Diabetes mellitus and preeclampsia during pregnancy symptoms. How gestational diabetes mellitus occurs during pregnancy: consequences, risks for the fetus. Sample menu for a day

Gestational diabetes is a type of disease that only occurs in pregnant women. Its appearance is explained by the fact that in the body future mother there is a violation of the metabolism of carbohydrates. Pathology is often diagnosed in the second half of the term.

How and why gestational diabetes mellitus occurs during pregnancy

The disease develops due to the fact that the female body lowers the perception of tissues and cells to their own insulin.

The reason for this phenomenon is called an increase in the level of hormones in the blood, which are produced during pregnancy.

During this period, sugar decreases due to the fact that the fetus and the placenta need it.

The pancreas starts producing more insulin. If it is not enough for the body, then gestational diabetes mellitus develops during pregnancy.

In most cases, after the birth of a child, a woman returns to normal.

Studies in the United States show that 4% of pregnant women develop the condition.

In Europe, this figure ranges from 1% to 14%.

It is worth noting that in 10% of cases, after the birth of a baby, signs of pathology turn into type II diabetes mellitus.

Consequences of GDM during pregnancy

The main danger of the disease is too large a fetus. It can be from 4.5 to 6 kilograms.

This can lead to difficult childbirth, during which it will be required. Larger children further increase the risk of obesity.

To even more dangerous consequences with diabetes mellitus in pregnant women, an increased risk of development can be called.

This complication is characterized by high blood pressure, a large number, and swelling.

All this poses a threat to the life of the mother and child. Sometimes doctors have to call.

If the fetus is overweight, respiratory failure may develop, and muscle tone decreases. Also, the sucking reflex is suppressed, edema, jaundice appear.

This condition is called diabetic fetopathy. It can lead in the future to heart failure, to a lag in mental and physical development.

What Causes Gestational Diabetes

There is a high probability of the appearance of this disease in women with:

• extra pounds;
• violations carbohydrate metabolism;
• diseases of the cardiovascular system;
• heavy;
• carrying twins or triplets;
• GDM in previous pregnancies.

The age of the expectant mother also affects the development of the disease. Most often it occurs in women over 30 years of age. Diabetes in one of the parents can also become the cause of the formation of pathology.

The birth of a previous child can also affect the formation of pathology. The fetus could be overweight, stillborn.

Chronic miscarriage of previous pregnancies may also be reflected.

Diagnosis of the disease

The diagnosis of gestational diabetes mellitus during pregnancy indicates that blood glucose levels were normal before conception.

Symptoms

There are no main symptoms of gestational diabetes mellitus during pregnancy.

The disease can manifest itself and frequent urination. But you should not rely too much on these symptoms.

Laboratory indications

For a glucose tolerance test, blood is taken several times over a couple of hours. Next, a study is carried out using a solution of 50, 75 or 100 grams of glucose.

When carrying a child, a woman on an empty stomach should have 5.1 mmol / l. An hour after eating - 10 mmol / l. And after two - 8.5 mmol / l.

If the indicator is higher, then the diagnosis is made - gestational diabetes mellitus during pregnancy.

After detecting the disease, you will need to monitor the pressure and kidney function.

To check if there is a violation, additional and are prescribed.

Your doctor may advise you to buy a blood pressure monitor to measure your blood pressure at home.

Principle of GDM Treatment in Pregnant Women

At the first signs of gestational diabetes during pregnancy, the main treatment is prescribed - a diet.

If necessary, then it is supplemented with insulin injections. The dose is calculated individually.

With this disease, mainly doctors prescribe.

If a disease is detected, an endocrinologist and a nutritionist should monitor the patient. If she has psychological outbursts, consultations with a psychologist will not be superfluous.

It is important to remember not to take medications that lower sugar.

Diet and daily routine during pregnancy with GDM

During the diet, there is a decrease in the calorie content of the diet.

You need to eat 5-6 times in small portions or consume the main portions 3 times a day, making snacks 3-4 times between them.

The main dishes are soups, salads, fish, meat, cereals, and snacks include vegetables, fruits, various desserts or low-fat dairy products.

When choosing food products, the expectant mother needs to make sure that her baby receives the necessary trace elements for his development. Therefore, if a pregnant woman herself decided to make a menu, then she should study the information on how people with type 1 and type 2 diabetes eat.

During the diet, carbohydrates should be replaced with proteins and healthy fats.

For the entire period of bearing the baby, it is necessary to exclude sweets, bread, buns, pasta and potatoes from the diet. You should also give up rice and some types of fruits.

