Diabetes pregnant indicators of sugar. Diabetes during pregnancy

Many people are familiar with type 1 or 2 diabetes mellitus, either directly or indirectly. But few have heard of the third kind of sweet ailment. This is gestational diabetes mellitus, which is diagnosed only in a woman carrying a long-awaited baby.

The reasons for the appearance, the effect on the development of the fetus and the condition of the mother, the method of diagnosis, how to treat gestational diabetes during pregnancy should be known to every woman of childbearing age.

Differences between gestational diabetes and other types

Violation of the blood sugar norms is always indicative of diabetes. It is only important to determine the type of this disease. If type 1 is mainly a disease of young people, and type 2 is the result of an improper diet and lifestyle, then type 3 of the disease can appear only in a woman, and only during pregnancy. More precisely, he can be diagnosed in this piquant position.

The specificity of gestational diabetes is such that jumps in glucose occur until the baby is born.

In the future, a woman can live as usual and not fear for her health. But there is no full guarantee of a positive outcome if the expectant mother does not follow the doctor's recommendations.

Diabetes in pregnant women occurs due to hormonal changes, which are the norm in most cases. Mechanism natural process next:

1. After fertilization of the egg, progesterone, a hormone that protects the safety of the fetus and its successful development, increases the activity. This hormone partially blocks the production of insulin. But the pancreas, receiving a signal about a deficiency of a substance, begins to produce it in greater quantities and can overexert itself. Hence the signs of diabetes.
2. The placenta conducts its work, rebuilding the inner life future mother, so that the baby is properly formed, gaining the necessary weight and safely born.
3. During pregnancy, overestimated levels of cholesterol and glucose are permissible, because it requires the provision of energy, nutrition for two organisms - a mother and a baby.

But gynecologists have a medical scale that determines what can be considered the norm during pregnancy, and what should be called pathology.

And also the situation is with the sugar content and the amount of insulin in a pregnant woman.

At a certain period, the increased numbers in the analysis do not cause alarm, but if the sugar or insulin content in the blood is higher than the permissible, then there is a reason to assume the development of pregnancy diabetes. Due to the increased production of hormones, there is a failure in the absorption of glucose or insufficient production of insulin by the pancreas.

Period of diagnosis of gestational diabetes

Despite the fact that the percentage of pregnant women without pathology and expectant mothers with gestational diabetes is small (about 5% out of 100), there is a pattern of how long hormonal imbalance can develop. Twenty-two weeks is the period when the gynecologist can diagnose the first changes during screening, which is prescribed for pregnant women. The activity of the placenta is enhanced to preserve intrauterine life and the full development of the fetus.

If the patient has no previous complaints or symptoms indicating that the pregnant woman is at risk, screening is carried out within 24-28 weeks. On an empty stomach, blood is taken from a vein and its composition is checked.

With an elevated glucose level, the pregnant woman is sent for additional analysis - a test for the ratio of body cells to insulin, the ability to assimilate glucose. The patient is offered to drink a liquid containing 50 grams of sugar. After a certain interval, an intravenous blood sample is taken and how much glucose is absorbed.

The fluid is usually converted to useful glucose and absorbed by the cells within 30 minutes or an hour. But if the metabolic process is disturbed, the indicators will be far from the standards. The figure of 7.7 mmol / l is a reason for the appointment of another blood sampling, only after a few hours of fasting.

Such testing can accurately determine if a woman has diabetes during pregnancy.

There are circumstances when gestational diabetes is determined early in pregnancy. Latent diseases of the pancreas, the initial stage of failure of carbohydrate metabolism can be enhanced by hormonal changes in a pregnant woman. Therefore, when registering with an antenatal clinic, the expectant mother needs to be told in detail about any diseases.

Candidates for diabetes in pregnancy

There are some criteria by which the gynecologist understands that a pregnant patient is at risk; increased monitoring of the general condition of the woman and the fetus is required. For ladies preparing for pregnancy or already expecting a baby, it will be useful to pay attention to this.

• The presence of a diagnosis of diabetes in someone in a related line.
• Excess weight in the expectant mother even before conception. If your body mass index is 20% higher than the permissible norm, then it is better to pay attention to diet and exercise to reduce the likelihood of a failure in the absorption of glucose into cells.
• Age of the expectant mother. It is believed that after the age of 30, processes occur in a woman's body that can affect the course of pregnancy. By this age, a violation of the cell's insulin tolerance is possible. Having such a problem before conception, the lady runs the risk of getting even more insensitive cells.
• Previous pregnancy ended in miscarriage, fetal fading and the birth of a dead baby.
• The weight of the woman herself at her birth was 4 kg or more.
• Previous children were born with a body weight of more than 4 kg.
• High water throughout the entire pregnancy cycle.
• Examination of urine revealed increased blood sugar levels.
• Gestational diabetes was already diagnosed in previous pregnancies, but did not develop into a serious illness after childbirth.

If at least one of the listed factors is present in the woman's history, control over the patient's health and the development of pregnancy should be strengthened.

But do not think that only those women who have precursors of gestational diabetes are at risk. Cases with one hundred percent health of the expectant mother are often diagnosed. The emergence and development of a new life is a complex process that can violate any rules of medicine and nature.

Why gestational diabetes is dangerous

Diabetes in pregnant women is a rare phenomenon, but it does not give a reason for a woman to be skeptical about it. If there is an imbalance in the absorption of glucose by the body of the mother and baby, serious problems will appear:

• On early dates pregnancy may stop developing. The fetus will experience oxygen starvation, the cells will not receive the necessary energy for development. The result can be a miscarriage or fetal freezing.
• With late development of diabetes, the embryo will receive excess glucose, which usually contributes to rapid weight gain. A child in utero can gain weight more than 4 kg. This will affect the ability of the embryo to unfold so that delivery is smooth. If the baby enters the birth canal with the booty or legs, complications can be serious, up to death or impaired brain activity.
• In babies, after birth, the sugar level is usually lowered, which requires more attention from doctors for the health of the newborn.
• Sometimes disruptions in the assimilation of glucose lead to the development of intrauterine fetal pathologies - the development of the brain, the respiratory system, and the formation of the pancreas. Lack of maternal insulin can provoke an increase in the function of the baby's pancreas, which by nature is not ready for this. Hence, there are problems with the production of enzymes after the birth of the baby.
• In a woman, uncompensated diabetes causes preeclampsia. Is increasing blood pressure, there is a strong swelling, the work of the vascular system is disrupted. The child may experience oxygen and nutritional deficiencies.
• Gestational diabetes is closely related to the formation of a large amount of amniotic fluid (polyhydramnios), which causes discomfort for both the mother and the embryo.
• Thirst and profuse urination can also be triggered by high glucose levels.
• Hyperglycemia increases the risk of genital infections in a pregnant woman due to a decrease in local immunity. Viruses, bacteria can get into the birth canal, get to the placenta and lead to infection of the crumbs. The woman will need additional therapy that may affect the course of the pregnancy.
• Lack of insulin in the mother's body can cause ketoacidosis, a serious disease that can lead a woman into a diabetic coma. The child often dies in utero.
• Due to a decrease in the process of glucose utilization in the usual way, the kidneys and circulatory system... Renal failure occurs or visual acuity is greatly reduced.

The listed consequences and complications in the presence of gestational diabetes arise only due to the inaction of the pregnant woman. If you approach temporary inconveniences with knowledge of the matter and following the recommendations of a gynecologist, you can normalize the course of pregnancy.

Gestational diabetes must be controlled

This feature in pregnant women is not a novelty for medicine. Despite the fact that the causes of the occurrence of pathology precisely when carrying a baby are not 100% determined, the mechanism for compensating for sugars and making a woman's life easier has been studied and worked out. You need to trust the gynecologist and follow a number of rules:

1. The patient's first task is to normalize blood glucose levels. How to help with any type of diabetes mellitus proper nutrition which is built on exclusion or reduction simple carbohydrates in the diet.
2. But the nutrition of a pregnant woman, in any case, should be complete, so as not to deprive the crumbs of nutrients, correct fats, vitamins, proteins. You need to diversify the menu, but watch out glycemic index products.
3. Moderate exercise has a positive effect on insulin production and prevents excess glucose from being deposited in fat.
4. Continuous diagnostics for blood glucose levels. You need to buy a blood glucose meter and measure the indicators 4 times a day. The doctor will tell you more about the monitoring method.
5. An endocrinologist and nutritionist should be involved in pregnancy management. If there are psychological outbursts in a woman, you can consult with a psychologist.

The sensitive attitude of the expectant mother to her health will help normalize the carbohydrate process and approach childbirth without complications.

Nutrition for gestational diabetes

When seeing a woman with diabetes, the doctor does not have much time for a detailed nutritional consultation. General guidelines or referral to a dietitian are given. But a pregnant woman herself can develop a diet and a list of acceptable foods if she studies information about how people with type 1 and type 2 diabetes eat. The only exception is the fact that the benefits of food should be not only for the mother, but also for the fetus.

• The emphasis should be placed on adherence to the meal interval. Main portions are consumed 3 times (breakfast, lunch, dinner). In between, there should be snacks up to 3-4 times.
• Energy value is also important, because two organisms feed at once. Excessive consumption of carbohydrates is replaced by proteins (from 30 to 60%), healthy fats(30%), fiber (up to 40%).
• Nutrition should be comprehensive, any mono-diet and starvation are excluded. Porridge, soups, salads, meat, fish dishes should be the foundation. For snacks, they use vegetables, fruits, permitted desserts, dairy products with low content fat.
• For the entire period of pregnancy, bakery products, cakes, sweets, some fruits, pasta, potatoes should be canceled. Even rice can be banned due to its high glycemic index.
• When choosing products in a store, you need to pay attention to the composition, energy value, study in advance and make a list of cereals, vegetables, fruits with a low glycemic index.
• Dishes should not be complicated, so as not to put stress on the pancreas and not deceive yourself.
• The way food is prepared needs to be changed. You can not fry, canned food. Any fast food, to which pregnant women are often not indifferent, is excluded. Semi-finished products from the category of dumplings, sausages, sausages, cutlets and other mass-produced products should remain on the shelves. Relatives should be in solidarity in refusal, so as not to injure already vulnerable women during pregnancy.
• You should pay attention to frozen vegetable shakes, which will allow you to prepare food in a hurry and give a lot of benefits. The assortment is large, but you need to monitor the correct storage of the goods.

If at first there are difficulties with the correct menu for gestational diabetes in pregnant women, you can focus on recipes for soups, salads, main courses, desserts for type 1 and type 2 diabetics. Mothers faced with a similar diagnosis often unite on forums and share their recipes.

The diet in this case does not differ in the type of sweet ailment, because it is focused on the normalization of carbohydrate metabolism in the body of the mother and fetus.

A nutritionist or endocrinologist will definitely give a recommendation on the calorie content of food. Daily rate should not exceed 35-40 kcal per 1 kg of pregnant woman's weight. Suppose that a woman's weight is 70 kg, then the total daily ration should have an energy index from 2,450 to 2,800 kcal. It is advisable to keep a food diary so that by the end of the day it can be seen whether there have been any violations.

