What does gestational diabetes mean during pregnancy. Gestational diabetes mellitus: what is the danger of a diagnosis during pregnancy for mom and baby

If a diabetes- this is a fairly common and well-known disease, then few people know gestational diabetes during pregnancy. This disease occurs in only four percent of pregnant women, but it is still worth knowing about this disease, since it is very dangerous.

Gestational diabetes and its complications

Gestational diabetes mellitus is a disease caused by a sharp increase in blood sugar levels during the period of childbearing. Such a phenomenon can adversely affect the health of a child growing in the womb. With the development of the disease in the first trimester of pregnancy, there is a high risk of miscarriage. The most dangerous is the fact that during this period, due to the disease, congenital malformations can form in the fetus, most often affecting such vital important organs like the brain and cardiovascular system.

If gestational diabetes mellitus develops in the second trimester of pregnancy, the fetus rapidly gains excessive weight and feeds. This can cause the baby to develop hyperinsulinemia after childbirth, when the baby cannot get the required amount of glucose from the mother. As a result, the level of glucose in the blood of the baby becomes excessively low, which affects his health.

If diabetes mellitus is detected during pregnancy, mandatory medical intervention is required so that the disease does not cause the development of all kinds of complications in the fetus due to uneven intake of carbohydrates in the pregnant woman's body.

A child with such pathologies may experience the following symptoms:

• Excessive size and weight of the baby at birth;
• Uneven distribution of body size - thin arms and legs, a wide stomach;
• Edema on the body and excessive accumulation of body fat;
• Yellowness of the skin;
• Violation of the respiratory tract;
• Low blood sugar in an infant, increased blood density, low levels of calcium and magnesium.

Gestational diabetes and its causes in pregnant women

A pregnant woman during the period of carrying a child experiences all kinds of hormonal changes, which can lead to various disorders and malfunctions in the body. Among these phenomena, there may be a decrease in the absorption of blood sugar by body tissues due to hormonal changes, but it is too early to talk about diabetes.

Gestational diabetes most often appears in the third trimester of pregnancy due to hormonal disorders in a woman's body. During this period, in a pregnant woman, the pancreas begins to produce three times more insulin in order to maintain normal changes in blood sugar levels. If a woman's body cannot cope with such a volume, a pregnant woman is diagnosed with gestational diabetes.

The risk group, as a rule, includes women with certain health indicators. Meanwhile, the presence of all these characteristics cannot assert that a pregnant woman develops gestational diabetes. It is also impossible to say with certainty that this disease will not appear in women who do not have the symptoms listed below.

The following pregnant women are at risk:

• Having increased body weight not only during pregnancy, but also earlier;
• The disease is often detected in people belonging to such nationalities as Asians, Hispanics, blacks, Americans.
• Women with elevated levels of glucose in the urine;
• High blood sugar or prediabetes;
• Women in the family of which there are patients with diabetes mellitus;
• Women giving birth for the second time, whose first baby had an increased birth weight;
• The birth of a dead child during the first pregnancy;
• Women diagnosed with gestational diabetes in their original pregnancy;
• Pregnant women who have polyhydramnios.

Diagnosis of the disease in pregnant women

If any suspicious symptoms are detected, the first thing to do is to consult a doctor who will do the necessary tests and conduct an examination to determine which one.

In addition, all women carrying a child, during the period of 24-28 weeks of pregnancy, undergo a mandatory screening examination to detect possible gestational diabetes. To do this, a blood test is performed to determine the level of sugar in the blood.

After that, you will need to drink sweet water, in which 50 g of sugar is mixed. 20 minutes later, venous blood is taken from the pregnant woman in the laboratory. Thus, the results are compared and it turns out how quickly and fully the body copes with the absorption of glucose. If the figure obtained is 7.7 mmol / l or more, the doctor will prescribe an additional analysis on an empty stomach after the pregnant woman has not eaten for several hours.

