How does diabetes mellitus affect the fetus? Gestational diabetes mellitus (GDM): the danger of a “sweet” pregnancy. Consequences for the child, diet, signs. Diagnosis of gestational diabetes: symptoms and laboratory values

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

The disease is not that 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 mellitus during pregnancy can negatively 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 baby are affected - the heart and brain.

Gestational diabetes onset in the second and third trimesters pregnancy, causes overfeeding and excessive growth of the fetus. This leads to hyperinsulinemia: after childbirth, when the baby no longer receives as much glucose from the mother, his blood sugar levels drop to very low levels.

If this disease is not identified 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, excess deposits of subcutaneous fat;
• jaundice;
• respiratory disorders;
• hypoglycemia of newborns, increased blood viscosity and the risk of blood clots, low levels of calcium and magnesium in the blood of the newborn.

How does gestational diabetes mellitus occur during pregnancy?

During pregnancy in female body there is not just a hormonal surge, but a whole hormonal storm, and one of the consequences of such changes is impaired body tolerance to glucose– some are stronger, some are weaker. What does this mean? Blood sugar levels are high (above the upper limit of normal), but not high enough to warrant a diagnosis of diabetes.

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 effect of specific hormones on the level of sugar contained in the blood.

If it does not cope with this function with increasing concentrations of hormones, then a phenomenon such as gestational diabetes mellitus occurs during pregnancy.

Risk group for developing gestational diabetes mellitus during pregnancy

There are certain risk factors that increase the likelihood that a woman will develop gestational diabetes during pregnancy. However, the presence of even all these factors does not guarantee that diabetes will still occur - just like the absence of these unfavorable factors, does not guarantee 100% protection against this disease.

1. Excess body weight observed in a woman even 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 much more common than in others. These include blacks, Hispanics, Native Americans and Asians;
3. High sugar level based on urine test results;
4. Impaired body tolerance to glucose (as we have already mentioned, the sugar level is higher than normal, but not so much as to make a diagnosis of diabetes);
5. Heredity. Diabetes is one of the most serious hereditary diseases, and your risk increases if someone close to you on your side 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 mellitus

If you find yourself with several signs that are at risk, tell your doctor about this - you may be prescribed additional examination. If nothing wrong is found, you will undergo another test 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, within 30-60 minutes, but individual indications vary, and this is what interests doctors. In this way, they find out how well the body is able to metabolize the sweet solution and absorb glucose.

If in the form in the “analysis results” column 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 fasting for several hours.

Treatment of gestational diabetes mellitus

Life for diabetics, frankly speaking, is not sugar - both directly and indirectly. figuratively. But this disease can also be controlled if you know how and strictly follow medical instructions.

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

1. Controlling blood sugar levels. 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. Urine tests. Shouldn't appear in it ketone bodies– they indicate that diabetes mellitus is not controlled;
3. Follow a special diet that your doctor will tell you. We will consider this issue below;
4. Reasonable physical exercise on the advice of a doctor;
5. Body weight control;
6. Insulin therapy as needed. On this moment During pregnancy, only insulin is allowed to be used as an antidiabetic drug;
7. Control blood pressure.

Diet for gestational diabetes mellitus

If you are diagnosed with gestational diabetes, you will have to reconsider your diet - this is one of the conditions for successful treatment of this disease. It is usually recommended to reduce body weight in diabetes (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. This means that you should reduce the calorie content of food without reducing its nutritional value.

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

2. Avoid fried and fatty foods, 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 products are quickly absorbed and provoke a rise in blood sugar levels; they contain little nutrients, but a lot of calories. In addition, to neutralize their high glycemic effect, too much insulin is required, which is an unaffordable luxury for diabetes.

3. If you feel sick in the morning, keep a cracker or dry salty cookie on your bedside table and eat a few before getting out of bed. If you are being treated with insulin and feel sick in the morning, make sure you know how to deal with it. low level blood sugar.

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

5. Pay attention to fiber-rich foods: 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 absorption excess fat and sugar in the blood. Fiber-rich foods also contain many essential vitamins and minerals.

6. Saturated fat in the daily diet should not be more than 10%. In general, use fewer products containing “hidden” and “visible” fats. Eliminate sausages, sausages, sausages, bacon, smoked meats, pork, and lamb. Lean meats are much preferable: turkey, beef, chicken, and fish. Remove all visible fat from meat: lard from meat, and skin from poultry. Prepare everything in a gentle way: boil, bake, steam.

7. Cook food without fat, and on vegetable oil, but there shouldn’t be too much of it.

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 restrictions? There are also products that you can there is 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 main meals or as snacks, preferably in the form of salads or boiled in the usual way or for a couple).

11. Make sure your body is provided with the full range of vitamins and minerals Supplements 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 with normal sugar levels, you will be prescribed insulin therapy.

Insulin is only injected because it is a protein, and if you try to put it into 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 observe personal hygiene rules. Your doctor will tell you all the other details of insulin therapy.

Exercise for gestational diabetes in pregnant women

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

Engage in familiar types of active activities that you like and bring pleasure: walking, gymnastics, exercises in the water. No stress on the stomach – you’ll have to forget about your favorite “abs” exercises for now. You should not engage in sports that are fraught with injuries and falls - horse riding, cycling, skating, skiing, etc.

