A pregnant woman is sometimes diagnosed with gestational diabetes, which has unpleasant consequences for the baby. The disease occurs even in people in excellent health who have not previously experienced problems with high blood glucose. It is worth learning more about the signs of diseases, provoking factors and risks to the fetus. Treatment is prescribed by a doctor, and its results are carefully monitored until delivery.

What is gestational diabetes

Otherwise, diabetes mellitus in pregnant women is called gestational diabetes (GDM). It occurs during pregnancy and is considered “prediabetes.” This is not a full-fledged disease, but only a predisposition to intolerance to simple sugars. Gestational diabetes in pregnant women is considered an indicator of the risk of developing a true type 2 disease. The disease may disappear after the birth of the baby, but sometimes it develops further. To prevent it, treatment and a thorough examination of the body are prescribed.

The cause of the development of the disease is considered to be a weak reaction of the body to its own insulin produced by the pancreas. The violation appears due to a failure hormonal levels. The risk factors for gestational diabetes are:

• overweight, metabolic disorders, obesity;
• hereditary predisposition to general diabetes mellitus in the population;
• age after 25 years;
• previous births ended with the birth of a child weighing 4 kg or more, with broad shoulders;
• already had a history of GDM;
• chronic miscarriage;
• polyhydramnios, stillbirth.

Effect on pregnancy

The effect of diabetes on pregnancy is considered negative. A woman suffering from the disease runs the risk of spontaneous abortion, late gestational toxicosis, fetal infection and polyhydramnios. GDM during pregnancy can affect the mother's health in the following ways:

• development of hypoglycemic deficiency, ketoacidosis, preeclampsia;
• complication of vascular diseases - nephro-, neuro- and retinopathy, ischemia;
• After childbirth, in some cases, a full-fledged illness appears.

What are the dangers of gestational diabetes for a child?

No less dangerous are the consequences of gestational diabetes for the child. With an increase in sugar in the mother's blood, the child grows. This phenomenon, coupled with excess weight, is called macrosomia, and occurs in the third trimester of pregnancy. The size of the head and brain remains normal, but large shoulders can cause problems during natural passage through the birth canal. Impaired growth leads to early birth, injury to the female organs and the child.

In addition to macrosomia, which leads to fetal immaturity and even death, GDM has the following consequences for the child:

• congenital malformations of the body;
• complications in the first weeks of life;
• risk of first degree diabetes;
• morbid obesity;
• breathing disorder.

Sugar standards for gestational diabetes in pregnant women

Knowledge of sugar levels for gestational diabetes in pregnant women can help prevent the development of a dangerous disease. Doctors recommend that women at risk constantly monitor glucose concentrations - before eating, and an hour after. Optimal concentration:

• on an empty stomach and at night – at least 5.1 mmol/liter;
• after an hour after food – no more than 7 mmol/l;
• percentage of glycated hemoglobin – up to 6.

Signs of diabetes in pregnant women

Gynecologists identify the following initial signs of diabetes in pregnant women:

• weight gain;
• frequent volume urination, smell of acetone;
• strong thirst;
• fast fatiguability;
• lack of appetite.

If diabetes mellitus in pregnant women is not controlled, the disease can cause complications with a negative prognosis:

• hyperglycemia - sudden jumps in sugar levels;
• confusion, fainting;
• high pressure, heart pain, stroke;
• kidney damage, ketonuria;
• decreased functionality of the retina;
• slow wound healing;
• tissue infections;
• numbness of the legs, loss of sensation.

Diagnosis of gestational diabetes mellitus

Having identified risk factors or symptoms of the disease, doctors quickly diagnose gestational diabetes mellitus. Blood is donated on an empty stomach. Optimal sugar levels range from:

• from the finger – 4.8-6 mmol/l;
• from the vein – 5.3-6.9 mmol/l.

Test for diabetes mellitus during pregnancy

When previous indicators are not within the normal range, a glucose tolerance test is performed for diabetes mellitus during pregnancy. The test includes two measurements and requires following the rules for examining the patient:

• three days before the analysis, do not change your diet, stick to your usual physical activity;
• It is not recommended to eat anything the night before the test; the test is done on an empty stomach;
• blood is taken;
• within five minutes the patient takes a solution of glucose and water;
• After two hours, another blood sample is taken.

The diagnosis of manifest (manifesting) GDM is made according to established criteria for blood glucose concentration using three laboratory tests:

• from a finger on an empty stomach – from 6.1 mmol/l;
• from a vein on an empty stomach – from 7 mmol/l;
• after taking a glucose solution – over 7.8 mmol/l.

Having determined that the indicators are normal or low, doctors prescribe the test again in the period of 24-28 weeks, because then the level of hormones increases. If the analysis is carried out earlier, GDM may not be detected, but later, it is no longer possible to prevent the occurrence of complications in the fetus. Some doctors conduct research with different amounts of glucose - 50, 75 and 100 g. Ideally, a glucose tolerance test should be done when planning conception.

Treatment of gestational diabetes mellitus in pregnant women

When laboratory tests show GDM, treatment for diabetes mellitus during pregnancy is prescribed. Therapy consists of:

• proper nutrition, dosing carbohydrate foods, increasing proteins in the diet;
• normal physical activity, it is recommended to increase it;
• constant glycemic control of blood sugars, ketone breakdown products in urine, pressure;
• in case of chronic elevated sugar concentrations, insulin therapy is prescribed in the form of injections; in addition to it, no other medications are prescribed, because sugar-lowering tablets have a negative effect on the development of the child

For what sugar level is insulin prescribed during pregnancy?

If gestational diabetes during pregnancy is prolonged and sugar does not decrease, insulin therapy is prescribed to prevent the development of fetopathy. Insulin is also taken when normal readings sugar, but when detecting excess growth of the fetus, swelling of its soft tissues and polyhydramnios. Injections of the drug are prescribed at night and on an empty stomach. Find out the exact dosage schedule from your endocrinologist after consultation.

