Gestational diabetes mellitus during pregnancy
What is gestational diabetes mellitus?
Gestational diabetes is an elevated blood sugar level that is diagnosed during pregnancy. In most cases, the disease begins to develop from the beginning of the second trimester. If gestational diabetes is detected at an earlier stage, the presence of common diabetes mellitus, which the woman had before pregnancy, can be suspected.
This pathology is observed in about 4-6% of pregnant women. After childbirth, it usually goes away on its own, but with previous gestational diabetes, the risk of developing common diabetes in the future increases.
The causes of gestational diabetes are as follows: under the influence of hormonal changes in the II-III trimester of pregnancy, the woman's pancreas must produce much more insulin in order to compensate for the effect of hormones on blood sugar levels. If it does not cope with increased functions, it leads to diabetes.
With gestational diabetes, there are no changes in well-being that are characteristic of normal type I and II diabetes.
However, there are some signs that can make themselves felt:
- constant thirst and dry mouth;
- frequent and profuse urination;
- increased fatigue;
- decreased visual acuity.
However, these signs are often perceived by pregnant women as specific features of their situation.
Gestational diabetes provokes an excessive increase in the weight of the fetus and leads to hyperinsulinemia in the child after birth: when the child ceases to receive the same amount of glucose from the mother, his blood sugar level drops to critical values. In addition, the threat of miscarriage and the risk of intrauterine malformations increase.
Statistics
In the United States, epidemiologists have conducted a number of studies concerning the development of gestational diabetes mellitus (GDM) in women during pregnancy. The results showed that this problem affects 4% of the number of women carrying a fetus.
In Europe, these indicators fluctuate at the level of 1-14%, and about 10% of those observed in the postpartum period continue to experience signs of this disease, which will transform into type II diabetes in the future. Moreover, 50% of women who have had gestational diabetes mellitus during the period of gestation during the next 10-15 years are susceptible to the development of SRS.
The fact that this pathology is so widespread indicates a poor awareness of the female part of the population about the risk of developing the disease and its irreversible consequences. Unfortunately, many women are diagnosed and receive qualified assistance with a great delay. In connection with this circumstance, in women's consulting and reproductive centers, specialists are engaged in educational activities aimed at protecting women's health and allowing healthy babies to be born.
Content:
- What is the threat of gestational diabetes?
- How is gestational diabetes different?
- Causes of Gestational Diabetes Mellitus
- Risk factors for diabetes during pregnancy
- Signs and symptoms of gestational diabetes
- Diagnosis of gestational diabetes mellitus
- Treatment of gestational diabetes
- How to prevent the development of gestational diabetes
- Nutrition for gestational diabetes
- Childbirth with gestational diabetes
What is the threat of gestational diabetes?
First of all, the risk of dysfunctional fetal development increases. In early pregnancy, GDM can cause congenital malformations of the brain and heart in the fetus, and can also cause spontaneous abortion. In the last two trimesters of pregnancy, due to diabetes mellitus, the fetus may grow above normal (macrosomia) or undergo hyperinsulinemia.
After childbirth, the disease can develop into a complication in the form of diabetic fetopathy, the signs of which are body imbalance, overweight crumbs (over 4 kg), respiratory distress against the background of hypoglycemia, excess subcutaneous fat, as well as blood viscosity above normal and blood clots.
How is gestational diabetes different from other types of diabetes?
Diabetes mellitus is caused by a serious violation of carbohydrate metabolism, for which insulin, a hormone of the pancreas, is responsible. Deficiency of this hormone is relative or absolute. As a rule, in diabetes mellitus, blood glucose levels are outside the normal range. This phenomenon is called hyperglycemia. Simultaneously with it, glucosuria (sugar in the urine) is found.
Specialists of the World Health Organization divide diabetes mellitus into several types. Type 1 disease affects adolescents and young children who have an autoimmune breakdown of cells that produce the hormone insulin in the pancreas. As a result of the breakdown of these cells, insulin production is reduced or completely stopped.
According to statistics, 15% of the total number of victims of the disease suffers from type 1 diabetes. A sure sign of illness is high glucose levels at a young age. Also, antibodies to insulin and β-cells can be found in the blood. In these patients, insulin levels are low. There is only one way to treat type 1 diabetes mellitus is by injecting insulin.
Genetic defects, acute chronic pancreatitis, various infectious diseases, the use of chemicals and certain medications can lead to the development of type 2 diabetes in overweight people.