All loads are based on how you feel! If you feel unwell or have pain in your lower abdomen or back, stop and catch your breath.

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

Gestational diabetes and childbirth

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

Many might want a “hero,” but the large size of the child can be a problem during labor and childbirth: in most such cases, it is carried out, and in the case of childbirth naturally There is a risk of injury to the child's shoulders.

For gestational diabetes children are born with reduced level blood sugar, but this can be corrected simply by feeding.

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

As a rule, no special measures are 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 an “irritating factor”, since produces hormones.

The first time after giving birth to you I'll have to keep an eye on it monitor your diet and periodically measure your sugar levels, but over time everything should return to normal.

Prevention of gestational diabetes mellitus

There is no 100% guarantee that you will never encounter gestational diabetes - it happens that women who, by 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 prerequisites.

If you already had gestational diabetes during a previous pregnancy, it is very likely to return. 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 will also help maintain your blood sugar at a safe level, provided that it is regular and does not cause you discomfort.

You also remain at risk of developing a permanent form of diabetes, type 2 diabetes. You will have to be more careful after childbirth. Therefore, it is not advisable 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, progestins, but this does not apply to low-dose combination drugs. When choosing a contraceptive after childbirth, follow your doctor's recommendations.

Replies

In some cases, pregnant women develop gestational diabetes mellitus (GDM). This form of the disease can appear exclusively during pregnancy and disappear some time after childbirth. But if timely treatment is not carried out, the disease can develop into type 2 diabetes, which has complex consequences.

When pregnancy occurs, every woman must register, where, under the supervision of specialists, the well-being of the expectant mother and the development of the fetus will be monitored.

Every pregnant woman should regularly monitor her sugar by taking urine and blood tests. Isolated cases of increased glucose levels in tests should not throw you into panic, since such jumps are considered normal physiological process. But, if when taking tests, high sugar is noticed in two or more cases, this already signals the presence of gestational diabetes mellitus during pregnancy. It is noteworthy that increased level is detected when donating material on an empty stomach (an increase in blood sugar levels after eating is normal).

Causes of pathology

The risk group includes women to whom the following parameters can be applied:

• overweight body or obesity;
• if previous births occurred with gestational diabetes;
• hereditary factor (transmitted genetically);
• ovarian pathologies (polycystic disease);
• pregnancy after 30 years of age.

According to statistics, complications during childbearing occur in 10% of women. The cause of gestational diabetes can be called, as with type 2 diabetes, loss of cell sensitivity to insulin. It is noted high rate blood glucose levels due to high concentrations of pregnancy hormones.

Insulin resistance most often appears between 28 and 38 weeks of pregnancy, and is accompanied by weight gain. It is believed that a decrease in physical activity during this period also affects the appearance of GDM.

Symptoms

Symptoms of GDM are not much different from the symptoms of type 2 diabetes:

• a constant feeling of thirst, while drinking does not bring relief;
• frequent urination, causing discomfort;
• There may be a decrease in appetite or a feeling of constant hunger;
• jumps in blood pressure appear;
• vision suffers, blurred vision appears.

Diagnostics

If at least one of the above signs is present, then a mandatory visit to the gynecologist and testing for sugar levels is required. This analysis is called - glucose tolerance test(GTT). The test helps determine the digestibility of glucose by the cells of a pregnant woman’s body and possible violations this process.

To conduct the test, venous blood is taken from the patient (on an empty stomach). If the result shows elevated sugar levels, a diagnosis of gestational diabetes is made. If the indicators are underestimated, GTT is carried out. To do this, glucose in the amount of 75 g is diluted in a glass (250 ml) of slightly warmed water and given to the woman to drink. After an hour they spend re-fence blood from a vein. If the indicators are normal, then for control the test can be repeated after 2 hours.

Danger of GDM for the fetus

What are the risks of histosis diabetes? developing fetus? Since this pathology does not pose a direct danger to the life of the expectant mother, but can only be dangerous for the baby, treatment is aimed at preventing perinatal complications, as well as complications during childbirth.

The consequences for the child with gestational diabetes are expressed in negative impact it on blood microcirculation in the tissues of a pregnant woman. All complex processes caused by impaired microcirculation ultimately lead to hypoxic effects on the fetus.

Also, the supply of large amounts of glucose to the baby cannot be called harmless. After all, insulin produced by the mother cannot penetrate the placental barrier, and the baby’s pancreas is not yet able to produce required amount hormone.

As a result of the influence of diabetes mellitus, the metabolic processes in the fetus are disrupted, and it begins to gain weight due to the growth of adipose tissue. Next, the baby experiences the following changes:

• an increase in the shoulder girdle is noticed;
• the stomach increases significantly;
• the liver and heart increase in size;

All these changes take place against the background of the fact that the head and limbs remain the same (normal) sizes. All this can affect the development of the situation in the future, and cause the following consequences:

• due to the increase in the fetal shoulder girdle, it becomes difficult to pass through the birth canal during childbirth;
• During childbirth, injuries to the baby and the mother’s organs are possible;
• premature birth may begin due to the large mass of the fetus, which has not yet fully developed;
• in the lungs of a baby in the womb, the production of surfactant, which prevents them from sticking together, decreases. As a result, after birth the baby may have breathing problems. In this case, the child is rescued using an apparatus artificial respiration, and then placed in a special incubator (incubator), where he will remain for some time under the close supervision of doctors.