Dishes must be simple. This will help avoid overloading the pancreas.

Try to eat as little fried foods, canned foods, and everyone's favorite fast foods as possible. It is worth giving up semi-finished products.

Calories per day

Usually this is 35-40 calories per kilogram of a woman's weight. For example, if its weight is 70 kg, then the norm will be 2450-2800 kcal.

It is advisable to keep a food diary throughout the entire period. This can track at the end of the day whether the rate has been exceeded.

If there is a feeling of hunger between meals, then it is worth drinking water in small sips. At least 2 liters of regular water should be drunk every day.

The course of labor and postpartum control in GDM

Type 1 and type 2 diabetes are not contraindications to labor, therefore, delivery without problems occurs with GDM.

The risk is only an overly large fetus, which may require a cesarean section.

Spontaneous childbirth is allowed if the situation has not worsened in the last 24 hours.

Only in the event that there is no natural or the pregnant woman oversteps the due date.

After birth, the baby may have low level blood sugar. It is compensated by nutrition.

Medication treatment is often not required.

For some time, the child is under the supervision of doctors. This is necessary to determine if there is a violation due to a glucose malfunction in the mother.

Usually, after the placenta leaves, the woman's condition returns to normal. There are no jumps in blood glucose levels. But all the same, during the first month, you need to adhere to the diet that was before the birth of the child.

It is better to plan the next birth only after a couple of years. This will help the body to recover and prevent the occurrence of serious pathologies.

Before conception, it is worth undergoing an examination and telling the gynecologist about GDM during the first pregnancy.

The appearance of this disease while carrying a child suggests that the woman has poor insulin sensitivity. This increases the risk of developing diabetes and vascular pathologies after childbirth. Therefore, it is important to engage in disease prevention.

After giving birth at 6-12 weeks, you need to take the sugar test again. Even if it is normal, then in the future it should be checked every 3 years.

Video: gestational diabetes during pregnancy

While expecting a baby, a woman regularly comes to the clinic and takes tests: changes are taking place in the body of the expectant mother, which doctors should keep under control. Sometimes a high sugar content is found in the blood of a pregnant woman. The patient herself does not notice a sharp deterioration in well-being, so she is surprised when the doctor, after an additional examination, diagnoses gestational diabetes mellitus. “Probably a mistake” - comes to mind of the expectant mother, who has never encountered diabetes before. But as a rule, the diagnosis is correct, and the woman must be explained: she must act immediately, otherwise the baby will suffer. The disease is dangerous primarily for the fetus.

When does gestational diabetes mellitus occur?

An autoimmune disease, in which metabolism is disturbed, carbohydrates stop being properly absorbed and broken down, is called diabetes mellitus. There are two types of diabetes, but sometimes the list is supplemented with two more. The result is:

1. Type 1 diabetes. In the pancreas, for some reason, endocrine cells that produce insulin die. Without the hormone that is responsible for the absorption of glucose, this simple sugar builds up unhindered in the blood. Affects mainly those who are under 30. The disease is chronic.
2. Type 2 diabetes. There is enough insulin, but the cells of the body lose their sensitivity to it, so the hormone loses its role as a "regulator" of glucose in the blood. More common in those over 50. Chronic pathology.
3. Secondary diabetes mellitus. It occurs against the background of other diseases - infections, disorders in the work of organs and systems. Failure in carbohydrate metabolism manifests itself as a symptom, and then develops into an independent disease.
4. Gestational diabetes mellitus. An increase in blood glucose concentration, which is characteristic exclusively of pregnancy, is recognized as a type of diabetes and is called gestational.

Gestation is another name for pregnancy, from the Latin gestare - "to carry in oneself." Unlike other types of diabetes, the one that occurs during the gestation of a fetus goes away on its own. After childbirth, as a rule, the symptoms disappear, but if the disease is started, it will have time:

• cause irreparable harm to the child;
• further provoke the development of type 2 diabetes in the mother.

When the first blood or urine tests of a pregnant woman show a high sugar content, it is early to panic: for expectant mothers, such results are considered the norm. If the glucose level is high and on repeated tests, there is cause for concern. When the following tests do not reveal a drop in blood sugar, the doctor most likely diagnoses gestational diabetes mellitus - GDM.

