Gestational diabetes occurs during pregnancy (gestation). Like other types of diabetes, gestational diabetes affects the ability of cells to use glucose.

Such a disease causes an increased amount of sugar in the blood serum, which can adversely affect the overall picture of pregnancy and the health of the fetus.

Read about risk groups, dangers, consequences of this type of diabetes below.

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Why is gestational diabetes dangerous?

Blood glucose levels usually return to normal immediately after delivery. But there is always a risk of developing type 2 diabetes.

When you are pregnant, hormonal changes can increase your serum glucose levels. Gestational diabetes increases the chance of complications before/after/during pregnancy.

Once the diagnosis has been made, your doctor/midwife will closely monitor your health and that of your baby until the end of your pregnancy.

Most women with this type of diabetes give birth to healthy babies.

The exact causes of this type of disease have not yet been identified. To understand the mechanism of the disease, it is necessary to clearly understand how pregnancy affects the processing of sugar in the body.

The mother's body digests food to produce sugar (glucose), which is then released into the blood. In response, the pancreas produces insulin, a hormone that helps glucose move from the blood to the body's cells, where it is used as energy.

During pregnancy, the placenta, which connects the baby to the blood, produces a large number of different hormones. Almost all of them interfere with the action of insulin in cells, raising blood glucose levels.

A moderate increase in sugar levels after eating is a normal reaction of the body in pregnant patients. As the fetus grows, the placenta produces more and more insulin-blocking hormones.

In gestational diabetes, placental hormones cause blood glucose to rise to levels that can negatively affect the growth and well-being of the baby.

Gestational diabetes usually develops during the last trimester of pregnancy - but sometimes becomes apparent as early as 20 weeks.

Risk factors

Include:

• Age over 25 years;
• Cases of diabetes in the family;
• The risk of developing diabetes is increased if the patient already has a pre-diabetic condition - moderately elevated sugar levels, which can be a precursor to type 2 diabetes;
• miscarriage/abortion;
• Excess weight;
• Presence of polycystic ovary syndrome.

There are many other diseases that increase your risk, including:

• High cholesterol;
• High blood pressure;
• Smoking;
• Lack of physical activity;
• Unhealthy food.

To confirm the presence of diabetes, the diagnostician gives you a sweet drink to drink. This will raise your glucose levels. After some time (usually half an hour to an hour), a blood test will be taken to understand how your body is coping with the resulting sugar.

If the result shows that blood glucose is 140 milligrams per deciliter (mg/dL) or more, You will be advised to fast for a few hours and then take another blood sample.

If your results are in the normal/target range but you are highly likely to develop gestational diabetes, follow-up testing during/during pregnancy may be recommended to make sure you do not already have it.

Important! Only a specialist can make a correct diagnosis! Self-diagnosis is the wrong approach to solving the problem.

If you already have diabetes and you are thinking about having a baby, consult your doctor before getting pregnant. Poorly controlled diabetes can cause complications for your unborn child.

Possible consequences of gestational diabetes

Blood sugar levels are likely to return to normal after delivery. But the patient will have a higher risk of developing type 2 diabetes in the future or having recurrent gestational diabetes again with another pregnancy.

High blood sugar levels affect the fetus as it receives nutrients from the mother's blood. The child will begin to store excess sugar in the form of fat, which can later affect his growth.

The child may also have the following complications:

Consequences after the birth of a child

Gestational diabetes usually does not cause birth defects or deformities. Most developmental defects occur during the first trimester of pregnancy, between the 1st and 8th weeks. The disease usually develops around 24 weeks of gestation.

If your baby was macrosomic or large fetal at birth, then he or she will be at a higher risk of developing obesity. Large children are also at greater risk of infection and are often diagnosed at an earlier age (under 30).

Here are a few rules to follow:

Note! Physical activity is good in moderation. Avoid playing basketball/football, and avoid activities that could cause you to fall, such as horseback riding or skiing. Do not exercise on your back after the first trimester. Such physical activity can put too much pressure on the abdomen and restrict blood flow to the fetus.

When to Seek Medical Care

Get help right away if:

• You have symptoms of high blood sugar: trouble concentrating, headaches, increased thirst, blurred vision, or weight loss;
• You have symptoms of low blood sugar: restlessness, confusion, dizziness, headaches, hunger, fast pulse or heartbeat, feeling shaky or shivering, pale skin, sweating or weakness;
• You have tested your blood sugar at home and it is above/below your target range.

