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 will prevent the mother's body from taking insulin. A woman has an abnormal concentration of glucose in her blood. Gestational diabetes during pregnancy occurs more often from the middle of the term. But his earlier presence is also possible.
Read in this article
Causes of diabetes in pregnant women
Experts cannot name a clear culprit for the violation of tissue response to glucose in expectant mothers. Undoubtedly, hormonal changes play a significant role in the appearance of diabetes. But they are common for all pregnant women, and, fortunately, not everyone is diagnosed in this position. Those who suffered it noted:
- hereditary tendency. If there is a history of diabetes in the family, there is also a higher probability of its occurrence in a pregnant woman compared to others.
- Autoimmune diseases that, due to their characteristics, disrupt the functions of the insulin-producing pancreas.
- Frequent viral infections. They are also capable of upsetting the functions of the pancreas.
- Passive lifestyle and high-calorie diet. They lead to excess weight, and if it existed before conception, the woman is at risk. This also includes those whose body weight has increased by 5-10 kg in adolescence in a short time, and its index has become 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.
- Previous birth of an infant weighing more than 4.5 kg or stillbirth for unexplained reasons.
Women of Asian or African descent are more susceptible to gestational diabetes than those of European descent.
Signs that you might suspect you have gestational diabetes
At an early stage, diabetes mellitus during pregnancy practically does not show symptoms. That 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, lost some weight, although there is no apparent reason for weight loss. Some find that it is more pleasant for them to lie or sit than to move.
With the development of malaise, a woman may feel:
- The need for a large amount of liquid. Despite her satisfaction, dry mouth worries.
- The need to urinate more often, the liquid 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 received load.
- Deterioration in the quality of vision. Blurring may occasionally occur in the eyes.
- Skin itching, and mucous membranes can also itch.
- Significant increase in the need for food and rapid weight gain.
The first and last signs of diabetes during pregnancy are difficult to separate from the most. Indeed, in healthy women expecting babies, appetite and thirst often increase.
How to get rid of diabetes during pregnancy
At the first stage of development, gestational diabetes is treated by streamlining lifestyle and. Indispensable is the control of the quantitative content of glucose 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 periodically do a urine test. 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.
Diet for gestational diabetes
it is impossible for a pregnant woman, the fetus must have everything necessary, and sugar from a lack of food grows. The expectant mother will have to adhere to healthy principles in food:
- Portions should be small and meals should be frequent. If you eat 5-6 times a day, you can maintain optimal weight.
- The largest amount of slow carbohydrates (40 - 45% of the total food) should be for breakfast. These are cereals, rice, pasta, bread.
- It is important to pay attention to the composition of products, postponing sugary fruits, chocolate, pastries until better times. Fast food, and seeds are excluded. We need vegetables, cereals, poultry, rabbit meat. Fat must be removed, no more than 10% of the total amount of food should be eaten per day. Fruits, berries, and greens that do not contain a large amount of sugar will be useful.
- Do not eat instant food. Having the same names as natural ones, they contain more glucose. We are talking about freeze-dried cereals, mashed potatoes, noodles.
- Food must 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 biscuits. 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 have a low glycemic index.
- Vitamin-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 nutrition should be drunk up to 8 glasses a day.
Medications
If changes in nutrition 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 weight of the patient and the duration of pregnancy.
Insulin is administered intravenously, usually divided into 2 doses. The first prick before breakfast, the second - before dinner. The diet during drug therapy is maintained, as is regular monitoring of the concentration of glucose in the blood.
Physical exercise
Physical activity is needed regardless of whether the rest of the treatment was limited to diet or the pregnant woman injects insulin. Sport helps to spend excess energy, normalize the balance of substances, increase the effectiveness of the hormone missing in gestational diabetes.
The movement should not be to the point of exhaustion, the possibility of injury must be excluded. Walking, exercises in the gym (except for swinging the press), swimming are suitable.
Prevention of gestational diabetes
For women at risk, a specialist will explain how dangerous gestational diabetes is during pregnancy. Pathology in the mother creates many threats to her and the fetus:
- At an early date 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 vessels of the placenta 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 disease can lead to defective formation of the cardiovascular system and the brain of the fetus, stimulate its excessive growth.
