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Gestational diabetes during pregnancy

What is gestational diabetes?

Gestational diabetes is elevated sugar levels in the bloodwhich is diagnosed during pregnancy. In most cases, the disease begins to develop from the beginning of the second trimester. The detection of gestational diabetes in the earlier stages it is possible to suspect the presence of normal diabetes, which the woman had before pregnancy.

This pathology is observed in approximately 4-6% of pregnant women. After birth, it often goes away by itself, however, history of gestational diabetes increases the risk of diabetes ordinary in the future.

Causes of gestational diabetes are as follows: under the influence of hormonal changes in the II-III trimester of pregnancy pancreas women should develop much more insulin to compensate for the effect of hormones on blood sugar levels. If it can not cope with elevated functions, it leads to diabetes.

In gestational diabetes, no changes in feeling typical of diabetes type I and II.

However, some signs can be felt:

  • constant thirst and dry mouth;
  • frequent and copious urination;
  • fatigue;
  • the decrease in visual acuity.
Often, however, these characteristics are perceived by pregnant women, the specificities of their situation.

Gestational diabetes provokes an excessive increase in fetal weight and leads to hyperinsulinemia in the child after birth: when the child ceases to receive from the mother the same amount of glucose, sugar level in his blood drops to critical values. In addition, increasing the threat of miscarriage and the risk of fetal malformations.

Statistics

In the US, epidemiologists have conducted a number of studies concerning the development of gestational diabetes mellitus (GDM) in women during pregnancy. The results showed that this issue affects 4% of the number of women bearing fruit.

In Europe these indicators vary at the level of 1-14%, with about 10% observed in the postpartum period continue to experience the symptoms of the disease, transforming in the future in diabetes of the second type. Moreover, 50% of women who suffered gestational diabetes during the period of gestation for the next 10-15 yearssusceptible to the development of the SRS.

The fact that this pathology is so widespread, says poor awareness of women about the risk of the development of the disease and its irreversible consequences. Unfortunately, many women are diagnosed and receive professional assistance with a big delay. In connection with the circumstance in a women's consulting centers and reproductive specialists carry out educational activities aimed to protect women's health and allow to be born healthy kids.

The content of the article:


What is the risk of gestational diabetes?

First, it increases the risk of an unfavorable development of the fetus. In early pregnancy gestational diabetes can cause birth defects of brain structures and development of the heart in the fetus and can cause spontaneous abortion. In the last two trimesters of pregnancy because of diabetes, the fetus can grow in excess of (macrosomia) or risk of hyperinsulinemia.

After birth, the disease can develop into a complication of diabetic fetopathy, which is a disproportion of the body, overweight crumbs (over 4 kg), respiratory disorders on the background of hypoglycemia, excessive amounts of subcutaneous fat, as well as the viscosity of blood is higher than normal and blood clots.


What is different about gestational diabetes from other types of diabetes?

To diabetes mellitus leads to serious disruption of carbohydrate metabolism, which is responsible for insulin – the hormone of the pancreas. Insufficiency of this hormone is relative or absolute. Usually, in diabetes mellitus level of glucose in the bloodbeyond the border rules. This phenomenon is called hyperglycemia. At the same time it reveals glucosuria (sugar in urine).

Experts of the world Health Organization, diabetes mellitus is divided into several types. Disease of 1st type affects teenagers and little children, which is an autoimmune collapse of the cells developing in the pancreas the hormone insulin. As a result of the collapse of these cells is reduced or completely stops insulin production.

According to statistics, diabetes mellitus of the 1st type affects 15% of the total number of victims of the disease. A sure sign of the disease – high levels of glucose at a young age. Also in the blood can be detected by antibodies to insulin and ?-cells. In these patients, insulin levels are reduced. There is only one way of treatment of diabetes of the 1st type - the introduction of insulin injections.

Genetic defects, chronic pancreatitis, various infectious diseases, ingestion of chemicals and certain medicines can lead to the development of people suffering from overweight, diabetes of the 2nd type.

This type of disease is typical for patients of Mature age with hereditary predisposition. In laboratory tests patients the rise of glucose level exceeding 5.5 mmol/L. Patients the doctor prescribes medicines, specific diet and required exercise. Such treatment allows to reduce the level of glucose in the blood.