Causes of the disease

The mechanism of the onset of GDM is associated with the new role of female hormones. Estrogen, lactogen and cortisol protect the fetus in the placenta. However, these hormones are insulin antagonists; stimulate the release of glucose into the blood. If earlier insulin, which the pancreas produces, regulated the flow of glucose, now the process cannot be controlled: hormones stubbornly "push" the monosaccharide into the blood. The pancreas is working hard, producing 3 times more insulin than before pregnancy, but still not enough to "bind" excess sugar.

Medical statistics say: gestational diabetes mellitus overtakes four pregnant women out of a hundred (according to some reports, ten out of a hundred). At risk are expectant mothers who give birth after 30 years and have diabetics among close relatives.

Hormonal changes occur in the body of every woman expecting a child, however, fortunately, GDM is diagnosed in only a few. Normally, the pancreas of a pregnant woman is still able to supply the required amount of insulin, which will not allow glucose to "roam". The following factors are capable of pushing the rise in blood sugar levels and, consequently, the development of gestational diabetes:

There is an opinion that GDM occurs more often in some ethnic groups than in others. The risk group is made up of indigenous women from Asia, Africa, Latin America.

Threats to mother and unborn child

“GDM is not eternal, it will disappear after childbirth” - this is how many expectant mothers calm themselves and are in no hurry to start treatment. Big mistake.

Consequences for a pregnant woman

In 10-15% of cases, after the birth of a child, a mother who has survived gestational diabetes mellitus develops the disease into a chronic stage - type 2 diabetes. As a rule, this is the "disease of the elderly"; the more unpleasant it is for a young woman to receive it. Long-term health effects are depressing. Among them:

Sometimes nephropathy affects a woman already during pregnancy: changes in the composition of the blood (constantly high glucose levels) have a detrimental effect on the kidney tissue. The main danger is that pathology initially develops without symptoms. And only then the woman notices that she has:

• limbs swell, bags form under the eyes;
• dyspnea;
• general weakness;
• nausea, vomiting.

In the early stages, nephropathy can be cured. But due to the fact that it is difficult to recognize the disease, therapy is often delayed. The bottom line is sad: nephropathy in a late stage forces you to terminate the pregnancy. Too much when carrying a fetus depends on the kidneys, which are no longer able to cope with their tasks.

Risks to the baby

Mom's gestational diabetes rarely appears in the 1st trimester of pregnancy. However, if it nevertheless occurs in the early stages, the consequences may include:

• risk of miscarriage;
• congenital defects in the unborn child: as a rule, the brain and the cardiovascular system are affected.

At 28–36 weeks of gestation, the opposition between female hormones and insulin reaches a maximum. GDM, as a rule, approaches the expectant mother at this very time, under the influence of a malfunction of carbohydrate metabolism. Along with diabetes, the threat of diabetic fetopathy increases, in other words, the effect of "feeding" the fetus. Glucose is delivered in excess from the mother's blood, and the baby's pancreas, having barely formed, is already working in an enhanced mode, converting excess sugar into fat. Eventually:

Diabetic fetopathy rarely passes without a trace: even with a successful delivery, the baby develops neurological disorders, the child lags behind in physical development.

How to recognize gestational diabetes

The disease is not distinguished by vivid symptoms. Happens clinical picture so smeared that the expectant mother feels the same as before and does not suspect about diabetes. If there are weak negative sensations, it is attributed to pregnancy. Indeed, one can be mistaken: the GDM seems to be “disguised” as an “interesting position”. Here are the signs of the disease:

• constant thirst, when quenched as a result - frequent urge to urinate;
• nausea, vomiting;
• increased blood pressure;
• slowly overgrowing wounds;
• inflammation in the genitourinary system (candidiasis and others);
• weight loss against the background of an increase in appetite;
• sometimes the appetite suddenly disappears;
• feeling of numbness or tingling in the limbs;
• constant fatigue;
• decreased visual acuity.

In fact - either diabetes, or pregnancy with normal sugar levels. When several symptoms appear at once, this is already a reason to visit a gynecologist. Only a thorough examination of a woman will reveal the disease with one hundred percent accuracy.

Diagnostics

If you suspect you have hereditary diabetes or have had GDM before, be sure to tell your doctor. Most likely, you will have to go to an endocrinologist and take an unscheduled test for GDM. And the examination according to the plan for expectant mothers is carried out at 24-28 weeks. The task of the test is to find out how the pregnant woman's body copes with the absorption of glucose.

You will have to take tests on an empty stomach. The order of actions of doctors:

1. Blood is taken from the patient from a vein. The received data becomes the original.
2. The woman is given a liquid to drink in which 50 grams of sugar has been dissolved.
3. After 1 hour, blood is taken again.
4. After 2 hours, final blood sampling.