Targets

Blood glucose targets (mg/dL) for women with gestational diabetes are listed below:

• Before meals and immediately after sleep: 95 or lower;
• 1 hour after eating: 140 or less;
• 2 hours after eating: 120 or less.

Conclusion

The risk of developing gestational diabetes can be reduced initially with a healthy diet and regular exercise. However, insulin injections will be strictly indicated for some patients.

It is very important to immediately seek medical help for any symptoms and signs of the disease in order to avoid negative consequences and complications for the mother and her unborn child.

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

According to the World Health Organization, there are more than 422 million people with diabetes in the world. Their number is growing every year. Increasingly, the disease affects young people.

Complications of diabetes lead to serious vascular pathologies, kidneys, retina, are affected. But this disease is controllable. With properly prescribed therapy, severe consequences are delayed in time. no exception and gestational diabetes that developed during gestation. This disease is called gestational diabetes mellitus.

• Can pregnancy cause diabetes?
• What are the types of diabetes during pregnancy
• Risk group
• What is gestational diabetes during pregnancy
• Consequences for the child
• What is the danger for a woman
• Symptoms and signs of gestational diabetes in pregnancy
• Analyzes and timing
• Treatment
• Insulin therapy: who is indicated and how it is carried out
• Diet: allowed and prohibited foods, basic principles of nutrition for pregnant women with GDM
• Sample menu for the week
• ethnoscience
• How to give birth: natural childbirth or caesarean section?
• Prevention of gestational diabetes in pregnant women

Pregnancy - a provocateur?

The American Diabetes Association reports that 7% of pregnant women develop gestational diabetes. In some of them, after childbirth, glucosemia returns to normal. But in 60%, type 2 diabetes (DM2) manifests in 10-15 years.

Gestation acts as a provocateur of impaired glucose metabolism. The mechanism of development of the gestational form of diabetes is closer to type 2 diabetes. A pregnant woman develops insulin resistance due to the following factors:

• synthesis in the placenta of steroid hormones: estrogen, placental lactogen;
• an increase in the formation of cortisol in the adrenal cortex;
• violation of insulin metabolism and a decrease in its effects in tissues;
• increased excretion of insulin through the kidneys;
• activation of insulinase in the placenta (an enzyme that breaks down the hormone).

The condition worsens in those women who have physiological resistance (immunity) to insulin, which did not manifest itself clinically. These factors increase the need for the hormone, pancreatic beta cells synthesize it in increased quantities. Gradually, this leads to their depletion and persistent hyperglycemia - an increase in the level of glucose in the blood plasma.

What are the types of diabetes during pregnancy?

Pregnancy can be accompanied by different types of diabetes. The classification of pathology according to the time of occurrence implies two forms:

1. diabetes that existed before pregnancy (DM 1 and DM type 2) - pregestational;
2. gestational diabetes (GDM) in pregnancy.

Depending on the treatment needed for GDM, there are:

• compensated by diet;
• compensated by diet therapy and insulin.

Diabetes can be in the stage of compensation and decompensation. The severity of pregestational diabetes depends on the need for various treatments and the severity of complications.

Hyperglycemia that develops during pregnancy is not always gestational diabetes. In some cases, this may be a manifestation of type 2 diabetes.

Who is at risk for developing diabetes during pregnancy?

Hormonal changes that can disrupt insulin and glucose metabolism occur in all pregnant women. But the transition to diabetes is not for everyone. This requires predisposing factors:

• overweight or obesity;
• existing impaired glucose tolerance;
• episodes of rising sugar before pregnancy;
• Type 2 diabetes in parents of a pregnant woman;
• age over 35;
• a history of miscarriages, stillbirths;
• birth in the past of children weighing more than 4 kg, as well as with malformations.

But which of these causes affects the development of pathology to a greater extent is not fully known.

What is gestational diabetes

GDM is considered to be the pathology that has developed after - bearing a child. If hyperglycemia is diagnosed earlier, then there is latent diabetes mellitus that existed before pregnancy. But the peak incidence is observed in the 3rd trimester. A synonym for this condition is gestational diabetes.

