Motherhood is a cherished dream for many women. To bear and give birth to a baby, the body of the expectant mother must be strong and strong, and most importantly, healthy. But what about those women who have been diagnosed with diabetes? Say goodbye to the dream of motherhood forever? Until recently, it was so.
Risk assessment and contraindications for pregnancy in diabetes mellitus
A few years ago, doctors were very categorical. The desire of a woman suffering from diabetes mellitus to give birth to a baby was completely suppressed. After all, the patient risked her life and her future baby. Long-term studies conducted by leading endocrinologists and obstetricians have questioned this taboo. Scientists have proven that the disease does not adversely affect the course of pregnancy. Increased sugar levels cause harm to the fetus. If it is possible to stabilize the glucose concentration, then the woman carries and gives birth to a healthy child.
The main risks
With diabetes, a woman’s glucose absorption is impaired. Glucose is not converted into energy for cells. This complicates the work of the mother’s body. The ovum suffers from a lack of energy. Doctors point out the following dangers for a pregnant woman with diabetes:
- The expectant mother’s load on the body increases. This can lead to complications in the work of the cardiovascular system, impaired renal function.
- Lack of control over the concentration of sugar in the blood can provoke a hypoglycemic coma (against the background of a decrease in glucose concentration).
- Infectious diseases are very dangerous with diabetes in a pregnant woman. These pathologies are harmful for a healthy woman, and for a weakened body, they can turn into severe defects in the development of an infant or a miscarriage. The flu vaccination allowed for expectant mothers is categorically contraindicated in diabetes mellitus.
- Blood sugar surges during the early stages of pregnancy can trigger miscarriage. Sometimes they lead to the formation of malformations in the baby.
- The high concentration of sugar in the mother’s blood causes excessive stress on the pancreas of the developing fetus. The baby’s body is forced to synthesize high doses of insulin. This hormone is a growth stimulant. Therefore, a baby in the womb can reach large sizes and large weight (more than 4.5 kg).
- Mothers with spikes in blood sugar give birth to babies with excess insulin and low glucose concentrations. Sometimes this leads to the development of diabetes in the child.
- A woman’s body, weakened by the disease, is more difficult to tolerate pregnancy. These women are more likely to develop complications. They tolerate toxicosis worse and face severe gestosis .
Not all women can experience the joy of motherhood. Some of them are categorically contraindicated to give birth to children for medical reasons. It is not recommended to have a child for women who have diabetes combined with the following pathologies and conditions:
- chronic pyelonephritis;
- gastroenteropathy ;
- active tuberculosis;
- insulin-resistant form of pathology (not amenable to insulin treatment);
- negative rhesus factor;
- renal failure.
According to statistics, if diabetes is diagnosed only in the mother, then the risk of transmitting the disease to the child is 2%. The chances of inheriting the pathology increase to 5% if the father suffers from the disease. But if both parents are diabetics, then the probability of transmission of the disease reaches 25%. This is a sufficient reason for an abortion. The issue of termination of pregnancy is decided in each case individually.
Preparing for pregnancy for women with diabetes
Having decided on motherhood, the patient must understand what responsibility for the future baby falls on her shoulders. In women with diabetes, only a planned pregnancy can be successful. Preparation for bearing a baby should be started 3-4 months before, and best of all six months before conception.
Needless to say, why accidental pregnancy is dangerous. In the first weeks, all organs and systems are laid in the fetus. If at this time there are jumps in glucose, then the baby may develop severe defects. And the mother will have serious health problems.
Sometimes women do not have control over their blood sugar concentration. This is typical of patients with mild forms of diabetes mellitus. Once you’ve made your decision to be a mother, you need to measure your glucose regularly several times a day. To do this, you will need to purchase a special device – a glucometer .
|The rate and stage of diabetes||Indicators of sugar concentration, mmol / l||Features:|
|Mild degree||5.5-7.7||The correct diet will help normalize concentration|
|Heavy||More than 12.7||Serious injuries in which pregnancy is impossible|
For a woman to be able to bear a healthy child, she needs to normalize carbohydrate metabolism. Fasting glucose values should vary in the range of 3.3-5.0 mmol / L. After eating (after 2 hours), the sugar concentration should not exceed 6.7 mmol / l.