It would seem - why such difficulties, and for the patient, in addition, unpleasant sensations? Let us analyze the results obtained as an example. If there is no GDM, a blood test will show:

1. The initial blood sampling is the amount of sugar 5.49 mmol / L (millimole per liter).
2. Blood sampling after taking sweet liquid - 11.49 mmol / l.
3. The last intake is 7.79 mmol / l.

That is, the body, having received sweet, first threw out glucose into the blood, and then a natural decrease occurred. Means, insulin knows its business. When the pancreatic hormone does not cope with the task and the patient develops GDM, the analysis will show:

1. Initial blood sampling is 5.49–6.69 mmol / l.
2. The next one, after taking the syrup, is less than 11.09 mmol / l.
3. The third intake is more than 11.09 mmol / l.

It can be seen that the syrup provoked a stable rise in blood sugar; over time, the indicator goes further and further from the norm - which means that glucose is poorly absorbed.
A test that determines glucose tolerance allows you to accurately diagnose GDM

Mistakes are not excluded: a woman came for tests, having a light snack or being very worried - which does not happen. To confirm the diagnosis, the endocrinologist will prescribe a second procedure - in 10-12 days.

A routine blood sugar test is also done on an empty stomach. A glucose level above 7.1 mmol / L gives reason to suspect GDM.

If sugar is found in urine during pregnancy, there is practically no doubt that a woman has gestational diabetes. Moreover, it is neglected, since the kidneys can no longer cope with their tasks.

How to treat GDM

Strict control over sugar levels, elimination of the reasons for its increase - these are the principles of therapy for gestational diabetes. It is recommended that expectant mothers buy a blood glucose meter and use the device 4-6 times a day:

1. On an empty stomach.
2. An hour after eating.

Visits to the polyclinic for testing are also a mandatory measure. As for medications, only insulin is allowed during pregnancy, moreover, only if other methods of dealing with diabetes turned out to be useless. Insulin therapy is entirely under the supervision of the attending physician: it prescribes the dosage and determines the duration of the course. The drug is administered by injection, disposable syringes are used.

Moving on to proper nutrition

Diet takes the first place in the treatment of GDM. It is important for a woman to remember: food restrictions are needed not in order to lose excess weight, but to restore normal glucose levels in the body. You should choose low-calorie, but nutritious foods; then the fetus will not suffer from a lack of nutrients.

Strongly exclude from the menu:

• confectionery, baked goods - due to the abundance of easily digestible carbohydrates;
• some fruits - bananas, grapes, persimmons - as they contain "light" carbohydrates;
• butter;
• fatty sauces;
• smoked meats;
• sausages, wieners;
• pork;
• mayonnaise;
• semi-finished products;
• food fast food- soups, cereals, noodles.

Actively include in the diet:

• foods high in fiber - cereals, rice, whole grain bread, legumes;
• lean meat - chicken, rabbit, also lean beef;
• fish;
• vegetables with "correct" carbohydrates - carrots, broccoli, pumpkin;
• cucumbers, tomatoes;
• cabbage;
• zucchini;
• Bulgarian pepper (little by little, because it is sweet);
• citrus fruits (if there is no allergy).

Photo Gallery: Products for Women with GDM

It is recommended to remove the skin from boiled chicken, in which there is a lot of fat Fish is a source of polyunsaturated fatty acids, protein, vitamin D, which are necessary for the expectant mother Broccoli cabbage is rich in carbohydrates, but they are not easily digestible and are not prohibited for GDM Oranges contain many vitamins, but with pregnancy citrus fruits are eaten with care Oz salad of cucumbers and tomatoes will perfectly complement the dinner of the expectant mother, who controls her weight

Choosing products is half the battle. To lower blood glucose levels, you will have to eat, observing the following norms:

• avoid fried foods, prefer boiled, stewed, baked food;
• sit at the table 3 times a day, at the same time, you can have a snack twice between main meals;
• a serving on a plate should not exceed 200-250 grams;
• if you feel sick in the morning, you can eat a few crackers.

Do not disdain arithmetic: patiently count the number of calories in your daily diet, find out the ratio of nutrients. Here is the norm:

• proteins - 20-25%;
• fats - 35-40%;
• carbohydrates - 35%.