- Childbirth may begin prematurely. And the large size of the fetus forces a caesarean 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 also causes other pathologies in the child in the postnatal period.
- A woman is more likely to develop preeclampsia and eclampsia. Both problems are dangerous with high blood pressure, convulsions, which during childbirth can kill both mother and child.
- Subsequently, a woman has an increased risk of developing diabetes.
For these reasons, prevention of the disease is needed at an early stage, which includes:
- Regular. It is important to register early, to do all the necessary tests, especially when you are at risk.
- Maintain optimal body weight. If she was more normal before pregnancy, it is better to lose weight first and plan later.
- . High blood pressure may indicate a tendency to increase sugar and stimulate it.
- To give up smoking. The habit affects the functions of many organs, including the pancreas.
A woman with gestational diabetes is quite capable of giving birth to more than one healthy child. It is necessary to identify the pathology in time and make efforts to contain it.
Gestational diabetes during pregnancy (GD)- a type of diabetes that occurs in women due to hormonal disorders in the third trimester. As a result, blood sugar levels rise after meals and fall on an empty stomach.
Pathology poses a threat to the child, as it can provoke the occurrence of congenital diseases.
To prevent this from happening, at 24-28 weeks, a woman is recommended to be tested for gestational diabetes, and if the disease is diagnosed, follow certain dietary and lifestyle rules. In some cases, drug therapy is required, which can only be prescribed by a doctor.
Gestational diabetes is assigned the ICD 10 code - O 24.
The causes of gestational diabetes in pregnant women have not been established. However, more and more experts are inclined to the version that the pathology develops against the background of hormonal failure. As a result, hormones block the production of insulin. However, the body cannot allow such a situation, since the mother and baby require 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 the possible causes of HD. Such diseases negatively affect the state 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.
- National affiliation. Scientists have proven that some nationalities suffer from gestational diabetes more often than others. They 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 births, if the weight of the baby exceeded 4 kg.
- Previous pregnancy was accompanied by gestational diabetes.
- Lots of amniotic fluid.
Symptoms
There are some signs that indirectly indicate the occurrence of gestational diabetes:
If you ignore these symptoms and do not consult a doctor, the disease will progress and the following symptoms will appear:
- confusion;
- fainting states;
- increase in blood pressure;
- pain in the heart area, which can eventually lead to a stroke;
- problems with the activity of the kidneys;
- blurred vision;
- slow healing of wounds on the epidermis;
- numbness of the lower extremities.
Diagnostics
To diagnose gestational diabetes, a patient is given a blood test. In order 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 diet and you should adhere to the usual physical activity;
- blood is taken on an empty stomach, so after dinner and in the morning you can not eat, 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;
- two hours later, the biomaterial is taken again.
Analysis indicators
Blood sugar level:
- 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 analysis 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 a normal or low glucose level, 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 you conduct a study later than 28 weeks, then the pathology can already cause irreversible harm to the baby.
Kinds
Diabetes during pregnancy has several types, depending on the time of occurrence:
- pregistational diabetes- this type of diabetes was diagnosed before pregnancy (this variety, in turn, is divided into type 1 and type 2 diabetes);
gestational diabetes or gestational diabetes.
Gestational diabetes, in turn, has its own classification, depending on the prescribed therapy:
- 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 to treat gestational diabetes? There are two main ways - and insulin therapy. Only a doctor can determine if clinical advice is required for a patient.
insulin therapy
Insulin therapy is indicated when if the diet did not bring the desired result and blood glucose levels do 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 at a normal concentration of sugar, but with a large baby weight, with a large amount of amniotic fluid or soft tissue swelling.
It is recommended to administer the drug on an empty stomach and before a night's rest. However, the doctor determines the exact dosage and schedule of injections 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 an increased daily dose of insulin is needed, the doctor may insert a subcutaneous insulin pump.