Menu option for pregnant women with gestational diabetes

Meal phase / Day of the week	Mon	W	Wed	NS	Fri	Sat	Sun
Breakfast	buckwheat porridge on water, 1 toast with butter, herbal tea b / s	oatmeal in milk, boiled egg, black tea	Omelet with boiled chicken breast and vegetables, non-alcoholic tea	cottage cheese casserole, rosehip broth b / s	oatmeal in water, low-fat or cottage cheese cheese, a slice of rye bread, weak coffee.	millet porridge with meat broth, toast, herbal tea	rice on water with vegetables or herbs, a piece of rye bread, low-fat cheese, weak unsweetened coffee.
2nd breakfast	baked apple, water	orange, low-fat yogurt	vegetable salad made from seasonal products, seasoned with lemon juice or vegetable oil.	an approved list of fruit salad with unflavored low-fat yogurt.	curd casserole, water	Cheese with a slice of oat bread, unsweetened tea.	drinking yoghurt.
Dinner	Vegetable soup with chicken meatballs, a piece of boiled chicken breast, vegetables, dried fruit compote.	Fish soup, boiled brown rice, steamed lean fish, boiled beet salad, tea.	Veal borscht without potatoes, boiled buckwheat with steamed veal cutlet, compote.	Chicken noodle soup without potatoes, vegetable stew, herbal tea	Turkey pea soup, lazy cabbage rolls with minced turkey in the oven, jelly.	Shrimp puree soup with vegetables, squid stuffed with vegetables and baked in the oven, freshly squeezed vegetable juice.	Pickle on lean beef, braised cabbage, boiled beef, berry juice b / s
Afternoon snack	a small handful of nuts	curd cheese, a slice of whole grain bread	baked apple (any fruit from the list)	assorted raw vegetables according to the season	dried fruits from permissible	yogurt	Vegetable Salad
Dinner	boiled cabbage (cauliflower, broccoli), baked fish, tea	stuffed turkey peppers with 15% sour cream, tea	vegetable stew, low-fat cheese, freshly squeezed fruit juice	veal pilaf, vegetable salad, tea	seafood salad, tea.	turkey baked in the oven with vegetables, berry juice	boiled potatoes with fresh cabbage salad
Late supper	Kefir 200 ml	Ryazhenka 200 ml	Low-fat cottage cheese 150 g.	Bifidoc 200 ml	Drinking yoghurt	Cheese, toast, green tea	Milkshake

This is an example of a sample menu for every day for pregnant women with a history of gestational diabetes. The diet can be more varied, it all depends on the season and personal taste preferences. If there is a feeling of hunger between the planned meals, you can drink plain water in small sips. The diet should contain up to 2 liters of regular water, not counting other liquid foods.

When treating gestational diabetes of a pregnant woman, it is not enough to follow a diet if the lifestyle is generally passive. Energy must be expended, oxygen must be supplied to the body in sufficient quantities, weakening of the muscles of the abdominal cavity and other parts of the body must be inadmissible.

Physical activity improves the production and absorption of insulin; excess glucose cannot be converted to fat.

But a lady in "special status" should not run to sport Club to get this load. It is enough to make daily walks, visit the pool or sign up for a special fitness for pregnant women.

Sometimes it is necessary to compensate for sugar with the help of insulin injections. In such a situation, it must be remembered that vigorous physical activity can reduce the level of glucose and hormone in the blood as much as possible, which leads to hypoglycemia.

Monitoring your blood sugar should be done both before and after your workout. You need to take some snacks with you to fill the deficit. Sugar or fruit juice can help prevent the effects of hypoglycemia.

Childbirth and the puerperium in gestational diabetes

Even a woman who has type 1 or 2 diabetes mellitus long before conception can become pregnant, carry a baby and give birth.

Therefore, even with diabetes that occurs during pregnancy, there are no contraindications for delivery. The main thing is that the preliminary stage is not complicated by the patient's inaction.

If the pregnancy proceeds according to a certain algorithm, the attending physician prepares a special mom in advance for the birth process.

The main risk in such births is considered to be a large fetus, which can lead to complications. Usually recommend cesarean section... In practice, independent childbirth is also permissible if there is no gestosis in the pregnant woman or the situation has not worsened in recent days.

They monitor the general condition of both the woman and the unborn baby. A pregnant woman enters the maternity hospital earlier than the ladies without such a complication. The gynecologist writes out a referral with a mark of childbirth at 38 weeks, but in reality the process can begin at 40 weeks and later, if there are no complications from ultrasound and analyzes.

They begin to stimulate contractions only in the absence of natural contractions, if the pregnant woman walks over the prescribed period.

Caesarean section is not mandatory for all women diagnosed with gestational diabetes, but only at risk to the fetus and the woman in labor. If there is a special department for the delivery of people with diabetes mellitus, then the gynecologist, if all indications are available, will refer the patient to such an institution.

After giving birth, the baby may have low blood sugar, but this is offset by nutrition. Drug therapy is usually not required. The baby is under special supervision and diagnostics is carried out for the absence of pathology due to gestational diabetes in the mother.

In a woman, after the placenta leaves, the condition is normalized, there are no jumps in the sugar level. But do not neglect the diet that you followed before giving birth, at least in the first month.

By next pregnancy it is better to plan no earlier than 2 years so that the body recovers and no more serious pathologies arise. But before conception, you need to undergo a full examination and warn the gynecologist about the fact of complications from a previous pregnancy.

Gestational diabetes is expressed in insulin resistance (reduced sensitivity) of cells to the insulin produced by the body against the background of a hormonal shift during pregnancy - the blocking effect is provided by lactogen, estrogen, cortisol and other substances that are extremely actively produced from the twentieth week after the conception of the fetus. However, gestational diabetes mellitus does not develop in all women - the risk factors for the development of the problem are:

1. Overweight. The basic factor in the development of type 2 diabetes can give a start to the formation of GDM in this difficult period for a woman's body.
2. More than thirty years old. Pregnant women are more at risk of developing gestational diabetes.
3. Violation of glucose resistance in a previous pregnancy. Prediabetes earlier may remind of itself more clearly and unambiguously in the next pregnancy.
4. Genetic predisposition. If any type of family member has been previously diagnosed with GDM, the risk of contracting GDM increases.
5. Polycystic ovary disease. As medical practice shows, women with this syndrome are more often diagnosed with gestational diabetes mellitus.
6. Poor obstetric history. Have you previously had chronic miscarriages, stillborn babies or with physiological malformations? Was the previous birth difficult, was the baby very large or small, were you diagnosed with other specific problems (for example, polyhydramnios)? All this significantly increases the risks of GDM in the future.

Symptoms of gestational diabetes

Symptoms of GDM are most often associated with manifestations. In most cases, the patient does not feel the external manifestations of the disease at all, associating a variety of ailments with a radical restructuring of the body and the processes of its adaptation to future childbirth, however, sometimes a pregnant woman may show strong thirst and excessive use of fluids along with frequent urges for little need, even in that case if the fruit is still small. In addition, gestational diabetes mellitus is characterized by periodic increases in pressure, minor neurological manifestations (from frequent mood swings to tantrums), in rare cases, a woman is worried about pain in the heart and numbness of the extremities.

