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One of the main reasons for pregnant women to turn to an endocrinologist is gestational diabetes, so what is it? Gestational diabetes - this is any violation of the metabolism of carbohydrates in the body, first occurring, or detected during pregnancy. More often, such a violation appears after 20 weeks of pregnancy and is associated with the hormonal characteristics of the woman during this period.
Gestational diabetes develops during pregnancy for several reasons:
- In our body, insulin is responsible for the uptake of glucose by cells. In the second half of pregnancy, the production of hormones that weaken its effect is enhanced. This leads to a decrease in the sensitivity of a woman's body tissues to insulin - insulin resistance.
- Excessive nutrition of a woman leads to an increase in the need for insulin after eating.
- As a result of a combination of these two factors, pancreatic cells become unable to produce adequate amounts of insulin, and gestational diabetes develops.
Not every pregnant woman has a risk of developing diabetes. However, there are factors that increase this probability. They can be divided into those that existed before pregnancy and occurred during it.
|Pre-Pregnancy Factors||Factors During Pregnancy|
|Age over 30||Large fruit|
|Obesity or overweight||Polyhydramnios|
|Relative diabetes in immediate family||Urinary glucose excretion|
|Gestational diabetes in a previous pregnancy||Overweight During Pregnancy|
|Early or late gestosis in a previous pregnancy||Congenital malformations of the fetus|
|Birth of children weighing up to 2500 g or more than 4000 g|
|Stillbirth, or the birth of children with developmental disabilities in the past|
|Miscarriages, miscarriages, past abortions|
|Polycystic Ovary Syndrome|
It must be remembered that glucose penetrates the baby through the placenta. Therefore, with an increase in her level in the mother’s blood, an excess of it reaches the child. The pancreas of the fetus works in an enhanced mode, releases large amounts of insulin.
How to identify?
Diagnosis of gestational diabetes is carried out in several stages. Each woman, when registering for pregnancy, performs a blood test for glucose. The blood glucose rate for pregnant women is from 3.3 to 4.4 mmol / L (in the blood from the finger), or up to 5.1 mmol / L in the venous blood.
If a woman belongs to a high-risk group (has 3 or more risk factors listed above), she is given oral glucose tolerance test (PGTT). The test consists of the following steps:
- A woman on an empty stomach gives blood for glucose.
- Then, within 5 minutes, a solution containing 75 g of glucose is drunk.
- After 1 and 2 hours, a repeated determination of the level of glucose in the blood is carried out.
Values of glucose in venous blood are considered normal:
- on an empty stomach - less than 5.3 mmol / l,
- after 1 hour - less than 10.0 mmol / l,
- after 2 hours - less than 8.5 mmol / l.
Also, a glucose tolerance test is performed for women who have an increase in fasting blood glucose.
The next stage is the implementation of PHTT for all pregnant women in the period of 24–28 weeks.
For the diagnosis of gestational diabetes mellitus, an indicator of glycated hemoglobin is also used, which reflects the level of glucose in the blood over the past few months. Normally, it does not exceed 5.5%.
GDM is diagnosed with:
- Fasting glucose greater than 6.1 mmol / L.
- Any random determination of glucose if it is more than 11.1 mmol / L.
- If the results of PGTT exceed the norm.
- The level of glycated hemoglobin is 6.5% or higher.
How is it manifested?
Most often, gestational diabetes is asymptomatic. The woman is not worried, and the only thing that makes the gynecologist worry is the increased level of glucose in the blood.
In more serious cases, thirst, excessive urination, weakness, acetone in the urine is detected. A woman is gaining weight faster than expected. When conducting an ultrasound examination, an advance is detected in the development of the fetus, symptoms of insufficiency of placental blood flow.
So what is the danger of gestational diabetes, why is glucose during pregnancy paid such close attention? Pregnant diabetes is dangerous for its consequences and complications for women and children.
Complications of gestational diabetes for a woman:
- Spontaneous abortion. An increase in the frequency of abortion in women with GDM is associated with frequent infections, especially of the urogenital organs. Hormonal disorders are also important, since gestational diabetes often develops in women who have polycystic ovary syndrome before pregnancy.
- Late gestosis (edema, increased blood pressure, protein in the urine in the second half of pregnancy). Severe gestosis is dangerous for the life of both a woman and a child, can result in convulsions, loss of consciousness, heavy bleeding.
- Frequent urinary tract infections.
- At high glucose levels, damage to the vessels of the eyes, kidneys, and placenta is possible.
- Preterm labor is more often associated with pregnancy complications requiring an earlier delivery.
- Complications of childbirth: weakness of labor, trauma of the birth canal, postpartum hemorrhage.
The effect of gestational diabetes on the fetus:
- Macrosomy is a large weight of a newborn (more than 4 kg), but the child’s organs are immature. Due to increased insulin levels in the fetal blood, excess glucose is deposited as subcutaneous fat. A baby is born large, with round cheeks, red skin, broad shoulders.