Diet
The main component of successful therapy of pathology is the observance of certain nutritional rules. This helps to normalize blood sugar levels. Here are the principles of nutrition, which are recommended to be followed in this type of pathology:
Effect on the fetus
How dangerous is the diagnosis for the unborn child? Let's figure it out.
Gestational diabetes during pregnancy adversely 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 birth defects in the infant.
Most often, the disease affects the brain and heart.
If the pathology occurs in the second or third trimester, then this leads to excessive growth of the baby and its weight gain. As a result, after giving birth, the baby's sugar drops below normal, which can cause health problems.
If a pregnant woman develops gestational diabetes, but there is no full-fledged therapy, there is a high probability of developing fetal fetopathy.
Such a pathology threatens the child with the following consequences:
- infant weight over 4 kg;
- body imbalances;
- excessive deposition of fat 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, a woman must adhere to the doctor's recommendations. With such a pathology, a woman is hospitalized at 37-38 weeks.
Even if labor activity does not occur, it is caused artificially, 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 caesarean 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 a woman to endure and give birth to a healthy child.
It is not always possible to avoid the occurrence 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;
- refusal 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 often asked a number of questions: what week they give birth, having this diagnosis, what to do after childbirth and what should be the postpartum care, 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 with a diagnosis of HD:
Conclusion
If gestational diabetes is diagnosed during the period of bearing a baby, this is not a reason to panic or terminate the pregnancy. Subject to certain principles of nutrition and compliance with the doctor's instructions, a woman has every chance to endure and give birth to a healthy baby without a threat to her own health.
Gestational diabetes mellitus is expressed in insulin resistance (reduced sensitivity) of cells to the insulin produced by the body against the background of a hormonal shift during pregnancy - a blocking effect is provided by lactogen, estrogen, cortisol and other substances that are extremely actively produced from the twentieth week after the conception of the fetus. However, not all women develop gestational diabetes - risk factors for the development of the problem are:
- Overweight. The basic factor in the development of type 2 diabetes can start the formation of GDM in this difficult period for a woman's body.
- Over thirty years old. Late-term women are more at risk of developing gestational diabetes.
- Impaired glucose resistance in a previous pregnancy. Previous prediabetes may reappear more clearly and unequivocally in the next pregnancy.
- genetic predisposition. If the relatives of the nearest row were previously diagnosed with any type, then the risks of getting GDM increase.
- Polycystic ovaries. As medical practice shows, women with this syndrome are more often diagnosed with gestational diabetes mellitus.
- Poor obstetric history. Have you previously had chronic miscarriage, stillborn children or with malformations of physiological development? Have previous births been difficult, was the baby very large or small, or have other specific problems been diagnosed (eg, polyhydramnios)? All this significantly increases the risk of GDM in the future.
Symptoms of gestational diabetes
Symptoms of GDM are most often associated with manifestations. In most cases, the patient does not feel the external manifestations of the disease at all, linking various ailments with a radical restructuring of the body and the processes of its adaptation to future childbirth, however, sometimes a pregnant woman may experience strong thirst and excessive consumption of liquids, along with frequent urges for small needs, even in that case if the fetus is still small. In addition, gestational diabetes is characterized by periodic increases in pressure, minor neurological manifestations (from frequent mood swings to tantrums), in rare cases, a woman is worried about pain in the heart and numbness of the limbs.
As can be seen from the above, such symptoms quite often characterize the usual and associated classical pathologies (for example, toxicosis). The fuzzy “picture” does not allow to unambiguously define the problem, and in most cases diabetes is diagnosed only with the help of appropriate tests.
Diagnostics
According to the standard scheme for monitoring patients in the period from 22 to 28 weeks (it is then that the female body's need for insulin increases significantly, on average up to 75 percent of the usual norm), a glucose tolerance test is performed. For this analysis, blood is first donated from a finger on an empty stomach in the morning. It should be noted that twelve hours before the test, you must refuse to eat, any medications not agreed with the doctor, as well as avoid physical / emotional stress, refrain from alcohol and smoking.
After taking capillary blood according to the above scheme, the fair sex is given an oral dose of glucose in the equivalent of 75 grams, after which, an hour and two hours later, the second and third capillary blood sampling is done.
