Gestational diabetes during pregnancy

What is gestational diabetes mellitus?

Gestational diabetes mellitus – This is an elevated blood sugar level, which 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 date, one can suspect the presence of ordinary diabetes mellitus, which the woman had before pregnancy.

Causes gestational diabetes are as follows: under the influence of hormonal changes in the II-III trimester of pregnancy, the pancreas of a woman must produce much more insulin to compensate for the effect of hormones on blood sugar levels. If it does not cope with increased functions, this leads to diabetes.

With gestational diabetes, there are no changes in well-being that are characteristic of ordinary type I and type II diabetes.

However, some signs may be present:

• constant thirst and dry mouth;

• frequent and profuse urination;

• fatigue;

• decrease in visual acuity.

However, these signs are often perceived by pregnant women as specific features of their situation.

Gestational diabetes provokes an excessive increase in fetal weight and leads to hyperinsulinemia in the child after birth: when the child ceases to receive the same amount of glucose from the mother, the level of sugar in his blood 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 on the development of gestational diabetes mellitus (GDM) in women during pregnancy. The results showed that this problem affects 4% of women who are pregnant.

The fact that this pathology is so widespread indicates the 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 very late. In connection with this circumstance, in women’s counseling and reproductive centers, specialists are engaged in educational activities aimed at protecting women’s health and allowing healthy babies to be born.

What is the risk of gestational diabetes?

First of all, the risk of unfavorable development of the fetus increases. In early pregnancy, GDM can cause congenital malformations of brain structures and heart development in the fetus, and can also cause spontaneous abortion. In the last two trimesters of pregnancy, due to diabetes, the fetus may grow above the norm (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 disproportion, overweight of the baby (over 4 kg), respiratory disorders due to 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 pancreatic hormone, is responsible. The deficiency of this hormone can be relative or absolute. As a rule, with diabetes, the level of glucose in the blood is outside the normal range. This phenomenon is called hyperglycemia. At the same time, glucosuria (sugar in the urine) is detected.

Specialists of the World Health Organization divide diabetes mellitus into several types. Type 1 disease affects teenagers and young children who have an autoimmune breakdown of the cells that produce the hormone insulin in the pancreas. As a result of the breakdown of these cells, the production of insulin is reduced or completely stopped.

According to statistics, 1% of the total number of victims of the disease suffer from type 15 diabetes. A sure sign of the disease is high glucose levels at a young age. Also, antibodies to insulin and ?-cells can be detected in the blood. These patients have low insulin levels. The only way to treat type 1 diabetes is by injecting insulin.

Genetic defects, acute chronic pancreatitis, various infectious diseases, chemicals and certain medications can cause overweight people to develop type 2 diabetes.

This type of disease is typical for mature patients with a hereditary predisposition. In laboratory tests of patients, an increase in glucose levels exceeding 5,5 mmol / l is observed. For patients, the doctor prescribes medications, a certain diet and mandatory physical activity. This course of treatment can lower blood glucose levels.

Causes of gestational diabetes

During the period of gestation, any woman may experience the development of GDM due to the reduced sensitivity of tissues and cells to the insulin produced by the body. Thus, there is a development of insulin resistance, which is interconnected with an increase in the level of hormones in the blood of the expectant mother. The placenta and 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, the development of gestational diabetes begins. Elevated levels of proinsulin serve as a clear confirmation of the deterioration of ?-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 immediately returns to normal, but even under such circumstances, the possibility of developing diabetes cannot be completely ruled out.

Risk factors for developing 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 higher than normal;

• various disorders of carbohydrate metabolism;

• obesity or overweight with signs of metabolic disorders;

• over thirty years of age;

• the presence of type 2 diabetes mellitus in relatives in a direct line;

• gestosis and severe toxicosis during past pregnancies;

• various diseases of the cardiovascular system;

• experienced GDM in the past;

• spontaneous abortions in the 1st or 2nd trimesters during previous pregnancies, chronic non-carrying of the fetus;

• congenital malformation of the nervous and cardiovascular systems 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 the laboratory is currently the only criterion that can accurately determine the development of GDM. At the time of registration in the antenatal clinic, the doctor can identify the expectant mother as a risk group, which means a mandatory fasting blood test to determine the level of sugar. The analysis is carried out against the background of normal physical activity and daily diet. Blood for laboratory testing 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 detect GDM, every pregnant woman is recommended to undergo a special oral test to determine the quality of glucose absorption by the body. This test is carried out at the 6-7th month of pregnancy. If necessary, the test is carried out as many times as the doctor considers necessary.

