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Diabetes and pregnancy (what is the danger of gestational diabetes)

Pregnancy exerts an increased load on the mother's body, it was at this time that many chronic diseases worsen, new problems appear. Among violations of metabolic processes in women who are carrying a child, gestational diabetes mellitus (GDM) occurs most often. About 4% of pregnancies accompany this disease, 80% of them occur with complications for the mother, in 45% of cases it causes gestosis.

Gestational diabetes does not pass without a trace for a child: due to an increase in the trauma of labor, 20% of children have problems with cerebral circulation, 19% - clavicle fractures. After birth, they have to adjust the composition of the blood, stabilize breathing and treat neurological disorders.

Mortality in children born to mothers with HSD is 2 times higher than the average.

Diabetes and pressure surges in the past

  • Sugar normalization -95%
  • Elimination of vein thrombosis - 70%
  • Elimination of palpitations -90%
  • Excessive Blood Pressure - 92%
  • Increased vigor during the day, improved sleep at night -97%

The number of complications in a woman and child depends largely on the timeliness of diabetes detection, proper treatment and the responsible attitude of the expectant mother to her condition.

Gestational diabetes - what is it?

During childbearing, the need for glucose increases, the body retains it in the blood to meet the energy needs of the fetus, therefore, physiological insulin resistance occurs. If this process fails, gestational diabetes develops. The time it began is the second half of pregnancy, when the baby is already quite large, usually from 16 to 32 week.

Unlike normal diabetes, gestational often not accompanied by severe hyperglycemia. Diabetes of pregnant women, as it is also called, can be expressed not only in an increase in sugar, but also in violation of glucose tolerance. This means that the fasting blood sugar standards are exceeded, but not so much that this disorder was considered diabetes.

Another difference with gestational diabetes is its temporary nature. All signs of violation disappear immediately after delivery. In the future, these women have a higher risk of similar disorders during the following pregnancies (more than 60%), the likelihood of type 2 diabetes is increased.

High blood sugar can mean not GDM, but a manifesto of ordinary diabetes mellitus, which will remain with a woman for life. To distinguish between these two disorders can be through the study of the blood and assess the state of the pancreas.

Criteria for the diagnosis of gestational diabetes:

Type of analysisIndicators for GSDIndicators for the manifestation of diabetes mellitus, mmol / l
mmol / lmg / dLmmol / lmg / dL
Glucose (GLU) on an empty stomach, the analysis is taken only from a vein5.1 ≤ GLU <792 ≤ GLU <126GLU ≥ 7GLU ≥ 126
Glucose tolerance test (75 ml of glucose)After an hourGLU ≥ 10GLU ≥ 180GLU ≥ 11.1GLU ≥ 200
2 hours laterGLU ≥ 8.5GLU ≥ 153

According to the classification of diseases, the disease is coded as Gestational diabetes mellitus, the ICD code is 10 O24.4.

Causes of HSD

Since the middle of pregnancy, serious hormonal changes occur in the mother's body: the production of progesterone, placental lactogen, estrogen, cortisol is activated. All of them are insulin antagonists, which means that their increase becomes the reason for its weakening. In addition, lactogen, synthesized by the placenta, contributes to an increase in the blood level of fatty acids, which increases tissue insulin resistance. Contribute to an increase in glucose and the usual changes in the life of a pregnant woman - an increase in caloric intake, a decrease in physical activity and mobility, and an increase in weight.

In a healthy woman, physiological insulin resistance is compensated. Insulin synthesis increases due to hypertrophy of pancreatic beta cells, its metabolism in the liver decreases. Gestational diabetes develops in pregnant women if some kind of compensation mechanism fails.

This most often occurs in the following cases:

  1. Excess weight in a pregnant woman (> 20% above normal), acquired earlier.
  2. High-calorie diet with plenty of carbohydrates.
  3. Sedentary lifestyle, including before pregnancy.
  4. Smoking.
  5. Diabetes or severe insulin resistance in close relatives.
  6. HSD during a previous pregnancy.
  7. The first children had a weight greater than 4 kg at birth.
  8. Polygonism
  9. Polycystic ovary.
  10. Age over 30 years. By age 40, the risk of gestational diabetes increases by 2 times.
  11. Belonging to the Mongoloid and Negroid race.

Symptoms and signs of gestational diabetes

Symptoms of gestational diabetes include:

  • frequent dry mouth;
  • increased appetite;
  • an increase in the volume of drunk water, more frequent and abundant urination;
  • increased gas formation in the digestive tract;
  • itching, especially on the stomach and in the perineum;
  • fatigue, drowsiness;
  • candidiasis poorly treatable;
  • weight gain ahead of the norm.

