestational diabetes mellitus in previous pregnancies.

Diabetes mellitus during pregnancy: symptoms and signs

There are no specific manifestations in gestational diabetes mellitus, so the only criterion for making a diagnosis is laboratory screening of pregnant women. Women at risk, at the first visit to the antenatal clinic, should be tested for fasting blood sugar levels against the background of a normal diet and physical activity. If your finger stick blood sugar is 4.8-6.0 mmol / L, a special glucose loading test is recommended.

To detect gestational diabetes mellitus, an oral glucose tolerance test is performed for all pregnant women between the sixth and seventh months, which shows the quality of glucose uptake by the body. If the level of glucose in blood plasma taken on an empty stomach exceeds 5.1 mmol / L, an hour after a meal - more than 10.0 mmol / L, and after a couple of hours - more than 8.5 mmol / L, then the doctor has a reason to diagnose GDM. If necessary, the test can be repeated several times.

With timely diagnosis of the disease and subsequent observation and implementation of all the doctor's recommendations, the risk of having a sick child is reduced to 1-2%.

Treatment of diabetes during pregnancy

The course of pregnancy with diabetes mellitus is complicated by the fact that a woman will have to constantly monitor blood glucose levels (at least 4 times a day). In addition, to correct gestational diabetes mellitus, it is necessary to adhere to a diet that includes three main meals and two or three snacks, while limiting the daily amount of calories consumed to 25-30 per kilogram of body weight. It is very important to control that the diet is as balanced as possible in terms of the content of basic nutrients (proteins, fats and carbohydrates), vitamins and trace elements, since the full growth and development of the fetus directly depends on this.

Taking medications that lower blood glucose levels during pregnancy is contraindicated. If the diet prescribed by your doctor, along with moderate physical activity, does not give the expected results, you will have to resort to insulin therapy.

Diet of patients with gestational diabetes mellitus

Diabetes mellitus during pregnancy requires mandatory diet therapy, since it is proper nutrition that can be the key to successful treatment of this disease. When developing a diet, it is important to remember that the emphasis must be on reducing the calorie content of food, without lowering its nutritional value. Doctors recommend following a number of simple but effective dietary guidelines for GDM:

Eat in small portions at the same hours;

Exclude from the diet fried, fatty foods saturated with easily digestible carbohydrates (cakes, pastries, bananas, figs), as well as instant foods and fast food;

Enrich the diet with cereals from various cereals (rice, buckwheat, pearl barley), salads from vegetables and fruits, bread and pasta made from whole grains, i.e. foods rich in fiber;

Eat low-fat meat, poultry, fish, exclude sausages, wieners, smoked sausages, which contain a lot of fat

Prepare food using a small amount of vegetable oil;

Drink enough liquid (at least one and a half liters per day).

Exercise for gestational diabetes during pregnancy

Exercise is very beneficial for pregnant women, as, in addition to maintaining muscle tone and maintaining a vigorous state of health, it improves the action of insulin and prevents the accumulation of excess weight. Naturally, physical activity for pregnant women should be moderate and consist of walking, gymnastics, water exercises. You should not abuse active physical activity, such as cycling or skating, horse riding, as this is fraught with injury. It is important to regulate the number of loads, based on the current state of health at a given time.

Preventive measures to prevent the development of diabetes mellitus during pregnancy

Preventing the development of gestational diabetes mellitus is likely to be difficult. Often, women at risk do not develop diabetes mellitus during pregnancy, and pregnant women who do not have any prerequisites may develop the disease. However, planning a pregnancy with gestational diabetes mellitus already suffered once should be responsible and possibly no earlier than 2 years after the previous birth. To reduce the risk of recurrence of gestational diabetes mellitus several months before the expected pregnancy, you should start monitoring your weight, include exercise in your daily routine, and monitor your blood glucose levels.

Taking any medications must be coordinated with the attending physician, since the uncontrolled use of certain medications (birth control pills, glucocorticosteroids, etc.) can also provoke the subsequent development of gestational diabetes mellitus.

1.5-2 months after giving birth, women who have had gestational diabetes need to be tested to determine the level of glucose in the blood and conduct a glucose tolerance test. Based on the results of these studies, the doctor will recommend a specific diet and exercise regimen, as well as determine the timing for control tests.