Normalization of carbohydrate metabolism is the main, but not the only moment that makes it possible to bear and give birth to a healthy baby. Pregnancy planning includes several successive stages:
- Visit to an endocrinologist . The doctor will develop an individual schedule for insulin therapy. To determine the effectiveness of such treatment, the patient is recommended to keep a diary in which the readings of the glucometer will be regularly recorded . It is necessary to measure the sugar concentration at least 6-7 times a day (in the morning on an empty stomach, after each meal, at night). During pregnancy, taking tablet drugs that lower glucose levels is contraindicated. Therefore, women who decide to become mothers are temporarily switched to insulin.
- Gynecologist’s consultation . With diabetes, a woman’s body creates a favorable environment for the development of genitourinary infections. Therefore, before planning a pregnancy, it is necessary to treat such pathologies.
- Visit to a nutritionist . It is impossible to normalize and maintain sugar levels without nutritional correction. The expectant mother is referred to a nutritionist who will develop a therapeutic diet. Diet table number 9 is taken as a basis.
- Examination by an ophthalmologist . For diabetes mellitus, peripheral vascular damage is characteristic. The capillaries that provide blood flow to the eyes are especially affected. During pregnancy, the load increases significantly. Accordingly, it is necessary to investigate the state of the fundus in advance. Based on the indications of the study, timely cauterization of the affected vessels is carried out.
- Consultation with a cardiologist . Long-term course of pathology can disrupt the work of the heart. Sometimes the vessels are affected. To identify changes in the work of the heart, the patient is prescribed an electrocardiogram. Regular measurement of pressure readings is recommended. To normalize the condition, a woman may be prescribed safe medications. In this case, the diabetes of the pregnant woman must be monitored by a cardiologist.
- Visit to a neurologist . Diabetes can cause neurological damage in women. They manifest as temporary loss of sensitivity. Such violations affect the toes, feet, hands. During sleep, “paralysis” can spread to other parts of the body. Ignoring such violations leads to muscle tissue atrophy. Timely consultation with a neurologist and adequate treatment will help to cope with such disorders.
- Visit to a nephrologist . Another “weak point” of women with diabetes is the kidneys. The blood vessels are damaged. The kidneys are not getting enough nutrition. Their functionality decreases. Against the background of such changes, diabetic nephropathy may develop. This pathology has been hidden for a long time. To diagnose an ailment, the nephrologist will prescribe a urine test. The presence of albumin in the submitted biomaterial may signal the development of pathology.
Types and features of diabetes
Diabetes mellitus is characterized by an increase in the concentration of glucose in the body. However, various mechanisms can trigger such a process. Depending on the underlying cause of diabetes, the following types of pathology are distinguished:
- 1 type . It is an autoimmune disease. This pathology is called insulin-dependent diabetes. The disease develops even in childhood. With this type of diabetes, the cells of the pancreas that synthesize insulin are damaged. A decrease in hormone production leads to an increase in glucose concentration.
- Type 2 . This is an acquired form of the disease. Non-insulin dependent diabetes. Most often, pathology appears in adulthood, after 30-40 years. The disease develops against the background of obesity, physical inactivity, malnutrition, genetic predisposition. With this disease, the pancreas produces a sufficient amount of insulin. But the cells of the body become immune to the hormone. This leads to an increase in blood sugar concentration.
- Gestational diabetes . This pathology develops only during pregnancy. In the patient’s body, the level of cortisol and female hormones increases. They significantly reduce the sensitivity of cells to insulin. Usually the body of the expectant mother copes with such a load with dignity. But some women (5-10% of cases) develop gestational diabetes. The pathology is reversible. After giving birth, it goes away.
Doctors distinguish another form of pathology – overt diabetes . This is a disease that is diagnosed in a woman during pregnancy. But all indicators indicate that the disease developed long before conception. Accordingly, diabetes will not go away after childbirth.