Gestational diabetes and its treatment

As with normal diabetes, pregnant women need to adhere to certain rules so as not to harm the unborn child and themselves.

• Every day four times a day it is necessary to carry out a test for the level of glucose in the blood. You need to do the control on an empty stomach and two hours after eating.
• It is important to regularly take urine for analysis in order to prevent the formation of ketone bodies in it, reporting the neglect of the disease.
• Pregnant women are prescribed a special diet and a certain diet.
• Women in position for prevention should not forget about light exercise and fitness for pregnant women;
• It is important to monitor your own weight and prevent weight gain;
• If necessary, pregnant women are given insulin to maintain the body. Women in position are allowed only this method of filling the lack of insulin in gestational diabetes.
• You should regularly monitor your blood pressure and report any changes to your doctor.

Dietary nutrition in case of illness

When gestational diabetes is detected, pregnant women are prescribed a special diet. Only proper nutrition and strict regime help to cope with the disease and carry the child without consequences. First of all, pregnant women should take care of their own weight in order to increase insulin production.

Meanwhile, fasting is contraindicated during pregnancy, so it is important that the fetus receives all the necessary nutrients, pay attention to the nutritional value of foods, but refuse high-calorie foods.

• It is necessary to eat small portions, but often. Standard breakfast, lunch and dinner plus two or three light snacks. In the morning, you need to eat food that is 45 percent rich in carbohydrates. Snacking in the evening should also be food with a carbohydrate content of at least 30 grams.
• It is important to avoid fatty and fried foods as much as possible, as well as foods that contain an increased amount of easily digestible carbohydrates. To put it simply, these are all kinds of flour products, buns, muffins, as well as grapes, bananas, figs, persimmons, and cherries. Such dishes, after being absorbed into the bloodstream, can dramatically increase blood glucose levels, while such foods are practically nutritious and have a high caloric content. To fully cope with their processing, you need a large amount of insulin. Which is missing in diabetes.
• With morning sickness, it is recommended to keep a plate of salted crackers next to the bed. Before you get up, you should eat a few cookies, after which you can safely go to wash.
• It is worth completely abandoning special products for fast food that are sold in shops. They are quickly processed and prepared when you need a quick bite to eat. However, these products have an increased rate of influence after their use on blood sugar levels, compared with natural counterparts. For this reason, do not abuse quick soups, instant mashed potatoes and cereals from bags.
• During pregnancy, it is advisable to eat as many fiber-rich foods as possible. These are fresh fruits, vegetables, rice, cereal dishes, bread and so on. For knocking, you need to eat at least 35 grams of fiber. This substance is useful for any pregnant women, not only diabetic patients. Fiber improves the functionality of the intestines, reducing the flow of excess fat and glucose into the blood. Also, these products contain the necessary minerals and vitamins.
• Saturated fat should make up no more than 10 percent of your total diet. It is advisable to exclude fatty foods altogether, you can not eat sausages, pork, lamb, sausages, smoked meat. You can replace this list of products with lean meats, including kritz, lean beef, turkey, as well as fish meals. You need to cook meat in vegetable oil, by boiling, steaming or baking in the oven. Salo and oily skin must be removed before cooking. Additionally, you need to abandon such fats as margarine, mayonnaise, seeds, cream cheeses, nuts, sour cream.
• In knocking, you must drink at least one and a half liters of any liquid without gases.
• Salads from vegetables will help to replenish the amount of vitamins and not harm health. In any quantity, you can eat tomatoes, radishes, cucumbers, cabbage, lettuce, zucchini. It is best to snack on such products in between breakfast, lunch and dinner. In addition to salads, vegetables can be steamed.
• It is important to ensure that the body and the fetus receive enough minerals and vitamins. To do this, the doctor may prescribe additional vitamin complexes suitable for pregnant women. Also, vitamin tea from rose hips will help maintain the necessary water balance.