Also, one cannot fail to mention the consequences of why gestational diabetes mellitus is dangerous: children born from a mother with GDM may have congenital organ defects, and some may develop second-degree diabetes in adulthood.

The placenta also tends to enlarge during GDM, begins to perform its functions insufficiently, and may become edematous. As a result, the fruit does not receive required quantity oxygen, hypoxia occurs. Namely, at the end of pregnancy (third trimester) there is a danger of fetal death.

Treatment

Since the disease is caused by high sugar levels, it is logical to assume that for the treatment and prevention of pathology it is necessary to control that this indicator is within the normal range.

The main factor influencing the course of diabetes treatment during pregnancy is strict adherence to dietary rules:

• Baked goods and confectionery products are excluded from the diet, which can affect the increase in sugar levels. But you shouldn’t completely give up carbohydrates, because they serve as a source of energy. It is only necessary to limit their number throughout the day;
• limit the consumption of very sweet fruits high in carbohydrates;
• exclude noodles, purees and instant cereals, as well as various semi-finished products;
• remove smoked meats and fats from the diet (butter, margarine, mayonnaise, lard);
• It is necessary to eat protein foods, it is important for the body of mother and child;
• for cooking, it is recommended to use: stewing, boiling, steaming, baking in the oven;
• You should eat food every 3 hours, but in small portions.

Moreover, it has been proven positive influence on the health of the expectant mother:

• complex physical exercise, designed for pregnant women. During physical activity, the concentration of sugar in the blood decreases, metabolic processes in the body improve and general well-being pregnant;
• regular walks away from highways.

In severe cases of the disease, your doctor may prescribe insulin medications. Other medications that lower sugar are prohibited.

1. B - category. It includes products whose description says that in animal studies, harmful effects no effect was observed on the fetus. The effect of the drug on pregnancy has not been tested.
2. C - category. Includes drugs that have been tested to have an effect on fetal development in animals. Tests have not been conducted in pregnant women either.

Therefore, all drugs should be prescribed only by a qualified doctor, with the obligatory indication trade name medicines.

Hospitalization for GDM is relevant only if there is a suspicion of complex obstetric complications.

GDM is not a reason to stimulate premature birth or a caesarean section.

Postpartum period

After childbirth, a woman should regularly check her sugar level, monitor the presence of symptoms and their frequency (thirst, urination, etc.) until they disappear completely. Testing is usually prescribed by doctors 6 and 12 weeks after birth. By this time, the woman’s blood sugar level should normalize.

But, according to statistics, in 5-10% of women who give birth, sugar levels do not normalize. In this case it is required medical assistance, which should not be neglected, otherwise a simple hormonal disorder can develop into a serious incurable disease.

In ancient times, when there were no hospitals and pharmacies, humanity already knew about the existence of diabetes. The first mention of this disease dates back to the 15th century BC. Already in that distant era, it was noticed that diabetes mellitus had an adverse effect on the condition of a pregnant woman and interfered with normal development her baby. How does the disease manifest itself in expectant mothers and what are the risks of its occurrence during pregnancy?

Types of Gestational Diabetes

Diabetes mellitus is a metabolic disease accompanied by increased blood glucose levels. The pathological process can develop as a result of absolute or relative insulin deficiency. During pregnancy, one of the types of pathology may make itself felt:

• diabetes mellitus type 1 or 2 that existed before pregnancy;
• gestational diabetes mellitus.

Gestational diabetes is a condition that first appears during real pregnancy. Before conceiving a child, the woman did not notice any changes in her body and did not make any special complaints. It also happens that the expectant mother simply did not know about her disease, because before pregnancy she was not examined by an endocrinologist or therapist. It is possible to clearly understand whether diabetes mellitus is gestational or a manifestation of true diabetes only after the birth of the child.

Before talking about the characteristics of the disease in expectant mothers, you should understand how diabetes manifests itself outside of pregnancy. The causes, development mechanisms and treatment principles are determined by the type of diabetes mellitus. The symptoms of the disease will be similar, and only targeted diagnosis makes it possible to distinguish between the types of this pathology.

Diabetes mellitus type 1 represents a typical autoimmune disease. In most cases, it occurs against the background of infection with a particular virus. Inflammation develops, leading to the destruction of beta cells thyroid gland. It is these cells that produce insulin, a hormone involved in all metabolic processes in organism. When more than 80% of the thyroid cells are affected, symptoms of type 1 diabetes appear.

Diabetes mellitus type 2 appears in the background genetic predisposition. Factors that provoke its appearance include:

• obesity;
• eating disorder;
• sedentary lifestyle;
• stress.

In type 2 diabetes, insulin levels remain normal, but the body's cells are not able to perceive this hormone. Insulin resistance develops, leading to numerous health problems. A characteristic feature of patients with type 2 diabetes is excess body weight. Obesity in this form of the disease is associated with impaired lipid metabolism as a result of high levels of insulin in the blood.