This type of disease is typical for mature patients with a hereditary predisposition. In laboratory analyzes of patients, an increase in glucose levels exceeding 5.5 mmol / l is observed. The doctor prescribes medications for patients, a specific diet and mandatory physical activity. This course of treatment can help lower blood glucose levels.
Causes of Gestational Diabetes Mellitus
During the period of gestation, any woman can face the development of GDM due to the reduced sensitivity of tissues and cells to the insulin produced by the body. Thus, insulin resistance develops, which is interconnected with an increase in the level of hormones in the blood of the expectant mother. The placenta and the fetus have a great need for glucose, its increased consumption by the body during pregnancy negatively affects homeostasis. As a result, the pancreas tries to compensate for the lack of glucose and increases the production of insulin, increasing its level in the blood.
When the pancreas stops producing the required amount of insulin, gestational diabetes begins to develop. An increased level of proinsulin is a clear confirmation of the deterioration of the work of β-cells in the pancreas and the development of diabetes mellitus during gestation.
It happens that after the birth of a baby, the mother's blood sugar level instantly returns to normal, but even under such circumstances, the possibility of developing diabetes cannot be completely ruled out.
Risk factors for diabetes during pregnancy
There are many risk factors for developing GDM during pregnancy, depending on the woman's genetics:
- the level of sugar in the urine is above normal;
- various disorders of carbohydrate metabolism;
- obesity or overweight with signs of metabolic disorders;
- age over thirty;
- the presence of type 2 diabetes mellitus in relatives in a straight line;
- gestosis and severe toxicosis during past pregnancies;
- various diseases of the cardiovascular system;
- past GDM;
- spontaneous abortions in the 1st or 2nd trimesters during previous pregnancies, chronic non-bearing of the fetus;
- congenital malformation of the nervous and cardiovascular system in a previous child;
- a history of stillbirth or the birth of a previous baby weighing more than 4 kg (hydramnios).
Signs and symptoms of gestational diabetes
Screening of pregnant women in laboratory conditions is currently the only criterion for accurately establishing the development of GDM. At the time of registration at the antenatal clinic, the doctor can identify the expectant mother at risk, which means the mandatory delivery of a fasting blood test to determine the sugar level. The analysis is carried out against the background of normal physical activity and daily diet. Blood for laboratory research is taken from a finger, the normal glucose level does not go beyond 4.8-6.0 mmol / l. Experts recommend taking a test where glucose acts as an additional load.
In order to timely identify GDM, every pregnant woman is recommended to undergo a special oral test to determine the quality of glucose uptake by the body. This test is performed at 6-7 months of pregnancy. If necessary, the test is performed as many times as the doctor deems necessary.
Blood plasma for analysis is taken on an empty stomach. If the plasma glucose level is above 5.1 mmol / L, 60 minutes after a meal - above 10.0 mmol / L, and 120 minutes after a meal - above 8.5 mmol / L, the doctor diagnoses GDM with complete confidence. If the disease is diagnosed in a timely manner and the pregnant woman is fully monitored, then subject to 100% compliance with the doctor's recommendations, the risk of having a sick baby is reduced to a minimum, that is, to 1-2%.
Diagnosis of gestational diabetes mellitus
There are certain risk factors that make you more likely to develop gestational diabetes.
Main risk factors:
- Being overweight (obese) before pregnancy
- Previously diagnosed impaired glucose tolerance;
- Having a disease during previous pregnancies;
- Hereditary predisposition;
- Nationality (Hispanics, Africans, Asians are more susceptible to the disease);
- Previous birth of a large (over 4 kg) or stillborn child;
- Polyhydramnios.
A blood glucose test is ordered every trimester of pregnancy. The norm for blood sugar is up to 5.1 mmol / l. At higher rates, a glucose tolerance test is additionally prescribed. To do this, a woman's blood is taken for analysis, first on an empty stomach, and then 30-60 minutes after drinking a glass of water with sugar dissolved in it (50 g). To obtain a more accurate result, the test is repeated after two weeks.
The diagnosis of "gestational diabetes" is made if the blood sugar level on an empty stomach exceeds 5.1 mmol / l, and an hour after the ingestion of glucose - 10.0 mmol / l, and after 2 hours 8.5 mmol / l.
Treatment of gestational diabetes
In women with gestational diabetes, there is late toxicosis, edema, increased blood pressure, impaired renal function and cerebral circulation. It also increases the risk of developing urinary tract infections and the risk of premature birth.