Causes of gestational diabetes

During the period of gestation any woman might face with the development of GDM due to reduced sensitivity of tissues and cells to produced by the body to insulin. Thus, there is the development of insulin resistance, which correlated with the increase in the level of hormones in the blood of the expectant mother. The placenta and the fetus have an increased need for glucose, it increased consumption by the body during pregnancy negatively affects homeostasis. In result, the pancreas tries to compensate for lack of glucose and increases insulin production, increasing its level in the blood.

When the pancreas ceases the production of the necessary volume of insulin, it begins the development of gestational diabetes. Elevated levels of proinsulin is clear evidence of reduced ?-cells in the pancreas and development of diabetes during gestation.

It happens that after the baby is born the blood sugar levels of the mother instantly comes back to normal, but even under such circumstances cannot be wholly excludedthe possibility of developing diabetes.


Risk factors for development of diabetes during pregnancy

There are many risk factors for the development of GDM during pregnancy, depending on genetics, women:

  • the sugar level in the urine above normal;
  • various disorders of carbohydrate metabolism;
  • obesity or overweight with symptoms of the metabolic disorders;
  • the age of thirty;
  • the presence of diabetes of the 2nd type, the next-of-kin;
  • severe gestosis and toxicosis during pregnancies;
  • various diseases of the cardiovascular system;
  • experienced in the past GSD;
  • spontaneous abortions in the 1st or 2nd trimester in previous pregnancies, chronic non-bearing fruit;
  • congenital malformation of the nervous and cardiovascular systems of the previous child;
  • stillbirth history or the birth of a previous baby weighing over 4 kg (hydramnion).

Signs and symptoms of gestational diabetes

Screening of pregnant women in the laboratory today is the only criterion to ascertain the development of gestational diabetes. At the time of registration in female consultation, the doctor can determine the expectant mother at risk, which means a mandatory blood test to determine fasting blood sugar. The analysis is conducted on the background of regular physical activity and daily diet. Blood for laboratory investigations is taken from the finger of normal glucose level does not go beyond the 4.8-6.0 mmol/L. Experts recommend to take the test, where the additional load is glucose.

In the timely detection of GDM all pregnant women are recommended to take a special oral test for determining the quality of absorption of glucose. This test is performed by 6-7 th month of pregnancy. If necessary, the test is conducted as many times as the physician deems necessary.

The plasma of the blood taken on an empty stomach. If the level of glucose in plasma above 5.1 mmol/l after 60 minutes after a meal is above 10.0 mmol/l, and after 120 minutes after a meal – above 8.5 mmol/l, the doctor with full confidence makes a diagnosis of GDM. If the disease is promptly diagnosed and pregnant being a full-fledged observation, then assuming 100% compliance with the recommendations of the doctor the risk of the birth of a sick kid is minimized, there is 1-2%.


Diagnosis of gestational diabetes

There are certain risk factors that increase the likelihood of developing gestational diabetes.

Major risk factors:

  • Excess body weight (obesity) prior to pregnancy;

  • The diagnosed earlier, the violation of tolerance to glucose;
  • The presence of the disease in previous pregnancies;
  • Genetic predisposition;
  • National identity (disease more susceptible to Hispanics, Africans, Asians);
  • Previous birth of a large (over 4 kg) or stillborn child;
  • Polyhydramnios.

Blood glucose is assigned in each trimester of pregnancy. The rate of blood sugar to 5.1 mmol/L. At higher rates additionally appointed tolerance test to glucose. To do this, the woman takes a blood test first on an empty stomach, and then 30-60 minutes after drinking a glass of water with dissolved sugar (50 g). For more accurate result the test should be repeated after two weeks.

The diagnosis of "gestational diabetes" if your blood sugar level on an empty stomach exceed 5.1 mmol/l one hour after intake of glucose – 10.0 mmol/l and after 2 hours 8.5 mmol/L.


Treatment of gestational diabetes

In women with gestational diabetes observed in late toxicosis, edema, increased pressure, disorders of renal function and cerebral circulation. Also increases the risk of urinary tract infections and the risk of premature birth.