It differs from gestational overt diabetes during pregnancy in that after one episode of hyperglycemia, sugar gradually increases and does not tend to stabilize. This form of the disease is more likely to progress to type 1 or type 2 diabetes after childbirth.

To determine the further tactics, all puerperas with GDM in the postpartum period determine the level of glucose. If it does not normalize, then it can be considered that type 1 or type 2 diabetes has developed.

Impact on the fetus and consequences for the child

The danger to the developing child depends on the degree of compensation of the pathology. The most severe consequences are observed in the uncompensated form. The effect on the fetus is expressed as follows:

1. Malformations of the fetus with an increased level of glucose in the early stages. Their formation occurs due to energy deficiency. In the early stages, the child's pancreas has not yet been formed, so the mother's organ must work for two. Violation of work leads to energy starvation of cells, disruption of their division and the formation of defects. This condition can be suspected by the presence of polyhydramnios. Insufficient intake of glucose into cells is manifested by intrauterine growth retardation, low weight of the child.
2. Uncontrolled sugar levels in a pregnant woman with gestational diabetes in the 2nd and 3rd trimester leads to diabetic fetopathy. Glucose crosses the placenta in unlimited quantities, the excess is deposited as fat. If there is an excess of own insulin, accelerated growth of the fetus occurs, but there is a disproportion of body parts: a large abdomen, shoulder girdle, small limbs. It also enlarges the heart and liver.
3. A high concentration of insulin disrupts the production of surfactant, a substance that coats the alveoli of the lungs. Therefore, after birth, respiratory disorders may occur.
4. Tying the umbilical cord of a newborn disrupts the supply of excess glucose, the child's glucose concentration drops sharply. Hypoglycemia after childbirth leads to neurological disorders, impaired mental development.

Also, in children born to mothers with gestational diabetes, the risk of birth trauma, perinatal death, cardiovascular diseases, pathology of the respiratory system, disorders of calcium and magnesium metabolism, and neurological complications increase.

Why high sugar is dangerous for a pregnant woman

GDM or pre-existing diabetes increases the possibility of late toxicosis (), it manifests itself in various forms:

• dropsy of pregnant women;
• nephropathy 1-3 degree;
• preeclampsia;
• eclampsia.

The last two conditions require hospitalization in the intensive care unit, resuscitation and early delivery.

Immune disorders that accompany diabetes lead to infections of the genitourinary system - cystitis, pyelonephritis, as well as recurrent vulvovaginal candidiasis. Any infection can lead to infection of the child in utero or during childbirth.

The main signs of gestational diabetes during pregnancy

Symptoms of gestational diabetes are not expressed, the disease develops gradually. Some signs of a woman are taken for normal changes in the condition during pregnancy:

• increased fatigue, weakness;
• thirst;
• frequent urination;
• insufficient weight gain with pronounced appetite.

Hyperglycemia is often an incidental finding during a mandatory blood glucose screening test. This serves as an indication for further in-depth examination.

Grounds for diagnosis, tests for latent diabetes

The Ministry of Health has determined the deadlines for a mandatory blood test for sugar:

• when registering;

In the presence of risk factors in - a glucose tolerance test is performed. If symptoms of diabetes appear during pregnancy, then a glucose test is performed according to indications.

One analysis, which revealed hyperglycemia, is not enough to make a diagnosis. You need to check after a few days. Further, with repeated hyperglycemia, an endocrinologist consultation is prescribed. The doctor determines the need and timing of the glucose tolerance test. Usually it is at least 1 week after the recorded hyperglycemia. The test is also repeated to confirm the diagnosis.

The following test results speak about GSD:

• fasting glucose more than 5.8 mmol / l;
• an hour after taking glucose - above 10 mmol / l;
• after two hours - above 8 mmol / l.

Additionally, according to indications, research is carried out:

• glycosylated hemoglobin;
• urinalysis for sugar;
• cholesterol and lipid profile;
• coagulogram;
• blood hormones: estrogen, placental lactogen, cortisol, alpha-fetoprotein;
• urinalysis according to Nechiporenko, Zimnitsky, Reberg's test.

Pregnant women with pregestational and gestational diabetes undergo fetal ultrasound from the 2nd trimester, doplerometry of the vessels of the placenta and umbilical cord, regular CTG.