If the diet does not help regulate blood glucose levels, the doctor will prescribe an insulin injection.

The impact of the disease on childbirth

After the birth of a child, gestational diabetes in a woman gradually disappears. In diabetes, this disease develops only in 20 percent of cases. Meanwhile, the disease itself can have an adverse effect on the passage of childbirth.

So, often when overfeeding the fetus, a too large child is born. Large sizes can cause problems during labor during labor. Often, the doctor prescribes a caesarean section for pregnant women. If the child is born naturally, there is a risk of injury to the infant's shoulder structure, in addition,

All nine months from the moment of conception of a baby are a rather stressful period in the life of absolutely every woman. With the advent of the fetus in the womb, the mother's body needs more strength and energy. Very often it is during this period that the course of all metabolic processes in the body changes. Moreover, gestational insulin dependence often appears.

Adipose tissue, liver, muscles become less susceptible to the hormone insulin. When adverse conditions occur, blood sugar rises, which very often leads to the appearance of diabetes. This disease, as a rule, is detected during the next examination in the antenatal clinic. For up to 24 weeks, only venous blood is taken for analysis, and in the third trimester a special test is performed -

general information

Gestational diabetes during pregnancy is a rather serious disease that requires a competent approach to treatment. The basis of this disease is the wrong metabolism of carbohydrates, or rather, a decrease in glucose tolerance.

In the United States, studies have been repeatedly conducted on this issue. According to available information, gestational diabetes in pregnant women is diagnosed in 4% of cases. European scientists announced other information. It is known that the prevalence of this disease varies in the range from 1 to approximately 14% of the total number of pregnancies. About 10% of women after childbirth remain with symptoms of this disease, which subsequently transforms into type 2 diabetes.

Such relatively high rates of the prevalence of pathology around the world testify, first of all, to the lack of awareness of women in issues possible consequences this disease. As a result, only a few turn to doctors for qualified help.

What is the risk of diabetes during pregnancy?

Firstly, it is a negative effect on the fetus inside the mother's womb. On the early dates Diabetes can provoke or lead to various kinds of malformations in the development of the baby's brain structures and heart. If the disease has been diagnosed for more than later dates(2-3 trimesters), the likelihood of excessive fetal growth is very high, which entails diabetic fetopathy. The main signs of this pathology are overweight (more than 4 kg), respiratory distress, body imbalances, hypoglycemia.

How is the pregnancy going?

In this case, it is impossible to accurately answer this question, since each case is individual. A woman, as a rule, is hospitalized three times. For the first time at an early stage, she undergoes a full examination, according to the results of which the doctor decides on the preservation and management of the pregnancy, and also prescribes preventive treatment. The second time hospitalization is carried out for a period of 20 weeks, since it is at this time that the first complications may appear. At 32 weeks, the doctor chooses the method and timing of future births.

Who is most susceptible to this disease?

Gestational diabetes mellitus during pregnancy, as a rule, develops in the presence of a genetic predisposition, which is realized under the influence of several factors at once, such as:

Excess body weight;

Inflated level indicators;

Various kinds of disorders of carbohydrate metabolism;

Age (over 30 years old);

Previous toxicosis and gestosis;

Various kinds of disorders in the work of the cardiovascular system;

Chronic miscarriage.

Main reasons

Gestational diabetes in women develops due to a decrease in the usual sensitivity of body cells to their own insulin. This is due to an increase in the level of hormones in the blood, which is very often observed during pregnancy. In addition, in women, glucose levels are rapidly decreasing, since both the fetus and the placenta now need it. The consequence of all the above factors is considered to be a compensatory increase in insulin production directly by the pancreas itself. So, that is why often in the blood of women in position, these indicators are slightly increased. If the pancreas on its own does not cope with its direct duties, namely with the production of the required amount of insulin, gestational diabetes develops.