Features of pregnancy with type 1 diabetes
Most often, obstetricians and endocrinologists are faced with this type of ailment, since the pathology has been going on since childhood. Diabetes of a pregnant woman is manifested by the characteristic symptoms:
- excessive hunger;
- increased urination;
- intense thirst.
With this pathology, a woman needs regular administration of insulin into the body. However, the expectant mother’s need for this hormone is constantly changing. Therefore, the doses of the drug for pregnant women should be adjusted in a timely manner. Dosages are changed at least three times:
- 1 trimester. The beginning of pregnancy is accompanied by a slight increase in the sensitivity of cells to insulin. Therefore, the dosage of the hormone should be reduced. Otherwise, the patient is at risk of hypoglycemia.
- 2 trimester. During this period, the placenta functions in women. The body’s need for the hormone increases. If the doses of insulin are not increased, then the patient is at risk of ketoacidosis (high concentration of glucose and ketone bodies). This condition can lead to coma.
- 3 trimester. Reducing insulin doses is required again. This is a difficult period in which diabetes of a pregnant woman can provoke kidney failure, premature birth, and sudden fainting.
Unpleasant consequences for a woman are associated with impaired microcirculation. They can manifest themselves in the following pathologies:
- placental insufficiency;
- gestosis (late toxicosis);
- placental abruption;
- eclampsia (a sudden increase in pressure that threatens the life of the baby and mother).
The consequences for the child can be as follows:
- Diabetic fetopathy . The fetus in the womb reaches a large size (from 4 to 6 kg). With this pathology, a woman is given a cesarean section. The baby, despite its impressive weight, is born very weak.
- Fetal hypoxia . A pregnant woman with diabetes may not develop the placenta properly. She is not able to provide the fetus with the necessary amount of nutrients and oxygen. A child who is undernourished sometimes lags behind in development.
After birth, maternal glucose no longer enters the body of the baby. But the infant’s pancreas continues to synthesize high doses of insulin. This can lead to hypoglycemia and even coma in the newborn.
Features of pregnancy with type 2
Pathology is accompanied by the same symptoms as in type 1. However, the clinical picture may be mild. If diabetes progresses, then the woman has:
- swelling of the face, limbs (typical for kidney damage);
- arterial hypertension;
- polyneuropathy (numbness of the limbs, tingling);
- retinopathy (damage to the retina).
Sometimes expectant mothers are not even aware of the development of pathology. The doctor notes an increased glucose concentration already during pregnancy. A simple test is done to confirm the suspected diagnosis. Blood is taken for analysis on an empty stomach. Re-examination is carried out 2 hours after eating. If both indicators significantly exceed the permissible norm, then the woman is diagnosed with diabetes mellitus. A slight increase in indicators is characteristic of the gestational form of the disease.
Non-insulin dependent pathology is considered the most severe form of diabetes for a pregnant woman. It can lead to serious complications for both the woman and the baby. Among the unpleasant consequences may be:
- placental abruption;
- premature birth;
- gestosis ;
- fetal hypoxia;
- developmental delay;
- diabetic fetopathy ;
- death of the baby in the womb.
The most common complications of type 2 diabetes for a pregnant woman are:
- Gestosis . Late toxicosis develops at approximately 22-26 weeks. It is characterized by swelling, pressure surges. Pathology gradually affects the functioning of the kidneys. The condition of the pregnant woman is rapidly deteriorating. The gestosis period can provoke placental abruption and premature birth. Often, with diabetes mellitus, you have to do a cesarean section at 37 weeks.
- Polyhydramnios. An excessive amount of amniotic fluid leads to an incorrect position of the fetus in the womb. To eliminate the risk of injury to a woman or child, doctors use a caesarean section.
Features of gestational diabetes
The pathology is very similar to type 2 diabetes. Often it is asymptomatic and is detected only during the next examination. Temporary diabetes mellitus occurs at about 20-24 weeks of gestation. The causes of the appearance of the pathology have not been established. After the birth of the baby, the sugar in the mother’s body is completely normalized. The hallmark of gestational diabetes is elevated glucose levels. Sometimes additional symptoms occur:
- unexplained weakness;
- increased urination;
- dryness of mucous membranes and skin.