Gestational diabetes mellitus during pregnancy is a condition associated with an increase in glucose levels above acceptable levels. The norm of blood sugar during the period of childbearing is up to 5.0 mmol / l on an empty stomach. After an hour after eating, this figure should not exceed 7.0 mmol / l.

How gestational diabetes occurs

There are no unequivocal opinions as to why diabetes mellitus develops during the period of bearing a child. It is believed that the main role in this is played by the restructuring of the woman's body, associated with the need to maintain the life and development of the fetus.

Requires strict adherence to the diet.

The baby is fed during this period with the help of the placenta. This organ produces hormones that promote the growth and development of the fetus, as well as blocking the action of insulin in the expectant mother. As a result, not all sugars from food are broken down. The pancreas is not able to produce more insulin. This leads to the development of hyperglycemia characteristic of diabetes mellitus.

The risks of GDM are determined by factors:

  • increased body weight;
  • weight gain in the period of gestation, exceeding normal values;
  • age over 25;
  • the presence of GDM during previous pregnancies;
  • diabetes mellitus in close relatives.

The likelihood of developing insulin deficiency is determined not only by these conditions. There are other factors that contribute to the onset of GDM.

How does gestational diabetes manifest?

Symptoms of GDM do not differ from those of type 1 or type 2 diabetes. You can suspect the presence of this condition by the following signs:

  • rapid weight gain for no apparent reason;
  • constant thirst;
  • an increase in the amount of urine excreted;
  • decreased appetite;
  • general deterioration in well-being.

If these symptoms appear, a pregnant woman should contact her healthcare provider as soon as possible.

Diagnosis of diabetes mellitus in pregnant women

Women during the period of bearing a child should regularly undergo examination, which includes determination of blood glucose levels. The results of this analysis are especially important for a period of 24-28 weeks. For patients who have a predisposition to developing GDM, doctors prescribe additional unscheduled blood sugar tests.

Blood is drawn on an empty stomach, after which the woman is given a glass of sugar water. The second time, blood is taken after an hour. If the blood glucose levels in these two tests exceed acceptable values, the patient is diagnosed with gestational diabetes.

Potential consequences of GDM

If this condition is detected, it is necessary to take measures aimed at combating hyperglycemia as soon as possible. Otherwise, uncorrected diabetes mellitus in a pregnant woman can lead to consequences:

  1. The birth of a child weighing more than 4 kg - macrosomia. Because of this, childbirth is much more difficult, there is a high risk of injury, which may require a cesarean section.
  2. Premature onset of labor, the development of respiratory distress syndrome in a child associated with insufficient development of the respiratory system in prematurity.
  3. Hypoglycemia after birth in a baby.
  4. Increased likelihood of developing preeclampsia and other complications in a woman during pregnancy. These conditions are also dangerous for the fetus.

Diagnosis of gestational diabetes mellitus is based on fasting and postprandial blood sugar testing.

The listed complications can be prevented only by following the instructions of your doctor.

Treatment of gestational diabetes

Correction of hyperglycemia in a pregnant woman begins with non-drug methods:

  • diet;
  • physical exercise;
  • blood sugar control.

Diet therapy is the mainstream in the treatment of gestational diabetes. It means:

  1. Complete exclusion from the diet of easily digestible carbohydrates - sweets, sugar, juices, honey, baked goods.
  2. Refusal of sugar substitutes, including products containing fructose, as they are prohibited during pregnancy and lactation.
  3. Overweight women - restriction of fat intake, complete rejection of semi-finished products, mayonnaise, sausages.
  4. Fractional meals - It is recommended to eat small meals 4 to 6 times a day. Fasting should not be allowed.

Physical activity is allowed for those patients who have no contraindications. To normalize the blood sugar level, it is sufficient to walk in the fresh air for 30 minutes every day, to do water gymnastics. Exercises that increase blood pressure are prohibited, as they can provoke uterine hypertonicity.

  1. Blood glucose level before meals, one hour after meals during the day. It is also necessary to register this indicator before going to bed.
  2. Meals and foods consumed.
  3. If special test strips are available, the urine ketone level measured in the morning.
  4. Blood pressure in the morning and evening - this figure should not exceed 130/80 mm Hg. Art.
  5. Fetal motor activity.
  6. Woman's body weight.

Keeping such a diary will help to track possible deviations in the state of health even before the onset of symptoms. It is also necessary for the doctor to better control the course of pregnancy.