Gestational diabetes mellitus is essentially similar to type 2 diabetes. High levels of female sex hormones and cortisol (adrenal hormone) during pregnancy lead to the development of physiological insulin resistance. In other words, while expecting a child, all women, to one degree or another, develop insensitivity of body cells to insulin. Moreover, in 5-10% of expectant mothers, this condition leads to the formation of gestational diabetes mellitus, while in other women the disease does not develop.

Symptoms of diabetes during pregnancy

Gestational diabetes mellitus is asymptomatic in most cases. The woman does not present any special complaints, and only routine examinations during pregnancy reveal elevated blood glucose levels. Typical symptoms of diabetes in expectant mothers occur quite rarely.

Signs of gestational diabetes include:

• polydipsia (constant thirst);
• polyuria (frequent urination);
• polyphagia ( increased appetite up to constant insatiable hunger).

All these symptoms are not very specific and can be mistaken for normal symptoms of pregnancy. Many women, while expecting a baby, feel severe hunger and notice a significant increase in appetite. Thirst often occurs in expectant mothers later, especially if this period falls in spring and summer. Finally, frequent urination occurs in all pregnant women, and it is not possible to distinguish it from symptoms of diabetes.

Diagnosis of gestational diabetes

During pregnancy, all women have their blood sugar levels determined. This analysis is taken from a vein on an empty stomach twice during pregnancy: at the first appearance and at 30 weeks. This approach allows you to identify the disease in time and take all measures to prevent its complications in expectant mothers.

When interpreting a blood glucose test, the following results are possible:

• from 3.3 to 5.5 mmol/l – normal;
• from 5.6 to 7.0 – impaired glucose tolerance;
• more than 7.1 – diabetes mellitus.

Impaired glucose tolerance is called prediabetes. This condition is on the border between normal and pathological, and the expectant mother needs to make every effort to maintain health in this situation. When determining a blood sugar level of more than 5.6 mmol/l, a pregnant woman should definitely see an endocrinologist.

If diabetes is suspected, a glucose tolerance test is performed. The analysis consists of two stages. First, blood is taken from a vein from a patient strictly on an empty stomach, after which the woman is asked to drink 75 ml of a sweet drink (glucose diluted in water). After 1-2 hours, blood is taken again to determine the sugar level. Based on the test results, the following conclusions are made:

• up to 7.8 mmol/l – normal;
• from 7.9 to 11.0 mmol/l – impaired glucose tolerance;
• more than 11.1 mmol/l – diabetes mellitus.

At the same time as determining blood glucose levels, pregnant women take a urine test. If sugar is detected in the urine, the development of gestational diabetes is indicated. Also, with this pathology, acetone (ketone bodies) can be detected in the urine. Acetone itself cannot be the basis for diagnosis, since this element is found in many pathological processes (for example, toxicosis in early pregnancy).

Complications of pregnancy with gestational diabetes

In the first trimester of pregnancy, diabetes may cause spontaneous miscarriage. This complication most often occurs after 6 weeks and is due to pathological processes, occurring in altered vessels. It is worth noting that this complication is more typical of true diabetes mellitus, which existed even before pregnancy.

Gestational diabetes mellitus is common complicated placental insufficiency after 20 weeks. This complication is also associated with impaired microcirculation, which ultimately leads to an insufficient supply of oxygen and nutrients to the baby. In the third trimester of pregnancy, gestational diabetes very often leads to the development of fetal hypoxia and intrauterine growth retardation.

One of the most severe complications of pregnancy due to gestational diabetes is premature detachment placenta. The same microcirculation disorders resulting from vasospasm are to blame for the occurrence of this pathology. In turn, the narrowing of the lumen of blood vessels is explained by numerous metabolic disorders against the background of developed insulin resistance.

All of these mechanisms lead to the placenta leaving the uterine wall earlier due date. Normally, the fetal place is born immediately after the birth of the child. Placental abruption during pregnancy can cause massive bleeding and even fetal death.

70% of women with gestational diabetes develop gestosis. This specific complication of pregnancy is characterized by increased blood pressure and impaired renal function. In diabetes, gestosis manifests itself quite early, and already at 24-26 weeks, many women notice the first symptoms of this disease. The combination of gestosis and diabetes is quite unfavorable and provokes multiple problems throughout pregnancy.

In the majority of expectant mothers, gestational diabetes leads to the development polyhydramnios. With this pathology, the volume amniotic fluid increases to 2 liters at 36-37 weeks. Polyhydramnios adversely affects the condition of the fetus, disrupting its normal position in the uterus. Often, excess amniotic fluid leads to the fact that the fetus occupies an oblique or transverse position, and it will be possible to remove it from the uterus only through a caesarean section.

Consequences of gestational diabetes for the fetus

Throughout pregnancy, the baby suffers from a lack of oxygen and essential nutrients. Constant hypoxia primarily affects the development of its nervous system. Lack of oxygen affects the brain, which ultimately leads to perinatal encephalopathy and other serious diseases that develop immediately after the birth of the child.