Upon confirmation of the diagnosis by a consultant endocrinologist appointed complex therapy to be followed until the birth:

  • Proper nutrition is the most important item;
  • Adequate physical activity – will be the best option long walks;
  • Regular monitoring of blood sugar levels, which is offered daily;
  • Regular urine samples for the presence of ketone bodies;
  • Control of blood pressure.

Find out more:How to lower blood sugar?

In most cases dieting is enough. With adequate implementation of medical recommendations have not required medical intervention. If this therapy is not enough and the sugar level remains elevated, insulin therapy is appointed. Insulin is used in the form of injections. Standard glucose-lowering drugs in pill form is contraindicated during pregnancy.


How to prevent the development of gestational diabetes during pregnancy?

The development of gestational diabetes it is almost impossible to warn in advance. Statistics show that those women who are at risk during pregnancy do not face this disease, while other pregnant women diabetes can develop without any preconditions.

In that case, if the woman has already moved once gestational diabetes, she must take full responsibility to approach the conception of the next child and schedule it no earlier than two years after the birth of the last child. To minimize the risk of re-development of a dangerous disease required six months before the pregnancy start to track your body weight and to include in the daily routine of daily exercise. in addition, the need for regular blood tests to determine the level of glucose in the blood.

Any pharmaceutical product may be used only upon agreement with the doctor as some products pharmaceuticals (steroids, birth control pills, etc.) can subsequently serve as a catalyst for the development of gestational diabetes.

If the woman moved during pregnancy, GDM, after two months after birth she is required to determine by analysis the level of glucose. Will not be superfluous to additionally take a test on tolerance to glucose. The results of these studies will allow doctors to select the optimal scheme for physical activity and nutrition, and to assign the duration of the control laboratory tests of blood.


Nutrition in gestational diabetes

Proper nutrition is the primary condition for the successful treatment of gestational diabetes. The diet should be full diet and at the same time. Dramatically reduce the energy value of the ration is prohibited.

  • It is advisable to go for smaller meals, 5-6 times a daysmall portions. The main volume of the food load should fall on the first half of the day. Avoid having feelings of hunger.

  • You must severely limit or completely exclude from the menu of easily digestible simple carbohydrates: pastries, buns, pastries and some sweet fruits (bananas, grapes, figs), the use of which leads to a rapid increase in the level of glucose in the blood.

  • You should limit the intake of fats (butter, margarine, mayonnaise, heavy cream, cream cheese). The proportion of saturated fat in the diet should make up no more than 10%. Pork, sausage, sausages, smoked meat, any meat products is recommended to replace the lean meats: beef, chicken, rabbit, and fish.

  • You need to include in the diet a sufficient amount of foods rich in fiber. These include complex carbohydrates (cereals, grains, bread from whole grains) and green vegetables (cucumbers, cabbage of all kinds, zucchini, radishes, celery, green beans, salad , etc.). In addition to fiber, these foods contain a significant supply of vitamins and important trace elements.

  • It is necessary to abandon fast food, fast food, carbonated beverages, and any foods containing flavorings, emulsifiers and other food additives. Nutrition a pregnant woman should be as close to natural.

A full list of what can and can't eat diabetes, as well as the importance of the glycemic index!


Childbirth with gestational diabetes

After the birth gestational diabetes in most cases takes place, but may lead to certain complications. As mentioned above, the child may be born very large, so they often underwent caesarean section because natural birth there is a high risk of birth defects.

The child in gestational diabetes born with low blood sugar, but no special measures for its normalization are not necessary. The level of glucose in the blood of the child gradually returns to normal during breastfeeding. This figure should be continuously monitored by personnel at the maternity hospital.

Postpartum women need some time to continue diet untilthe sugar level in her blood is also not completely normalized.

However, if you neglect the complex therapy during pregnancy, it is such a violation of metabolism in the pregnant woman's body can lead to diabetic fetopathy newborn, which is characterized by the following features:

  • Violations of the proportions of the child's body (big belly, thin limbs);
  • Jaundice;

  • Tissue swelling;

  • Disorders of the respiratory system;
  • Increased blood clotting.

obolenko, Valentina, endocrinologist