As you can see, all these symptoms are non-specific, they can all be triggered by other causes, including the pregnancy itself. Gestational diabetes has no obvious symptoms, so every woman, after registration, undergoes a compulsory examination to detect metabolic disorders of glucose.

Diagnostic measures

At the first visit to the doctor, all pregnant women are prescribed blood sugar tests. When fasting glucose is above 7 mmol / l and the glycated hemoglobin level exceeds 6.5%, the probability of diabetes mellitus is high. If poor blood counts are combined with signs of hyperglycemia, the diagnosis is considered established. If there are no visible symptoms of a rise in sugar, rerun the test to eliminate the error. A patient with a diagnosed debut of diabetes is referred to an endocrinologist, who conducts additional research, determines the type and stage of the disease, prescribes treatment. During pregnancy in women, which for several reasons can be attributed to the group of increased likelihood of diabetes, such tests are repeated again after a few weeks.

The optimal time to detect gestational diabetes is period from 24 to 26 weeks of pregnancy. According to the clinical guidelines of the Ministry of Health for the diagnosis using glucose tolerance test. If a woman has an increased risk of diabetes, large fetal size, signs of fetopathy, the analysis can be carried out later. Deadline - 32 weekLater, the test may be dangerous due to a strong rise in blood sugar.

The essence of the test consists in measuring glucose of the venous blood on an empty stomach, and then 60 and 120 minutes after the "load" with fast carbohydrates. 75 g of glucose anhydrite or 82.5 g of glucose monohydrate act as carbohydrates. They are dissolved in a glass of warm water and give a pregnant woman to drink. The glucose tolerance test fairly accurately describes the rate of glucose uptake from the blood, so one poor result is enough to diagnose HSD.

To be sure of the correctness of the test, it is necessary to take seriously the preparation for blood donation: in the morning before the analysis, you can only drink water. Smoking, taking medication is not allowed. For 3 days it does not cost anything to change either in lifestyle or in nutrition.

Reasons to postpone the test:

  • toxicosis;
  • limited activity, bed rest;
  • acute inflammation or infection;
  • gastrointestinal tract diseases in which glucose absorption is impaired.

How to treat diabetes in pregnant women

Diagnosing diabetes during pregnancy is no reason to panic. If we start treatment on time, visit the doctor in a disciplined manner and comply with all of his appointments, you can eliminate the negative consequences for the child, avoid complications in the mother, and eliminate diabetes mellitus in the future.

The goal of treatment is to achieve glucose level: in the morning, before each meal, before sleep, at night (stopped at 3:00) less than 5.1 mmol / l, an hour after any food - less than 7 mmol / l. There should be no hypoglycemia and ketones in the urine. The target pressure is less than 130/80.

To control these indicators, pregnant women keep a diary in which they note daily: blood sugar - at least 8 measurements per day, the presence of ketones in the urine in the morning before meals, pressure, weight, fetal activity, menu, and carbohydrate content.

Observation during pregnancy are simultaneously gynecologist and endocrinologist. Attend doctors will have 2 times a month until 29 weeks and weekly - at a later date. As a rule, for the normalization of glucose enough diet and moderate exercise. In rare cases, insulin therapy is additionally prescribed.

Medication use

Sugar-lowering drugs, which are prescribed for type 2 diabetes, are strictly prohibited during pregnancy, as they lead to a lack of nutrition of the fetus. Therefore, the only way at this time to control blood glucose medication is insulin by injection.

Assign insulin in two cases. First, if the diet and exercise were powerless, the blood sugar norm can not be achieved for 2 weeks from the start of therapy. Secondly, if according to the results of the ultrasound, signs of the effect on the fetus of elevated glucose levels are noticed: a large weight, an increased layer of subcutaneous fat, tissue edema, high water.

The mode of insulin therapy is chosen by the doctor according to the diary of self-control. Long-acting insulin during pregnancy, as a rule, is not needed, as it lacks its own hormone. Therefore, only short insulin or its ultrashort counterparts will have to prick. Insulin is injected subcutaneously, in the abdomen or thigh, using an insulin syringe or pen - see how to inject insulin properly.

The drug is prick before each meal in which there are carbohydrates, the dose is calculated depending on the amount of bread units in the food. When visiting the doctor, the dosage will be reviewed each time based on the glycemic data for the last week. If the amount of insulin needed for normal blood sugar exceeds 100 units per day, the patient can be installed an insulin pump, with which the drug will be administered continuously at a low rate.

Proper nutrition and diet

Very useful: Diet for gestational diabetes in pregnant women

Revising the menu for the entire pregnancy is one of the main conditions for the victory over gestational diabetes. Most pregnant women with this disease are overweight, so you need to limit caloric intake.

Recommended calories:

Body mass index

Kcal per kg of weight

18-24,9

30

25-29,9

25

30 and more

12-15

In order to get all the necessary vitamins with reduced caloric content, the menu should include greens, vegetables, meat and fish, fruits.