A specific complication of gestational diabetes is diabetic fetopathy. Children born to mothers with this pathology have a characteristic appearance:

• heavy weight (more than 4 kg at birth);
• purple or bluish skin tone;
• a large amount of cheese-like lubricant on the skin;
• swelling of the skin and soft tissues;
• puffiness of the face;
• petechial rash (small hemorrhages under the skin).

Despite their large size, babies are born weak. Many children experience shortness of breath and even apnea (stopping breathing) in the first hours of life. Characterized by prolonged jaundice associated with pathological changes in the liver of a newborn. Most children experience various neurological disorders (decreased muscle tone, adynamia or hyperexcitability, suppressed reflexes).

Especially dangerous condition Hypoglycemia (low blood glucose) that occurs in a newborn in the first days of life. The thing is that in utero the baby received a large amount of sugar from the mother’s blood. The fetal pancreas is accustomed to working in an increased mode, and cannot always quickly switch to a different rhythm. After birth, the supply of maternal sugar to the baby stops, while insulin levels still remain high. Hypoglycemia develops - a sharp decrease in blood sugar levels. This condition can have serious consequences, including coma and death.

Treatment of gestational diabetes mellitus

If gestational diabetes is detected, the woman is placed under the supervision of an endocrinologist. It is recommended to visit your doctor every two weeks (unless there are complications). If adverse consequences of diabetes develop, treatment of a pregnant woman can be continued in hospital.

Treatment of diabetes during pregnancy is aimed at preventing various complications associated with metabolic disorders. Treatment begins with the selection of an optimal diet, balanced in essential nutrients. In this case, dietary recommendations should take into account the real needs of the mother and fetus in accordance with the duration of the actual pregnancy.

For gestational diabetes from a woman's diet easily digestible carbohydrates are excluded:

• cakes, pastries and other sweets;
• jam;
• products made from white flour;
• sweet fruits;
• juices and syrups;
• carbonated drinks.

To prevent excess weight gain, fats are also limited in a pregnant woman's diet. Meals for gestational diabetes mellitus should be frequent, up to 5-6 times a day, but in fairly small portions. This scheme avoids the load on digestive tract and prevent the development of hyperglycemia (increased blood glucose levels) after eating.

Sharp dietary restrictions and fasting are prohibited. A pregnant woman's diet should be balanced and contain optimal quantity vitamins and microelements. General increase weight during pregnancy should be no more than 12 kg for women with normal weight and no more than 8 kg in case of obesity.

The criterion for the effectiveness of diet therapy is determination of blood sugar levels. Normally, glucose should be no more than 5.5 mmol/l on an empty stomach and no more than 7.8 mmol/l two hours after eating. If these indicators are exceeded, the issue of insulin therapy is decided.

The selection of insulin and determination of its dosage is carried out by an endocrinologist. It is worth considering that most women suffering from gestational diabetes mellitus retain the ability to synthesize their own insulin. To maintain normal metabolism, such women only need a very small dose of the hormone daily. The need for insulin may increase as pregnancy progresses.

Management of childbirth with gestational diabetes mellitus

The optimal time for delivery for gestational diabetes is 37-38 weeks of pregnancy. It makes no sense to delay beyond this period. By 37 weeks, the fetus is already fully formed and can exist safely outside the mother’s womb. Further prolongation of pregnancy can be quite dangerous due to insufficient functioning of the placenta and depletion of its resources after 38 weeks.

Experts recommend that women give birth to a child in a specialized obstetric hospital. Such maternity hospitals have everything necessary equipment to assist a newborn. Also, experienced therapists and endocrinologists work here around the clock, able to solve any problems associated with the progression of diabetes.

Women with gestational diabetes usually give birth vaginally. Indications for cesarean section are very large fetal sizes, as well as gestosis, nephropathy and other complications of pregnancy. In many cases, insulin therapy is administered during childbirth or during surgery.

Gestational diabetes goes away on its own after childbirth without additional treatment. It is possible that the situation will recur during the second and subsequent pregnancies. Preservation high level Blood glucose levels after childbirth indicate the development of true diabetes mellitus. In this case, the woman is recommended to undergo full examination see an endocrinologist and begin treatment of the disease as soon as possible.

Pregnancy. An amazing, wonderful and one of the most exciting periods in a woman’s life, which promises very important changes - the birth of a child. Of course, all mothers want the best for their baby - first of all, that he is healthy. The key to a baby’s health is, first of all, the health of his mother. But, unfortunately, it often happens that at the stage of pregnancy planning, or in the early stages of pregnancy, the gynecologist talks about the need to visit an endocrinologist, since an increase in blood sugar levels has been detected.

At the first visit to the gynecologist, all pregnant women are examined for glycemia (blood sugar - gr. glykys sweet + haima blood) on an empty stomach. At the same time, the expectant mother may hear: “Your blood sugar is 5.1 mmol/l, this is higher than normal.” How so? It seems that the indicator is “low”. But the thing is that glycemic targets are different for pregnant and non-pregnant women.

The normal level of venous blood plasma sugar in a pregnant woman on an empty stomach is strictly below 5.1 mmol/l.(it should be noted that before taking the test you can drink ONLY still water. Tea, coffee, etc. are prohibited).