Diet for gestational diabetes mellitus in pregnant women

One of the treatment points for the disease is a diet for gestational diabetes, which helps maintain normal sugar levels. There are rules on how to reduce sugar during pregnancy:

• exclude sausages, smoked meats, and fatty meats from the menu, give preference to lean poultry, beef, and fish;
• cooking food should include baking, boiling, using steam;
• eat dairy products with a minimum percentage of fat, avoid butter, margarine, fatty sauces, nuts and seeds;
• You can eat vegetables, herbs, and mushrooms without restrictions;
• eat often, but little, every three hours;
• daily calorie content should not exceed 1800 kcal.

Childbirth with gestational diabetes

In order for delivery to go smoothly with gestational diabetes mellitus, you need to follow your doctor’s instructions. Macrosomia can become a danger for a woman and baby - then natural childbirth are impossible, a method is assigned caesarean section. For the mother, childbirth in most situations means that diabetes mellitus during pregnancy is no longer dangerous - after the release of the placenta (the irritating factor), the danger passes, and a full-fledged disease develops in a quarter of cases. One and a half months after the birth of the baby, the amount of glucose should be measured regularly.

Video: gestational diabetes mellitus during pregnancy

In the imagination of every woman, the period of waiting for a child seems to be something rosy, airy and serene, but it happens that this idyll is violated serious problems with health.

Gestational diabetes mellitus during pregnancy, why it is dangerous, what indicators and signs do pregnant women have, diet and menu, consequences for the child, analysis for hidden blood sugar is the topic of this article.

The material will be useful to any woman of fertile age who has risk factors and heredity for the disease.

Gestational diabetes in pregnant women: what is it?

Gestational or preeclampsia diabetes is a disease of increased blood sugar that occurs during pregnancy at any stage. Many people confuse the name and call it remote. Before pregnancy, the woman was completely healthy and showed no signs of illness. This disease is also called “diabetes mellitus in pregnancy.”

As a rule, this type of diabetes occurs in the second half of gestation, when the woman is at a decent age. After delivery, gestational diabetes may disappear, or it may develop into full-blown type 1 or type 2 diabetes.

However, there are studies that show a strong link between diabetes during pregnancy and type 2 diabetes later in life. In other words, if a woman is at a young age suffered from gestational diabetes, then in adulthood she has a greater risk of developing type 2 diabetes if there are risk factors in the form of obesity, poor nutrition and others.

The incidence of this type of diabetes is about 2.5 - 3.0%. There are certain risk factors that contribute to this, which I list below:

• overweight and obesity
• age over 30 years
• heredity for diabetes
• large baby from previous pregnancy
• detection of glucose in urine in a previous pregnancy
• gestational diabetes in the past
• polycystic ovary syndrome (PCOS)

Diabetes in pregnant women: dangers and consequences for the child

Diabetes is always a pathology and it cannot but affect the course of pregnancy and the health of the fetus. But with good compensation, it is possible to safely carry and give birth to a healthy baby. I’ll tell you what you need for good compensation below, but now I’ll list what the expectant mother can expect.

• high risk of fetal death in utero or in the first week of life after birth
• birth of a child with developmental defects
• high risk various diseases a newborn baby in the first month of life (for example, infection)
• the birth of a large fetus and the risk of complications associated with this (injuries to the child’s skull and limbs, maternal ruptures during childbirth, etc.)
• Your child's risk of developing diabetes in the future
• late complications of pregnancy (eclampsia and preeclampsia, arterial hypertension, edema syndrome)
• polyhydramnios
• intrauterine infection

What are the signs of diabetes during pregnancy?

Quite often, an increase in glucose levels is asymptomatic, and if there are any signs, they are usually attributed to the pregnancy itself. The symptoms of gestational diabetes are no different from those of any other type of diabetes. The severity of these manifestations depends on the level of sugar in the blood.

Symptoms of diabetes during pregnancy

• dry mouth
• frequent urination
• skin itching and perineal itching
• thrush
• rapid weight gain
• general weakness and drowsiness

As you can see, manifestations are often a manifestation of pregnancy itself and therefore every woman regularly undergoes blood and urine tests to early diagnosis carbohydrate disorder.

Blood sugar levels in gestational diabetes

As I already described in the article, in order to make a diagnosis of Gestational Diabetes, you need to conduct a special analysis - an oral glucose tolerance test. Based on the results of this test, you can accurately diagnose and choose the right tactics management

I also said there that during pregnancy not only gestational diabetes can occur, which is caused directly by the state of pregnancy, but also manifest diabetes mellitus, which is caused by other reasons, and pregnancy only provoked its development.

The difference between these types is that gestational diabetes is more sluggish and goes away after childbirth, and with overt diabetes, glycemic indicators are higher, the clinical picture is more pronounced, and it remains forever and does not disappear with childbirth.

Below you can see a table that displays diagnostic indicators for gestational diabetes. Anything that exceeds these indicators indicates manifest diabetes mellitus type 1 or 2. Click to make it larger.

So, you see that the diagnosis of Gestational Diabetes Mellitus (GDM) is made when fasting sugar is above 5.1 mmol/L, but less than 7.0 mmol/L.

After the glucose test, after 1 hour, blood glucose should not exceed 10.0 mmol/L, and after 2 hours - no more than 8.5 mmol/L.

What normal indicators for a pregnant woman I spoke in the article. I recommend reading it.

How to properly take an analysis (test) for latent diabetes in pregnant women

The test is performed at 24-26 weeks of gestation. First of all, you need to wait for a 10-12 hour period of fasting and get a good night's sleep the night before. No smoking. For the procedure you will need 75 grams of glucose powder and warm water 200 ml.

1. First, fasting blood sugar is tested
2. After this, dissolve the glucose powder in the brought water and drink it.
3. We sit down in a chair or on a couch in the laboratory reception area and don’t go anywhere.
4. After 1 and 2 hours we donate blood from a vein again.
5. After the third fence you can be free.