As can be seen from the above, such symptoms quite often characterize the usual and associated classical pathologies (for example, toxicosis). A blurry "picture" does not allow to unambiguously define the problem and in most cases diabetes mellitus is diagnosed only with the help of appropriate tests.

Diagnostics

According to the standard monitoring scheme for patients in the period from 22 to 28 weeks (it is then that the female body's need for insulin increases significantly, on average up to 75 percent of the usual rate), a glucose tolerance test is performed. For this analysis, blood is first donated from a finger on an empty stomach in the morning. It should be noted that twelve hours before the test, it is necessary to refuse food intake, any medications not agreed with the doctor, as well as avoid physical / emotional stress, refrain from alcohol and smoking.

After capillary blood sampling according to the above scheme, the fair sex is given an oral dose of glucose in the equivalent of 75 grams, after which, an hour and two hours later, the second and third capillary blood sampling is done.

The norms of the above test - on an empty stomach not higher than 5.1 mmol / l, one hour after oral administration of glucose, not more than 10 mmol / l, after 2 hours - no more than 8.5 mmol / l. As a rule, the fasting test values ​​in pregnant women with GDM are even lower than normal, but they are significantly exceeded during exercise.

In contrast to the classical and type 2, the test for glycated hemoglobin is not performed if gestational diabetes is suspected, since it is often false-negative due to the peculiarities of the formation of temporary GDM in women.

In addition to this analysis, to confirm the diagnosis, the doctor must exclude other diseases that cause hyperglycemia, and, if necessary, prescribe alternative forms of research.

Due to certain risks to the future health of the baby, gestational diabetes mellitus is treated using the safest methods possible with a minimum set of medicines. After detecting GDM, the fair sex will be prescribed a special diet, as well as moderate physical loads that are feasible for her at this stage of fetal development. Now, up to 7 times a day, you will have to change the current blood sugar level using a glucometer and keep a detailed diary of test results so that the doctor, if necessary, can familiarize himself with such statistics and correct the course of therapy.

In some cases, diet and physical activity are not enough - in this case, a specialist prescribes a course of insulin therapy for the period of pregnancy until childbirth. The specific dosages and the dosage regimen of the drug are prescribed exclusively by your attending physician! Unfortunately, insulin injections do not give the maximum possible effect due to the poor sensitivity of tissue cells to this hormone in the case of gestational diabetes mellitus.

Another classic medication lowering blood sugar levels is taking oral antihyperglycemic drugs. The vast majority of them are prohibited from using during pregnancy due to the very high risks to the health and life of the unborn child. An exception is metformin, but it is prescribed only as a last resort, carefully weighing all possible consequences and taking into account serious side effects.

The most effective mechanism for combating GDM is a properly selected diet - this is an axiom that has been relevant for more than five decades. With all the similarity of symptoms and methodology for the treatment of gestational diabetes mellitus and type 1.2 diabetes mellitus, the nutritional systems for them differ significantly. Low-carb or vegan diets should not be used with GDM, as such a dietary pattern can negatively affect the future health of the fetus. The formation of ketone bodies is especially dangerous after the transition to the body's nutrition with its own fats. What to do? Doctors at this stage of the mother's life, up to childbirth, suggest switching to a rational balanced diet. Her main theses:

1. Fractional meals, 3 main approaches (breakfast, lunch, dinner) and 3 snacks.
2. Refusal to use any products containing simple "fast" carbohydrates - flour, sweets, pickles, fast food and potatoes in any form.
3. The normal caloric intake is 35 kcal per kilogram of body weight.
4. The systemic distribution of BJU is 25-30 percent of proteins, about 30 percent of fats and up to 40-45 percent of carbohydrates.
5. Be sure to eat foods with fiber - to improve digestion and stabilize peristalsis.
6. Continuous monitoring of sugar and ketone levels, optimally after each meal (after 60 minutes).

According to such a diet, the optimal weight gain for the entire duration of pregnancy ranges from 11-16 kilograms. In general, the diet for women with GDM in the period from the onset of pregnancy to childbirth is almost identical from the main correct healthy eating representatives of the fair sex in an interesting position without health problems, however, it requires stricter adherence to circadian rhythms and complete control of the level of sugar / ketone bodies in the blood.

Menu for the week

The classic weekly menu with a six-time daily diet provides a pregnant woman with all the necessary elements, while helping to maintain normal carbohydrate metabolism and minimize the risks of GDM complications.

Day 1

We have breakfast with a large sandwich with hard cheese and two tomatoes, as well as one boiled egg... For a snack before lunch - a small bowl with cottage cheese and a handful of raisins. We have lunch with vegetable soup. Have an afternoon snack with a large glass of natural yogurt. We have dinner with a plate of vegetable salad and one avocado. Before going to bed, you can use a glass of rosehip broth.

Day 2

We will have breakfast with a plate of oatmeal brewed in milk. We have a snack with two apples. We have lunch with chicken soup with meat. Have an afternoon snack with one hundred grams of low-fat cottage cheese. We have dinner with vegetable stew and a small piece of boiled beef. Before going to bed, we can drink a glass of 1% sugar-free kefir.

Day 3

We will have breakfast with a plate of omelet with two cucumbers. For the second breakfast - a glass of yogurt. We have lunch with fish soup. We have lunch with two bananas. We have dinner with a plate of milk porridge. Before going to bed, we eat half a plate of vegetable salad.

Day 4

We have breakfast with cheesecakes interspersed with raisins and the addition of 15% natural sour cream. For a snack - a handful of peeled walnuts... We dine with a bowl of lentil soup. We have an afternoon snack with two small pears. We have dinner with a plate of steamed rice, baked chicken meat with tomatoes (100 grams). Before going to bed we drink tea.

Day 5

For breakfast, prepare an omelet with a sandwich (butter, hard cheese, rye bread). Before lunch we drink a glass of tomato juice. We have lunch with vegetable stew and 100 grams of steamed meat. We have lunch with two peaches. For dinner - a plate of spaghetti hard varieties wheat with the addition of tomato sauce. Drink a glass of herbal tea before bed.