If the venous blood plasma sugar level is ≥ 5.1 mmol/l, but below 7.0 mmol/l, a diagnosis is made gestational diabetes mellitus. In some cases, an oral glucose tolerance test (OGTT) is performed to confirm the diagnosis, but this is not mandatory .

Criteria for diagnosing gestational diabetes mellitus and its causes

• Gestational diabetes mellitus- when fasting blood sugar is equal to or more than 5.1 mmol/l and less than 7.0 mmol/l, 1 hour after the OGTT (oral glucose tolerance test) is equal to or more than 10.0 mmol/l, 2 hours after the OGTT is equal to or more than 8.5 mmol/l and less than 11.1 mmol/l.
• If the blood sugar level is higher than or equal to 7.0 mmol/l, blood is taken again from a vein on an empty stomach and 2 hours after a meal to determine glycemia. If blood sugar is again 7.0 mmol/l or higher, and two hours after eating 11.1 mmol/l or higher, a diagnosis is made manifest diabetes mellitus.

All studies should be carried out on venous blood plasma. When assessing indicators blood sugar from finger- data not informative!

So why does a healthy woman, whose blood sugar was always normal before, experience an increase?

In fact, high blood sugar (hyperglycemia) during pregnancy is now a common situation. According to statistics, about 14-17% of all pregnancies occur in conditions of hyperglycemia. Pregnancy is a state of physiological (with related to the physiology of the body, with its vital functions) insulin resistance (decreased tissue sensitivity to insulin).

Let's look at this term to make it clear. Glucose is a source of energy for the cells of our body. But glucose cannot enter cells from the blood on its own (with the exception of vascular and brain cells). And then insulin comes to her aid. Without this hormone, the cell “does not recognize” the useful and necessary glucose. Speaking in simple language, insulin “opens the doors” of the cell for glucose to pass into it. The cell receives its energy, and the blood sugar level decreases. Thus, insulin ensures the maintenance normal level glycemia. Insulin resistance is a condition in which cells partially do not recognize insulin. As a result, the cells will not receive enough energy, and blood sugar levels will rise.

The hormones produced by the new organ of a pregnant woman, the placenta, are to blame for physiological insulin resistance. Due to this effect of hormones on cells, insulin production in the blood increases to “overcome” insulin resistance. Normally, this is sufficient, and when glucose enters the cells, the blood sugar level decreases. But in some pregnant women, despite increased insulin synthesis, insulin resistance is not overcome, and blood sugar remains elevated.

Overt diabetes mellitus- This is diabetes mellitus diagnosed for the first time during pregnancy, and its occurrence is not associated with physiological insulin resistance. This is the same diabetes that occurs outside of pregnancy - type 2 or type 1 diabetes.

When the mother's blood sugar level increases, glycemia and insulin levels in the blood of the fetus increase. As a result, this worsens the course of pregnancy and harms the health of the child.

Why is gestational diabetes mellitus dangerous?

Hyperglycemia during pregnancy significantly increases the risk of:

• Preeclampsia (a form of late toxicosis - increased blood pressure above 140/90 mmHg, proteinuria (the appearance of protein in the urine), edema).
• Premature birth.
• Polyhydramnios.
• Urogenital infections.
• Development of placental insufficiency.
• High frequency of operative delivery.
• Thromboembolic disorders.
• Perinatal diseases of the newborn, perinatal mortality.
• Diabetic fetopathy of the newborn.
• Ischemic changes in the brain of a newborn.
• Lesions of the central nervous system of the newborn.
• Pneumonia of newborns.
• Fetal macrosomia ( large fruit) is the main cause of birth injuries.

Who needs to be examined at the stage of pregnancy planning:

• Women who are obese.
• Women with ovarian dysfunction and infertility.
• Women with burdened obstetric history, miscarriage.
• Women who had gestational diabetes mellitus in a previous pregnancy and are planning a pregnancy again.

So, the diagnosis of gestational diabetes mellitus has been made. Of course it is necessary individual approach to the treatment of any disease, there are no exceptions. An individual treatment regimen can only be selected by an endocrinologist or gynecologist-endocrinologist at an appointment. For one patient, the endocrinologist will only prescribe special diet for the entire gestation period, another will be needed additionally drug therapy. But the basis is the same for everyone. This is special balanced diet and proper self-monitoring of glycemia.

How to properly self-monitor glycemia

Self-monitoring of glycemia is carried out independently using a glucometer. At the pharmacy it is possible to purchase a glucometer, both the simplest and the more complex, which stores measurement values ​​and can build a glycemic curve.

But whatever the glucometer, it is best to start keeping a diary of self-monitoring of glycemia and a food diary. This regular notebook, in which all blood sugar measurements are recorded on one page, indicating the dates and times of measurement (before meals, an hour after meals, before bed).

On another page they write daily ration nutrition, indicating the time of food consumption (breakfast, lunch, dinner or snack) and the amount of product (required) + calorie content, protein, fat and carbohydrate content (desirable).