Management of pregnant women with diabetes mellitus and treatment

The course of pregnancy with existing diabetes depends on the level of self-control on the part of the woman and the correction of hyperglycemia. Those who had diabetes before conception must go through the "School of Diabetes" - special classes that teach proper eating behavior, self-control of glucose levels.

Regardless of the type of pathology, pregnant women need the following observations:

• visiting a gynecologist every 2 weeks at the beginning of gestation, weekly - from the second half;
• consultations with an endocrinologist once every 2 weeks, in a decompensated state - once a week;
• observation of the therapist - every trimester, as well as when extragenital pathology is detected;
• ophthalmologist - once a trimester and after childbirth;
• neurologist - twice during pregnancy.

Mandatory hospitalization is provided for examination and correction of therapy for a pregnant woman with GDM:

• 1 time - in the first trimester or when diagnosing a pathology;
• 2 times - in - to correct the condition, determine the need to change the treatment regimen;
• 3 times - with type 1 and type 2 diabetes - in, GDM - in to prepare for childbirth and the choice of the method of delivery.

In a hospital, the frequency of studies, the list of analyzes and the frequency of the study is determined individually. Daily monitoring requires a urine test for sugar, blood glucose, blood pressure control.

Insulin

The need for insulin injections is determined individually. Not every case of GDM requires this approach; for some, a therapeutic diet is sufficient.

Indications for starting insulin therapy are the following blood sugar levels:

• fasting blood glucose on the background of a diet of more than 5.0 mmol / l;
• one hour after eating above 7.8 mmol / l;
• 2 hours after a meal, glycemia is above 6.7 mmol / l.

Attention! In pregnant and lactating women, the use of any hypoglycemic drugs, except for insulin, is prohibited! Long-acting insulins are not used.

The basis of therapy is short- and ultrashort-acting insulin preparations. In type 1 diabetes, basal bolus therapy is performed. For type 2 diabetes and GDM, it is also possible to use the traditional scheme, but with some individual adjustments that are determined by the endocrinologist.

In pregnant women with poor hypoglycemic control, insulin pumps can be used to facilitate hormone administration.

Diet for gestational diabetes during pregnancy

Nutrition of a pregnant woman with GDM should comply with the following principles:

• Little and often. It is better to have 3 main meals and 2-3 small snacks.
• The amount of complex carbohydrates is about 40%, protein - 30-60%, fats up to 30%.
• Drink at least 1.5 liters of liquid.
• Increase the amount of fiber - it is able to adsorb glucose from the intestines and remove it.

Actual video

Diet for gestational diabetes in pregnancy

Products can be divided into three conditional groups presented in Table 1.

Table 1

It is forbidden to use	Limit Quantity	You can eat
Sugar sweet pastries Honey, sweets, jam Fruit juices from the store Carbonated sweet drinks Semolina and rice porridge Grapes, bananas, melon, persimmon, dates Sausages, sausages, any fast food Sweeteners	Durum wheat pasta Potato Animal fats (butter, lard), fatty Margarine	All kinds of vegetables, including Jerusalem artichoke Beans, peas and other legumes Wholemeal bread Buckwheat, oatmeal, barley, millet Lean meat, poultry, fish Low fat dairy products Fruits, except prohibited Vegetable fats

Sample menu for a pregnant woman with gestational diabetes

The menu for the week (table 2) may look something like this (table No. 9).

Table 2.

Day of the week	Breakfast	2 breakfast	Dinner	afternoon tea	Dinner
Monday	Millet porridge with milk, bread with unsweetened tea	Apple or pear or banana	Fresh vegetable salad with vegetable oil; Chicken broth with noodles; Boiled meat with stewed vegetables	Cottage cheese, unsweetened cracker, tea	Braised cabbage with meat, tomato juice. Before going to bed - a glass of kefir
Tuesday	Omelette for a couple with, Coffee/tea, bread	Any fruit	Vinaigrette with butter; milk soup; barley porridge with boiled chicken; dried fruits compote	Unsweetened yogurt	Steamed fish with vegetable garnish, tea or compote
Wednesday	Cottage cheese casserole, tea with cheese sandwich	Fruits	Vegetable salad with vegetable oil; low-fat borscht; mashed potatoes with beef goulash; dried fruits compote	Low fat milk with crackers	Buckwheat porridge with milk, egg, tea with bread
Thursday	Oatmeal in milk with raisins or fresh berries, tea with bread and cheese	Yogurt without sugar	Cabbage and carrot salad; pea soup; Mashed potatoes with boiled meat; tea or compote	Any fruit	Stewed vegetables, boiled fish, tea
Friday	Millet porridge, boiled egg, tea or coffee	Any fruit	Vinaigrette in vegetable oil; milk soup; baked zucchini with meat;	Yogurt	Vegetable casserole, kefir
Saturday	Milk porridge, tea or coffee with bread and cheese	Any permitted fruit	Vegetable salad with low-fat sour cream; buckwheat soup with chicken broth; boiled pasta with chicken;	Milk with crackers	Cottage cheese casserole, tea
Sunday	Oatmeal with milk, tea with a sandwich	Yogurt or kefir	Bean and tomato salad; cabbage soup; boiled potatoes with stew;	Fruits	Grilled vegetables, chicken fillet, tea