Day 6

We have breakfast with cottage cheese with the addition of grated berries. Snack on one small sandwich with a slice of hard cheese. We have lunch with a plate of buckwheat with stew, vegetable salad and green tea... Have an afternoon with a glass of fresh. We have dinner with vegetable salad and 100 grams of chicken breast with tomatoes. Before bed, you can drink a glass of 1 percent milk.

Day 7

We have breakfast with a plate of milk corn porridge with dried apricots. We have a snack with two apples. Lunches classic salad from tomatoes / cucumbers and cabbage cabbage soup. Have an afternoon snack with a handful of dried fruits. We have dinner with pancakes on zucchini with the addition of sour cream, as well as a glass of juice. Before going to bed, you can drink a rosehip decoction.

All pregnant women who have been diagnosed with gestational diabetes mellitus, we first of all recommend not to panic - this syndrome, as the world medical statistics, annually diagnosed in four percent of expectant mothers. Yes, this is an alarming "call" that not everything is in order with the body, but in most cases GDM disappears after childbirth. Naturally, for one and a half to two years after delivery, a woman should monitor the state of the body, regularly donate blood for sugar and try to refrain from a new pregnancy during this period - the risks of re-occurrence of the disease and its transition to the main type 1 or 2 diabetes increase significantly.

Eat rationally and correctly, spend more time in the fresh air, engage in dosed and doctor-recommended physical activity - the planned birth will go well and you can even breastfeed your baby, carefully monitoring possible manifestations of diabetes in the future.

Useful video

Gestational diabetes mellitus or diabetes mellitus during pregnancy

Gestational diabetes mellitus in pregnant women

Gestational diabetes mellitus (GDM) or pregnancy diabetes denotes a violation of carbohydrate metabolism that occurs or is first recognized during pregnancy. According to the data of large-scale epidemiological studies in the United States, GDM develops in about 4% of all pregnancies, which is 100 times more often than pregnancies occurring against the background of diabetes mellitus (DM) detected before pregnancy. The prevalence and incidence of GDM in our country is unknown, since no real epidemiological studies have been carried out. According to European researchers, the prevalence of GDM can vary from 1 to 14% depending on the population of women, which undoubtedly requires close attention of doctors to pregnant women with risk factors for developing GDM. In our age of information saturation and family planning, women should also be aware of the possible risk of developing GDM in order to timely seek qualified medical care. This will make it possible to timely identify the disease and prescribe treatment in order to preserve the woman's health and give birth to a healthy child.

Differences between gestational diabetes mellitus and other types of diabetes mellitus.

Diabetes mellitus is known to be a disease characterized by persistently elevated blood sugar (glucose) levels. There are several types of SD.

Type 1 diabetes mellitus (DM-1)- develops as a result of autoimmune destruction of β-cells of the pancreas, which leads to a decrease or absence of insulin production and an increase in blood sugar levels. Type 1 diabetes is most common in children and young adults. Diabetes symptoms (dry mouth, thirst, weakness, frequent urination, dramatic weight loss) are acute. Treatment in this case is possible only with insulin injections. Antibodies to β-cells and insulin are often found in the blood - specific indicators of the autoimmune nature of the disease. About 15% of all diabetic patients have type 1 diabetes.

Type 2 diabetes mellitus (DM-2) It is also characterized by an increased level of sugar in the blood, but this condition is not caused by an absolute deficiency of insulin, but by a decrease in the sensitivity of peripheral tissues to it. SD-2 develops most often in obese patients and is hereditary. Patients with CD-2 can maintain normal blood sugar levels through diet, physical activity and / or antihyperglycemic tablets. If the listed funds are ineffective, they are prescribed insulin.

Secondary diabetes mellitus occurs as a result of various genetic defects, endocrine, infectious diseases, intake drugs, chemicals, diseases of the pancreas. Violation of carbohydrate metabolism is one of the symptoms of the listed diseases and conditions.

Gestational diabetes occurs during pregnancy... Its cause is a reduced sensitivity of cells to their own insulin (insulin resistance) - associated with high levels of pregnancy hormones in the blood. After childbirth, blood sugar levels most often return to normal. However, the likelihood of developing CD-1 during pregnancy or the existence of CD-2 that was not detected before pregnancy cannot be ruled out. Diagnosis of these diseases is carried out after childbirth.

Why is glucose always present in the blood?
There are two sources of glucose entering the bloodstream:
1.absorption of glucose from food (food containing carbohydrates)
2.from the liver

Carbohydrates are divided into two groups: simple, or easily digestible, and complex, or hard to digest. The first group includes sugar, honey, jam, juices, sweets, that is, all foods that taste sweet. They are rapidly absorbed from the intestines and raise blood sugar levels. Another group includes: vegetables, fruits, bread, pasta, cereals, dairy products. Under the influence of digestive enzymes, hard-to-digest carbohydrates are broken down for a long time in the intestine to glucose, which is gradually absorbed into the bloodstream. Therefore, the rate and level of rise in blood sugar is much lower when using hard-to-digest than easily-digestible carbohydrates.

The second source of glucose is the liver. It contains the main store (depot) of sugar for the body, which is called glycogen. If carbohydrates are not supplied with food, then glycogen breaks down in the liver and glucose is released into the blood to maintain it normal level Sahara. Also in the liver, glucose is formed from the breakdown products of fats and proteins. Therefore, a certain level of sugar is constantly maintained in the blood, even if we are starving or food does not contain carbohydrates.

What is glucose for?
Once in the blood, glucose is carried to all organs and tissues. It is the main source of energy for the cells of our body, for their vital activity. Glucose is the same "fuel" for the cell as gasoline is for a car. But the car will not run if the gasoline does not enter the engine. By analogy with a car, for the normal functioning of the whole organism, glucose must penetrate into the cell. The hormone insulin plays the role of a glucose conductor into the cell.