In case of gestational diabetes mellitus, at the stage of selecting and assessing the adequacy of treatment, glycemic measurements should be from 4 to 7 times a day. These are indicators on an empty stomach before breakfast, before lunch, before dinner and at night (required) + 1-1.5 hours after breakfast, after lunch (optional).

What are the goals of treatment for gestational diabetes?

• Fasting glycemia - strictly less than 5.1 mmol/l
• Glycemia 1-1.5 hours after eating is less than 7 mmol/l.

Features of the diet for gestational diabetes mellitus:

• Fasting and long breaks between meals are unacceptable.
• The last meal - an hour before bedtime (snack) - is protein (meat, fish, egg, cottage cheese) + complex carbohydrates (uncooked cereals, pasta, black, whole grain bread, vegetables, legumes). If you are obese, the last snack before bed is protein + vegetables.
• Minimize or completely avoid sweets (honey, sugar, sweet pastries, ice cream, chocolate, jam), sweet drinks (juices, fruit drinks, soda), boiled cereals/pasta, mashed potatoes, white bread, white rice.
• The frequency of meals is at least 6 times a day! (3 main + 3 snacks)
• Carbohydrate starvation should not be allowed; carbohydrates must be eaten, but the right ones! These are uncooked cereals, pasta, potatoes, black and whole grain bread, vegetables, legumes, liquid unsweetened dairy and dairy products. It is recommended to consume carbohydrates in non- large quantities every 3-4 hours.
• Physical activity is required - a walk in the morning and evening for 30 minutes.
• Increase your fiber intake - these are vegetables (except potatoes, avocados). If you are obese, include fiber in every main meal.
• Low-calorie diets are unacceptable. Consume at least 1600 kcal per day. (taking into account the actual body weight, the endocrinologist will select an individual norm).
• Fats at normal weight bodies should make up about 45% of the daily diet, for obesity - 25-30%.
• Protein food is required - at least 70 grams of protein per day.
• Eat fruits with a low glycemic index in small quantities (grapes, cherries, cherries, watermelon, melon, figs, persimmons, bananas are not recommended). It is better to combine with protein foods (for example, cottage cheese, cottage cheese casserole with fruit).
• Dried fruits - no more than 20 grams of dried fruits per serving in main meals. If it is a snack, combine it with protein (for example, cottage cheese). No more than 2 times a day.
• Chocolate - only bitter, no more than 3 slices (15 grams) per serving, no more than 2 times a day. In the main meal or in combination with protein (for example, cottage cheese).

It is recommended to follow the “plate rule”. This rule is that at each main meal you need to eat foods rich in fiber (vegetables), proteins, fats and carbohydrates. Wherein, most plates (1/2) should be occupied by vegetables.

Recommendations are general. If, when consuming a particular product, blood sugar rises above the target values, it is recommended to limit its consumption or reduce the amount of the product. All questions regarding the preparation of an individual nutrition plan must be resolved at an appointment with an endocrinologist.

Need to know during pregnancy It is prohibited to take tableted glucose-lowering drugs, since their safety during pregnancy has not been proven.

If the diet fails to achieve glycemic targets, the doctor prescribes insulin. You shouldn't be afraid of this. Insulin does not cause any harm to either the mother or the fetus. Popular myths about insulin are nothing more than myths. After delivery, in 99% of cases, insulin is discontinued. Do not forget that the main thing in the treatment of gestational diabetes mellitus is achieving stable glycemic targets.

Gestational diabetes mellitus:postpartum period and lactation

As noted earlier, most often after childbirth, blood sugars return to normal. But sometimes there are exceptions. In the first three days after birth, an examination is necessary, which is carried out in order to identify the possible persistence of impaired carbohydrate metabolism - fasting glycemia is monitored.

Lactation and breastfeeding are the prevention of diabetes mellitus for women who have had gestational diabetes mellitus. If a woman continues to have an increase in glycemia, and against the background of diet therapy, blood sugars do not return to normal, the endocrinologist prescribes insulin therapy for the entire period breastfeeding. Taking tableted glucose-lowering drugs during lactation is prohibited.

Let's sum it up

• Gestational diabetes mellitus is characterized by a systematic increase in glycemia in the absence of treatment.
• Even the slightest increase in glycemia in a pregnant woman ultimately leads to adverse consequences.
• When blood sugar increases in the mother, glycemia and insulin levels in the baby’s blood increase, which ultimately leads to serious complications described above.
• During pregnancy, it is better to come to the endocrinologist once again if you are worried about this or that issue, than not to come.
• The basics of treating gestational diabetes mellitus: proper self-control + diet therapy + drug therapy (if prescribed by an endocrinologist). Goals are stable glycemic targets.

Dear mothers, take care of yourself. Take your health and the health of your baby seriously. Have an easy pregnancy and healthy babies!

Endocrinologist Galina Aleksandrovna Akmaeva

Pregnancy means sudden change hormone balance. And this natural feature can lead to the fact that the components secreted by the placenta prevent the mother’s body from receiving insulin. A woman has abnormal levels of glucose in her blood. Gestational diabetes mellitus during pregnancy occurs more often from the middle of pregnancy. But its earlier presence is also possible.