ethnoscience

Traditional medicine methods offer many recipes for using herbal remedies to reduce blood sugar and replace sugary foods. For example, stevia and its extracts are used as a sweetener.

For diabetics, this plant is not dangerous, but use in pregnant women and lactating women is not recommended. Studies on the effect on the course of pregnancy and the formation of the fetus have not been conducted. In addition, the plant can cause an allergic reaction, which is highly undesirable during pregnancy against the background of gestational diabetes.

Natural birth or caesarean?

How the delivery will take place depends on the condition of the mother and child. Hospitalization of pregnant women with gestational diabetes is carried out in -. To avoid birth trauma, they try to induce labor with a full-term baby during this period.

In a serious condition of a woman or fetal pathology, the issue of a caesarean section is decided. If, according to the results of ultrasound, a large fetus is determined, the correspondence of the size of the woman's pelvis and the possibility of childbirth are determined.

With a sharp deterioration in the condition of the fetus, the development of severe preeclampsia, retinopathy and nephropathy of the pregnant woman, a decision can be made on early delivery.

Prevention methods

It is not always possible to avoid the disease, but it is possible to reduce the risk of its occurrence. Women who are overweight or obese should start planning their pregnancy with diet and weight loss.

Everyone else should adhere to the principles of a healthy diet, control weight gain, reduce the consumption of sweet and starchy, fatty foods. We must not forget about sufficient physical activity. Pregnancy is not a disease. Therefore, in its normal course, it is recommended to perform special sets of exercises.

Women with hyperglycemia should take into account the recommendations of the doctor, be hospitalized at the scheduled time for examination and correction of treatment. This will help prevent the development of complications of gestational diabetes. Those who had GDM in a previous pregnancy have a significantly increased risk of developing diabetes when they re-gestate.

During pregnancy, a lot of changes occur in a woman's body, the hormonal background, various biochemical parameters change. In most cases, this is a normal and natural process, because the body is being rebuilt. But, there are also indicators that should be closely monitored, because their deviation from the norm is fraught with serious risks for the expectant mother and her baby. One of these indicators is the level of blood sugar, which can suddenly rise even in those women who had everything before that.

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GDM due to pregnancy - causes

This is an increase in sugar levels, which is diagnosed during pregnancy. This phenomenon can occur both in healthy women who did not have such problems before, and in those who suffered from diabetes or prediabetes. The reason is that the cells of the body lose their sensitivity to insulin. This is often caused by hormonal changes that occur in the body of the expectant mother.

Elevated sugar levels during pregnancy pose a threat not only to the woman, but also to the unborn baby. Therefore, when it is detected, doctors need to take action, and the woman should follow their instructions.

signs

The insidiousness of GDM is that in many pregnant women, it occurs without any symptoms at all. Only those women who have diabetes or high blood sugar should seriously consider getting their levels checked during pregnancy.

Most, however, attribute all changes in their state of health to their interesting position. Measurement of blood sugar levels, even in healthy women who have not had problems with this, during childbearing is mandatory. That is why it is necessary to visit a doctor on time, undergo all scheduled examinations and take tests in order not to miss this moment, since the consequences can be serious.

Diagnostics

If you follow the standard scheme, even during the initial treatment, when the pregnant woman is registered, she is recommended to check her blood sugar level. Then, if everything is in order, for a period of 24-28 weeks, the woman undergoes an additional screening test, which takes several hours.