Symptoms

The increase in sugar levels in this disease is usually insignificant. That is why pronounced signs in pregnant women occur very rarely. In some cases, there is thirst and frequent urination, as well as dry skin. However, all these symptoms are perceived by women as specific features of their situation.

How is the disease confirmed?

Diagnosis of gestational diabetes mellitus involves a blood test for glucose levels and a special glucose tolerance test.

In medicine, two types of GTT are distinguished depending on the method of glucose administration: intravenous and oral. In the second version of the test, the patient is asked to drink a sweetened liquid that contains exactly 50 g of sugar. After 20 minutes, venous blood is taken from her for analysis (the content of glucose in it is determined). If the sugar level exceeds 140 mg/dl, you will also need to pass an intravenous glucose tolerance test.

When conducting this study, it is very important to observe certain conditions. First of all, patients are advised to adhere to the usual rules for five days before the expected date of the test. physical activity and nutrition, however, the carbohydrate content in the diet should exceed 150 g. It is important to remember that blood sampling is carried out only in morning hours and on an empty stomach. The patient is advised to fast for 14 hours before the test. During the study itself, it is better to be in a calm state.

What should be the treatment?

Gestational diabetes during pregnancy is very often complicated by the fact that a woman has to measure her glucose level about four times a day. It is important to note that drug therapy in this case is categorically contraindicated, since it can adversely affect the development of the baby in the womb.

As for the issue of treatment, in this case, experts recommend adhering to a special diet, regularly checking sugar levels. If all of the above tips do not give the desired results, insulin therapy is prescribed.

How is the diet different for this disease?

Gestational diabetes during pregnancy involves following a certain diet. As noted above, it is proper nutrition that most often becomes the key to successful treatment of the disease. Experts recommend in no case to reduce the nutritional value of food, it is better to slightly reduce its calorie content. Below are effective dietary tips for this diagnosis.

You should eat in small portions and always at a certain time.

What can you eat? It is better to enrich the diet with various kinds of cereals, fresh vegetables and fruits pasta(whole grain only). All of these products contain a large amount of fiber, which is very useful during pregnancy.

In the diet, you can use lean meats and fish, it is better to limit the consumption of smoked meats, sausages and sausages.

Cooking food should be steamed or baked in the oven using a minimum amount of oil.

Exercise stress

Daily exercise is very beneficial for pregnant women, as it maintains muscle tone, improves well-being and insulin action, and prevents the appearance of excess body fat. Of course, the load in this case should be moderate. Women are encouraged to attend yoga classes, take small walks every day, swim in the pool. Active physical exercises (horse riding, skating and skiing) should not be abused, as they can lead to injuries. It is important to regulate the number of loads each time, based on the well-being of the pregnant woman herself.

Postpartum care

Gestational diabetes in women usually resolves immediately after delivery, but in some cases it can lead to complications. As noted above, the baby is born very large, so you often have to resort to the help of a caesarean section. The thing is that with natural childbirth, there is a chance of getting birth injuries.

The child is born with a low sugar level, but no special measures are taken to normalize it. Glucose levels return to normal on their own if the mother breastfeeds the baby. This indicator should be constantly monitored by specialists from the maternity hospital.

If a woman strictly follows all the prescriptions from the doctor during pregnancy, then her baby will not be threatened by gestational diabetes, the birth will go smoothly.

If a woman neglects complex therapy during pregnancy, then this violation can lead to the fact that the newborn will appear. It is characterized by the following symptoms:

Jaundice;

Increased blood clotting;

tissue swelling;

Violation of the natural proportions of the body (for example, excessively thin limbs);

Various kinds of disorders of the respiratory system.

To finally overcome such an ailment as gestational diabetes, the diet must continue after childbirth. It is recommended to stick to a strict diet until the blood sugar finally returns to normal.

Experts advise all women with this diagnosis to do a test annually. It is believed that one in five women who have had the disease actually have undiagnosed type 2 diabetes.