What is insulin?
Insulin is a protein hormone. It is produced in the β-cells of the pancreas, which is located behind the stomach. Insulin acts as a key, opening the way for glucose to enter the cell. It is the only hormone that helps glucose to get inside the cell. With the help of insulin, glucose from the blood enters the various cells of the body (muscle, liver, fat) - thus they receive energy (fuel) for their work. Glucose penetrates into the cells of some organs without insulin (brain and nerves, heart, kidneys, lens of the eye). In addition, without the help of insulin, glucose crosses the placenta to the fetus. Insulin also promotes the deposition of excess glucose in liver cells in the form of glycogen (glucose depot in the body), inhibits the breakdown of proteins, fats and the formation of ketone bodies in the liver.
If there is not enough insulin, then glucose does not enter the cells, accumulates in the blood and is excreted from the body by the kidneys. Cells do not receive energy and "starve".
In a person without diabetes, the required amount of insulin constantly enters the bloodstream: with an increase in blood sugar (after a meal), the pancreas increases the production of insulin, and with a decrease (during fasting), it decreases.

Why does gestational diabetes develop?
A pregnant woman, starting from the 20th week of pregnancy, has even more insulin in the blood than a non-pregnant woman. This is because the action of insulin is partially blocked by other hormones produced by the placenta. This condition is called insulin resistance, or decreased sensitivity of cells to insulin.
The placenta is the organ through which nutrients, trace elements and oxygen are supplied to the baby from the mother's body. It also produces hormones that preserve pregnancy (pregnancy hormones). Some of them, such as estrogen, cortisol, placental lactogen, have the effect of blocking the action of insulin. This is called the "counterinsulin" effect. It usually begins to appear from the 20th to 24th week of pregnancy. To maintain blood sugar within the normal range, the pancreas of a pregnant woman must produce large quantity insulin. If she cannot cope with the increased load, then a relative insulin deficiency occurs and GDM develops. If somehow all pregnancy hormones could be removed from the blood of a mother with GDM, then blood sugar would return to normal, which actually happens after childbirth.

What is the normal level of sugar in capillary whole blood, that is, taken from a finger?
In men and non-pregnant women
- on an empty stomach (after an overnight fast for at least 8-14 hours) 3.3 - 5.5 mmol / l.
- 2 hours after meals up to 7.8 mmol / l.
In pregnant women
- fasting 4-5.2 mmol / l
- 2 hours after a meal, no more than 6.7 mmol / l .

During physiological pregnancy in a woman, the level of fasting glycemia decreases due to the accelerated excretion of glucose by the kidneys and a decrease in the production of glucose in the liver. However, in the second half of pregnancy, the synthesis of contrainsulin hormones of the placenta is activated and the level of diabetogenic hormones of the mother, such as cortisol, progesterone, estrogens, increases. All this, combined with a sharp decrease in the physical activity of a pregnant woman, an increase in the calorie content of food consumed, and weight gain leads to pronounced insulin resistance, which in a healthy woman with normal reserves of her own insulin is compensated for. Because of the above changes, the level of fasting glycemia in a pregnant woman who does not suffer from diabetes is lower than in a non-pregnant woman, and the rise in blood glucose levels 1 hour after a meal never exceeds 7.7 mmol / L, and after 2 hours - 6 , 7 mmol / l due to adequate supply of the body with insulin.
Therefore, if a pregnant woman's blood sugar content exceeds the indicated values, for example, on an empty stomach, 5.3 mmol / l was detected, and after 2 hours 6.8 mmol / l, then the woman needs additional examination to clarify the diagnosis (see below).

Why don't all pregnant women develop gestational diabetes?

There is a genetic predisposition to the development of GDM, which is realized under the influence of certain risk factors.

Risk factors for the development of GDM include:

Overweight, obesity
Diabetes mellitus in immediate family
Over 25 years of age
Complicated obstetric history
- the previous child was born weighing more than 4000 grams, with a large abdominal circumference, a wide shoulder girdle
- GDM in a previous pregnancy
- chronic miscarriage (more than 3 spontaneous abortions in the first or second trimesters of pregnancy)
- polyhydramnios
- stillbirth
- malformations in previous children

How can gestational diabetes be diagnosed?

If you have the above risk factors for GDM or at least one of them, then it is necessary to examine the fasting blood sugar level during the first visit to the antenatal clinic against the background of normal diet and physical activity. That is, you should eat all the foods that you usually eat, without excluding anything from your diet!
Causes concern!
Fingerstick blood sugar on an empty stomach from 4.8 to 6.0 mmol / l
Blood sugar taken from a vein, on an empty stomach from 5.3 to 6.9 mmol / l

In case of doubtful results, a special glucose load test is prescribed to detect a violation of carbohydrate metabolism.

Test rules:
1. 3 days before the examination, you are on your usual diet and exercise your usual physical activity.
2. The test is carried out in the morning on an empty stomach (after an overnight fast for at least 8-14 hours)
3. After taking a fasting blood sample, you should drink a glucose solution, consisting of 75 grams of dry glucose dissolved in 250-300 ml of water, within 5 minutes. A repeat blood sugar sample is taken 2 hours after glucose loading.

The diagnosis of GDM is established according to the following criteria
glucose of blood taken from a finger on an empty stomach і 6.1 mmol / l or
blood glucose taken from a vein on an empty stomach і 7 mmol / l or
blood glucose taken from a finger or from a vein 2 hours after loading 75 g glucose і 7.8 mmol / l.

4. If the test results are normal, then the test is repeated at 24-28 weeks of pregnancy, when the level of pregnancy hormones increases. In the earlier stages, GDM is often not detected, and the establishment of the diagnosis after 28 weeks does not always prevent the development of complications in the fetus.

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Gestational diabetes mellitus (or diabetes mellitus during pregnancy) is a condition characterized by an increase in blood sugar during pregnancy and usually resolves spontaneously after delivery. Gestational diabetes mellitus is considered as a risk factor for the development of type 2 diabetes mellitus in the mother in later life. The prevalence of gestational diabetes mellitus, according to various sources, is from 1 to 14% in the population of pregnant women.

GDM is detected in different terms: in the first trimester in about 2.1%, in the second trimester in 5.6%, in the third trimester in 3.1%.

Now the norms regarding carbohydrate metabolism in pregnant women have been revised, and the diagnostic criteria have become even more stringent. The rates in pregnant women and other patients in the population differ.

Blood sugar levels in pregnant women

What is the normal blood sugar level in capillary whole blood (laboratory fingerstick test or calibrated glucometer)?