Remembering physical education

To lie in bed and suffer the right way aggravate your condition and, in addition, gain even more kilograms. Reasonable physical exercise on the contrary, it will alleviate the symptoms of GDM because:

• individual muscles that do not depend on insulin consume glucose during warm-up, thereby helping to reduce its level;
• metabolism improves;
• the general tone of the body rises, the mood rises.

Of course, exercises for the press will have to be excluded, since the load on the abdomen during pregnancy is unacceptable. Avoid sudden movements as well. Suitable for expectant mothers:

• light gymnastics;
• walking;
• swimming, exercise in water.

A set of exercises for pregnant women will be advised by a specialist in physiotherapy exercises in the clinic or in courses for pregnant women.

Exercise 3 times a week, 20 minutes - that's enough. You can walk in the fresh air, away from the roadway, without restrictions.

How to give birth with gestational diabetes

If the condition of the expectant mother is severe or complications in the fetus are noticeable, they resort to early birth - as a rule, at the 37th week of pregnancy. In other cases, the best time for delivery is the 38th week: the baby's lungs are already formed, and there are no risks of breathing disorders.

During childbirth, a woman's sugar level is checked every 2-3 hours. Since this level jumps, prompt measures are needed, therefore, with an increase, insulin is injected, with a decrease - glucose. The child's breathing and heartbeat are closely monitored. In emergency situations, a caesarean section is performed.

A large baby, with large shoulders and a stomach, when passing through the birth canal, can injure his mother, and he himself will get dislocations. In such cases, caesarean is also possible.

If the mother has GDM, the newborn is born with low glucose levels, but when feeding breast milk or mixtures of sugar returns to normal.

After leaving the body of the placenta, which produced hormones "hostile" to insulin, the amount of sugar returned to normal in the mother. It could be called a happy ending, if not for possible complications in those with advanced diabetes.

Video: a doctor about the diagnosis and treatment of GDM

We reduce the risks of the appearance of GDM

The disease does not recognize logic and often appears in healthy women, bypassing those at risk. Therefore, precautions are needed for every expectant mother. Here are some:

• Monitor your glucose levels, get tests regularly.
• Avoid excess weight gain.
• Eat right.
• Stay physically active.

If a woman has already dealt with GDM during a previous pregnancy, even tighter blood sugar control is needed. And after giving birth, keeping in mind the possibility of type 2 diabetes, medications that cause insulin resistance should be avoided, for example:

• nicotinic acid;
• prednisone.

Pregnancy means a drastic change in the balance of hormones. And this natural feature can lead to the fact that the components secreted by the placenta prevent the mother's body from perceiving insulin. The woman has an abnormal blood glucose concentration. Gestational diabetes mellitus during pregnancy occurs more often from the middle of the term. But his earlier presence is also possible.

Read in this article

Reasons for the development of diabetes in pregnant women

Experts cannot name the obvious culprit for the violation of tissue response to glucose in expectant mothers. Undoubtedly, hormonal changes are not the least important factor in the development of diabetes. But they are common for all pregnant women, and, fortunately, not everyone is diagnosed with the disease in this position. Those who transferred it noted:

• Hereditary tendency. If the family has cases of diabetes, there is also a higher probability of its occurrence in a pregnant woman in comparison with others.
• Autoimmune diseases that, due to their characteristics, disrupt the function of the insulin-producing pancreas.
• Frequent viral infections. They can also upset the function of the pancreas.
• Passive lifestyle and high-calorie food... They lead to overweight, and if it existed before conception, the woman is at risk. This also includes those whose body weight increased by 5-10 kg in adolescence in a short time, and its index became above 25.
• Age from 35 years. Those who are under 30 at the time of pregnancy are less likely to get gestational diabetes than others.
• Past birth of an infant weighing more than 4.5 kg or a stillborn child for unknown reasons.

Women of Asian or African descent are more prone to diabetes during pregnancy than European women.

Signs for Suspecting Gestational Diabetes

On early stage diabetes mellitus during pregnancy practically does not show symptoms. This is why it is important for expectant mothers to control the concentration of sugar in the blood. Initially, they may notice that they began to drink a little more water, have lost a little weight, although there is no apparent reason for losing weight. Some find that they find it more pleasant to lie or sit than to move.

With the development of malaise, a woman may feel:

• The need for a large amount of fluid. Despite her satisfaction, dry mouth worries.
• The need to urinate more often, while the fluid comes out much more than usual.
• Increased fatigue. Pregnancy already takes a lot of energy, and now a woman's desire to take a break arises faster than before, with diabetes her self-awareness does not correspond to the load received.
• Deterioration in the quality of vision. Clouding may periodically appear in the eyes.
• Itchy skin, mucous membranes may also itch.
• A significant increase in the need for food and a rapid increase in weight.