The norms of the above test are on an empty stomach no higher than 5.1 mmol / l, an hour after oral administration of glucose no more than 10 mmol / l, after 2 hours - no more than 8.5 mmol / l. As a rule, fasting test values in pregnant women with GDM are even lower than normal, but they are significantly exceeded during exercise.
Unlike classical and type 2, the test for glycated hemoglobin is not performed if gestational diabetes is suspected, since it is often falsely negative due to the peculiarities of the formation of temporary GDM in women.
In addition to this analysis, to confirm the diagnosis, the doctor must exclude other diseases that cause hyperglycemia, and, if necessary, prescribe alternative forms of research.
Due to certain risks for the future health of the baby, the treatment of gestational diabetes is carried out with the safest methods with a minimum set of medicines. After the detection of GDM, the fair sex will be prescribed a special diet, as well as moderate physical loads that are feasible for her at this stage of fetal development. Now, up to 7 times a day, you will have to change the current blood sugar level using a glucometer and keep a detailed diary of test results so that the doctor, if necessary, can familiarize himself with such statistics and correct the course of therapy.
In some cases, diet and exercise is not enough - in this case, a specialist prescribes a course of insulin therapy for the period of pregnancy until childbirth. Specific dosages and the scheme of drug administration are prescribed exclusively by your doctor! Unfortunately, insulin injections do not give the maximum possible effect due to the poor sensitivity of tissue cells to this hormone in the case of gestational diabetes.
Another classic medication for lowering blood sugar levels is taking hypoglycemic oral medications. The vast majority of them are forbidden to use during pregnancy due to the very high risks to the health and life of the unborn child. Metformin is an exception, but it is prescribed only as a last resort, carefully weighing all the possible consequences and taking into account serious side effects.
The most effective mechanism for combating GDM is a properly selected diet - this is an axiom that has been relevant for more than five decades. Despite the similarity of symptoms and treatment methodology for gestational diabetes mellitus and type 1.2 diabetes mellitus, the nutrition systems for them differ significantly. Low-carbohydrate or vegan diets should not be used in GDM, as this eating pattern may adversely affect the future health of the gestating fetus. The formation of ketone bodies is especially dangerous after the transition to the body's own fat supply. What to do? Doctors at this stage of the mother's life, up to childbirth, suggest switching to a rational, balanced diet. Her main theses:
- Fractional meal, 3 main approaches (breakfast, lunch, dinner) and 3 snacks.
- Refusal to eat any products containing simple "fast" carbohydrates - flour, sweets, pickles, fast food and potatoes in any form.
- The normal calorie intake is 35 kcal per kilogram of body weight.
- The systemic distribution of BJU is 25–30 percent protein, about 30 percent fat, and up to 40–45 percent carbohydrates.
- Be sure to use foods with fiber - to improve digestion and stabilize peristalsis.
- Constant control of sugar and ketone bodies, optimally after each meal (after 60 minutes).
According to such a diet, the optimal weight gain for the entire pregnancy ranges from 11-16 kilograms. In general, the diet of women with GDM during the period from the onset of pregnancy to childbirth is almost identical to the basic healthy diet of the fair sex in an interesting position without health problems, but requires more strict adherence to circadian rhythms and complete control of sugar / ketone bodies in blood.
Menu for the week
The classic weekly menu with a six-time daily diet provides the pregnant woman with all the necessary elements, while helping to maintain normal carbohydrate metabolism and minimize the risks of GDM complications.
Day 1
Breakfast is a large sandwich with hard cheese and two tomatoes, as well as one boiled egg. For a snack before dinner - a small bowl with cottage cheese and a handful of raisins. We have vegetable soup for lunch. Have an afternoon snack with a large glass of natural yogurt. We have dinner with a plate of vegetable salad and one avocado. Before going to bed, you can use a glass of rosehip broth.
Day 2
We have breakfast with a bowl of oatmeal brewed in milk. We have a snack with two apples. We have chicken soup with meat for lunch. We have an afternoon of one hundred grams of low-fat cottage cheese. We have dinner with vegetable stew and a small piece of boiled beef. Before going to bed, we can drink a glass of one percent kefir without sugar.