Treatment and diet for gestational diabetes in pregnant women

In some cases, nutrition and dieting are already powerful tools in the treatment of gestational diabetes. During pregnancy, all tablets medicines are contraindicated, so the only way to lower blood sugar, besides diet, is insulin injections.

But in most cases, it is possible to do without it only by properly adjusting your diet, creating a rational menu, and also increasing feasible physical activity in the form of walking, for example.

Only a few are prescribed insulin and only in two cases:

• failure to achieve target glycemic values ​​within 1-2 weeks with diet alone
• presence of signs of fetal distress according to ultrasound data

What is the diet and nutrition of a woman with diabetes?

If to normalize blood sugar in a non-pregnant woman effective method There will be a low-carb diet, then this method is not suitable for a pregnant woman.

Such a woman should not completely deprive herself of carbohydrates, as this will lead to the formation of ketone bodies, which can negatively affect the development of the fetus. But there are still some restrictions. These restrictions are imposed on carbohydrates with a high glycemic index, namely any sweets, bread and flour, potatoes, cereals, sweet fruits (banana, persimmon, grapes).

What can you eat if you have gestational diabetes in pregnant women?

All types of meat and fish, any vegetables except potatoes, whole grains, seasonal local fruits and berries, nuts, mushrooms, and herbs are allowed. Maintain the following protein/fat/carbohydrate ratio. It is important to get high-quality proteins and healthy fats, both plant and animal in equal proportions.

• proteins 30 - 25%
• fats 30%
• carbohydrates 40 - 45%

Various cooking sites offer many recipes and menus, so I won’t go into more details. In addition, it is not always possible to satisfy the tastes of an audience of thousands of blog readers.

What should a pregnant woman's sugar level be (normal)

How do you know you're doing everything right? Frequent monitoring of blood glucose will help you with this. Be sure to check your blood sugar before each meal, as well as 1 hour after eating; after 2 hours you don’t have to check it. If necessary, you will have to check your sugar at night at 2-3 o'clock.

• fasting sugar should be less than 5.1 mmol/l
• 1 hour after eating should not exceed the level of 7.0 mmol/l
• before going to bed and at night, sugar should not exceed 5.1 mmol/l
• the level of glycated hemoglobin should not be more than 6.0%

Tactics for managing women after childbirth

If a woman has received insulin therapy, then immediately after childbirth this insulin is discontinued. During the first three days, blood glucose is monitored to identify disturbances in carbohydrate metabolism. If your sugar is normal, then you can be calm.

All women who have had GDM should be monitored because they are at increased risk of recurrent GDM or developing type 2 diabetes in the future.

• after 6-12 weeks, a repeat glucose test is performed, only in its classic version (sugar is checked only on an empty stomach and 2 hours after exercise)
• It is recommended to adhere to a low-water diet (but not ketosis) in order to lose weight, if any.
• increased physical activity
• planning subsequent pregnancies

That's all for me. Good sugars and easy labor. Click on the social buttons. networks if you liked the article and found it useful. so as not to miss the release of new articles. See you again!

With warmth and care, endocrinologist Lebedeva Dilyara Ilgizovna

The problem of high blood glucose levels concerns not only diabetics who struggle with it all their lives: a similar disease has become common in women during pregnancy. Diabetes in pregnant women it is also called gestational. Are you familiar with this concept? The instructions below will help you understand the causes, diagnosis and treatment of this disease.

Causes of diabetes during pregnancy

When diabetes mellitus appears in pregnant women for the first time, it is called gestational diabetes, otherwise known as GDM. It appears due to a violation of carbohydrate metabolism. Blood sugar levels in pregnant women vary from 3.3 to 6.6 mmol/l. It increases according to next reason:

1. The baby growing inside requires energy, especially glucose, so carbohydrate metabolism is disrupted in pregnant women.
2. The placenta produces an increased amount of the hormone progesterone, which has the opposite effect of insulin, because it only increases blood sugar in pregnant women.
3. The pancreas is under heavy load and often cannot cope with it.
4. As a result, GDM develops in pregnant women.

Risk factors

The average risk group includes pregnant women with the following symptoms:

• slightly increased body weight;
• polyhydramnios in a previous pregnancy;
• birth large child;
• the child had developmental defects;
• miscarriage;
• gestosis.

The risk of gestational diabetes mellitus in pregnant women is even higher in following cases:

• high degree obesity;
• diabetes in a previous pregnancy;
• sugar found in urine;
• polycystic ovary syndrome.

Symptoms and signs of the disease

A glucose test cannot be ruled out during pregnancy, because gestational diabetes in a mild form is almost invisible. The doctor often orders a thorough examination. The point is to measure sugar in a pregnant woman after drinking liquid with dissolved glucose. Signs of diabetes in women during pregnancy contribute to the purpose of the analysis:

• strong feeling hunger;
• constant desire drink;
• dry mouth;
• fast fatiguability;
• frequent urination;
• blurred vision.

Diagnostic methods

During pregnancy from 24 to 28 weeks, a woman should undergo a glucose tolerance test. The first test is performed on an empty stomach, the second test is performed 2 hours after food, the last control test is performed an hour after the previous one. Diagnostics on an empty stomach can show a normal result, so a series of studies is carried out. Pregnant women need to follow several rules before it:

1. 3 days before the test, you cannot change your usual diet.
2. When performing the analysis on an empty stomach, at least 6 hours must pass after the last meal.
3. After taking blood for sugar, drink a glass of water. 75 g of glucose are first dissolved in it.

In addition to tests, the doctor examines the pregnant woman’s medical history and several other indicators. After reviewing these data, the specialist draws up a curve of values ​​by which a pregnant woman’s weight can increase each week. This helps keep track possible deviations. These are the indicators:

• body type;
• abdominal circumference;
• pelvic dimensions;
• height and weight.

Treatment of diabetes mellitus during pregnancy

If diabetes is confirmed, there is no need to despair, because the disease can be controlled if you take certain measures:

1. Blood sugar measurements.
2. Periodic urine testing.
3. Compliance dietary nutrition.
4. Moderate physical activity.
5. Weight control.
6. Take insulin if necessary.
7. Blood pressure study.