The first and last signs of diabetes during pregnancy are difficult to separate from the diabetes itself. Indeed, in healthy women expecting babies, appetite and thirst often increase.

How to get rid of diabetes during pregnancy

In the first stage of development, gestational diabetes is treated by streamlining the lifestyle and. It becomes indispensable to control the quantitative glucose content on an empty stomach, as well as 2 hours after each meal. Sometimes a blood sugar measurement may be required before it.

You will need to do a urinalysis periodically. This is necessary to make sure that there are no ketone components in the liquid, that is, the containment of pathological processes.

Diet and physical activity are key at this stage.

Nutrition for gestational diabetes

it is impossible for a pregnant woman, the fetus must have everything it needs, and sugar grows from lack of food. The expectant mother will have to adhere to healthy eating principles:

• Portions should be small and meals frequent. If you eat 5-6 times a day, you can maintain an optimal weight.
• The largest amount of slow carbohydrates (40 - 45% of the total food) should come from breakfast. These are cereals, rice, pasta, bread.
• It is important to pay attention to the composition of the products, putting off sugary fruits, chocolate, pastries until better times. Fast food and sunflower seeds excluded. We need vegetables, cereals, poultry, rabbit. Fat must be removed; no more than 10% of the total amount of food should be eaten per day. Fruits, berries, and also greens that do not contain a large amount of sugar will be useful.
• Do not eat instant food. Having the same names as natural, they contain more glucose. We are talking about freeze-dried cereals, mashed potatoes, noodles.
• Food should not be fried, only boiled or steamed. If stewed, then with a small amount of vegetable oil.
• You can fight morning sickness with dry, unsweetened cookies. It is eaten in the morning without getting out of bed.
• Cucumbers, tomatoes, zucchini, lettuce, cabbage, beans, mushrooms can be eaten in large quantities. They are low in calories and their glycemic index is low.
• Vitamin and mineral complexes are taken only on the recommendation of a doctor. Many of them contain glucose, the excess of which is now harmful.

Water with this style of food should be drunk up to 8 glasses a day.

Medicines

If changes in diet do not work, that is, the glucose level remains elevated, or the urine test is poor with normal sugar, insulin will have to be administered. The dose in each case is determined by the doctor, based on the patient's weight and the duration of pregnancy.

Insulin is given intravenously, usually in two divided doses. The first is injected before breakfast, the second before dinner. The diet with drug therapy is maintained, as is the regular monitoring of the concentration of glucose in the blood.

Physical exercise

Physical activity is needed, regardless of whether the rest of the treatment is limited to a diet or the pregnant woman is injecting insulin. Sport helps to spend excess energy, normalize the balance of substances, and increase the effectiveness of the hormone that is missing in gestational diabetes.

The movement should not be to the point of exhaustion, it is necessary to exclude the possibility of injury. Walking, exercise in the gym (except for swinging the press), swimming are suitable.

Prevention of gestational diabetes

For women at risk, the specialist will explain the dangers of gestational diabetes during pregnancy. Pathology in the mother creates many threats to her and the fetus:

• On early term increases the likelihood. With gestational diabetes, a conflict is created between her body and the fetus. He seeks to reject the embryo.
• Thickening of the placenta vessels due to gestational diabetes leads to circulatory disorders in this area, therefore, a decrease in the supply of oxygen and nutrients to the fetus.
• Having arisen from 16 to 20 weeks, the ailment can lead to defective formation of the cardiovascular system and the fetal brain, stimulate its excessive growth.
• Childbirth may start ahead of time. And the large size of the fetus forces a cesarean section. If the birth is natural, it will create a risk of injury to the mother and baby.
• A newborn baby may be at risk of jaundice, respiratory distress, hypoglycemia, and increased blood clotting. These are signs of diabetic fetopathy, which causes other pathologies in a child in the postnatal period.
• A woman is more likely to develop preeclampsia and eclampsia. Both problems are dangerous with high blood pressure, seizures, which during childbirth can kill both the mother and the baby.
• Subsequently, the woman has an increased risk of developing diabetes mellitus.

For these reasons, prevention of the disease is needed at an early stage, which includes:

• Regular. It is important to register early, do all the necessary tests, especially when you are in a risk group.
• Maintaining optimal body weight. If she was more than normal before pregnancy, it is best to lose weight first and plan later.
• . High pressure may indicate a tendency to increase sugar and stimulate it.
• To give up smoking. Habit affects the function of many organs, including the pancreas.