Day 3
We have breakfast with a plate of omelet with two cucumbers. For the second breakfast - a glass of yogurt. We have fish soup for lunch. We dine on two bananas. We have dinner with a bowl of milk porridge. Before going to bed, we use half a plate of vegetable salad.
Day 4
We have breakfast with cheesecakes interspersed with raisins and the addition of 15% natural sour cream. For a snack - a handful of peeled walnuts. We have lunch with a bowl of lentil soup. We have an afternoon snack with two small pears. We have dinner with a plate of steamed rice, baked chicken meat with tomatoes (100 grams). We drink tea before bed.
Day 5
For breakfast, we prepare an omelette with a sandwich (butter, hard cheese, rye bread). Before dinner, we drink a glass of tomato juice. We have lunch with vegetable stew and 100 grams of steamed meat. We dine on two peaches. For dinner - a plate of durum wheat spaghetti with tomato sauce. Before going to bed, you can drink a glass of herbal tea.
Day 6
We have breakfast with cottage cheese with the addition of grated berries. We have a snack with one small sandwich with a slice of hard cheese. We have lunch with a plate of buckwheat with stew, vegetable salad and green tea. We have an afternoon glass of fresh juice. We have dinner with vegetable salad and 100 grams of chicken breast with tomatoes. Before going to bed, you can drink a glass of 1 percent milk.
Day 7
We have breakfast with a plate of milk corn porridge with dried apricots. We have a snack with two apples. I will have lunch with a classic tomato/cucumber salad and cabbage soup. We have an afternoon snack with a handful of dried fruits. We have dinner with pancakes on zucchini with the addition of sour cream, as well as a glass of juice. Before going to bed, you can drink a rosehip decoction.
First of all, we recommend that all pregnant women who are diagnosed with gestational diabetes mellitus do not panic - this syndrome, as world medical statistics show, is diagnosed annually in four percent of expectant mothers. Yes, this is a wake-up call that something is not right with the body, but in most cases, GDM disappears after childbirth. Naturally, for one and a half to two years after delivery, a woman should monitor the state of the body, regularly donate blood for sugar and try to refrain from a new pregnancy during this period - the risks of recurrence of the disease and its transition to the main type 1 or 2 diabetes increase significantly.
Eat rationally and properly, spend more time in the fresh air, do metered and recommended by the doctor physical activity - the planned birth will go well and you will even be able to breastfeed the baby, carefully monitoring the possible manifestations of diabetes in the future.
Useful video
Gestational diabetes mellitus or gestational diabetes
Gestational diabetes mellitus in pregnancy
In the views of every woman, the period of expectation of a child seems to be something rosy, airy and serene, but it happens that this idyll is disturbed by serious health problems.
Gestational diabetes mellitus during pregnancy, what is dangerous, what are the indicators and signs in pregnant women, diet and menu, consequences for the child, analysis for latent blood sugar - the topic of this article.
The material will be useful to any woman of childbearing age who has risk factors and heredity for the disease of the sweet ailment.
Gestational Diabetes in Pregnancy: What is it?
Gestational or gestational diabetes is a disease of high blood sugar that occurs during pregnancy at any time. Many confuse the name and call it remote. Before pregnancy, the woman was perfectly healthy and showed no signs of illness. This disease is also called "pregnancy diabetes".
As a rule, this type of diabetes occurs in the second half of gestation, when a woman is at a decent time. After delivery, gestational diabetes may disappear or develop into overt type 1 or type 2 diabetes.
However, there are studies that show a strong link between diabetes during pregnancy and type 2 diabetes later in life. In other words, if a woman had gestational diabetes at a young age, then in adulthood she has a greater risk of developing type 2 diabetes if there are risk factors in the form of obesity, malnutrition, and others.