Preventive measures

According to experts, it is actually very difficult to prevent the development of this disease. Often women who are at risk do not suffer from diabetes at all.

It is important to note that pregnancy planning after this diagnosis should take place under the supervision of a doctor and not earlier than 2 years after the previous birth. A few months before this period, it is recommended to start monitoring your own weight, introduce physical exercises into your daily routine, and ask your doctor what to eat with diabetes.

Reception of absolutely any medicines must always be consulted with a specialist. The thing is that the uncontrolled use of medications, including birth control pills, can result in the development of such an ailment as gestational diabetes mellitus.

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

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

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

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

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

Signs of diabetic fetopathy in a child:

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

How does gestational diabetes occur during pregnancy?

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

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

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

Risk group for developing gestational diabetes during pregnancy

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

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

Diagnosis of gestational diabetes

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

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

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

Treatment of gestational diabetes

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

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

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

Diet for gestational diabetes

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Exercise for gestational diabetes in pregnancy

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

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

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

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

Gestational diabetes and childbirth

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

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

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

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

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

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

Prevention of gestational diabetes

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

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

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

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

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

Answers

Marina Pozdeeva about impaired glucose tolerance that manifests during pregnancy and why gestational diabetes occurs

About 7% of all pregnancies are complicated by gestational diabetes mellitus (GDM), which is more than 200 thousand cases in the world annually. Along with arterial hypertension and preterm birth, GDM is one of the most common complications of pregnancy.

• Obesity increases the risk of developing gestational diabetes during pregnancy by at least two times.
• A glucose tolerance test should be performed for all pregnant women at 24–28 weeks of gestation.
• If the fasting plasma glucose level exceeds 7 mmol / l, they speak of the development of overt diabetes mellitus.
• Oral hypoglycemic drugs are contraindicated in GDM.
• GDM is not considered an indication for a planned caesarean section, and even more so for early delivery.

Pathophysiology of the consequences of gestational diabetes mellitus and the effect on the fetus

Starting from the earliest stages of pregnancy, the fetus and the developing placenta need a large amount of glucose, which is continuously supplied to the fetus with the help of transporter proteins. In this regard, the utilization of glucose during pregnancy is significantly accelerated, which helps to reduce its level in the blood. Pregnant women tend to develop hypoglycemia between meals and during sleep, as the fetus receives glucose all the time.

What is the danger of gestational diabetes during pregnancy for the child and mother:

As pregnancy progresses, tissue sensitivity to insulin steadily decreases, and insulin concentration increases compensatory. In this regard, the basal level of insulin (on an empty stomach) increases, as well as the concentration of insulin stimulated using a glucose tolerance test (the first and second phases of the insulin response). With an increase in gestational age, the elimination of insulin from the bloodstream also increases.

With insufficient insulin production in pregnant women, gestational diabetes mellitus develops, which is characterized by increased insulin resistance. In addition, GDM is characterized by an increase in the content of proinsulin in the blood, which indicates a deterioration in the function of pancreatic beta cells.

Risk factors for GDM

An assessment of the risk of developing GDM should be made even at the first visit of a pregnant woman to an obstetrician-gynecologist about pregnancy. There are factors that increase the risk of developing GDM by at least double, these are:

• overweight and obesity (body mass index (BMI) above 25 kg/m2 and above 30 kg/m2);
• increase in body weight after 18 years by 10 kg;
• the age of the pregnant woman is over 40 years (compared to women aged 25–29 years);
• belonging to the Mongoloid race (compared to Caucasoid).

In addition, the likelihood of GDM is increased by smoking, sedentary image life, genetic predisposition to type 2 diabetes mellitus (DM). AT last years information has emerged suggesting that short stature may be associated with GDM. Women with impaired glucose tolerance (IGT) are more likely to develop insulin resistance during pregnancy; patients suffering from polycystic ovary syndrome, as well as arterial hypertension.

