Pregnancy, developed on the background of diabetes, carries a risk to the health of the mother and fetus.
Risk factors for a mother with diabetes:
• progression of vascular complications (retinopathy, nephropathy, ischemic heart disease);
• more frequent development of hypoglycemia, ketoacidosis;
• more frequent complications of pregnancy (late preeclampsia, infection, multilingual govode).
Risk factors for the fetus:
• high perinatal mortality;
• congenital anomalies (2-4 times higher);
• neonatal complications;
• risk of developing diabetes:
– 1.3% – if type 1 diabetes in the mother,
– 6.1% – if type 1 diabetes is in the father.
Contraindications to pregnancy
(medical indications for abortion are determined by an endo-clinologist-diabetologist and obstetrician-gynecologist)
• Severe nephropathy with creatinine clearance less than 50ml / min, the daily proteinuria 3.0 g or more, blood creatinine more than 120 mmol / l, arterial hydrochloric hypertension.
• Severe coronary heart disease.
• Progressive proliferative retinopathy. Pregnancy is undesirable with:
• women over 38 years old;
• in early pregnancy HbAlc> 7%;
• the development of diabetic ketoacidosis in early pregnancy;
• the presence of diabetes in both spouses;
• combination of diabetes mellitus with Rhesus sensitization in the mother;
• combination of diabetes and active pulmonary tuberculosis;
• the presence of chronic pyelonephritis;
• have a history of patients with well-compensated during baa belt diabetes repeated cases of death or the birth of children with developmental disabilities;
• poor social conditions.
Tactics in planning pregnancy (before conception)
(determined by the endocrinologist-diabetologist)
• Risk information for mother and fetus.
• Pregnancy planning.
• Ideal compensation 3-4 months before conception:
– fasting glycemia of 3.5-5.5 mmol / l,
– glycemia 2 hours after eating – 5.0-7.8 mmol / l,
– HbA1c <6.5%).
• Use only highly purified human insulins.
• Compliance with a diet rich in vitamins, iron, folic acid (400 mcg per day).
• Treatment of retinopathy.
• Antihypertensive therapy (cancel ACE inhibitors!).
• Stop smoking.
Tactics during pregnancy
(determined by the endocrinologist-diabetologist and obstetrician-gynecologist) Compliance with an adequate diet
• Calorie content:
– trimester – 30 kcal / kg BMI,
– 2-3 trimester – 35-38 kcal / kg BMI;
• Proteins – 15%; (protein intake 1.5-2.0 g / kg)
• Fats – 30%;
• Carbohydrates – 55% (mostly complex);
Intensive insulin therapy with highly purified human insulins
Regular self-monitoring of glycemia. Purpose:
– fasting glycemia of 3.5-5.5 mmol / l,
– glycemia after eating 5.0-7.8 mmol / L.
Control HbA1c every trimester. The goal is up to 6.5%.
Ophthalmologist observation – fundus examination 1 time per trimester. Observation of a gynecologist and a diabetologist (at each visit, weight measurement, blood pressure, albuminuria):
– up to 34 weeks of pregnancy – every 2 weeks,
– after 34 weeks – weekly.
Antenatal assessment of the fetus (obstetrician-gynecologist).
|Pregnancy, weeks||Ongoing research|
|7-10||Ultrasound (fetal viability)|
|16||Determination of alpha-fetoprotein|
|24||Ultrasound of fetal growth every 4 weeks|
|28||Cardiotocography (CTG), with late gestosis – CTG regularly after 1 -2 weeks.|
|38||Daily CTG, amniocentesis for the definition Niya lung maturity (if necessary)|
Antenatal fetal assessment
During pregnancy are contraindicated:
• any tablet sugar-lowering drugs;
• ACE inhibitors;
• ganglion blockers;
• antibiotics (aminoglycosides, tetracyclines, macrolides, etc.).
(determined by an endocrinologist-diabetologist and obstetrician-gynecologist)
• In the early stages of pregnancy (survey, the question of preservation SRI pregnant holding a preventive treatment, diabetes compensation, the passage of “School of diabetes”).
• With a gestational age of 21-24 weeks.
• For a period of 35–36 weeks (for careful monitoring of the fetus, treatment of obstetric and diabetic complications, choice of term and method of delivery).
Antihypertensive therapy during pregnancy
(determined by the obstetrician-gynecologist)
• The optimal period is 38-40 weeks.
• The best method – programmed through natural childbirth ro dovye way with careful control of blood glucose during and after childbirth.
• Indications for cesarean section:
• generally accepted in obstetrics;
• presence of the expressed or progressive complications of diabetes and bere mennosti;
• pelvic presentation of the fetus.
(determined by the endocrinologist)
• Reduced insulin requirements.
• Breast-feeding (to warn about the possible development of hypo glycemia).
• Control of compensation, complications, weight, blood pressure.
• Contraception 1-1.5 years.