Blood plasma for analysis is taken on an empty stomach. If the plasma glucose level is higher than 5,1 mmol/L, 60 minutes after a meal it is higher than 10,0 mmol/L, and 120 minutes after a meal it is higher than 8,5 mmol/L, the doctor makes the diagnosis of GDM with full 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 the birth of a sick baby is minimized, that is, to 1-2%.

Diagnosis of gestational diabetes

There are certain risk factors that increase the likelihood of developing gestational diabetes.

Main risk factors:

• Overweight (obesity) before pregnancy;

• Previously diagnosed impaired glucose tolerance;

• The presence of the disease during previous pregnancies;

• Genetic predisposition;

• Nationality (Latin Americans, Africans, Asians are more susceptible to the disease);

• Previous birth of a large (more than 4 kg) or stillborn child;

• Polyhydramnios.

A blood glucose test is prescribed in each trimester of pregnancy. The norm of sugar content in the blood is up to 5,1 mmol / l. At higher rates, a glucose tolerance test is additionally assigned. To do this, a woman takes blood 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 one hour after glucose enters the body – 10,0 mmol / l, and after 2 hours 8,5 mmol / l.

Treatment of gestational diabetes

In women with gestational diabetes, late toxicosis, edema, increased pressure, impaired renal function and cerebral circulation are observed. It also increases the risk of developing urinary tract infections and the risk of preterm birth.

When the diagnosis is confirmed by an endocrinologist, complex therapy is prescribed, which should be followed until the very birth:

• Proper rational nutrition is the most important point;

• Sufficient physical activity – the best option would be long walks;

• Regular monitoring of blood sugar levels, which is carried out daily;

• Regular urinalysis for the presence of ketone bodies;

• Blood pressure control.

In most cases, following a diet is sufficient. With adequate implementation of medical recommendations, no medical intervention is required. If this therapy is not enough and the sugar level remains elevated, insulin therapy is prescribed. Insulin is used as an injection. Antidiabetic drugs in the form of tablets 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 fall into the risk group do not experience this disease during pregnancy, while other pregnant women can develop diabetes without any prerequisites.

In the event that a woman has already suffered once gestational diabetes mellitus, she should approach the conception of the next child with full responsibility and plan it no earlier than two years after the birth of the last child. To minimize the risk of re-development of a dangerous disease, it is necessary to start tracking body weight six months before pregnancy and include daily exercise in the daily routine. in addition, it is necessary to regularly take tests to determine the level of glucose in the blood.

Any pharmaceutical preparation is allowed to be taken only upon agreement with the doctor, since some pharmaceutical products (glucocorticosteroids, birth control pills, etc.) can subsequently serve as a catalyst for the development of gestational diabetes.

If a woman suffered GDM during pregnancy, one and a half to two months after the birth of a child, she needs to determine the level of glucose using an analysis. It will not be superfluous to additionally pass 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 time for control laboratory blood tests.

Diet for gestational diabetes

Proper nutrition is the main condition for the successful treatment of gestational diabetes. The diet should be dietary and at the same time complete. It is forbidden to sharply 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 be in the first half of the day. Feelings of hunger should be avoided.

• It is necessary to sharply limit or completely exclude easily digestible simple carbohydrates from the menu: confectionery, muffins, pastries, as well as some sweet fruits (bananas, grapes, figs), the use of which leads to a rapid increase in blood glucose levels.

• Fat intake should be limited (butter, margarine, mayonnaise, sour cream, cream cheese). The proportion of saturated fat in the diet should be no more than 10%. It is recommended to replace pork, sausages, sausages, smoked meats, any semi-finished meat products with lean meats: beef, chicken, rabbit, and also fish.

• You need to include enough fiber-rich foods in your diet. These include complex carbohydrates (cereals, grains, whole grain breads) and green vegetables (cucumbers, cabbage of all kinds, zucchini, radishes, celery, green beans, lettuce, etc.). In addition to fiber, these products contain a significant supply of vitamins and important trace elements.

• It is necessary to abandon fast food, fast food, carbonated drinks, any products containing flavorings, emulsifiers and other food additives. Nutrition of a pregnant woman should be as close to natural as possible.

Childbirth with gestational diabetes

After childbirth, gestational diabetes in most cases goes away, but it can lead to certain complications during childbirth. As mentioned above, the child in this case can be born very large, so a caesarean section is often performed, since there is a high risk of birth injuries during natural childbirth.

A child with gestational diabetes is born with a low blood sugar level, 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 finally normalizes.

However, if complex therapy is neglected 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:

• Violations of the proportions of the child’s body (large belly, thin limbs);

• Jaundice;

• swelling of tissues;

• Respiratory system disorders;

• Increased blood clotting.