There are also risk factors associated with the course of pregnancy. Thus, the likelihood of developing GDM significantly increases with multiple pregnancies (twice during pregnancy with twins and 4–5 times with triplets), as well as with rapid weight gain during pregnancy. The use of beta-blockers or corticosteroids to prevent threatened preterm labor increases the risk of GDM by 15% to 20% or more.

Risk factors for GDM associated with obstetric history include:

• GDM in previous pregnancies;
• glucosuria (during current or previous pregnancy);
• history of large fetus and/or hydramnios;
• stillbirth in history.

What not to do with gestational diabetes? With GDM, it is necessary to limit the amount of energy consumed per day. Changes in the diet should be directed towards the transition to fractional nutrition (for example, three main meals and three "snacks"). Carbohydrates should be no more than 50% of the diet, with fat and protein content of 25% each.

According to the 2013 American Diabetes Association standards, a woman is classified as at high risk for developing GDM if she has at least one of the following criteria: obesity; burdened heredity; GDM in history; glycosuria; history of polycystic ovary syndrome.

A woman is at low risk of developing GDM if she meets all of the following criteria: age under 25; normal weight before pregnancy; belonging to an ethnic group with a low probability of developing DM; absence of first-line relatives suffering from diabetes; absence of NTG in the anamnesis; no burdened obstetric anamnesis.

Women who do not fall into the high and low risk categories have a moderate risk of developing GDM.

Diagnosis of gestational diabetes mellitus: indicators and norm

In 2012 experts Russian Association endocrinologists and experts of the Russian Association of Obstetricians and Gynecologists adopted the Russian National Consensus "Gestational Diabetes Mellitus: Diagnosis, Treatment, Postpartum Care" (hereinafter referred to as the Russian National Consensus). According to this document, GSD is identified as follows:

1 phase

at the first visit of a pregnant woman

• fasting plasma glucose, or
• glycated hemoglobin (method certified according to the National Glycohemoglobin Standardization Program NGSP and standardized according to the reference values ​​adopted in the DCCT - Diabetes Control and Complications Study), or

plasma glucose at any time of the day, regardless of food intake.

2 phase

at 24–28 weeks of gestation

• All pregnant women, including those who had no abnormalities in carbohydrate metabolism in the early stages, undergo an oral glucose tolerance test (PGGT) at 24–28 weeks of gestation. The optimal time is 24-26 weeks, however, OGTT can be performed up to 32 weeks of gestation.

AT different countries OGTT is carried out with various glucose loads. The interpretation of the results may also differ slightly.

In Russia, OGTT is performed with 75 g of glucose, and in the USA and many EU countries, a test with 100 g of glucose is recognized as a diagnostic standard. The American Diabetes Association confirms that both the first and second variants of OGTT have the same diagnostic value.

According to the Russian National Consensus in the Russian Federation, the criteria for diagnosing gestational diabetes mellitus are fasting plasma glucose levels of more than 7 mmol / l, and 2 hours after a glucose load, more than or equal to 7.8 mmol / l.

Interpretation of OGTT can be carried out by endocrinologists, obstetrician-gynecologists and therapists. If the test result indicates the development of overt diabetes, the pregnant woman is immediately referred for management to an endocrinologist.

Management of patients with GDM

Within 1–2 weeks after the diagnosis is established, the patient is shown observation by obstetrician-gynecologists, therapists, and general practitioners.

Rules for conducting an oral glucose tolerance test (OGTT)

1. The test is carried out against the background of normal nutrition. For at least three days before the study, at least 150 g of carbohydrates should be consumed per day.
2. The last meal before the study should contain at least 30-50 g of carbohydrates.
3. The test is carried out on an empty stomach (8-14 hours after a meal).
4. It is not forbidden to drink water before the analysis.
5. Smoking is not allowed during the study.
6. The patient must be seated during the test.
7. If possible, the day before and during the study, it is necessary to exclude the use of drugs that can change the level of glucose in the blood. These include multivitamins and iron preparations, which include carbohydrates, as well as corticosteroids, beta-blockers, beta-agonists.
8. OGTT should not be performed:
   • with early toxicosis of pregnant women;
   • if necessary, in strict bed rest;
   • against the background of an acute inflammatory disease;
   • during exacerbation chronic pancreatitis or resected stomach syndrome.