The incidence of this type of diabetes is about 2.5 - 3.0%. Certain risk factors contribute to this, which I list below:
- overweight and obesity
- age over 30
- family history of diabetes
- large baby from a previous pregnancy
- detection of glucose in the urine in a previous pregnancy
- gestational diabetes in the past
- polycystic ovary syndrome (PCOS)
Pregnancy diabetes: what is dangerous and the consequences for the child
Diabetes is always a pathology and it cannot but affect the course of pregnancy and the health of the fetus. But with good compensation, it is possible to safely endure and give birth to a healthy baby. I’ll tell you what you need for good compensation below, and now I’ll list what a future mother can expect.
- high risk of fetal death in utero or in the first week of life after childbirth
- the birth of a child with malformations
- high risk of various diseases of the born child in the first month of life (for example, infections)
- the birth of a large fetus and the risk of complications associated with it (injuries to the skull and limbs of the child, maternal ruptures during childbirth, etc.)
- child's risk of developing diabetes in the future
- late complications of pregnancy (eclampsia and preeclampsia, arterial hypertension, edematous syndrome)
- polyhydramnios
- intrauterine infection
What are the signs of diabetes during pregnancy
Quite often, an increase in glucose levels is asymptomatic, and if there are any signs, they are usually attributed to the pregnancy itself. The symptoms of gestational diabetes are no different from those of any other type of diabetes. The severity of these manifestations depends on the level of sugar in the blood.
Symptoms of Diabetes During Pregnancy
- dry mouth
- frequent urination
- skin itching and itching of the perineum
- thrush
- rapid weight gain
- general weakness and drowsiness
As you can see, the manifestations are often a manifestation of the pregnancy itself, and therefore every woman regularly takes blood and urine tests for early diagnosis of a carbohydrate disorder.
Blood sugar levels in gestational diabetes
As I already said in the article, in order to make a diagnosis of "Gestational Diabetes" you need to conduct a special analysis - an oral glucose tolerance test. Based on the results of this test, you can accurately diagnose and choose the right management tactics.
In the same place, I said that during pregnancy, not only gestational diabetes can occur, which is caused directly by the state of pregnancy, but also manifest diabetes mellitus, which is caused by other reasons, and pregnancy only provoked its development.
The difference between these types is that the gestational period is more sluggish and disappears after childbirth, and with overt diabetes, glycemia is higher, a pronounced clinic, and it remains forever and does not disappear with childbirth.
Below you see a table that displays diagnostic indicators for gestational diabetes. Anything that exceeds these figures indicates overt diabetes mellitus type 1 or 2. Click to enlarge.
So, you can see that the diagnosis of "Gestational diabetes mellitus (GDM)" is made when fasting sugar is above 5.1 mmol/L, but less than 7.0 mmol/L.
After a glucose test, after 1 hour, blood glucose should not exceed 10.0 mmol / l, and after 2 hours - no more than 8.5 mmol / l.
What are the normal indicators for a pregnant woman I said in the article. I recommend reading.
How to take an analysis (test) for latent diabetes in pregnant women
The test is carried out at 24-26 weeks of gestation. First of all, you need to wait for a 10-12 hour fasting period and get a good night's sleep the night before. No smoking. For the procedure, you will need 75 grams of glucose powder and 200 ml of warm water.
- First, fasting blood sugar
- After that, we dissolve the glucose powder in the brought water and drink it.
- We sit down in a chair or on a couch in the reception laboratory, we don’t leave anywhere.
- After 1 and 2 hours, we again donate blood from a vein.
- After the third fence, you can be free.
Treatment and diet for gestational diabetes in pregnant women
In some cases, nutrition and dietary compliance are already powerful tools in the management of gestational diabetes. During pregnancy, all tableted drugs are contraindicated, so the only way to lower blood sugar, in addition to diet, is insulin injections.
But in most cases, it is possible to do without it, only by properly adjusting the diet, compiling a rational menu, and also increasing feasible physical activity in the form of walking, for example.
Only a few are prescribed insulin, and only in two cases:
- failure to achieve target glycemic values within 1-2 weeks only with the help of diet
- the presence of signs of fetal distress according to ultrasound
What is the diet and nutrition of a woman with diabetes
If a low-carbohydrate diet is an effective method for normalizing blood sugar in a non-pregnant woman, then this method is not suitable for a pregnant woman.