- Possible delayed fetal development.
- Congenital malformations are more common in women who have very high blood glucose levels during pregnancy.
- Hypoxia of the fetus. To enhance metabolic processes, the fetus needs oxygen, and its intake is often limited by a violation of placental blood flow. With a lack of oxygen, oxygen starvation, hypoxia occurs.
- Respiratory disorders occur 5-6 times more often. Excess insulin in the baby’s blood inhibits the formation of surfactant - a special substance that protects the baby’s lungs after childbirth from falling.
- More often, fetal death occurs.
- Injury to the child during childbirth due to large sizes.
- High probability of hypoglycemia in the first day after birth. Hypoglycemia is a decrease in blood glucose below 1.65 mmol / L in a newborn. The child is sleepy, lethargic, inhibited, poorly sucks, with a strong decrease in glucose, loss of consciousness is possible.
- The neonatal period proceeds with complications. Possible increased levels of bilirubin, bacterial infections, immaturity of the nervous system.
Treatment is the key to success!
As is now clear, if diabetes is detected during pregnancy, it must be treated! Lowering blood glucose levels helps minimize complications and give birth to a healthy baby.
A woman with gestational diabetes needs to learn how to control her glucose level herself with a glucometer. Record all indicators in a diary, and visit the endocrinologist regularly with him.
The basis for the treatment of gestational diabetes is diet. Nutrition should be regular, six times, rich in vitamins and nutrients. It is necessary to exclude refined carbohydrates (products containing sugar - sweets, chocolate, honey, cookies, etc.) and consume more fiber contained in vegetables, bran and fruits.
You need to calculate calories and consume no more than 30–35 kcal / kg of body weight per day at normal weight. If a woman is overweight, this figure is reduced to 25 kcal / kg of weight per day, but not less than 1800 kcal per day. Nutrients are distributed as follows:
In no case should you go hungry. This will affect the condition of the child!
During pregnancy, a woman should gain no more than 12 kg of weight, and if she was obese before pregnancy - no more than 8 kg.
It is necessary to make daily walks, breathe fresh air. If possible, do water aerobics or special aerobics for pregnant women, perform breathing exercises. Exercise helps to reduce weight, reduce insulin resistance, increase fetal oxygen supply.
Diet and exercise are used for two weeks. If during this time normalization of the blood glucose level does not occur, the doctor will recommend starting insulin injections, since the tablet sugar-lowering drugs are contraindicated during pregnancy.
No need to be afraid of insulin during pregnancy! It is absolutely safe for the fetus, does not negatively affect a woman, and it will be possible to stop insulin injections immediately after childbirth.
When prescribing insulin, they will explain in detail how and where to inject it, how to determine the required dose, how to control the level of glucose in the blood and your condition, as well as how to avoid an excessive decrease in glucose in the blood (hypoglycemia). It is necessary to strictly adhere to the doctor's recommendations in these matters!
But the pregnancy is coming to an end, so what next? What will be the birth?
Women with gestational diabetes mellitus successfully give birth on their own. During childbirth, blood glucose is monitored. Obstetricians monitor the condition of the child, control signs of hypoxia. A prerequisite for natural birth is the small size of the fetus, its mass should be no more than 4000 g.
Gestational diabetes alone is not an indication for caesarean section. However, often such a pregnancy is complicated by hypoxia, large fetus, gestosis, weak labor, which leads to surgical delivery.
In the postpartum period, monitoring of the mother and child will be lent. As a rule, glucose levels return to normal within a few weeks.
Forecast for a woman
6 weeks after the birth, the woman should come to the endocrinologist and perform a glucose tolerance test. More often, the glucose level is normalized, but in some patients it remains elevated. In this case, the woman is diagnosed with diabetes and the necessary treatment is carried out.
Therefore, after childbirth, such a woman should make every effort to reduce body weight, eat regularly and properly, and receive sufficient physical activity.
Symptoms to consider:
- thirst intensified, and although you drink enough water, you’re still feeling dry in your mouth,
- sharply increases the number of urinations and the amount of escaping fluid,
- there are signs of slight weight loss for no apparent reason or vice versa - a sharp increase in appetite and rapid weight gain,
- decreased tone, energy, reluctance to move, increased fatigue,
- vision deteriorates, sometimes there is blurred eyes
- increased dryness of the skin and mucous membranes, itching.
Some of these symptoms are difficult to separate from a healthy pregnancy, since increased appetite, thirst and urination, as well as a decrease in tone are characteristic of the position of the future mother. That is why controlling blood sugar is so important.