If the effectiveness of non-drug treatment is insufficient, a woman should be referred for consultation with an endocrinologist. If high blood glucose levels persist, insulin medications are indicated. The correct dosage of the medicine is safe for women. Insulin does not cross the placenta, so it does not harm the fetus.

Delivery with GDM

After the diagnosis of gestational diabetes mellitus, the most appropriate delivery method is selected for each woman. The final examination is carried out no later than 38 weeks, according to its results, the doctor determines the possible prospects for childbirth.

With GDM, it is not recommended to prolong the pregnancy for more than 40 weeks. This significantly increases the likelihood of complications for the child, since at this time the reserves of the placenta are reduced, and its rupture may occur at the birth of the fetus. For this reason, the most favorable period for delivery is considered to be from 38 to 40 weeks.

After giving birth to a child, women with GDM should:

  1. If insulin therapy was carried out, cancel it.
  2. Follow the diet for another month and a half.
  3. Monitor blood glucose levels for three days after birth.
  4. In the period 6-12 weeks after childbirth - consult with an endocrinologist, conduct an additional examination to assess the metabolism of carbohydrates.

For women who have been diagnosed with gestational diabetes, when planning subsequent pregnancies, measures should be taken to reduce the likelihood of re-developing this pathological condition.

To prevent severe consequences of GDM, a woman should regularly monitor her blood glucose levels.

Children who are born to mothers with GDM are more likely to develop type 2 diabetes. Therefore, throughout life they should adhere to a diet with a low sugar content, be observed by an endocrinologist.

Prevention of diabetes mellitus in pregnant women

Knowing about the presence of factors contributing to the development of insulin deficiency, you can reduce the likelihood of this pathological condition.

To prevent the development of GDM, all women during the period of bearing a child are recommended to follow preventive measures:

  1. A diet that excludes easily digestible carbohydrates, restricts the use of fat and salt.
  2. Normalization of body weight - it is advisable to do this before pregnancy.
  3. Regular physical activity, walks in the fresh air.
  4. In the presence of relatives with diabetes mellitus - once a year, fasting blood glucose control and after meals.

Gestational diabetes mellitus is a disease that can only develop during the period of gestation. Hyperglycemia is dangerous by the development of many complications for both the mother and the fetus. Therefore, it is important to take measures aimed at normalizing blood glucose levels. If diet and other non-pharmacological methods are ineffective, insulin is indicated depending on the amount of carbohydrates consumed.

- a type of diabetes that occurs exclusively in women during pregnancy. After giving birth, after a while, it usually goes away. However, if such a violation is not treated, started, then the problem can turn into a serious disease - type 2 diabetes (and this is a mass of difficulties and unpleasant consequences).

Every woman with the onset of pregnancy is registered in the antenatal clinic at the place of residence. Due to this, throughout the entire period of bearing a child, the health of a woman and her fetus is monitored by specialists, and periodic blood and urine tests are mandatory for monitoring.

If suddenly an increase in glucose levels is found in the urine or blood, then a single such case should not cause panic or any fears, because for pregnant women this is considered a physiological norm. If the test results showed more than two such cases, and glucosuria (sugar in the urine) or hyperglycemia (blood sugar) are found not after eating (which is considered normal), but taken on an empty stomach in tests, then we can already talk about gestational diabetes mellitus of a pregnant woman.

Causes of Gestational Diabetes, Its Risk and Symptoms

According to statistics, approximately 10% of women suffer from complications during pregnancy, and among them there is a certain risk group who may develop gestational diabetes. These include women:

  • with a genetic predisposition,
  • overweight or obese
  • with ovarian disease (for example),
  • with pregnancy and childbirth after the age of 30,
  • with previous births accompanied by gestational diabetes mellitus.

There may be several reasons for the occurrence of GDM, but this is mainly due to a violation of loyalty to (as in type 2 diabetes). This is due to the increased load in pregnant women on the pancreas, which may not be able to cope with the production of insulin, namely, it controls the normal level of sugar in the body. The "culprit" of this situation is the placenta, which secretes hormones that resist insulin, while increasing the level of glucose (insulin resistance).

The "opposition" of the placental hormones to insulin usually occurs at 28-36 weeks of pregnancy and, as a rule, this occurs due to a decrease in physical activity, which is also explained by the natural weight gain during gestation.