Individual correction of the diet depending on the body weight and height of the woman. It is recommended to completely eliminate easily digestible carbohydrates and limit the amount of fat. Food should be distributed evenly over 4-6 meals. Non-caloric sweeteners can be used in moderation.

For women with a BMI >30 kg/m2, the average daily calorie intake should be reduced by 30-33% (approximately 25 kcal/kg per day). This measure has been proven to reduce hyperglycemia and plasma triglyceride levels.

1. Aerobic exercise: walking at least 150 minutes a week, swimming.
2. Self-monitoring of the main indicators:
   • the level of glucose in capillary blood on an empty stomach, before meals and 1 hour after meals;
   • the level of ketone bodies in the urine in the morning on an empty stomach (before going to bed or at night, it is recommended to additionally take carbohydrates in an amount of about 15 g for ketonuria or ketonemia);
   • blood pressure;
   • fetal movements;
   • body weight.

Sulfonylureas (glibenclamide, glimepiride) cross the placental barrier and may be teratogenic, so they are not used in GDM.

• Failure to achieve target plasma glucose levels
• Signs of diabetic fetopathy on ultrasound (indirect evidence of chronic hyperglycemia)
• Ultrasound signs of diabetic fetopathy of the fetus:
• large fetus (abdominal diameter greater than or equal to the 75th percentile);
• hepatosplenomegaly;
• cardiomegaly and/or cardiopathy;
• double-circuit head;
• swelling and thickening of the subcutaneous fat layer;
• thickening of the neck fold;
• newly diagnosed or increasing polyhydramnios with an established diagnosis of GDM (if other causes are excluded).

When prescribing insulin therapy, a pregnant woman is led jointly by an endocrinologist (therapist) and an obstetrician-gynecologist.

Treatment of gestational diabetes mellitus in pregnant women: selection of pharmacotherapy

Lifestyle modification, in particular, increased physical activity, helps to control GDM. Cells muscle tissue Initially, they use glycogen stores for energy, but as they become more active, they are forced to consume blood glucose, which causes its level to drop. Physical exercises also increase the sensitivity of muscle cells to insulin. In the long term, physical activity reduces the risk of developing GDM in repeat pregnancies.

Oral hypoglycemic drugs during pregnancy and lactation are contraindicated!

• category B (adverse effects on the fetus have not been identified in animal studies, adequate and well-controlled studies in pregnant women have not been conducted);
• category C (adverse effects on the fetus have been identified in animal studies, studies on pregnant women have not been conducted).

• all insulin preparations for pregnant women must be prescribed with an indispensable indication of the trade name;
• hospitalization for the detection of GDM is not mandatory and depends on the presence of obstetric complications;
• GDM is not considered an indication for planned caesarean section or early delivery.