Diet therapy

The basis of treatment for diabetes mellitus during pregnancy is a change in diet, but the principle here is not weight loss, but a decrease in daily caloric intake at the same nutritional level. Pregnant women are recommended to divide meals into 2-3 main meals and the same number of snacks; it is advisable to keep portions small. The following foods are recommended for diabetes:

1. Porridge – rice, buckwheat.
2. Vegetables - cucumbers, tomatoes, radishes, zucchini, beans, cabbage.
3. Fruits - grapefruits, plums, peaches, apples, oranges, pears, avocados.
4. Berries – blueberries, currants, gooseberries, raspberries.
5. Meat – turkey, chicken, beef without fat and skin.
6. Fish – perch, pink salmon, sardine, carp, blue whiting.
7. Seafood – shrimp, caviar.
8. Dairy products - cottage cheese, cheese.

Balance the daily menu so that the body receives about 50% carbohydrates, 30% proteins and the remaining amount of fats. The pregnancy diet for cases of gestational diabetes mellitus does not allow the consumption of the following foods;

• fried and fatty;
• sour cream;
• baked goods, confectionery;
• fruits – persimmon, banana, grapes, figs;
• sauce;
• sausages, sausages;
• sausages;
• mayonnaise;
• pork;
• mutton.

In addition to refusing harmful products, on a diet for diabetes, you still need to properly prepare healthy ones. For processing, use methods such as stewing, boiling, steaming, baking. In addition, pregnant women are advised to reduce the amount of vegetable oil during the cooking process. It is better to eat vegetables raw in salads or boiled as a side dish for meat.

Physical exercise

Physical activity for diabetes in pregnant women, especially in the fresh air, it helps to increase the flow of oxygenated blood to all organs. This is good for the child, because his metabolism improves. Physical exercise help burn excess sugar in diabetes and burn calories so that weight does not increase more than necessary. Pregnant women will have to forget about abdominal exercises for now, but you can include other types of physical activity in your regimen:

1. Walking at an average pace for at least 2 hours.
2. An activity in the pool, such as water aerobics.
3. Gymnastics at home.

The following exercises can be performed independently during pregnancy with diabetes:

1. Standing on tiptoes. Rest your hands on the chair and rise up onto your toes, and then lower yourself down. Repeat about 20 times.
2. Wall push-ups. Place your hands on the wall, stepping back 1-2 steps from it. Perform movements similar to push-ups.
3. Rolling the ball. Sit on a chair and place a small ball on the floor. Grab it with your toes and then release it or just roll it on the floor.

Drug therapy

In the absence of effectiveness therapeutic diet and physical activity is prescribed by the doctor drug therapy diabetes mellitus Pregnant women are only allowed insulin: it is administered according to the schedule in the form of injections. Tablets taken for diabetes before pregnancy are not allowed. During pregnancy, two types of recombinant human insulin are prescribed:

1. Short-acting - "Actrapid", "Lizpro". Administered after meals. Characterized by fast but short-term action.
2. Medium duration – “Isophane”, “Humalin”. Maintains sugar levels between meals, so only 2 injections per day are enough.

Possible complications and consequences

If there is no due and proper treatment Both correctable and serious consequences of diabetes mellitus can occur. In most cases, a child born with low blood sugar recovers thanks to breastfeeding. The same thing happens to the mother - the delivered placenta, as an irritating factor, no longer releases a large amount of hormones into her body. There are other complications of diabetes in pregnant women:

1. Increased sugar during pregnancy leads to excessive growth of the fetus, so childbirth is often performed by cesarean section.
2. When giving birth naturally to a large baby, the baby's shoulders may be damaged. In addition, the mother can also suffer birth injuries.
3. Diabetes mellitus can persist in a woman even after pregnancy. This happens in 20% of cases.

During pregnancy itself, a woman may experience the following complications of diabetes:

1. Preeclampsia on latest dates pregnancy.
2. Spontaneous miscarriage.
3. Inflammation urinary tract.
4. Polyhydramnios.
5. Ketoacidosis. Precedes ketonemic coma. Symptoms include thirst, vomiting, drowsiness, and a feeling of acetone odor.

Is it possible to give birth with diabetes? This disease is a serious threat to the kidneys, heart and vision of a pregnant woman, so there are cases when it is not possible to reduce the risks and pregnancy is included in the list of contraindications:

1. Insulin-resistant diabetes mellitus with a tendency towards ketoacidosis.
2. An additional disease is tuberculosis.
3. Each parent has diabetes mellitus.
4. Rhesus conflict.
5. Cardiac ischemia.
6. Kidney failure.
7. Severe form of gastroenteropathy.

Video about gestational diabetes during pregnancy

The future health of her baby depends on the condition of a woman during pregnancy. Diabetes mellitus and pregnancy - this combination is very common, but the disease can be controlled and treated different ways. To learn more about diabetes during pregnancy, watch a useful video describing the course of the disease.

For a woman, carrying a child is not an easy test, because at this time her body works in an intense mode. Therefore, during such a period, various pathological conditions often appear, for example, pregnancy diabetes. But what is gestational diabetes and how can it affect the health of the woman and the fetus.

This disease occurs when blood sugar levels are elevated during pregnancy. Often the disease disappears immediately after the birth of the child. However, this form of diabetes is dangerous for women, since its course can be considered a risk factor for developing type 2 disease in the future.

Gestational diabetes mellitus occurs in 1-14% of women. The disease may appear on different dates pregnancy. Thus, in the first trimester, diabetes occurs in 2.1% of patients, in the second – in 5.6%, and in the third – in 3.1%

Causes and symptoms

In general, any form of diabetes is an endocrine disease in which there is a malfunction in carbohydrate metabolism. Against this background, a relative or complete deficiency of insulin occurs, which should be produced by the pancreas.