Symptoms of gestational diabetes during pregnancy are the same as in type 2 diabetes:

  • increased feeling of thirst,
  • lack of appetite or constant feeling of hunger,
  • the occurrence of discomfort from frequent urination,
  • possibly an increase in blood pressure,
  • blurred vision.

If at least one of the above symptoms is present, or you are at risk, then be sure to inform your gynecologist so that he examines you for GDM. The final diagnosis is made not only in the presence of one or more symptoms, but also on the basis of tests that need to be passed correctly, and for this you need to eat foods that are included in your daily menu (do not change them before taking the test!) And lead a usual lifestyle ...

The norm for pregnant women are indicators:

  • 4-5.19 mmol / liter- on an empty stomach,
  • no more than 7 mmol / liter - 2 hours after eating.

If the results are questionable (i.e., an insignificant increase), a glucose load test is performed (5 minutes after taking an analysis on an empty stomach, the patient drinks a glass of water in which 75 g of dry glucose is dissolved) - to accurately determine the possible diagnosis of GDM.

Why is gestational diabetes mellitus (GDM) dangerous for a child?

For the preservation of the fetus in the placenta, hormones such as cortisol, estrogen and lactogen are necessary. However, these hormones are forced to resist insulin, which disrupts the normal functioning of the pancreas, and because of this, not only mommy suffers, but also her baby.

The formation of the fetus occurs in the first trimester of pregnancy, and therefore the manifested GDM after 16-20 weeks cannot lead to any abnormalities in the development of organs. Moreover, timely diagnosis is quite capable of helping to avoid complications, but there remains the danger of diabetic fetopathy (DF) - "feeding" the fetus, the symptoms of which are associated with impaired development.

The most common symptom of DF deviation in GDM disease is macrosomia - an increase in the size of the fetus in weight and height. This is due to the large amount of glucose supplied for the development of the fetus. The child's pancreas, which is not yet fully developed at this moment, is already producing its own insulin in excess, which converts the excess sugar into fat. As a consequence, with normal head and limb sizes, an increase in the shoulder girdle, heart, liver, abdomen occurs, and a fat layer is expressed. And as the consequences of this:

  • due to the difficult passage of the child's shoulder girdle by the birth canal - difficult childbirth;
  • for the same reason - damage to the internal organs of the mother and possible injury to the child;
  • due to an increase in the fetus (which may not yet fully develop), the call for premature birth.

Another symptom of DF is impaired breathing of the newborn after delivery. This happens due to a decrease in surfactant - a substance in the lungs (this is due to the GDM of a pregnant woman), and therefore, after the birth of a child, they can be placed in a special incubator (incubator) under constant control, and, if necessary, they can even carry out artificial respiration using a lung ventilation apparatus.

Treatment and prevention of gestational diabetes mellitus

As we have already said, the main reason for the occurrence of GDM is an increase in sugar, and therefore treatment, like the prevention of the disease, is based on controlling this indicator in the body.

The task of a pregnant woman is to regularly take tests and strictly follow the recommendations of the attending gynecologist. In addition, you should control (or even change) your diet and lifestyle.

As the practice of doctors and statistics show, the main key to the health of a mother and her child is proper nutrition, which is needed not to lose weight (lose weight), but to normalize glucose levels. And here it is important to eat less high-calorie, but at the same time nutritious food. This means:

  • exclude baked goods and confectionery from the diet, but do not exclude carbohydrates from the diet in general (this is a source of energy);
  • limit or exclude certain types of fruits that contain easily digestible carbohydrates;
  • refuse to use semi-finished products and instant products (noodles, soups, cereals, mashed potatoes, sausages);
  • give up the use of smoked meats, margarine, mayonnaise, butter, pork;
  • do not forget about protein food: it is very important for the body;
  • when preparing food, cooking, stewing, baking or steaming food is preferred;
  • meals should be in small portions, but every 3 hours.

In addition, the expectant mother will benefit from:

  • special classes,
  • outdoor walks away from the roadway.

Physical activity contributes to the effective neutralization of sugars (less glucose accumulates in the blood, and its level decreases), a good metabolism and has a beneficial effect on overall well-being.

This is the rise in blood sugar above normal for the first time during pregnancy.