First, an analysis is given without a load - that is, from a vein and on an empty stomach. She is then given very sweet water to drink and is tested in an hour. Again, blood is drawn from a vein. This test allows you to evaluate how efficiently and quickly glucose is absorbed.

The consequences of gestational diabetes for women and children

For women, if nothing is done with GDM, there is a high risk of preeclampsia, as well as complications during the birth process. The risk of developing type 1 or type 2 diabetes is very high.

For a baby, GDM is also not useful. Due to the large amount of incoming glucose, the growth process is stimulated, so the weight of a newborn can reach 4 or more kilograms, which can also lead to complicated births, birth injuries. These children are at increased risk of obesity during adolescence.

Features of the course of pregnancy with GDM

The fact of the matter is that the symptoms are not very pronounced, and most women attribute many of the signs of GDM to the pregnancy itself. Complications may arise closer to childbirth. It can be difficult and prolonged childbirth, especially if the fetus is large.

In general, there are no strong differences when setting up a GDM, if everything is detected in time and appropriate measures are taken. In the case of GDM, if appropriate measures are not taken, a woman can gain a lot of weight. Also, the child will have a lot of weight. Premature birth may be provoked.

Treatment Methods

As such, there is no drug treatment, unless the sugar level is sky-high. A slight increase in its level can be controlled by:

• special diet;
• physical activity;
• regular monitoring of blood sugar levels.

A woman is prescribed a strict diet. It is difficult for many to adhere to it, especially during pregnancy, when it is difficult to control their gastronomic desires. But, for the sake of the health of the child and your own, this will have to be done.

Prevention

If there are risks of increased sugar, it is better to take care of this before pregnancy by normalizing your diet. You can do moderate sports, lose weight if you have it. Check your sugar levels in advance and make sure everything is normal.

Otherwise, it should be normalized if possible. And finally, there is no need to make a common mistake during pregnancy when a woman tries to eat for two. It is impossible to sharply increase the volume and calorie content of food consumed.

Gestational diabetes during pregnancy: diet and sample menu

1. You need to eat often 5-6 times a day. But portions, at the same time, should not be too large. They should not be confused with the portions consumed by losing weight non-pregnant women. They shouldn't be too small, but not too big either.
2. Fast carbohydrates should be abandoned, which are easily digested and dramatically increase blood sugar. Such products include flour products, potatoes in any form, sweets and sugary drinks, including natural fruit juices.
3. It is necessary 1 hour after each meal, using a home glucometer to measure the level of glucose.

Sample menu of a pregnant woman with GDM:

1. Breakfast. Oatmeal on the water, whole grain bread and sausage sandwich, herbal tea without sugar.
2. Snack (second breakfast). Baked green apple.
3. Dinner. Boiled lean meat, vegetable salad or soup.
4. afternoon tea. Nuts, low-fat cottage cheese.
5. Dinner. Steamed fish, vegetables, unsweetened tea.

You can experiment with the menu, most importantly, do not forget about prohibited foods, count calories.

Childbirth and GDM

As noted above, GDM can lead to complications during childbirth. They may be premature. Although there are cases when a woman overwears. The large weight of the child, which is also a consequence of GDM, further complicates the birth process.

In some severe cases, when it is clear that natural childbirth is impossible or dangerous, a decision is made to perform a caesarean section.

A type of diabetes that occurs exclusively in women during pregnancy. After childbirth, after some time, 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 lot of difficulties and unpleasant consequences).

Every woman with the onset of pregnancy becomes 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 detected 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 results of the tests showed more than two such cases, and glucosuria (sugar in the urine) or hyperglycemia (sugar in the blood) are found not after eating (which is considered normal), but on an empty stomach in the tests, then we can already talk about gestational diabetes of the pregnant woman.

Causes of gestational diabetes, its risk and symptoms

According to statistics, about 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 diseases (for example,),
• with pregnancy and childbirth after the age of 30,
• with previous births accompanied by gestational diabetes mellitus.

There can be several reasons for the occurrence of GDM, but this is mainly due to a violation of loyalty to (as in type 2 DM). 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 glucose levels (insulin resistance).

The "opposition" of placental hormones to insulin usually occurs at 28-36 weeks of gestation and, as a rule, this is due to a decrease in physical activity, which is also explained by 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,
• discomfort from frequent urination,
• possible increase in blood pressure,
• blurred vision (blurred vision).