The reason for the deficiency of this hormone can be different. For example, disruptions in the processes of converting proinsulin into an active hormone, a decrease in the number of beta cells in the pancreas, cells not accepting insulin, and much more.

The effect of insulin on carbohydrate metabolism is determined by the presence of specific glycoprotein receptors in hormone-dependent tissues. When they are activated, glucose transport in cells increases and blood sugar levels decrease.

In addition, insulin simulates the utilization of sugar and the process of its accumulation as glycogen in tissues, in particular in skeletal muscles and in the liver. It is noteworthy that glucose is also released from glycogen under the influence of insulin.

The hormone also affects protein and fat metabolism. It has an anabolic effect, inhibits lipolysis, and activates the biosynthesis of DNA and RNA in insulin-dependent cells.

When gestational diabetes mellitus develops, its causes include several factors. Of particular importance in this case is the functional failure between the hypoglycemic effect of insulin and the hyperglycemic effect exerted by other hormones.

Tissue insulin resistance, which progresses gradually, makes insulin deficiency even more pronounced. Provoking factors also contribute to this:

1. excess weight, exceeding the norm by 20% or more, existing even before conception;
2. elevated blood sugar levels, as confirmed by urine test results;
3. previous birth of a child weighing 4 kilograms or more;
4. nationality (most often gestational diabetes appears in Asians, Hispanics, blacks and Native Americans);
5. previous stillbirth;
6. lack of glucose tolerance;
7. presence of ovarian diseases;
8. polyhydramnios, characterized by excess amniotic fluid;
9. heredity;
10. endocrine disorders that occurred during a previous pregnancy.

During pregnancy, endocrine disruptions occur due to physiological changes, after all, it’s already initial stage During gestation, metabolism changes. As a result, with a slight deficiency of glucose in the fetus, the body begins to use reserve reserves, obtaining energy from lipids.

On early stages During pregnancy, such a metabolic restructuring satisfies all the energy needs of the fetus. But in the future, to overcome insulin resistance, hypertrophy of pancreatic beta cells occurs, which also become overactive.

The increased production of the hormone is compensated by its accelerated destruction. However, already in the 2nd trimester of pregnancy, the placenta performs an endocrine function, which often affects carbohydrate metabolism.

Estrogens, steroid-like hormones, and cortisol produced by the placenta become insulin antagonists. As a result, the first symptoms of gestational diabetes appear already at 20 weeks.

However, in some cases, a woman exhibits only slight changes in glucose sensitivity, a condition called pregestational diabetes mellitus. In this case, insulin deficiency is observed only with the abuse of carbohydrate foods and the presence of other provoking factors.

It is noteworthy that diabetes during pregnancy is not accompanied by the death of beta cells or changes in hormone molecules. Therefore, this form of endocrine disruption is considered reversible, meaning that when delivery occurs, it corrects itself.

Signs of gestational diabetes are moderate, so women often attribute them to physiological characteristics the course of pregnancy. The main manifestations that occur during this period are typical symptoms of any form of carbohydrate metabolism disorder:

• thirst;
• dysuria;
• skin itching;
• poor weight gain and so on.

Since the symptoms of gestational diabetes mellitus are not typical, laboratory tests are the basis for diagnosing the disease. Also, a woman is often prescribed an ultrasound, which can be used to determine the level of fetoplacental insufficiency and detect pathology of fetal development.

Blood sugar levels in pregnant women and diagnosis of the disease

Sugar level

What blood sugar level is considered acceptable during pregnancy? Fasting glucose levels should not exceed 5.1 mmol/l, after breakfast the figure can be up to 6.7 mmol/l.

What percentage should glycated hemoglobin be? The norm for this indicator is up to 5.8%.

But how to determine these indicators? To find out whether the sugar norm is exceeded during pregnancy, a special diagnosis is carried out, including testing general analyzes urine and blood for sugar, acetone, performing a glucose tolerance test and determining the level of glycated hemoglobin.

Also, the diagnosis of “gestational diabetes mellitus” is made after general examinations, such as blood biochemistry and CBC. According to indications, bacteriological urine culture and urine testing according to Nechiporenko may be prescribed. Also consult with doctors, an endocrinologist, a therapist and an ophthalmologist.

The first sign of diabetes during pregnancy is high rate glycemia (from 5.1 mmol/l). If blood sugar standards are exceeded, then in-depth research methods are used to help diagnose diabetes during gestation.

It is noteworthy that if glycated hemoglobin is increased, this means that the increase in glucose concentration was not immediate. Thus, hyperglycemia appeared periodically in the last 90 days.

But sugar that appears in the urine can be detected only when blood glucose levels are at least 8 mmol/l. This indicator is called the renal threshold.

However ketone bodies in urine can be detected regardless of blood glucose levels. Although the presence of acetone in the urine is not a direct indication for a woman to be diagnosed with remote diabetes. After all, ketones can be detected when:

1. toxicosis;
2. poor appetite;
3. poor nutrition;
4. ARVI and other diseases accompanied by fever;
5. preeclampsia with edema.

Regarding the glycemic profile, the essence of this study is to measure blood sugar levels over a 24-hour period. different times, before and after meals. The goal is to determine glycemic peaks, which will help in the treatment of chronic hyperglycemia.

What is a glucose tolerance test? This technique allows you to detect hidden disruptions in carbohydrate metabolism. It is worth remembering that improper preparation for the study can affect its results. Therefore, on the eve you should eat right and avoid emotional and physical stress.

To diagnose gestational diabetes, you will need to consult an ophthalmologist who will conduct a fundus examination.

Indeed, with endocrine disorders, complications such as diabetic retinopathy often arise.

What is the danger of the disease for a child?

All pregnant women who have high sugar ask themselves: what is the danger of gestational diabetes for a child? Often this disease does not pose a threat to the mother’s health, and its course does not particularly affect her well-being. But reviews from doctors claim that in the absence of treatment, childbirth often occurs with obstetric and perinatal complications.

