Pregnancy and childbirth with diabetes mellitus is a problem that remains relevant even today. But in the era preceding the discovery of insulin, a rare woman who fell ill with diabetes in childhood lived to be of childbearing age. Those that survived had reduced fertility (the ability to fertilize). Cases of normal pregnancies and childbirth in diabetes were an exception and were related to women who in adulthood had a mild form of diabetes, first diagnosed after conception.
Significant hormonal disturbances suppressed the function of the gonads, caused menstrual irregularities, absence of menstruation (amenorrhea), and infertility.
The discovery of insulin and the improvement of methods for treating juvenile diabetes contributed to an increase in the number of girls with diabetes mellitus reaching childbearing age. The reproductive function of many of these patients turned out to be normal, and the frequency of pregnancies increased.
If in those early years the mortality rate among pregnant women with diabetes mellitus was about 70%, now it is 1–2%. For women with mild to moderate diabetes, pregnancy can be saved. Only pregnant women with diabetes require particularly careful medical supervision (obstetrician-gynecologist + endocrinologist). With a severe form of the disease with damage to the organs of vision and kidneys, pregnancy is contraindicated.
How diabetes progresses during pregnancy
The development of the fetus and the course of the disease itself has its own characteristics, therefore, there is often a need for hospitalization, which means that the expectant mother should be under continuous medical supervision throughout pregnancy.
Some women experience an improvement in the picture of the disease (diabetes) at the very beginning of pregnancy, as well as 6-7 weeks before and immediately after childbirth. The level of sugar in the blood and urine decreases, the patients notice a good state of health. More often, in the first half of pregnancy, the course of diabetes mellitus is aggravated. This is due to the fact that the growth and development of the fetus causes an increase in the intensity of metabolic processes, an increased production of insulin is required. But with diabetes mellitus, the body is not capable of this. All pregnant women with diabetes mellitus are given insulin administration. The dosage is calculated based on blood and urine glucose levels. This is necessary not only for the patient, but also for the correct development of the fetus.
It happens that in the second half of pregnancy, some women feel better, the content of sugar in the blood and urine decreases. But in most cases, the sugar level rises, thirst increases, and urine output increases. The reason is the excessive production of growth hormone by the pituitary gland. It has long been noticed: a woman preparing to become a mother enlarges her facial features. An excess of this hormone not only increases the growth of certain parts of the body, but also enhances the manifestation of diabetes.
Childbirth, as a rule, occurs at 40–41 weeks. However, with diabetes, there is a prolonged pregnancy and the birth of large babies (4–4.5 kilograms). In order to avoid complications, in some cases preterm labor is artificially caused at 36–37 weeks. If at the time of delivery, the diabetes in the pregnant woman is sufficiently compensated, the delivery is easier, the newborn feels well.
The newborn’s pancreas sometimes continues to produce more insulin than the body needs. Then in his blood sugar content decreases to a level below normal, hypoglycemia may develop. The condition is corrected by administering a glucose solution to the child. The mother’s body at this time, due to the loss of connection with the baby’s pancreas, on the contrary, feels a lack of insulin, which causes a deterioration in well-being.
Children of diabetic mothers are often healthy. However, they require systematic monitoring, especially after reaching the age of 5 years. Diabetes is most often found in these children between the ages of 5 and 13. They should not be overfed with food containing easily digestible carbohydrates (confectionery and flour products, sugar, chocolate, sweets). These children should not be given any medication without the consent of the doctor. An endocrinologist should be examined at least twice a year.
For women with impaired glucose tolerance during pregnancy, systematic medical supervision is also necessary. If, by adjusting the diet, it is not possible to achieve normalization of blood glucose levels, then insulin will need to be used.
Despite the improvement in obstetric care in recent years, as well as the increase in the level of therapy in the field of endocrinology, which ensure a favorable pregnancy outcome in diabetic patients, congenital malformations are still found in children . The first 12 weeks of pregnancy are crucial for the normal formation of the baby’s body. During this period, insufficient compensation for diabetes in a pregnant woman can subsequently cause fetal anomalies. Ideally, conception should be postponed until the woman has an optimal glucose level that should be maintained throughout the pregnancy.
What is gestational diabetes and when can it develop
The diagnosis suggests a condition where the pancreas is unable to cope with the body’s resistance to insulin. Typical for the second half of pregnancy (after 18 weeks). However, in Russia, in particular, gestational diabetes is called any diabetes during pregnancy.
The early pregnancy registration protocol includes a blood glucose test. If at an early stage a woman’s blood glucose values are 5.1-5.2, rarely anyone understands the reasons – a diagnosis of gestational diabetes is made, although this is not the case, and does not even mean that the disease will develop later. At the same time, such women need to do a glucose tolerance test and other studies and understand the reasons.
Fortunately, insulin treatment is not required for gestational diabetes, but the very knowledge of diabetes is traumatic for a woman, and this can lead to more serious complications.
All women take a glucose tolerance test at 24–28 weeks , and expectant mothers at risk for diabetes a little earlier. It is this test that shows whether insulin administration is required.