If in men and non-pregnant women the fasting sugar rate (the last meal at least 8 hours ago) is 3.3 - 5.5 mmol / l, and 2 hours after a meal (the so-called postprandial glycemia) is up to 7.8 mmol / l, then in pregnant women it should be even less - on an empty stomach 4-5.1 mmol / l, and 2 hours after eating up to 6.7 mmol / l.

Glycated hemoglobin (HbA1c): in men and non-pregnant women, the norm is 5.7 - 6.0%, in pregnant women up to 5.8%.

Risk groups for the development of gestational diabetes mellitus

Diabetes mellitus of pregnant women rarely occurs against the background of complete health, as a rule, there are prerequisites in the form of certain disorders and diseases in the pregnant woman herself and her blood relatives (especially the first line of relationship). The risk level is calculated based on the sum of the criteria.

If we are talking about body weight, then here the reference point is the body mass index (BMI). BMI = weight in kg / height in meters 2

BMI less than 18.5 - underweight
BMI 18.5 - 25 - normal
BMI 25 - 30 - overweight (pre-obesity)
BMI 30 - 35 - obesity I degree
BMI 35 - 40 - obesity II degree
BMI over 40 - obesity III degree (morbid, which means painful)

I. Low-risk group of gestational diabetes mellitus:

Age less than 25 years old,
- normal body weight before pregnancy,
- there is no indication of type 2 diabetes in first-line relatives (mother, father, siblings),
- never had any signs of impaired glucose metabolism (high blood sugar, sugar and acetone in the urine),
- there is no indication of a burdened obstetric history (should attract attention: the birth of children weighing 4000 grams or more, polyhydramnios, frequent genitourinary infections during pregnancy, preeclampsia, miscarriage, antenatal fetal death, fetal malformations).

All criteria must be met to classify a woman as a low risk woman.

II. Medium risk group

Slight excess body weight before pregnancy (pre-obesity),
- burdened obstetric history (see above).

III. High-risk group of gestational diabetes mellitus

Obesity (BMI over 30),
- history of gestational diabetes,
- diabetes mellitus in first-line relatives,
- an indication of a violation of carbohydrate metabolism before pregnancy (transient increase in blood sugar, impaired glucose tolerance, the appearance of sugar in the urine),

To classify a patient as a high-risk group, 1 criterion is sufficient.

Symptoms of gestational diabetes mellitus

Unlike other types of diabetes, there may be no symptoms here. Nonspecific symptoms may disturb: fatigue, muscle weakness, increased thirst, moderate dry mouth, increased urination, itching and dryness in the vagina, recurrent vulvovaginal infections (primarily, persistent thrush in pregnant women).

The definitive diagnosis of gestational diabetes mellitus is made on the basis of laboratory tests.

Diagnostics

1. Blood sugar.
2. Glycated hemoglobin.
3. General analysis urine + sugar and ketone bodies (acetone).
4. Glycemic profile.
5. Glucose tolerance test.
6. Other analyzes from the general examination plan (CBC, detailed biochemical blood test).
7. According to indications: urine analysis according to Nechiporenko, bacteriological culture of urine and others.
8. Consultations of doctors - specialists (ophthalmologist, therapist, and then an endocrinologist).

Blood sugar above 5.1 mmol / l is the first criterion for impaired carbohydrate metabolism. In case of detection of excess of the norm, an in-depth study is begun, aimed at identifying gestational diabetes mellitus. The long-term data on the birth of large-bodied children with various deviations in health from mothers with a sugar level of more than 5.1 mmol / l, but seemed to fit into generally accepted norms, forced to revise the blood sugar norms for pregnant women. Observation revealed in such children a reduced immune resistance, a frequent (in comparison with the general population) occurrence of malformations and a high risk of developing diabetes in a child!

Glycated hemoglobin above 5.8% indicates that blood sugar did not rise all at once. This means that intermittent hyperglycemia was present for at least 3 months.

Sugar in the urine begins to appear when the blood sugar reaches approximately 8 mmol / L. This is called the renal threshold. The glucose level is less than 8 mmol / l, it is not reflected in the urine.

But ketone bodies (acetone) in the urine can appear independently of the blood sugar level. But some ketone bodies in urine (ketonuria) do not indicate the indispensable development of gestational diabetes mellitus, they can appear against the background of toxicosis of a pregnant woman with repeated vomiting and lack of normal nutrition and appetite, against the background of preeclapsia with edema, even ARVI or other painful condition with a high temperature (food poisoning and others) can provoke ketonuria.

The glycemic profile is the measurement of blood sugar over time for 1 day in different periods (fasting, after meals, at night) in order to identify the peaks of glycemia (they are individual for each person) and the selection of therapy.

On an empty stomach in the morning
- Before you start eating
- Two hours after each meal
- Before you go to bed
- In 24 hours
- At 3 hours 30 minutes.

Glucose tolerance test is a research method in endocrinology, which is aimed at revealing hidden disorders of carbohydrate metabolism.

Preparation for the glucose tolerance test: for 3 days before the study, you should adhere to the usual diet, the day before you should not be physically and emotionally overwhelmed, overcooling and overeating, it is advisable to exclude sexual intercourse, you should not smoke before the study (as in general during pregnancy, of course).

Fasting blood glucose is measured, a solution of 75 grams of glucose in 300 ml of warm water is taken within 5 minutes, blood sugar is measured every half hour for 2 hours, then a sugar curve is plotted from the indicators. The interpretation of the results of the glucose tolerance test is carried out by an endocrinologist.

An ophthalmologist's consultation is needed to examine the fundus. Diabetic damage to the retina can be of different severity and requires a different approach, from conservative treatment before surgical intervention(laser coagulation of proliferation foci on the retina, which, if indicated, can be performed even during pregnancy).

Complications of gestational diabetes mellitus

The consequences for the fetus in gestational diabetes mellitus are similar to those that develop in diabetes mellitus types 1 and 2. The main trigger for all complications is high blood sugar, regardless of the type of diabetes.

The complications of diabetes for the mother are not as obvious as in type 1 diabetes, since the duration of the disease is different. But gestational diabetes mellitus serves as a "wake-up call" for the future; such mothers have a higher risk of developing type 2 diabetes mellitus than in the population.