A pregnant woman suffering from gestational diabetes experiences disruptions in microcirculation in the tissues. When small vessels spasm, the endothelium is damaged, lipid peroxidation is activated and disseminated intravascular coagulation syndrome develops. This causes complications such as the development of fetoplacental insufficiency with subsequent fetal hypoxia.

The negative impact of diabetes on a child also lies in the increased supply of glucose to the fetus. After all, his pancreas is not yet capable of producing insulin in the required volume, and the hormone synthesized in the maternal body cannot penetrate the fetoplacental barrier.

Uncontrolled blood glucose levels contribute to metabolic and circulatory disorders. And secondary hyperglycemia causes functional and structural changes in cell membranes, and it also increases hypoxia of fetal tissues.

Also high level glucose causes hypertrophy of the beta cells of the pancreas in children and leads to their early depletion. As a result, after birth, the child may experience severe disruptions in carbohydrate metabolism and defects that threaten the life of the newborn.

If treatment for gestational diabetes mellitus is not carried out in the third trimester of pregnancy, the fetus develops macrosomia with dysplastic obesity with hepato- and splenomegaly. Even after birth, some children have immaturity of various organs and systems.

The main consequences of gestational diabetes are:

• intrauterine fetal death;
• fetal hypoxia with retention intrauterine development;
• high risk of death in infancy;
• premature birth;
• frequent infections urinary tract during pregnancy;
• gestosis, eclampsia and preeclampsia in women;
• macrosomia and damage to the birth canal;
• fungal infections of the genital mucosa.

Also during pregnancy is spontaneous abortion that occurs in the early stages. However, often the causes of miscarriage lie in decompensation of diabetes, which was not diagnosed in a timely manner.

Even in the absence of treatment for endocrine disruption during pregnancy, gestational diabetes after childbirth can turn into regular diabetes.

This form of the disease requires longer and possibly lifelong treatment.

Treatment and childbirth

If a pregnant woman has diabetes, treatment is carried out jointly with an endocrinologist and gynecologist. In this case, the patient must be able to independently control glycemia on an empty stomach and after meals.

In order for childbirth with gestational diabetes to be successful, the patient is prescribed special diet. When following it, it is important to eat food in small portions, not to eat fatty or fried foods, and not to eat junk food, including fast food products. When carrying a child, foods that boost immunity and saturate the body with vitamins, minerals and fiber (fruits, whole grains, various cereals, vegetables) will be useful.

But if the results after following a diet do not turn out to be significant in the fight against chronic hyperglycemia, then the patient is prescribed insulin therapy. Ultra-short and short-acting insulin is used for GDM.

Insulin should be injected multiple times, taking into account the calorie content of food taken and glycemic indicators. Doses and instructions on how to inject the drug should be checked with an endocrinologist.

It is worth remembering that pregnant women with diabetes are not allowed to take glucose-lowering pills. Sometimes auxiliary treatment may be carried out, in which they are prescribed.

Gestational diabetes mellitus (GDM): the danger of a “sweet” pregnancy. Consequences for the child, diet, signs

According to the World Health Organization, there are more than 422 million people with diabetes in the world. Their number is growing every year. The disease is increasingly affecting young people.

Complications of diabetes lead to serious vascular pathologies, affecting the kidneys, retina, etc. But this disease is controllable. With properly prescribed therapy severe consequences move away in time. No exception pregnancy diabetes, which developed during gestation. This disease is called gestational diabetes mellitus.

• Can pregnancy cause diabetes?
• What are the types of diabetes during pregnancy?
• Risk group
• What is gestational diabetes mellitus during pregnancy?
• Consequences for the child
• What is the danger for a woman?
• Symptoms and signs of gestational diabetes mellitus in pregnant women
• Analyzes and deadlines
• Treatment
• Insulin therapy: who is indicated and how it is carried out
• Diet: allowed and prohibited foods, basic principles of nutrition for pregnant women with GDM
• Sample menu for the week
• ethnoscience
• How to give birth: natural birth or caesarean section?
• Prevention of gestational diabetes in pregnant women

Is pregnancy a provocateur?

The American Diabetes Association reports that 7% of pregnant women develop gestational diabetes. In some of them, after childbirth, glucose levels return to normal. But 60% will develop type 2 diabetes (T2DM) within 10-15 years.

Gestation acts as a provocateur for impaired glucose metabolism. The mechanism of development of the gestational form of diabetes is closer to T2DM. A pregnant woman develops insulin resistance due to the following factors:

• synthesis of steroid hormones in the placenta: estrogen, placental lactogen;
• increased production of cortisol in the adrenal cortex;
• disruption of insulin metabolism and reduction of its effects in tissues;
• increased excretion of insulin through the kidneys;
• activation of insulinase in the placenta (an enzyme that breaks down hormones).

The condition worsens in those women who have physiological resistance (immunity) to insulin, which has not manifested itself clinically. The listed factors increase the need for the hormone; beta cells of the pancreas synthesize it in increased quantity. This gradually leads to their depletion and persistent hyperglycemia - an increase in the level of glucose in the blood plasma.

What types of diabetes are there during pregnancy?

Pregnancy may be accompanied by different types diabetes Classification of pathology by time of occurrence involves two forms:

1. diabetes that existed before pregnancy (DM 1 and DM 2) – pregestational;
2. gestational diabetes (GDM) in pregnant women.

Depending on the necessary treatment GSD happens:

• compensated by diet;
• compensated by diet therapy and insulin.

Diabetes can be in the stages of compensation and decompensation. The severity of pregestational diabetes depends on the need to use various methods treatment and severity of complications.

Hyperglycemia that develops during pregnancy is not always gestational diabetes. In some cases, this may be a manifestation of type 2 diabetes.

Who is at risk for developing diabetes during pregnancy?