Such a woman should not completely deprive herself of carbohydrates, as this will lead to the formation of ketone bodies, which can negatively affect the development of the fetus. But there are still some limitations. These restrictions are imposed on carbohydrates with a high glycemic index, namely any sweets, bread and flour, potatoes, cereals, sweet fruits (banana, persimmon, grapes).
What can you eat with gestational diabetes in pregnancy
Any kind of meat and fish, any vegetables except potatoes, whole grains, seasonal local fruits and berries, nuts, mushrooms, herbs are allowed. Observe the following ratio of proteins / fats / carbohydrates. It is important to get high-quality proteins and healthy fats, both vegetable and animal in equal proportions.
- proteins 30 - 25%
- fats 30%
- carbohydrates 40 - 45%
Various cooking websites offer a variety of recipes and menus, so I won't elaborate further. In addition, it is not always possible to satisfy the tastes of thousands of blog readers.
What should be the sugar in a pregnant woman (normal)
How do you know that you are doing everything right? Frequent monitoring of blood glucose will help you with this. Be sure to watch blood sugar before each meal, as well as 1 hour after eating, after 2 hours you can not watch. If necessary, you will have to watch sugar at 2-3 o'clock at night.
- fasting sugar should be less than 5.1 mmol / l
- 1 hour after eating should not exceed the level of 7.0 mmol / l
- before going to bed and at night, sugar should be no more than 5.1 mmol / l
- the level of glycated hemoglobin should not be more than 6.0%
Management of women after childbirth
If a woman received insulin therapy, then immediately after childbirth, this insulin is canceled. During the first three days, blood glucose is monitored to detect a violation of carbohydrate metabolism. If the sugar is normal, then you can be calm.
All women who have had GDM should be monitored because they are at increased risk of recurrent GDM or developing type 2 diabetes in the future.
- after 6-12 weeks, a second test with glucose is performed, only in its classic version (sugar is only looked at on an empty stomach and 2 hours after exercise)
- it is recommended to follow a low-gut diet (but not ketosis) in order to reduce weight, if any
- increased physical activity
- planning subsequent pregnancies
That's all for me. Good sugars and easy delivery. Click the social buttons networks, if you liked the article and found it useful. so as not to miss the release of new articles. See you soon!
With warmth and care, endocrinologist Lebedeva Dilyara Ilgizovna
Pregnancy diabetes or gestational diabetes mellitus (GDM) is a violation tolerance(from the Latin tolerantia - tolerance, that is, the maximum amount of a substance introduced into the body that can be absorbed without detectable pathological manifestations) to carbohydrates (glucose) of varying degrees, which occurs or is first detected during pregnancy. At the same time, fasting glucose levels can remain normal, glucose is not detected in the urine, and there are no clinical symptoms of diabetes. The frequency of occurrence among pregnant women is 2-3%.
dangerously Often, this pathology remains undiagnosed and manifests itself either as complications during pregnancy and childbirth, or in the occurrence of diabetes mellitus in the long term.
Risk factors
- Diabetes mellitus in close relatives;
- GDM in a previous pregnancy;
- Violation of fat metabolism in a pregnant woman;
- Birth in the previous children weighing more than 4 kg;
- Stillbirth, miscarriage, polyhydramnios in previous pregnancies;
- (4 kg or more);
- Congenital malformations in the fetus;
- Pathological weight gain;
- Elevated blood glucose ( hyperglycemia) on an empty stomach - more than 4.5 mmol / l;
- Detection of glucose in the urine 2 or more times.
With a physiologically proceeding pregnancy, the fasting glucose level in the first trimester is 3.3 - 4.4 mmol / l.
In the presence of risk factors, pregnant women are oral(from Latin per os - through the mouth) glucose tolerance test(GTT) no later than 16 weeks of pregnancy. Further, if necessary, GTT is carried out for about 24 weeks, and then at 32-34.
