Among other types of metabolic disorders, endocrinologists distinguish gestational diabetes mellitus (ICD-10 / O00-O99 / O20-O29 / O24). With this disease, an increase in blood glucose levels is observed in women during pregnancy and, as a rule, disappears after childbirth. This metabolic disorder can lead to the development of type 2 diabetes. This happens somewhat after the birth of the child. The risk group for the disease includes overweight women.
Differences between gestational diabetes and other types
Due to the adjustment of metabolic processes by the body, during pregnancy, the work of the endocrine system is often disrupted. The disease can occur against the background of these changes. Due to the restructuring of metabolism, in the event of a decrease in the amount of glucose entering the fetus, the main pathway of energy metabolism, carbohydrate, switches to a secondary pathway – lipid. This scheme (the phenomenon of rapid starvation) allows the body to provide constant glucose transport to the fetus even when the available reserves of this monosaccharide in the mother’s body are depleted. In the first trimester of pregnancy, the changes in metabolism are sufficient to provide the embryo with the necessary nutrients. However, later the placenta begins to perform an endocrine function, which affects carbohydrate metabolism and can lead to its disruption. The course of the disease is determined by several factors, the key of which is an imbalance in the action of insulin (lowers glucose levels) and other hormones that increase blood glucose levels. This leads to the fact that body tissues stop responding normally to insulin. Its production is reduced. An increase in the percentage of adipose tissue, high-calorie nutrition, and an increase in body weight become provocateurs for the onset of a disease while carrying a child. The main enemies of insulin during pregnancy are hormones produced by the placenta, estrogens and cortisol (secreted by the mother’s adrenal glands). These substances are potentially diabetogenic . With an increase in their number in the body, which occurs at 16-18 weeks of pregnancy, the expectant mother begins to show relative insular insufficiency, and later, at 20 weeks, the first signs of the disease. Usually this disorder is diagnosed at 24-28 weeks. Sometimes patients do not have the usual complaints. It is not uncommon that prediabetes can be diagnosed during pregnancy . This changes the body’s tolerance for glucose in the blood. A lack of insulin can occur with a number of provocative factors, for example, with an excess of carbohydrates entering a woman’s body with food.
Diabetes mellitus in pregnancy is reversible: during this disease, the cells of the pancreas and insulin molecules are not affected.
Some women are at risk of the disease from the very beginning of pregnancy. A gynecologist, working with a patient, will either class her as one of this group, or not. In this case, the doctor is guided by the following criteria:
- there were or are people among the relatives of a woman with diabetes;
- the expectant mother is overweight;
- the age of the patient (after 30 years, the likelihood of this diagnosis increases slightly);
- a woman’s past pregnancy ended in miscarriage, stillbirth, fetal fading;
- the patient herself at birth weighed more than 4 kg, or her previous children were born with the same weight;
- after a urinalysis examination, an increased amount of sugar was found in it;
- in a previous pregnancy, the woman had already gone through gestational diabetes.
But despite everything, it is worth remembering that this disease can manifest itself completely spontaneously, without any initial reasons. The birth of a new life in a lady’s body is a complex process that sometimes violates medical laws.
Symptoms of gestational diabetes
This ailment has no specific symptoms. The defining symptom of the disorder in pregnant women is an increased concentration of glucose in the blood, which was not observed before conception. This violation is ascertained at 20 or more weeks of pregnancy. In addition to an increase in the amount of sugar in the blood, patients may have an accelerated increase in body weight (more than 300 grams per week), excessive thirst, lack of appetite, and rapid fatigue. How this disease affects the fetus is also worth knowing. The disproportionality of some parts of the body, the rapid growth of mass, the excessive deposition of fatty tissue are a reflection of the gestational diabetes mellitus of the mother in the fetus.
Diagnostics
To diagnose this disease, the following studies are carried out:
- blood sugar;
- glycated hemoglobin;
- general urine analysis, analysis for sugar and ketone bodies (acetone);
- glycemic profile;
- glucose tolerance test;
- analyzes of the general survey plan (OAC, detailed biochemical blood test);
- consultations of specialist doctors (ophthalmologist, therapist, after – an endocrinologist).