Hormonal changes that can disrupt the metabolism of insulin and glucose occur in all pregnant women. But the transition to diabetes does not occur for everyone. This requires predisposing factors:

• overweight or obesity;
• existing impaired glucose tolerance;
• episodes of high blood sugar before pregnancy;
• Type 2 diabetes in the parents of a pregnant woman;
• age over 35 years;
• history of miscarriages, stillbirths;
• previous birth of children weighing more than 4 kg, as well as with developmental defects.

But which of these reasons influences the development of pathology to a greater extent is not completely known.

What is gestational diabetes mellitus

GDM is considered to be the pathology that developed after bearing a child. If hyperglycemia is diagnosed earlier, then latent diabetes mellitus exists, which existed before pregnancy. But the peak incidence is observed in the 3rd trimester. A synonym for this condition is gestational diabetes.

Manifest diabetes during pregnancy differs from gestational diabetes in that after one episode of hyperglycemia, sugar gradually increases and does not tend to stabilize. This form of the disease is likely to develop into type 1 or type 2 diabetes after childbirth.

To decide on further tactics, all postpartum women with GDM should postpartum period determine glucose levels. If it does not return to normal, then we can assume that type 1 or type 2 diabetes has developed.

Effect on the fetus and consequences for the child

The danger for the developing child depends on the degree of compensation of the pathology. The most severe consequences are observed in the uncompensated form. The effect on the fetus is as follows:

1. Fetal malformations with elevated glucose levels in the early stages. Their formation occurs due to energy deficiency. In the early stages, the baby's pancreas is not yet formed, so the maternal organ must work for two. Malfunction leads to energy starvation of cells, disruption of their division and the formation of defects. This condition can be suspected by the presence of polyhydramnios. Insufficient supply of glucose into cells is manifested by intrauterine growth retardation and low baby weight.
2. Uncontrolled sugar levels in a pregnant woman with gestational diabetes mellitus in the 2nd and 3rd trimester leads to diabetic fetopathy. Glucose penetrates the placenta in unlimited quantities, the excess is stored as fat. If your own insulin is in excess, accelerated growth of the fetus occurs, but there is a disproportion of body parts: a large belly, shoulder girdle, small limbs. The heart and liver also enlarge.
3. A high concentration of insulin disrupts the production of surfactant, a substance that coats the alveoli of the lungs. Therefore, respiratory distress may occur after birth.
4. Tying the umbilical cord of a newborn disrupts the supply of excess glucose, and the child's glucose concentration sharply decreases. Hypoglycemia after childbirth leads to neurological disorders and mental development disorders.

Also, children born to mothers with gestational diabetes have an increased risk birth trauma, perinatal death, cardiovascular diseases, pathology of the respiratory system, calcium and magnesium metabolism disorders, neurological complications.

Why high sugar is dangerous for a pregnant woman

GDM or pre-existing diabetes increases the possibility late toxicosis(), it manifests itself in various forms:

• dropsy of pregnancy;
• nephropathy 1-3 degrees;
• preeclampsia;
• eclampsia.

The last two conditions require hospitalization in the intensive care unit, resuscitation measures and early delivery.

Immune disorders that accompany diabetes lead to infections of the genitourinary system - cystitis, pyelonephritis, as well as recurrent vulovaginal candidiasis. Any infection can lead to infection of the child in utero or during childbirth.

The main signs of gestational diabetes mellitus during pregnancy

Symptoms of gestational diabetes are not pronounced, the disease develops gradually. Some signs of a woman are mistaken for normal changes conditions during pregnancy:

• increased fatigue, weakness;
• thirst;
• frequent urination;
• insufficient weight gain with pronounced appetite.

Often hyperglycemia is an incidental finding during a mandatory blood glucose screening test. This serves as an indication for further in-depth examination.

Basis for diagnosis, tests for latent diabetes

The Ministry of Health has determined the time frame within which a mandatory blood sugar test is carried out:

• upon registration;

If there are risk factors, a glucose tolerance test is performed. If symptoms of diabetes appear during pregnancy, a glucose test is performed as indicated.

A single test that reveals hyperglycemia is not enough to make a diagnosis. Monitoring is required after a few days. Further, in case of repeated hyperglycemia, a consultation with an endocrinologist is prescribed. The doctor determines the need and timing of a glucose tolerance test. Usually this is at least 1 week after recorded hyperglycemia. The test is also repeated to confirm the diagnosis.

The following test results indicate GDM:

• fasting glucose value more than 5.8 mmol/l;
• an hour after taking glucose – above 10 mmol/l;
• after two hours – above 8 mmol/l.

Additionally, according to indications, the following studies are carried out:

• glycosylated hemoglobin;
• urine test for sugar;
• cholesterol and lipid profile;
• coagulogram;
• blood hormones: estrogen, placental lactogen, cortisol, alpha-fetoprotein;
• urine analysis according to Nechiporenko, Zimnitsky, Rehberg test.

Pregnant women with pregestational and gestational diabetes undergo fetal ultrasound from the 2nd trimester, Dopplerometry of the vessels of the placenta and umbilical cord, and regular CTG.

Management and treatment of pregnant women with diabetes mellitus

The course of pregnancy with existing diabetes depends on the woman’s level of self-control and correction of hyperglycemia. Those who had diabetes before conception must undergo “Diabetes School” - special classes that teach proper eating behavior and self-monitoring of glucose levels.

Regardless of the type of pathology, pregnant women need the following observations:

• visiting a gynecologist every 2 weeks at the beginning of gestation, weekly from the second half;
• consultations with an endocrinologist once every 2 weeks, in case of decompensated condition – once a week;
• observation by a therapist - every trimester, as well as when extragenetic pathology is detected;
• ophthalmologist - once every trimester and after childbirth;
• neurologist - twice during pregnancy.

Provided mandatory hospitalization for examination and correction of therapy for a pregnant woman with GDM:

• 1 time - in the first trimester or when diagnosing a pathology;
• 2 times - in - to correct the condition, determine the need to change the treatment regimen;
• 3 times - for type 1 and type 2 diabetes - in, GDM - in to prepare for childbirth and select the method of delivery.