What fruits and vegetables are allowed: all kinds of cabbage, cucumbers, onions, all greens, radishes, zucchini, eggplants, raw carrots, avocados, lemons, apples, cherries, strawberries, grapefruit.

Prohibited: potatoes, boiled carrots, dates, melons, bananas, grapes, especially sugary kishmish.

Diet for gestational diabetes should meet the following requirements:

  1. The granularity of power. Up to 6 times, in small portions at approximately equal intervals.
  2. Regularity. Do not skip or postpone a set meal time.
  3. The exclusion of fast carbohydrates. A complete ban on sugar, desserts with its content, baking, fast food - about fast and slow carbohydrates //diabetiya.ru/produkty/bystrye-i-medlennye-uglevody.html.
  4. Increase in the amount of fiber in the menu. Preference is given to fresh, rather than heat-treated vegetables - foods rich in fiber.
  5. Limit saturated fat to 10%. Switching to low-fat meats, cooking in vegetable oil, not animal fat.
  6. Sufficient fluid intake. If you are pregnant, you need to drink at least 1.5 liters per day.
  7. Extra Vitamins.

The ratio of nutrients (BJU) with gestational diabetes should look like: proteins = 20-25%, fats <30%, carbohydrates = 38-45%.

Gymnastics and physical education for gestational diabetes

Regular muscle work helps reduce insulin resistance and prevent excessive weight gain, so exercise should not be overlooked for gestational diabetes. The training program is drawn up for each woman individually, depending on her health and physical abilities. Usually low-intensity exercises - walking, swimming or aqua aerobics. You can not do exercises lying on your back or stomach, prohibits lifting the body and legs. Not suitable sports that are fraught with injuries: horses, bicycles, skates or rollers.

The minimum class time per week is 150 minutes. Exercises stop with any ailments and resume with good health.

Traditional methods of treating HSD

Pregnancy is a time of heightened vulnerability for both mother and baby. Due to the desire to avoid medications, many women are switching to herbal treatments at this time. Meanwhile, attempts to cure gestational diabetes, not having special knowledge, according to recipes from the Internet, can end in tears.

For example, a decoction of dandelion roots, which is advertised as a remedy for diabetes, changes the hormones of a pregnant woman, yarrow and nettle can provoke premature birth, and St. John's wort and sage worsen blood circulation in the placenta.

On the majority of packages with vegetable raw materials in the list of contraindications is listed and pregnancy. Therefore, we must take a rule: each new method of treatment should be allowed by the attending physician.

The only folk remedy, the use of which for gestational diabetes is not contested - rosehip infusion. It will eliminate the lack of vitamin C, reduce the number of free radicals, relieve swelling. The recipe is simple: a handful of rosehips before going to bed is placed in a thermos, poured with a liter of boiling water. In the morning a fragrant infusion is ready. Drink it half a cup before a meal.

Consequences of diabetes in pregnancy

The higher the blood sugar level of a pregnant woman, the more dangerous it is for the baby. If not enough attention has been paid to treatment, fetal fetopathy develops: the child is born too large, with an enlarged pancreas, excess fat. He may have breathing problems, hypoglycemia, a violation of lipid metabolism. In the future, these children have an increased risk of obesity and diabetes.

Births with gestational diabetes are usually prescribed as planned, at week 38. If the child has a lot of weight, a cesarean section is performed. Unlike normal babies, those born to mothers with diabetes need nutrition from the first minutes of life, because their pancreas, which is used to coping with excess blood sugar, continues to release increased amounts of insulin for some time. If nutrition is impossible or it is not enough to normalize blood glucose, glucose is administered to the baby intravenously.

What is dangerous for gestational diabetes for the mother: during pregnancy - edema, high blood pressure, late toxicosis. During childbirth - an increased risk of rupture due to a large fetus. After them - high risk of gestational diabetes in the next pregnancy and type 2 diabetes.

Is it necessary to be observed after childbirth

Clinical observations and feedback from moms suggest that the vast majority of gestational diabetes disappears as soon as a baby is born. Immediately after the departure of the placenta, which is the largest hormone-producing organ during pregnancy, blood sugar returns to normal. Until the woman is discharged, she continues to control the level of glucose.After 2 months, you will need to pass the glucose tolerance test again to find out if there are any violations of carbohydrate metabolism and if you are facing diabetes in the near future.

To reduce the risk, women who have undergone GDM need to lose weight to normal, avoid fast carbohydrates, and expand their physical activity. In preparation for the next pregnancy, be sure to be examined by an endocrinologist.

Watch the video: Gestational Diabetes: Managing Risk During and After Pregnancy Video - Brigham and Womens Hospital (November 2019).

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