Gestational diabetes during pregnancy: risk group
There are certain risk factors that enable gestational diabetes to develop:
- with obesity, overweight,
- with a diagnosis of diabetes, there are close relatives of a pregnant woman,
- if the age of the pregnant woman is more than 35 years old,
- at the birth of a large child (more than 4 kg) from a previous pregnancy,
- with gestational diabetes in a previous pregnancy,
- with miscarriage of previous pregnancies,
- with malformations in previously born children, in case of stillbirths,
- with polyhydramnios.
If you have noticed at least one risk factor, inform your gynecologist about it so that he can conduct an investigation of your blood sugar level on an empty stomach.
If the doctor notices any deviations (in the analysis of blood sugar taken from a finger, on an empty stomach the indicators are from 4.8 to 6.0 mmol / l: in the analysis of blood sugar taken from a vein, on an empty stomach the indicators are from 5.3 to 6 , 9 mmol / l), he will prescribe a special test.
When will a doctor diagnose gestational diabetes?
- if the glucose value of blood taken from a finger on an empty stomach is 6.1 mmol / l,
- if the glucose value of blood taken from an empty stomach vein is 7 mmol / l,
- if the glucose value of blood taken from a finger or from a vein 2 hours after loading is 7.8 mmol / l.
With normal indicators, the doctor will suggest you conduct a glucose tolerance test at 24-28 weeks of pregnancy, since during this period the level of pregnancy hormones will increase. At these dates, it is possible to prevent the development of defects in the fetus.
Diabetes during pregnancy: consequences for the baby
- the risk of miscarriage,
- heart and brain defects
- diabetic fetopathy: large fetal size or imbalance - large belly, but thin
- swelling of the tissues
- excess subcutaneous fat
- respiratory system disorders
- hypoglycemia (abnormally low blood glucose) in newborns,
- high viscosity blood and the possibility of blood clots,
- insufficient calcium and magnesium in the blood of the child,
Can I deal with gestational diabetes during pregnancy?
It is possible, provided that the pregnant woman will:
- daily monitor blood sugar levels on an empty stomach and after eating with a glucometer,
- regularly take a urine test and ask the doctor about its results,
- follow the diet the doctor will talk about
- monitor body weight
- daily give the body physical activity on the advice of a doctor,
- use insulin therapy if necessary,
- control blood pressure.
Diet for gestational diabetes in pregnant women
If you have gestational diabetes, then pregnancy with diabetes will require a strict review of the menu and diet.
The most important in the menu and power mode:
- eat main meals at the same time 3 times a day, have snacks 2-3 times a day,
- in breakfast and the last snack in the evening include about 40% of complex carbohydrates, fresh vegetables, unsweetened fruits, herbal teas,
- exclude from the menu fatty, fried, sweets, white sugar, pastries, sweet fruits (banana, grapes, figs, persimmons, etc.), instant products (freeze-dried products from bags, fast food),
- with morning toxicosis, before getting out of bed, eat a couple of salted crackers (cook them in advance),
- when preparing a side dish, choose cereals and pasta rich in fiber: it is necessary for diabetics to stimulate the intestines, as well as to prevent the absorption of excess sugar and fat into the blood,
- do not abuse saturated and “hidden” fats found in sausages, sausages, pork, lamb, smoked meats,
- choose lean meats (chicken, beef, turkey) and try to cook them baked or steamed,
- drink clean water, at least 8 glasses a day,
- try less often to eat foods high in fat: cheese, nuts, butter, sour cream, seeds, etc.,
- enter a maximum of low-calorie vegetables in the menu: celery, cucumbers, zucchini, mushrooms, radishes, lettuce, tomatoes, green beans, zucchini, cabbage,
- enter Jerusalem artichoke (earthen pear), which is called "vegetable insulin" in the menu: add it to salads, use in a cooked form, drink juice.
When is insulin therapy necessary?
If you follow a diet, but it doesn’t help: either the blood sugar level remains high, or ketone bodies are present in the urinalysis. You should not be afraid of addiction to insulin and refuse therapy: addiction to modern human insulin does not occur, and after giving birth and placenta, your body will no longer need therapy.
Births with gestational diabetes
With the birth of the baby and the release of the placenta, gestational diabetes most often disappears (although in some cases it can develop into type 2 diabetes mellitus). If, as a result of the diagnosis, the fetus is too large, Caesarean section is unlikely to be avoided.
Although the level of sugar in a newborn from a mother with gestational diabetes is significantly reduced, breastfeeding can regulate it. To keep the infant and mother's sugar levels in check, they will be measured before feeding and 2 hours after it. When the indicators return to normal, there will be no need for control.
How to avoid gestational diabetes?
- if you have already experienced gestational diabetes during the previous pregnancy, try to bring the weight back to the next pregnancy and accustom the body to regular physical activity,
- warn doctors about your risk and avoid taking medications that can increase insulin resistance - glucocorticoids, nicotinic acid, some birth control pills (for example, progestin contraceptives).
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