Read in this article

Causes of diabetes in pregnant women

Experts cannot name the obvious culprit for the disruption of tissue response to glucose in expectant mothers. There is no doubt that not the least importance in the emergence of diabetes belongs to hormonal changes. But they are common for all pregnant women, and the disease, fortunately, is not diagnosed in this position in everyone. Those who suffered it noted:

• Hereditary tendency. If there are cases of diabetes in the family, there is a higher probability of its occurrence in the pregnant woman compared to others.
• Autoimmune diseases that, due to their characteristics, disrupt the functions of the insulin-producing pancreas.
• Frequent viral infections. They can also disrupt 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 behind a short time, and its index became above 25.
• Age from 35 years. Those who are under 30 at the time of pregnancy have a lower risk of developing gestational diabetes than others.
• Previous birth of a baby weighing more than 4.5 kg or dead child for unknown reasons.

Women of Asian or African descent are more susceptible to gestational diabetes than Caucasian women.

Signs to suspect you have gestational diabetes

On early stage Diabetes mellitus during pregnancy shows virtually no symptoms. This is why it is important for expectant mothers to control their blood sugar levels. Initially, they may notice that they began to drink a little more water, lost a little weight, although there are no weight loss measures visible reasons. Some people find that they find it more pleasant to lie down or sit than to move.

As the illness develops, a woman may feel:

• Need for large amounts of fluid. Despite her satisfaction, she is bothered by dry mouth.
• The need to urinate more often, and much more fluid comes out than usual.
• Increased fatigue. Pregnancy already takes a lot of energy, but now a woman’s desire to rest arises faster than before; with diabetes, her sense of self does not correspond to the load she receives.
• Deterioration in the quality of vision. Cloudiness may occur in the eyes from time to time.
• Itchy skin, and mucous membranes may also itch.
• A significant increase in the need for food and rapid increase weight.

The first and last signs of diabetes during pregnancy are difficult to separate from the diabetes itself. After all, even 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. It is imperative to monitor the quantitative glucose content on an empty stomach, as well as 2 hours after each meal. Sometimes measuring your sugar level may be required beforehand.

You will need to periodically do a urine test. This is necessary to ensure that there are no ketone components in the liquid, that is, to curb pathological processes.

Main on at this stage diet and physical activity become.

Nutrition for gestational diabetes

a pregnant woman cannot, the fetus must have everything it needs, and sugar increases from lack of food. For the expectant mother will have to stick 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 occur at breakfast. These are porridge, rice, pasta, bread.
• It is important to pay attention to the composition of products, postponing sugary fruits, chocolate, and baked goods until better times. Fast food and seeds are excluded. You need vegetables, grains, poultry, and rabbit. Fat must be removed; no more than 10% of it should be eaten per day. total number food. Fruits, berries, and greens that do not contain a large amount of sugar will be beneficial.
• You cannot eat instant foods. Having the same names as natural ones, they contain more glucose. We're talking about freeze-dried cereals, mashed potatoes, noodles.
• Food cannot be fried, only boiled or steamed. If you simmer, do so with a small amount of vegetable oil.
• You can fight morning sickness with dry, unsweetened cookies. It is eaten in the morning without getting out of bed.
• Cucumbers, tomatoes, zucchini, lettuce, cabbage, beans, and mushrooms can be eaten in large quantities. They are low in calories and have a low glycemic index.
• Vitamin and mineral complexes are taken only on the recommendation of a doctor. Many of them contain glucose, the excess of which is now harmful.

With this style of eating, you need to drink up to 8 glasses of water per day.

Medicines

If dietary changes do not have an effect, that is, the glucose level remains elevated, or the urine test is poor with normal sugar levels, insulin will have to be administered. The dose in each case is determined by the doctor, based on the patient’s weight and gestational age.

Insulin is administered intravenously, usually dividing the dose by 2 times. The first is injected before breakfast, the second before dinner. The diet during drug therapy is maintained, as is regular monitoring of blood glucose concentrations.

Physical exercise

Physical activity is needed regardless of whether the rest of the treatment is limited to diet or whether the pregnant woman injects insulin. Sport helps you spend extra 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 abdominal swings), and swimming are suitable.

Preventing Gestational Diabetes

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

• On early 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 blood vessels of the placenta due to gestational diabetes leads to circulatory disorders in this area, consequently, 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 cardio-vascular system and the fetal brain, stimulate its excessive growth.
• Labor may begin prematurely. A big size the fetus is forced to perform a cesarean section. If the birth is natural, this will create a risk of injury for mother and baby.
• The newborn baby may be at risk for jaundice, breathing problems, hypoglycemia, and increased blood clotting. These are signs of diabetic fetopathy, which causes other pathologies in the child in the postnatal period.
• A woman is more likely to develop preeclampsia and eclampsia. Both problems are dangerous due to high blood pressure and convulsions, which during childbirth can kill both mother and child.
• Subsequently, the woman has increased risk get diabetes.

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

• Regular. It is important to register early and do everything necessary tests, especially if you are in a risk group.
• Maintaining optimal body weight. If it was larger than normal before pregnancy, it is better to lose weight first and plan later.
• . High 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 child. healthy child. It is necessary to identify the pathology in time and make efforts to contain it.