If at least one of the above symptoms is present, or you are at risk, then be sure to inform your gynecologist about this 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 must 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 normal life .

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.

With doubtful results (i.e., a slight increase), a glucose load test is performed (5 minutes after the test, 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, GDM that manifests itself 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” of the fetus, the symptoms of which are associated with a violation of its development.

The most common symptom of DF deviation in GDM is macrosomia - an increase in the size of the fetus in weight and height. This happens due to the large amount of glucose supplied for the development of the fetus. The pancreas of the child, which is not yet fully developed at this moment, already produces its own insulin in excess, which processes the excess sugar into fat. As a consequence of this, with normal sizes of the head and limbs, there is an increase in the shoulder girdle, heart, liver, abdomen, and the fat layer is expressed. And what are the implications of this:

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

Another symptom of DF is a violation of the breathing of the newborn after childbirth. 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 (couveuse) under constant control, and if necessary, they can even carry out artificial respiration using a lung ventilator.

Treatment and prevention of gestational diabetes mellitus

As we have already said, the main cause of GDM is an increase in sugar, and therefore the treatment, as well as the prevention of the disease, is based on the control of 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 (weight loss), but to normalize glucose levels. And here it is important to eat less high-calorie, but at the same time nutritious food. And this means:

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

In addition, the expectant mother will be useful:

• special classes,
• hiking in the fresh air away from the roadway.

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

A pregnant woman is sometimes diagnosed with gestational diabetes, which backfires on the baby. The disease occurs even in people with excellent health who have not previously experienced problems with high blood glucose. It is worth learning more about the signs of diseases, provoking factors and risks to the fetus. Treatment is prescribed by a doctor, and its results are carefully monitored until delivery.

What is gestational diabetes

Otherwise, diabetes mellitus in pregnancy is called gestational diabetes (GDM). It occurs during gestation, it is considered "prediabetes". This is not a full-fledged disease, but only a predisposition to intolerance to simple sugars. Gestational diabetes in pregnancy is considered to be an indicator of the risk of presenting type 2 disease. The disease may disappear after the birth of the baby, but sometimes it develops further. To prevent it, prescribe treatment and a thorough examination of the body.

The cause of the development of the disease is considered to be a weak response of the body to its own insulin produced by the pancreas. Violation appears due to a failure of the hormonal background. The risk factors for gestational diabetes are:

• overweight, metabolic disorders, pre-obesity;
• hereditary predisposition to general diabetes mellitus in the population;
• age after 25 years;
• previous births ended with the birth of a child from 4 kg in weight, with broad shoulders;
• had a history of GDM;
• chronic miscarriage;
• polyhydramnios, stillbirth.

Impact on pregnancy

The impact of diabetes on pregnancy is considered negative. A woman suffering from the disease is at risk of spontaneous abortion, late gestational toxicosis, infection of the fetus and polyhydramnios. GDM during pregnancy can affect the health of the mother in the following ways:

• development of hypoglycemic deficiency, ketoacidosis, preeclampsia;
• complication of vascular diseases - nephro-, neuro- and retinopathy, ischemia;
• after childbirth, in some cases, a full-fledged disease appears.

What is the danger of gestational diabetes for a child

No less dangerous are the consequences of gestational diabetes for the child. With an increase in sugars in the maternal blood, the growth of the child is observed. This phenomenon, coupled with overweight is called macrosomia, occurs in the third trimester of pregnancy. The size of the head and brain remains normal, and large shoulders can cause problems with the natural passage through the birth canal. Violation of growth leads to early childbirth, trauma to the female organs and the child.

In addition to macrosomia, leading to immaturity of the fetus and even death, GDM has the following consequences for the child:

• congenital malformations of the body;
• complications in the first weeks of life;
• risk of first degree diabetes;
• morbid obesity;
• respiratory failure.

Sugar levels for gestational diabetes in pregnant women

Knowing the norms of sugar in gestational diabetes in pregnant women can help prevent the development of a dangerous disease. Doctors recommend that women at risk constantly monitor the concentration of glucose - before eating, after an hour after. Optimal concentration:

• on an empty stomach and at night - at least 5.1 mmol / liter;
• after an hour after eating - no more than 7 mmol / l;
• the percentage of glycated hemoglobin is up to 6.