A woman with gestational diabetes is quite capable of giving birth to more than the only healthy child. It is necessary to identify pathology in time and make efforts to contain it.

Gestational diabetes mellitus in pregnancy (GD)- a type of diabetes that occurs in women due to hormonal disorders in the third trimester. As a result, blood sugar rises after a meal and decreases on an empty stomach.

Pathology poses a threat to the child, since it can provoke the onset of congenital diseases.

To prevent this from happening, at 24-28 weeks a woman is recommended to be tested for gestational diabetes, and in case of diagnosing a disease, adhere to certain dietary and lifestyle rules. In some cases, drug therapy is required, which can only be prescribed by a doctor.

Gestational diabetes has been assigned an ICD code 10 - O 24.

The causes of gestational diabetes in pregnant women have not been established. However, more and more experts are inclined to believe that pathology develops against the background of hormonal disruption. As a result, hormones block insulin production. However, the body cannot allow such a situation, since mother and baby need glucose for the normal functioning of organs and systems. As a result, there is a compensatory increase in insulin synthesis. This is how gestational diabetes develops.

Autoimmune pathologies are one of possible reasons occurrence of HD. Such diseases negatively affect the condition of the pancreas. As a result, there is a decrease in insulin synthesis.

At-risk groups

There are factors that increase the risk of HD:

• Obesity.
• Nationality. Scientists have proven that some nationalities suffer from gestational diabetes more often than others. These include Blacks, Asians, Hispanics, and Native Americans.
• Increased concentration of glucose in the urine.
• Violation of the body's tolerance to glucose.
• Genetic disposition. If someone in the family suffered from this pathology, then there is a possibility that such a disease will be diagnosed in a woman.
• Previous childbirth, if the baby's weight exceeded 4 kg.
• The previous pregnancy was accompanied by gestational diabetes.
• A large amount of amniotic fluid.

Symptoms

There are some signs that indirectly indicate the occurrence of gestational diabetes:

If these symptoms are ignored and do not consult a doctor, then the disease will progress and the following symptoms will appear:

• confusion of consciousness;
• fainting;
• increased blood pressure;
• pain in the region of the heart, which can ultimately lead to a stroke;
• problems with kidney function;
• deterioration of vision;
• slow healing of wounds on the epidermis;
• numbness of the lower extremities.

Diagnostics

A blood test is given to diagnose gestational diabetes. For the result to be reliable, it is recommended to follow the rules for the delivery of biomaterial:

• three days before the study, it is not recommended to make adjustments to the nutritional system and you should adhere to the usual physical activity;
• blood is donated on an empty stomach, therefore, after dinner and in the morning hours, you cannot eat, as well as drink tea and other drinks, with the exception of clean water without gas.

The analysis is carried out as follows:

• biomaterial is taken from the patient;
• a woman drinks water with glucose;
• after two hours, the biomaterial is collected again.

Analysis indicators

Blood sugar rate:

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

Accordingly, gestational diabetes is diagnosed with the following test indicators:

• from a finger on an empty stomach - above 6.1 mmol / l;
• from a vein on an empty stomach - above 7 mmol / l;
• after drinking water with glucose - above 7.8 mmol / l.

If the study showed normal or low glucose levels, then a second test is prescribed at 24-28 weeks of pregnancy. This is due to the fact that at an early stage, the analysis may show an unreliable result.

Important!

If the study is carried out later than 28 weeks, then the pathology can already cause irreversible harm to the baby.

Views

Diabetes during pregnancy has several types, depending on the time of occurrence:

• prehistory diabetes- this type of diabetes was diagnosed before pregnancy (this type, in turn, is divided into type 1 and type 2 diabetes);

gestational diabetes or pregnancy diabetes.

Gestational diabetes, in turn, has its own classification, depending on the therapy prescribed:

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

Therapy is prescribed, depending on the type of diabetes and the severity of the pathology.

Treatment

How is gestational diabetes treated? There are two main ways - and insulin therapy. Only a physician can determine if a patient's clinical recommendation is required.

Insulin therapy

Insulin therapy is prescribed if if adherence to the diet did not bring the desired result and blood glucose does not return to normal for a long time.

In this case, the introduction of insulin is a necessary measure that prevents the occurrence of fetopathy.