List of sources

1. Mellitus D. Diagnosis and classification of diabetes mellitus // Diabetes care. 2005; T.28: S. S37.
2. Willhoite M. B. et al. The impact of preconception counseling on pregnancy outcomes: the experience of the Maine diabetes in pregnancy program. Diabetes Care 1993; 16:450-455.
3. Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: normal and problem pregnancies. New York: Churchill Livingstone; 2002.
4. Schmidt M. I. et al. Prevalence of gestational diabetes mellitus-do the new WHO criteria make a difference? Diabetes Med 2000; 17:376–380.
5. Ogonowski J., Miazgowski T. Are short women at risk for gestational diabetes mellitus? //European Journal of Endocrinology 2010; T.162: № 3 - С.491–497.
6. American Diabetes Association. Standards of Medical Care in Diabetes - 2013. Diabetes Care. Jan 2013. 36 Suppl 1: S11‑S66.
7. Krasnopolsky V.I., Dedov I.I., Sukhikh G.T. Russian national consensus “Gestational diabetes mellitus: diagnosis, treatment, postpartum care” // Diabetes mellitus. 2012; No. 4.
8. World Health Organization. Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus. WHO/NCD/NCS/99.2ed. Geneva: World Health Organization; 1999.
9. American College of Obstetricians and Gynecologists. Screening and diagnosis of gestational diabetes mellitus. Committee Opinion No. 504 Obstetrics & Gynecology 2011; 118:751–753.
10. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes 2008; 32 (Suppl 1).
11. International Association Of Diabetes And Pregnancy Study Groups Consensus Panel. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care2010; 33(3): 676–682.
12. Franz M. J. et al. Nutrition principles for the management of diabetes and related complications (Technical Review). Diabetes Care 1994, 17: 490–518.
13. Schaefer-Graf UM, Wendt L, Sacks DA, Kilavuz Ö, Gaber B, Metzner S, Vetter K, Abou-Dakn M. How many sonograms are needed to reliably predict the absence of fetal overgrowth in gestational diabetes mellitus pregnancies? Diabetes Care. Jan 2011; 34(1): 39–43.

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

How and why gestational diabetes occurs during pregnancy

The disease develops due to 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 placenta need it.

The pancreas begins to produce 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.

According to studies in the United States, this disease develops in 4% of pregnant women.

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 2 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. In larger children, the risk of obesity further increases.

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

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

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

With excess body weight, the fetus may develop respiratory failure, and muscle tone decreases. The sucking reflex is also inhibited, edema and 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 higher risk of developing this disease in women with:

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

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

The birth of a previous child can also affect the formation of pathology. The fruit 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 before conception, the level of glucose in the blood was normal.

Symptoms

There are no main symptoms of gestational diabetes during pregnancy.

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

Laboratory indications

To conduct a glucose tolerance test, blood is taken several times over a couple of hours. Further, 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 they make a diagnosis - gestational diabetes mellitus during pregnancy.

After the discovery of the disease, it will be necessary to monitor the pressure and work of the kidneys.

To check for violations, additional and are prescribed.

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

The principle of treatment of GDM in pregnant women

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

If there is a need, then it is supplemented with insulin injections. The dose is calculated individually.

With this disease, doctors mainly prescribe.

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

It is important to remember that you should not take medicines that lower sugar.

Diet and daily routine during pregnancy with GDM

During the diet, the caloric content of the diet decreases.

It is necessary to eat 5-6 times in small portions or use 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 for the expectant mother, it is necessary to ensure that her baby receives the microelements necessary for his development. Therefore, if a pregnant woman decides to make a menu herself, then she should study the information on how people with type 1 and type 2 diabetes eat.

For the duration of 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 certain types of fruits.

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

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

Norm of calories per day

Usually this is 35-40 calories per kilogram of a woman's weight. For example, if her 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 norm has been exceeded.

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

Course of labor and postpartum control in GDM

Contraindications to labor activity are not type 1 and type 2 diabetes, therefore, with GDM, delivery passes without problems.

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

Self-birth is allowed if the situation has not worsened in the last 24 hours.

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

After birth, the baby may have low blood sugar levels. It is compensated by food.

Drug treatment is often not required.

Some time the child is under the supervision of doctors. This is necessary to identify whether there is a violation due to a glucose failure in the mother.

Usually, after the placenta is delivered, the woman's condition returns to normal. There are no spikes in blood glucose levels. But still, during the first month, you need to stick to the diet that was before the birth of the child.

The next birth is best planned only after a couple of years. This will help the body 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 during childbearing suggests that a 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 re-test for sugar. Even if it is normal, then in the future it should be checked every 3 years.

Video: gestational diabetes during pregnancy