The gestational type can have the same negative effects on the fetus and harm the mother’s health as regular diabetes mellitus. To normalize glucose, doctors prescribe a diet for a woman. The correct diet allows you to quickly restore your condition. In rare cases, minimum doses of insulin are additionally prescribed.
There are special remote “diabetes schools” where a woman can get answers to any questions.
Diet for pregnant women with diabetes
When blood sugar levels are elevated, doctors prescribe dietary meals. The correct diet is aimed at restoring metabolic processes and timely utilization of glucose. Basic nutritional guidelines for pregnant women with diabetes:
- Food intake. A woman should eat 5-6 times a day. Breaks between meals – 2-3 hours.
- Serving sizes. With 5-6 meals a day, it is necessary to revise the doses of the absorbed food. It is recommended to reduce portions by 1.5 times. The woman should feel full, but not heaviness in the stomach. Overeating, as well as hunger, leads to a sharp increase in glucose.
- Competent menu. The diet must be thought out in advance. All meals should be ready by the time you eat. This will allow you to adhere to the selected regime and not to seize the sudden hunger with “wrong” food. When planning a menu, nutritionists recommend preparing hearty and hearty meals for breakfast and lunch. And it’s better to have supper with light food.
- Drinking regime. It is recommended for diabetes mellitus to drink about 1.5-2 liters of liquid per day. For a pregnant woman, water without gas, vegetable juices, herbal teas are useful. It is better to refuse sweet fruit drinks. Doctors say that a pregnant woman can drink weak coffee, but only without sugar and milk.
|What can be consumed||What to give up|
|Diet meat;cabbage;eggplant, zucchini;seafood;greens;cucumbers;tomatoes (in limited quantities);fish;mushrooms;almonds, hazelnuts;eggs;hard cheese;cottage cheese;cream;cherry (in small quantities);yogurt (natural without additives)||Cereals (rye, wheat, rice, buckwheat);sugar;flour products;fruits;ketchup, tomato juice;pumpkin, bell peppers;potatoes, carrots, corn;legumes;sweet desserts, yoghurts;whole milk;semi-finished products, canned food;watermelons;instant food;chocolate, sweets;smoked meats;fatty broths|
The choice of diet depends entirely on the stage of diabetes progression. In order not to harm the baby, any changes in the menu must be agreed with the attending physician or nutritionist.
Childbirth in the presence of diabetes in a pregnant woman
A diabetic woman is advised to give birth in a specialized clinic. If this is not possible, then you should enlist the support of an experienced endocrinologist. During childbirth, the expectant mother may fluctuate in blood glucose levels. And after the birth of a baby, a woman’s blood sugar drops rapidly. Natural childbirth is preferred. But if there is a risk to the health of the mother and the baby, then doctors resort to surgical intervention. Caesarean section is recommended in the following cases:
- fetal weight over 4 kg;
- severe gestosis ;
- kidney damage;
- retinopathy ;
- placental abruption;
- severe fetal hypoxia;
- inability to control glucose levels;
- polyhydramnios and abnormal fetal position.
With severe gestosis , eclampsia or twin pregnancy, caesarean section is performed at 37-38 weeks.
After giving birth, a woman should remain in the clinic under the supervision of obstetricians and endocrinologists for 5-7 days. During this time, the doctor changes the prescription protocol several times. Patients, depending on the type of diabetes, will be given the following recommendations:
- 1 type . Immediately after delivery, the dosage of insulin is reduced. On day 3, the woman’s body begins to recover. More insulin is required during this time. Gradually, the woman in labor returns to the usual dosages (those that were prescribed before pregnancy).
- Type 2 . After childbirth, dosages are sharply reduced. The woman is then switched from insulin to oral medication.
Many women suffering from diabetes mellitus today were able to bear and give birth to healthy, strong children. The main thing is to strictly follow all the doctor’s recommendations and take the prescribed drugs. After all, the health of the baby growing in the womb depends on you.