In a hospital setting, the frequency of studies, the list of tests and the frequency of studies are determined individually. Daily monitoring requires a urine test for sugar, blood glucose, and blood pressure control.

Insulin

The need for insulin injections is determined individually. Not every case of GDM requires this approach; for some, a therapeutic diet is sufficient.

Indications for starting insulin therapy are the following blood sugar levels:

• fasting blood glucose on a diet more than 5.0 mmol/l;
• one hour after eating above 7.8 mmol/l;
• 2 hours after eating, glycemia is above 6.7 mmol/l.

Attention! Pregnant and lactating women are prohibited from using any glucose-lowering drugs except insulin! Long-acting insulins are not used.

The basis of therapy is short- and ultra-short-acting insulin preparations. For type 1 diabetes, basal-bolus therapy is carried out. For type 2 diabetes and GDM, it is also possible to use the traditional regimen, but with some individual adjustments, which are determined by the endocrinologist.

In pregnant women with poor hypoglycemia control, insulin pumps may be used to make the hormone easier to administer.

Diet for gestational diabetes during pregnancy

The nutrition of a pregnant woman with GDM should comply with the following principles:

• Often and little by little. It is better to have 3 main meals and 2-3 small snacks.
• The amount of complex carbohydrates is about 40%, protein – 30-60%, fats up to 30%.
• Drink at least 1.5 liters of liquid.
• Increase the amount of fiber - it is able to adsorb glucose from the intestines and remove it.

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Diet for gestational diabetes mellitus in pregnant women

Products can be divided into three conditional groups, presented in Table 1.

Table 1

Prohibited to use	Limit quantity	You can eat
Sugar Sweet pastries Honey, candy, jam Fruit juices from the store Carbonated sweet drinks Semolina and rice porridge Grapes, bananas, melon, persimmons, dates Sausages, sausages, any fast food Sweeteners	Durum wheat pasta Potato Animal fats ( butter, pork fat), fatty Margarine	All types of vegetables, including Jerusalem artichoke Beans, peas and other legumes Wholemeal bread Buckwheat, oatmeal, pearl barley, millet Lean meat, poultry, fish Low-fat dairy products Fruits, except prohibited ones Vegetable fats

Sample menu for a pregnant woman with gestational diabetes

The menu for the week (Table 2) may look approximately as follows (table No. 9).

Table 2.

Day of the week	Breakfast	2 breakfast	Dinner	Afternoon snack	Dinner
Monday	Millet porridge with milk, bread with unsweetened tea	Apple or pear or banana	Salad from fresh vegetables in vegetable oil; Chicken broth with noodles; Boiled meat with stewed vegetables	Cottage cheese, unsweetened cracker, tea	Stewed cabbage with meat, tomato juice. Before bed – a glass of kefir
Tuesday	Steamed omelette with, Coffee/tea, bread	Any fruit	Vinaigrette with oil; milk soup; pearl barley porridge with boiled chicken; dried fruits compote	Unsweetened yogurt	Steamed fish with vegetable side dish, tea or compote
Wednesday	Cottage cheese casserole, tea with cheese sandwich	Fruits	Vegetable salad with vegetable oil; low-fat borscht; mashed potatoes with beef goulash; dried fruits compote	Low-fat milk with cracker	Buckwheat porridge with milk, egg, tea with bread
Thursday	Oatmeal with milk with raisins or fresh berries, tea with bread and cheese	Yogurt without sugar	Cabbage and carrot salad; pea soup; Mashed potatoes with boiled meat; tea or compote	Any fruit	Stewed vegetables, boiled fish, tea
Friday	Millet porridge, boiled egg, tea or coffee	Any fruit	Vinaigrette with vegetable oil; milk soup; baked zucchini with meat;	Yogurt	Vegetable casserole, kefir
Saturday	Milk porridge, tea or coffee with bread and cheese	Any allowed fruit	Vegetable salad with low-fat sour cream; buckwheat soup with chicken broth; boiled pasta with chicken;	Milk with cracker	Curd casserole, tea
Sunday	Oatmeal with milk, tea with sandwich	Yogurt or kefir	Bean and tomato salad; cabbage soup; boiled potatoes with stewed meat;	Fruits	Grilled vegetables, piece of chicken fillet, tea

ethnoscience

Methods traditional medicine offer many recipes, both using herbal remedies lower blood sugar and replace sugary foods. For example, stevia and its extracts are used as a sweetener.

This plant is not dangerous for diabetics, but use in pregnant and lactating women is not recommended. No studies have been conducted on the effect on the course of pregnancy and fetal formation. In addition, the plant can cause an allergic reaction, which is extremely undesirable during pregnancy against the background of gestational diabetes.

Natural birth or caesarean?

How delivery will take place depends on the condition of the mother and child. Hospitalization of pregnant women with gestational diabetes mellitus is carried out in -. To avoid birth trauma, they try to induce labor with a full-term baby at this time.

If the woman’s condition is serious or the fetus is pathological, the issue of performing a caesarean section is decided. If the results of ultrasound determine large fruit, the correspondence of the size of the woman’s pelvis and the possibility of childbirth are determined.

If there is a sharp deterioration in the condition of the fetus, the development of severe gestosis, retinopathy and nephropathy in the pregnant woman, a decision may be made to give birth early.

Prevention methods

It is not always possible to avoid the disease, but you can reduce the risk of its occurrence. Women who are overweight or obese should start planning pregnancy with diet and weight loss.

Everyone else should adhere to the principles healthy eating, control weight gain, reduce consumption of sweets, starchy foods, and fatty foods. We must not forget about sufficient physical activity. Pregnancy is not a disease. Therefore, during its normal course, it is recommended to perform special sets of exercises.

Women with hyperglycemia should take into account the doctor’s recommendations and be hospitalized within the prescribed time frame for examination and treatment adjustment. This will prevent the development of complications of gestational diabetes mellitus. For those who had GDM in a previous pregnancy, the risk of developing diabetes is significantly increased with a second pregnancy.