GTT options:
- Blood from a finger is taken on an empty stomach with the determination of glucose levels ( glycemia). The woman then drinks 100 grams of glucose dissolved in a glass of water. Further, the study of glycemia is carried out after 1, 2 and 3 hours.
- A more simplified version with 75 grams of glucose and blood sampling on an empty stomach, as well as 2 hours after a glucose load. Normal indicators of glycemia during a glucose tolerance test in pregnant women (mmol / l) are shown in the table.
| on an empty stomach | After 1 hour | In 2 hours | After 3 hours | |
| 75 grams | Less than 5.3 | Less than 7.6 | ||
| 100g | Less than 5.3 | Less than 9.4 | Less than 8.6 | Less than 7.7 |
For the diagnosis of gestational diabetes mellitus, an excess of 2 indicators is necessary. With changes in the GTT, it is possible to conduct daily monitoring of glucose levels in an endocrinological hospital, as well as conduct special additional studies (for example, determining the level of glycated hemoglobin - a biochemical blood indicator that reflects the average blood sugar over a long period (up to three months).
Important Clinically, GDM, as a rule, does not manifest itself. Most often, the lack of treatment leads to complications of the course of pregnancy, which can be treated much worse than usual.
Complications of gestational diabetes
- . Features of the course in pregnant women with GDM: early onset, more severe course, rapid increase in symptoms, low efficiency of therapy.
- Gestational pyelonephritis(inflammation of the pelvicalyceal system and kidney parenchyma)
- diabetic fetopathy (fetal complications), which manifests itself:
- Macrosomia(large fetus)
- Hypoglycemia(low glucose level) in the postpartum period (the fetus tries to compensate for the increased glucose level in the mother, and after childbirth, insulin production remains elevated, so the glucose level drops sharply up to hypoglycemic coma);
- Hypocalcemia(decreased calcium levels in the blood);
- Hyperbilirubinemia (elevated serum bilirubin and associated jaundice);
- Thrombocytopenia(decreased level of blood platelets);
- Respiratory distress syndrome of the newborn(the lungs of a newborn are not ready for extrauterine life);
- Hypertrophic cardiomyopathy(changes in the heart with possible disruption of its work)
- Intrauterine fetal death.
Treatment of gestational diabetes
- Conducted in conjunction with an endocrinologist;
- Continuous monitoring of blood glucose levels;
- Diet number 9: frequent, fractional meals up to 6-7 times a day with a restriction of easily digestible carbohydrates (confectionery, fruits, honey, sweets, sugar), no more than 30-35 kcal / kg of body weight;
- If the diet does not allow for compensation of gestational diabetes, then the woman is shown insulin therapy. The multiplicity and dosage of drugs is determined by the attending physician together with the endocrinologist!
Important Tableted hypoglycemic drugs during pregnancy are contraindicated.
Criteria for compensation of diabetes mellitus in pregnant women:
- Fasting glucose level 3.5 - 5.5 mmol / l;
- The glucose level 2 hours after eating is not more than 6.7 mmol / l.
With compensated gestational diabetes mellitus, a satisfactory condition of the pregnant woman and the absence of fetal disorders, delivery can be performed at 39-40 weeks. The best way is programmed birth through the natural birth canal with glucose control during and after childbirth.
Information In the presence of complications that cannot be corrected, early delivery is performed. The method depends on the obstetric situation.
In the postpartum period, glucose control is mandatory. If GDM was compensated, then GTT is carried out 1.5 months after birth. If the pregnant woman was on insulin therapy, then after delivery, insulin is canceled and glucose levels are monitored. With hyperglycemia, treatment is prescribed by an endocrinologist. At normal glucose levels, GTT is carried out after 1.5, 6 months, and then 1 time per year. Planning the next pregnancy not earlier than in 1.5 years.
Additionally After giving birth, 2/3 develop type 1 diabetes and 30-50% develop type 2 diabetes. It also increases the risk of developing diabetes in children.
Thus, gestational diabetes mellitus is a serious pathology, since a large number of women develop diabetes mellitus in the future. And if left untreated during pregnancy, it often leads to complications from both the pregnant woman and the fetus.