Blood sugar rate at pregnantin the morning on an empty stomach (before meals) no more 5.0 mmol / l, 1 hour after eating, no more than 7.0 mmol / l.

And after loading with glucose when conducting a glucose tolerance test at 24-28 weeks of pregnancy: after 1 hour< 10,0 ммоль/л, через 2 часа < 8,5 ммоль/л.

Glucose loading should not be performed if the blood sugar level in the morning on an empty stomach was ≥ 5.1 mmol / L.

What you need to know about gestational diabetes.

Gestational diabetes mellitus (GDM) is a disease that is first diagnosed during pregnancy and usually resolves after childbirth, characterized by an increase in blood sugar (hyperglycemia).

Due to physiological changes in a woman's metabolism during this period, any pregnancy in itself is a risk factor for the development of gestational diabetes mellitus. Especially if the pregnancy is multiple or after IVF, and being overweight before pregnancy and a large increase during it increases the risk of developing GDM. In the second half of pregnancy, the body's need for insulin increases due to the fact that some pregnancy hormones block its action. Sometimes it happens that the pancreas cannot produce enough insulin. Then the excess sugar is not removed from the blood, but remains in it in large quantities. From the mother's blood, glucose enters the fetal blood through the placenta, therefore, maternal hyperglycemia will lead to the development of fetal hyperglycemia. The fetal pancreas is stimulated to produce an increased amount of insulin, followed by the formation of insulin resistance (decreased insulin sensitivity), which affects the development of diabetic changes in the child. It can also lead to complications in childbirth, respiratory distress, hypoglycemia (low glucose levels) after birth, jaundice in newborns. If GDM is not detected in a timely manner or the expectant mother does not take any action to treat it, then the risk of early aging of the placenta and, as a consequence, delayed fetal development, premature birth, as well as polyhydramnios, increased blood pressure, preeclampsia, the formation of a large fetus and the need for in cesarean section, traumatization of a woman and a child during childbirth, hypoglycemia and respiratory failure in a newborn. The most formidable complication of untreated GDM is perinatal fetal death.... Therefore, the modern healthcare organization around the world recommends mandatory examination of ALL pregnant women for the earliest detection of GDM and its timely treatment.

If you have been diagnosed with GDM, then uhthen there is no reason to despair. Without delay, you need to take all measures to keep your blood sugar within the normal range for the rest of your pregnancy. Since the increase in blood sugar with GDM is very insignificant and is not subjectively felt, it is necessary to begin to conduct regular self-monitoring of blood sugar using a portable device - glucometer(during pregnancy, only glucometers calibrated by blood plasma are used - see the instructions for the device).

Blood sugar rates for pregnant: 3.3-5.0 mmol / l in the morning before meals, 1 hour after meals - less than 7.0 mmol / l.

It is necessary to record each sugar value in self-control diary with the date, time and a detailed description of the food content after which you measured the sugar.

You should take this diary with you every time to an appointment with an obstetrician-gynecologist and endocrinologist.

Treatment of GDM during pregnancy:

  1. Diet- the most important thing in the treatment of GDM
  • Digestible carbohydrates are completely excluded from the diet: sugar, jam, honey, all juices, ice cream, pastries, cakes, bakery products made of white high-grade flour; rich pastries (rolls, buns, pies),
  • Any sweeteners, for example, products based on fructose (sold in stores under the brand name "diabetic") - are prohibited for pregnant and breastfeeding women,
  • If you have an excess of body weight, then in your diet you need to limit all fats and completely exclude: sausages, sausages, sausages, bacon, margarine, mayonnaise,
  • Do not starve at all! Meals should be evenly distributed over 4 to 6 meals throughout the day; breaks between meals should not be more than 3-4 hours.

2. Physical exercise... If there are no contraindications, then moderate physical activity for at least 30 minutes daily is very useful, for example, walking, swimming in the pool.

Avoid exercise, which causes blood pressure to rise and uterine hypertonia.

3. Diary self-controlin which you write:

  • blood sugar in the morning before meals, 1 hour after each meal during the day and before bedtime - daily,
  • all meals (in detail) - daily,
  • ketonuria (ketones or acetone of urine) in the morning on an empty stomach (there are special test strips for determining ketone bodies in urine - for example, "Uriket", "Ketofan") - daily,
  • blood pressure (BP should be less than 130/80 mm Hg) - daily,
  • fetal movement - daily,
  • body weight - weekly.

