Not all future mothers can boast of excellent health. Some women have chronic diseases in which it is necessary to carefully prepare for pregnancy and be constantly under medical supervision in the event of its occurrence. One of these diseases is sugar diabetes. As a rule, responsible mothers study in advance the question of the characteristics of pregnancy and childbirth in women with diabetes. However, there are situations when diabetes mellitus first occurs during pregnancy and passes after the birth of a baby into the world. This disease is called gestational diabetes mellitus (GDM). We will talk about this condition in more detail today.
Gestational diabetes: what is it?
Around the world, the number of women who are diagnosed with diabetes mellitus is growing steadily. Why? Perhaps it simply became better to identify? Or is the health of future mothers really worsened? And the one and the other takes place. The prevalence of the disease in different countries varies from 1 to 14%, averaging 7%. With the presence of gestational diabetes, the risk of adverse outcomes increases, both for the mother and the baby.
During the whole pregnancy, every woman undergoes serious hormonal changes. In particular, they relate to carbohydrate metabolism. During pregnancy, insulin sensitivity of tissues decreases in all women. As a result, a large amount of its production is required in order to utilize the glucose coming from food. But not every pregnant woman’s pancreas copes with the increased load on her, which affects their increased sugar content in the blood. This condition will be called gestational diabetes.
Although it is believed that gestational diabetes mellitus goes along with pregnancy, in the future the disease may be felt. Patients with a history of HSD have an increased risk of diabetes type 2, obesity, and various cardiovascular diseases. Moreover, this risk applies even to children.
It is necessary to take into account the fact that it is not always easy to make a diagnosis and figure out what kind of disease a woman faced – there is gestational diabetes or another type of diabetes mellitus that just made its first appearance during the current pregnancy, or was it just not recognized before.
Experts from different countries in the field of obstetrics, gynecology and endocrinology have been studying disorders of carbohydrate metabolism during pregnancy for many years, sharing experience, developing common criteria for diagnosing and treating patients, correcting previously created recommendations.
Examination of blood sugar levels during pregnancy: extremely important!
Blood sugar is examined in future moms repeatedly during pregnancy. Investigated sugar venous of blood on an empty stomach (usually in the morning). Alarming are the numbers of glucose of 5.1 mmol / l and above. Some patients are sampled blood sugar at any time of the day (without reference to food intake).
According to the testimony, the level of glycated hemoglobin is examined and the glucose tolerance test (load test with glucose) is carried out . As a rule, this test is prescribed for women at risk for up to 24 weeks gestation. Women with normal Toshchakovy sugar and non-at-risk glucose tolerance test is not performed until 24 weeks of pregnancy. But they need to conduct this test between 24 and 28 weeks of pregnancy. In extreme cases, the test is carried out up to 32 weeks of pregnancy. In later periods it can not be done, as it can be dangerous for the baby.
The following patients are at risk of developing gestational diabetes mellitus:
- Women are obese initially. Their BMI is greater and equals 30.0 kg / m2.
- Future mothers with immediate family members suffer from type 2 diabetes.
- Patients who have had any disorders of glucose metabolism in previous pregnancies.
- Women whose sugar is determined in a general urine test (glycosuria).
Expectant mothers have increased blood sugar: what to do next?
After the doctor (obstetrician-gynecologist, therapeutist, endocrinologist) diagnosed gestational diabetes, the following recommendations are given to the expectant mother:
- Follow a specific diet
It is necessary to reduce as much as possible, and it is better to completely eliminate easily digestible carbohydrates (muffins, sweets, white bread). You also need to restrict fats in your diet. You need to eat regularly throughout the day (4-6 times), do not need to make portions large.
- Every day to give the body exercise
For this, it is not necessary to sign up for fitness. It is enough just to walk daily on foot – 2-3 hours of hiking a week would be quite a reasonable load. It is very useful to go to the pool 1-2 times a week.
- Independently control blood sugar
To do this, you should purchase a portable blood glucose meter and test strips. It is recommended to measure sugar before the main meal and one hour after that. Many doctors advise to keep a food diary.
- Keep control of other parameters of your health
It is important to regularly pass a general urinalysis, monitor blood pressure, monitor fetal movements, monitor weight gains. It will be great if the future mother keeps a diary of self-control over her health.
Would you need medicine?
Of all the sugar – reducing drugs during pregnancy only insulin is allowed. It is prescribed in those cases if the patient fails to stabilize blood sugar for 1-2 weeks after the start of self-control.
There is another very serious indication for the appointment of insulin therapy to the expectant mother: the appearance of signs of diabetic fetopathy , that is, signs that a developing baby suffers intrauterinely from excess insulin. As a rule, the doctor notes these signs during an ultrasound examination of the fetus (the fruit is large, edematous, its organs are enlarged in size).
If a pregnant woman needs to prescribe insulin, then the endocrinologist will have to consult her. The treatment regimen and specific insulin preparations are selected individually.
Where does excess insulin come from a fetus?
At first glance, it seems strange that the fetus may have an excess of insulin in the body when it is deficient in the mother. But the thing is this: an excess of my mother’s glucose easily penetrates to the fetus, but maternal insulin is not. But after 20 weeks his pancreas makes his insulin. If there is an excess of glucose from the mother, the fetus produces a lot of insulin.
Against this background, the production of fetal adrenal hormones begins in large numbers . As a result, proteins and fats start to be produced in excess in the body of the baby, which results in accelerated growth of the fetus. But the problem lies not only in accelerated growth, but in that the maturation of its organs is delayed. For example, a child may be born premature at 36 weeks with a body weight of 4800 and at the same time be in a very serious condition due to the inability to breathe normally.
Do I need to stay in the hospital with gestational diabetes?
Most women do not require hospitalization for gestational diabetes. Even insulin can be administered on an outpatient basis. You will only have to go to the hospital if, in addition to diabetes, the patient has associated obstetric problems or exacerbates other chronic diseases.
It recommended planned to go to hospital at 37 weeks of pregnancy to women with GDM who manage to control the disease with the help of diets. If the patient takes insulin, or the baby has signs of fetopathy , it will be necessary to go to the hospital early (about 36 weeks).
It is recommended to give birth to the future mother at 38-39 weeks of pregnancy. Gestational diabetes is not an indication for cesarean section. The operation is carried out with the same indications as non-diabetic women. However, operative labor can be recommended for large sizes of the baby or in the presence of pronounced signs of diabetic fetopathy .