The doctor also prescribes this type of treatment with a normal concentration of sugar, but with a large weight of the baby, with a large amount of amniotic fluid or swelling of soft tissues.

The introduction of the drug is recommended to be done on an empty stomach and before a night's rest. However, the exact dosage and schedule of injections is determined by the doctor, based on the severity of the pathology and the individual characteristics of the patient.
Insulin injections are made with a special syringe. The drug is administered subcutaneously. Usually, a woman performs injections on her own after consulting a specialist.

If you need a higher daily dose of insulin, your doctor may insert a subcutaneous insulin pump.

Diet

The main component of successful therapy of pathology is the observance of certain dietary rules. It helps to normalize blood sugar concentration. Here are the principles of nutrition that are recommended to be adhered to with this type of pathology:

Influence on the fetus

Why is the diagnosis dangerous for the unborn child? Let's figure it out.

Gestational diabetes during pregnancy negatively affects the development of the baby.

If the pathology is diagnosed in the first weeks, then there is a risk of spontaneous miscarriage. The disease can also lead to congenital diseases in the infant.

Most often, the brain and heart are affected by the disease.

If the pathology occurs in the second or third trimester, then this leads to excessive growth of the baby and his weight gain. As a result, after childbirth, the baby's sugar will drop below normal, which can provoke health problems.

If a pregnant woman develops gestational diabetes, but there is no complete therapy, there is a high likelihood of fetal fetopathy.
Such a pathology threatens the child with the following consequences:

• baby weight over 4 kg;
• body imbalances;
• excessive fat deposition in the subcutaneous space;
• swelling of soft tissues;
• breathing problems;
• jaundice;
• problems with blood circulation and blood viscosity.

Childbirth

If a pregnant woman was diagnosed with diabetes mellitus, then for the normal course of labor, the woman must adhere to the doctor's recommendations. With such a pathology, a woman is hospitalized at 37-38 weeks.

Even if labor does not occur, it is artificially induced, but only if the child is considered full-term. This avoids birth trauma.

Natural delivery is not always possible. If the child is too large, then doctors prescribe a cesarean section.

Forecast and prevention

Compliance with the doctor's recommendations for gestational diabetes gives a favorable prognosis for the pregnant woman and the baby. If it is possible to maintain the sugar level at a normal value, then this will enable the woman to bear and give birth to a healthy child.
It is not always possible to avoid the onset of gestational diabetes, but it is still possible to reduce the risk of the onset of the disease.
The following preventive measures will help to do this:

• weight reduction to an acceptable level;
• transition to the principles of proper nutrition;
• rejection of the so-called sedentary lifestyle and increased physical activity, if this does not threaten pregnancy;
• hospitalization on the recommendation of a doctor.

Useful video

Expectant mothers with HD are very often asked a number of questions: what week they give birth with this diagnosis, what to do after childbirth and what postpartum follow-up should be, as well as the consequences for the child.
We have selected for you a video with expert comments, and a video diary of a future mother diagnosed with HD:

Conclusion

If gestational diabetes is diagnosed during the period of gestation, this is not a reason to panic or terminate the pregnancy. Subject to certain principles of nutrition and adherence to the doctor's prescriptions, a woman has every chance to bear and give birth to a healthy baby without a threat to her own health.

Gestational diabetes mellitus during pregnancy is a condition associated with an increase in glucose levels above acceptable values. 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 a meal, 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 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 child's nutrition during this period is carried out 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 unable 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 during gestation, exceeding normal values;
• over 25 years of age;
• 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 contributing to the onset of GDM.

How is gestational diabetes mellitus manifested?

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:

• a rapid increase in body weight 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 the 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 the development of GDM, doctors prescribe additional unscheduled blood sugar tests.

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

Potential consequences of GDM

When this condition is detected, it is necessary to take measures as soon as possible to combat hyperglycemia. 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 caesarean 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 an analysis of fasting and postprandial blood sugar levels.

The listed complications can be prevented only by following the instructions of the attending physician.

Treatment of gestational diabetes mellitus

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 in the 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 a woman. 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.

Women who have been diagnosed with gestational diabetes mellitus, when planning subsequent pregnancies, should take measures to reduce the likelihood of re-developing this pathological condition.

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

Babies 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 advised to follow preventive measures:

1. A diet that excludes easily digestible carbohydrates, restricts the use of fats and salt.
2. Normalization of body weight - it is advisable to do this before the start of 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-drug methods are ineffective, insulin is indicated depending on the amount of carbohydrates consumed.