Attention: if you do not keep a diary, or do not keep it honestly, thereby you are deceiving yourself (and not the doctor) and risking yourself and your baby!

  1. If, despite the measures taken, the blood sugar exceeds the recommended values, then it is necessary to start treatment with insulin (for this you will be referred for a consultation with endocrinologist).
  2. Don't be afraid to prescribe insulin. You should be aware that addiction to insulin does not develop, and after childbirth, in the vast majority of cases, insulin is canceled. Insulin in adequate doses does not harm the mother, it is prescribed to maintain her full health, and the baby will remain healthy and will not learn about the mother's use of insulin - the latter does not pass through the placenta.

Childbirth and GDM:

The time and method of childbirth is determined individually for each pregnant woman. Not later than 38 weeks of pregnancy, the obstetrician-gynecologist conducts a final examination of the mother and child and discusses the prospects of childbirth with the patient. Prolongation of pregnancy for more than 40 weeks with GDM is dangerous, the placenta has few reserves and may not withstand the load during childbirth, therefore, earlier births are preferable. Gestational diabetes is NOT an indication for caesarean section by itself.

GDM after childbirth:

  • adherence to a diet for 1.5 months after childbirth,
  • insulin therapy is canceled (if any),
  • blood sugar control in the first three days (blood sugar rate after childbirth: on an empty stomach 3.3 - 5.5 mmol / l, 2 hours after meals up to 7.8 mmol / l),
  • 6-12 weeks after childbirth - consultation of an endocrinologist for diagnostic tests to clarify the state of carbohydrate metabolism,
  • women who have undergone GDM are at high risk of developing GDM in the next pregnancies and type 2 diabetes in the future, therefore, a woman who has undergone GDM needs:
  • - follow a diet aimed at reducing body weight with its excess,
  • - expand physical activity,
  • - plan subsequent pregnancies,
  • children from mothers with GDM have an increased risk of obesity and type 2 diabetes mellitus throughout their lives, therefore, they are advised to have a balanced diet and sufficient physical activity, observation of an endocrinologist.

If GDM is detected, patients need to completely stop using:

  • all sweet foods (this applies to both sugar and honey, ice cream, sugary drinks, and the like);
  • white bread, baked goods and any flour products (including pasta);
  • semolina;
  • semi-finished products;
  • smoked meats;
  • fast food products;
  • fast food;
  • fruits that are high in calories;
  • lemonades, juices in packages;
  • fatty meat, jellied meat, lard;
  • canned food, regardless of their type;
  • alcohol;
  • cocoa;
  • cereals, diet bread;
  • all legumes;
  • sweet yoghurts.

You will also have to significantly limit the use of:

  • potatoes;
  • butter;
  • chicken eggs;
  • baking from non-tasty dough.
  • Foods from the prohibited list should be completely excluded from the diet. Even a small consumption of them can lead to negative consequences. Potatoes, butter, eggs and pastries made from non-rich dough are allowed to be consumed in very limited quantities

What can pregnant women eat with gestational diabetes? The above products can be substituted:

  • hard cheeses;
  • fermented milk cottage cheese;
  • natural yoghurts;
  • heavy cream;
  • seafood;
  • green vegetables (carrots, pumpkins, beets, as opposed to cucumbers, onions and cabbage, must be consumed in limited quantities);
  • mushrooms;
  • soy and products made from it (in small quantities);
  • tomato juice;
  • tea.

There are several diet options that can be followed for gestational diabetes, but a low-carb diet is ruled out.

This is due to the fact that in case of insufficient intake of carbohydrates from food, the body will begin to burn fat reserves for energy.

The following foods must be included in the diet:

  • whole wheat bread;
  • any vegetables;
  • legumes;
  • mushrooms;
  • cereals - preferably millet, pearl barley, oatmeal, buckwheat;
  • lean meats;
  • fish;
  • chicken eggs - 2-3 pcs / week;
  • dairy products;
  • sour fruits and berries;
  • vegetable oils.

In most cases, doctors prescribe a diet high in carbohydrates and moderate in protein for their patients. Preference is given to unsaturated fats, the use of which, however, must also be limited. Saturated fats are completely eliminated from the diet.

Sample menu for pregnant women with gestational diabetes:

First option

Second option

Third option