When the diagnosis is confirmed by an endocrinologist, complex therapy is prescribed, which should be adhered to until the very birth:
- Proper balanced nutrition is the most important point;
- Adequate physical activity - long walks are the best option;
- Regular monitoring of blood sugar levels, which is carried out daily;
- Regular urine analysis for the presence of ketone bodies;
- Blood pressure control.
Find out more: How to lower your blood sugar?
In most cases, dieting is sufficient. With adequate implementation of medical recommendations, no medication is required. If this therapy is not enough and the sugar level remains elevated, insulin therapy is prescribed. Insulin is used by injection. Anti-hypoglycemic drugs in pill form are contraindicated during pregnancy.
How to prevent the development of gestational diabetes during pregnancy?
The development of gestational diabetes mellitus is almost impossible to prevent in advance. Statistics show that those women who are at risk do not face this disease during pregnancy, while other pregnant women can develop diabetes without any prerequisites.
In the event that a woman has already had gestational diabetes mellitus once, she should take full responsibility for conceiving the next child and plan it no earlier than two years after the birth of the last child. To minimize the risk of re-developing a dangerous disease, it is necessary to start tracking body weight six months before pregnancy and include daily exercise in your daily routine. in addition, you must regularly take tests to determine the level of glucose in the blood.
Any pharmaceutical product is allowed to be taken only with the agreement of a doctor, since some pharmaceutical products (glucocorticosteroids, birth control pills, etc.) can later serve as a catalyst for the development of gestational diabetes mellitus.
If a woman has suffered GDM during pregnancy, one and a half to two months after the birth of a child, she needs to determine the glucose level using an analysis. It will not be superfluous to additionally take a glucose tolerance test. The results of these studies will allow the doctor to choose the optimal scheme of physical activity and nutrition, as well as to set the date for the control laboratory blood tests.
Nutrition for gestational diabetes
Eating a healthy diet is essential to successfully treating gestational diabetes. The diet should be dietary and complete at the same time. It is prohibited to drastically reduce the energy value of the diet.
- It is recommended to switch to fractional meals, 5-6 times a day, in small portions. The bulk of the food load should fall on the first half of the day. Feeling hungry should be avoided.
- It is necessary to sharply limit or completely exclude from the menu easily digestible simple carbohydrates: confectionery, pastries, pastries, as well as some sweet fruits (bananas, grapes, figs), the use of which leads to a rapid increase in blood glucose levels.
- You should limit the consumption of fats (butter, margarine, mayonnaise, fatty sour cream, cream cheese). The proportion of saturated fat in the diet should not exceed 10%. It is recommended to replace pork, sausages, sausages, smoked meats, any semi-finished meat products with lean meats: beef, chicken, rabbit, and fish.
- You need to include a sufficient amount of fiber-rich foods in your diet. These include complex carbohydrates (cereals, grains, whole grain breads) and green vegetables (cucumbers, cabbage of all kinds, squash, radishes, celery, green beans, lettuce, etc.). In addition to fiber, these foods contain a significant supply of vitamins and important micronutrients.
- It is necessary to refuse fast food, fast food, carbonated drinks, any products containing flavors, emulsifiers and other food additives. The nutrition of a pregnant woman should be as close to natural as possible.
A complete list of what you can and cannot eat with diabetes, as well as the importance of the glycemic index!
Childbirth with gestational diabetes
After giving birth, gestational diabetes usually goes away, but it can lead to certain complications during childbirth. As mentioned above, in this case, the child can be born very large, therefore, a cesarean section is often performed, since there is a high risk of birth injuries during natural childbirth.
A child with gestational diabetes is born with low blood sugar, but no special measures to normalize it are necessary. The baby's blood glucose level gradually returns to normal during breastfeeding. This indicator should be constantly monitored by the staff of the maternity hospital.
After giving birth, a woman needs to continue to follow a diet for some time until her blood sugar level also completely normalizes.
However, if you neglect complex therapy during pregnancy, then such a metabolic disorder in the body of a pregnant woman can lead to diabetic fetopathy of the newborn, which is characterized by the following symptoms:
- Violation of the proportions of the child's body (large belly, thin limbs);
- Jaundice;
- Swelling of tissues;
- Respiratory system disorders;
- Increased blood clotting.
The author of the article: Kuzmina Vera Valerievna | Endocrinologist, nutritionist
Education: Diploma of the Russian State Medical University named after NI Pirogov with a degree in General Medicine (2004). Residency at Moscow State University of Medicine and Dentistry, diploma in Endocrinology (2006).