The main method for laboratory diagnosis of the disorder is to determine the amount of glucose in the blood by testing. When the ladies register with the antenatal clinic, all of them are sent for a blood test. If the amount of glucose in it was 4.8-6.0 mmol / L (from a finger) and 5.3-6.9 mmol / L (from a vein), the patient is given a referral for a special test, by which disorders of the processes of carbohydrate metabolism are detected … Glucometer indicators are not used to measure blood sugar: no matter how accurate they are, the discrepancy with laboratory tests will be at least 10%. To diagnose this disease, it is necessary to find out the amount of glucose contained in the venous plasma of a pregnant woman. Gestational diabetes mellitus is set at 5.1-7.0 mmol / l (on an empty stomach), after an hour during an oral glucose tolerance test – more than 10.0 mmol / l, after two hours – more than 8.5 mmol / l … Fasting time before analyzes is from 8 to 14 hours. Blood is not taken during toxicosis. Patients with diabetes mellitus, developed even before pregnancy, as well as women with a pre-gestational form of the disease, are seen by an endocrinologist.
Why is gestational diabetes dangerous ?
For the expectant mother, diabetes mellitus (not only gestational ) is dangerous because it increases the likelihood of premature birth and stillbirth. Possible infectious complications in the postpartum period, visual impairment, fetal malnutrition. Often, infections of the genital tract are observed, later passing to the embryo. Why is the mother’s illness dangerous for the child? Hyperglycemia in the first trimester of pregnancy can cause some birth defects. An enlarged liver and heart, a wide shoulder girdle, and a large belly of the fetus are the results of excess glucose and impaired metabolism. After 12 weeks of gestation, when the fetus is able to produce insulin on its own, hyperinsulinemia occurs . It can lead to disturbances in the child’s respiratory system, an increase in fetal weight ( delivery in this case is possible through a cesarean section), hypoglycemic state of the newborn, trauma during natural childbirth. Babies in the womb with gestational diabetes can develop fetal fetopathy .
Childbirth
The method of childbirth depends on the stage of the pathogenesis of the disease and is prescribed by the doctor. With an unexpected start of labor or stimulation, natural childbirth is possible only if:
- the size of the baby’s head fits the parameters of the mother’s pelvis;
- the fetus has no congenital malformations;
- the baby’s weight does not exceed 4 kilograms;
- there is the possibility of monitoring the fetus during childbirth;
- the baby is in the womb correctly (head down).
Patients suffering from gestational diabetes mellitus are often faced with premature amniotic fluid retention, early childbirth. Due to severe weakness that breaks the body of a woman in labor, during the birth of a child, it is difficult for women to make efforts to push. On what week patients with this ailment give birth, it is impossible to say for sure. As a rule, doctors prescribe a period no later than 38 weeks, but, depending on the situation, this figure may change. Women with this diagnosis after childbirth and for some time before them need to be under the supervision of doctors. This is done to monitor whether the pregnancy is progressing normally and whether the birth is normal. As a rule, a child, after his birth, needs an injection of insulin, and later the observation of doctors for one and a half months. During this time, his tolerance to sugar is checked and it is established whether the mother’s illness affected the baby. If the mother has already experienced this kind of metabolic disorder during a previous pregnancy, the next baby can be planned no earlier than two years later. To prevent relapse, six months before pregnancy, you should begin to carefully monitor your body weight, check your blood sugar in a laboratory, and exercise.
It is impossible to predict whether the pregnancy will pass without the onset of the disease. To be on the safe side, follow the clinical guidelines, eat the right diet, and consult your doctor more often.
Diet for gestational diabetes
A careful approach to nutrition with this ailment is one of the keys to preventing the dangerous consequences of diabetes and its treatment. When choosing a diet, the patient’s weight, the degree of her physical activity are taken into account. It is necessary to ensure that the necessary vitamins and nutrients are obtained from food. It is recommended to eat 4-6 times a day. This helps keep your blood sugar levels roughly the same. In addition to breakfast, lunch and dinner, you need to have small snacks. The daily diet is divided between proteins (20-25%), fats (35-40%) and carbohydrates (30-35%). The calorie content of food varies depending on the woman’s body mass index (from 25 to 35 kcal per 1 kg of body weight). Reducing the calorie content of food is carried out with special attention. As a rule, pregnant patients are prescribed a diet (table number 9). This therapeutic nutritional system consists of low-carb foods and tends to help overweight women lose weight by preventing the severe consequences of the disease. With this diet, among the permitted types of food are:
- fermented milk products (low-fat, no added sugar);
- wheat, rye, protein- tube bread (no more than 200 grams per day);
- boiled / jellied lean meats (veal, rabbit), diabetic sausage;
- eggs (soft-boiled, omelets);
- low-sugar vegetables (cabbage, cucumbers, soaked potatoes, salads, zucchini);
- fresh berries containing a minimum of sugar;
- vegetarian and vegetable soups;
- butter and vegetable oil (no more than 40 grams per day);
- tea without sugar, tea with milk, coffee (weak), tomato juice, fruit juices (sour fruits);
- mushrooms;
- hard cheeses.