Signs of diabetes in pregnancy

Gynecologists identify the following initial signs of diabetes in pregnant women:

• weight gain;
• frequent volumetric urination, the smell of acetone;
• strong thirst;
• fast fatiguability;
• lack of appetite.

If diabetes mellitus in pregnant women is not controlled, then the disease can cause complications with a negative prognosis:

• hyperglycemia - sharp jumps in sugars;
• confusion, fainting;
• high blood pressure, heart pain, stroke;
• kidney damage, ketonuria;
• decreased functionality of the retina;
• slow wound healing;
• tissue infections;
• leg numbness, loss of sensation.

Diagnosis of gestational diabetes

Having identified risk factors or symptoms of the disease, doctors conduct a prompt diagnosis of gestational diabetes. Blood is donated on an empty stomach. Optimal sugar levels range from:

• from a finger - 4.8-6 mmol / l;
• from a vein - 5.3-6.9 mmol / l.

Analysis for diabetes during pregnancy

When the previous indicators do not fit into the norm, a glucose tolerance test is performed for diabetes mellitus during pregnancy. The test includes two measurements and needs to follow the rules for examining the patient:

• three days before the analysis, do not change the diet, stick to normal physical activity;
• the night before the test, it is not recommended to eat anything, the analysis is done on an empty stomach;
• blood is taken;
• within five minutes the patient takes a solution of glucose and water;
• Two hours later, another blood sample is taken.

The diagnosis of manifest (manifested) GDM is made according to the established criteria for the concentration of glucose in the blood according to three laboratory samples:

• from a finger on an empty stomach - from 6.1 mmol / l;
• from a vein on an empty stomach - from 7 mmol / l;
• after taking a glucose solution - over 7.8 mmol / l.

Having determined that the indicators are normal or low, doctors prescribe the test again in the period of 24-28 weeks, because then the level of hormones increases. If the analysis is carried out earlier, GDM may not be detected, and later, complications in the fetus can no longer be prevented. Some doctors conduct a study with different amounts of glucose - 50, 75 and 100 g. Ideally, a glucose tolerance analysis should be done even when planning conception.

Treatment of gestational diabetes in pregnant women

When laboratory tests show GDM, treatment for diabetes mellitus during pregnancy is prescribed. The therapy is:

• proper nutrition, dosing of carbohydrate foods, increasing proteins in the diet;
• normal physical activity, it is recommended to increase it;
• constant glycemic control of blood sugars, ketone breakdown products in the urine, pressure;
• with chronic elevated sugar concentration, insulin therapy is prescribed in the form of injections, in addition to it, other drugs are not prescribed, because sugar-lowering pills negatively affect the development of the child

At what sugar is insulin prescribed during pregnancy

If gestational diabetes during pregnancy is prolonged, and sugar does not decrease, insulin therapy is prescribed to prevent the development of fetopathy. Insulin is also taken with normal sugar readings, but with the detection of excessive fetal growth, swelling of its soft tissues and polyhydramnios. Injections of the drug are prescribed at night and on an empty stomach. Find out the exact schedule of admission from the endocrinologist after consultation.

Diet for gestational diabetes in pregnancy

One of the points of treatment for the disease is a diet for gestational diabetes, which helps to maintain normal sugar. There are rules on how to reduce sugar during pregnancy:

• exclude sausages, smoked meats, fatty meat from the menu, give preference to lean poultry, beef, fish;
• culinary processing of food should include baking, boiling, using steam;
• eat dairy products with a minimum percentage of fat, give up butter, margarine, fatty sauces, nuts and seeds;
• without restrictions it is allowed to eat vegetables, herbs, mushrooms;
• eat often, but little, every three hours;
• daily calorie content should not exceed 1800 kcal.

Childbirth with gestational diabetes

In order for delivery in gestational diabetes mellitus to be normal, you need to follow the doctor's instructions. Macrosomia can become a danger for a woman and a baby - then natural childbirth is impossible, a caesarean section is prescribed. For a mother, childbirth in most situations means that diabetes mellitus during pregnancy is no longer dangerous - after the placenta (an irritating factor) is released, the danger disappears, and a full-fledged disease develops in a quarter of cases. One and a half months after the birth of the baby, the amount of glucose should be measured regularly.

Video: gestational diabetes during pregnancy