Contraindicated in diabetes:
- sugar;
- pastry and confectionery;
- sweets (no ice cream or chocolate);
- fatty dishes and strong broths;
- food high in cholesterol;
- vegetables and fruits with a high sugar content;
- rice and semolina dishes.
You can not drink sweet drinks, eat honey, condensed milk. The diet should not contain peanuts, some types of other nuts, watermelons, melons, grapes, bananas, dates, persimmons. Alcohol, canned food, bacon, mayonnaise, sour cream, cream are contraindicated. Drinking more water is recommended. Here are some fruits, vegetables, cookies and other foods that can be consumed in small quantities:
- fish;
- Cereals: oats, buckwheat, pearl barley, wheat, brown rice, barley;
- bread, pasta (dumplings are not worth eating);
- ordinary potatoes, corn, peas, beans, lentils;
- strawberries, cherries, cherries, blueberries, apricots, dried apricots (soaked), oranges, apples;
- biscuit biscuits;
- sweeteners (undesirable).
Berry consumption is reduced to a few small handfuls a day. The same strawberries or cherries are not worth eating in large quantities. It is often recommended to eat raspberries, gooseberries and mulberries. These berries lower the amount of glucose in the blood. A more accurate list of what you can eat with this disease, check with your doctor. An example of a daily menu for a pregnant woman with gestational diabetes mellitus:
| Small breakfast | Oatmeal, green tea without sugar |
| Breakfast | Rye bread and low-fat cheese sandwich, apple |
| Afternoon snack | Cookies with cereals / biscuit (no more than 2-3 pieces), fat-free cottage cheese |
| Dinner | Buckwheat soup in vegetable broth, veal stewed with vegetables, cauliflower (boiled), black bread |
| Dinner | Stewed eggplants with a slice of bread |
| Snack before bed | Gray bread and hard cheese sandwich |
Because how a woman will eat during pregnancy and after, depends not only on the pathogenesis of the disease, but also on its treatment. However, eating healthy is not only important during diabetes: it should always be followed.
Treatment of gestational diabetes
The treatment protocol for the disease consists of prescribing blood sugar pills, insulin therapy, and diet. The main method of treatment is diet therapy. Pills for gestational diabetes mellitus are rarely prescribed. When insulin is prescribed, the following criteria are taken into account in dose selection:
- anamnesis, body weight;
- the amount of sugar and glycated hemoglobin in the blood;
- the patient has complications or accompanying diseases.
Insulin therapy, like pills, is prescribed only if diet therapy and exercise do not give any results. There are many types of insulin in medicine. They are divided according to their duration: short, medium and long. The first includes Aktrapid , the second is Lispro , and the third, for example, Levemir . Moderate exercise can help with treatment. During the performance of various exercises, the metabolism improves, which helps to restore the correct metabolism of carbohydrates in the body. The plan and intensity of physical activity must be discussed with the doctor: during pregnancy, it is very easy to overdo it with them and, moreover, it is dangerous. Among other things, exercise helps to keep in good physical shape and to some extent prepares a woman for the upcoming birth of a baby. Among other types of loads, you should choose something from the following list:
- swimming;
- aqua aerobics;
- bicycling;
- dancing (not too mobile);
- aerobics for pregnant women;
- bicycle rides.
Not only obstetricians-gynecologists, but also some doctors of a narrow specialty are increasingly paying attention to the problem of gestational diabetes mellitus. If a woman registers for pregnancy on time, she will find out the exact level of glucose in her blood on time. When there is a suspicion of a disease, the necessary measures to prevent it are immediately taken. Only when the patient follows all the recommendations of doctors, the outcome of pregnancy for mothers suffering from this disorder will be favorable.