Coma in gestational diabetes is extremely rare. Hypoglycemic conditions may occur in the second trimester of pregnancy, when the body's natural need for insulin decreases, as the fetal pancreas begins to function.

Treatment

Treatment of gestational diabetes mellitus is carried out jointly by an obstetrician-gynecologist and an endcrinologist. Initially, the decision on the choice of treatment tactics is made by the endocrinologist, and then control is carried out by the attending physician in the antenatal clinic. If necessary, the patient is sent for additional consultation with an endocrinologist.

Diet

The diet for gestational diabetes is the same as for type 1 diabetes (see the article "Type 1 diabetes mellitus"). You also need to learn how to count units of bread (XE) in order to choose the right food for your meals. With disciplined adherence to the diet, it is often possible to achieve complete compensation for carbohydrate metabolism, as well as to reduce weight. Thus, all possible risks to the mother and fetus are significantly reduced.

Insulin therapy

In the case of diagnosing gestational diabetes mellitus, a combination of factors is assessed (history, body weight, level of sugars and glycated hemoglobin, the presence of complications and concomitant diseases), based on the total assessment, the preferred insulin dosing regimen is selected.

All the same types of insulins are used as for type 1 diabetes, but, as a rule, the dosage regimen is different. Sometimes, a single or double administration of prolonged insulin per day is sufficient, following a low-carb diet.

At the time of delivery, a mandatory revision of the insulin dose is performed in order to avoid hypoglycemia during labor.

Delivery

Directly gestational diabetes mellitus is not a contraindication to vaginal delivery.

Indications for operative delivery:

Large fruit (over 4 kg) and a giant fruit (over 5 kg). The karinka depicts newborns, on the left with a normal body weight, and on the right, the fetus is a giant.

History of perinatal losses (death of a child from 22 weeks of gestation to 7 days of newborn due to reasons related to delivery and congenital anomalies).

A history of birth trauma to the mother and / or the fetus (perineal ruptures of grade III and IV in the mother, head trauma, fracture of the clavicle, damage to the brachial plexus in the fetus).

A history of complications in the postoperative / postpartum period (suppuration of sutures, formation of fistulas, hernias and other complications).

Damage to the day of the eye, which requires the exclusion of a persistent period (proliferative retinopathy with a high risk of retinal detachment during attempts).

Forecast

Currently, the problem of gestational diabetes mellitus attracts the attention of not only obstetricians - gynecologists, but also narrow specialists. If you registered at the antenatal clinic on time, you will know your blood glucose level in a timely manner. If gestational diabetes is suspected, you will be tested and given a diet. Subject to all the recommendations of the obstetrician - gynecologist and endocrinologist, the prognosis for the mother and fetus is relatively favorable.

Prophylaxis

Prevention this disease is the elimination of all possible predisposing factors listed in the section on risk groups. It is clear that age and history cannot be corrected, but normalizing weight is quite possible. Bringing body weight close to normal prevents a large number of risks, and this is not only gestational diabetes mellitus, but also gestational arterial hypertension, preeclampsia, edema of a pregnant woman and others.

Also, when planning a pregnancy, it will not be superfluous to learn about the diseases of blood relatives, complications of pregnancy in first-line relatives. This can help predict and prevent risks.

Your "double" health is in your hands, you are required to realize the degree of responsibility and accept a slightly changed lifestyle. Self-discipline and adherence to guidelines will help you lay a good foundation for your baby's health. Take care of yourself and be healthy!

Obstetrician-gynecologist A.V. Petrova

During pregnancy, girls often experience hormonal surges, as a result of which metabolism is disrupted and at the same time gestational diabetes mellitus (GDM) appears, which is also called gestosis. This happens even in very young females, the ailment is diagnosed with a standard examination in the 2nd trimester.

In pregnant women, the gestational type of diabetes mellitus passes after childbirth, but it is dangerous for the child with its complications and the sooner the first signs of the disease are discovered, the less the consequences will be for the baby. It is worth noting that an empty stomach blood test for this type of diabetes is usually within normal limits, but 2 hours after a meal, its level rises significantly, as in people in a pre-diabetic state. This phenomenon occurs due to a misperception of glucose by the body and to confirm or refute their fears, doctors prescribe glucose tolerance test(GTT).

In pregnant women, the disease usually does not manifest itself and is diagnosed after taking tests for sugar content, but sometimes it is accompanied by certain symptoms.

Signs of GDM:

• Intense thirst;
• Persistent dryness in the mouth;
• Frequent urination
• Prostration;
• Susceptibility to infectious diseases;
• Decreased visual acuity.

Gestational diabetes mellitus during pregnancy usually disappears after childbirth, so it cannot do much harm to the mother, but the disease is dangerous for the child, and in order to avoid consequences, you need to monitor the symptoms that arise. In addition, doctors recommend that women do not forget about the time indicated by the specialist for the tests, since it is their results that will show the presence or absence of pathology.

Gestational diabetes in pregnant women is a serious threat to baby's health!

Risk group

Regardless of whether there are signs of this type of diabetes during pregnancy or not, women should understand what it threatens them and take blood sugar tests on time. In this case, the disease can be avoided, but for this you need to find out if the girl is at risk:

• Excess weight;
• After 16-20 years, the woman began to grow extra pounds for no particular reason;
• Decision to give birth after 30 years;
• Hereditary predisposition;
• During the first pregnancy, GDM was diagnosed or the child was born with a weight of more than 4 kg during the previous birth;
• Metabolic ovarian dysfunction (polycystic).

Causes of gestational diabetes

Diabetes is caused by poor production or absorption of the pancreatic hormone (insulin). This raises blood sugar levels, and doctors call this condition hyperglycemia. In a normal state, insulin serves to move glucose into the cells of the body and so it receives energy, but if it does not react to the hormone, then the concentration of sugar becomes higher, and this is dangerous for humans. Over time, the walls of the vessels will begin to collapse, they will clog up due to which the patency will be impaired.

Diabetes mellitus in pregnant women occurs due to hormonal changes in a woman's body, therefore, when the cause is eliminated, you will not have to worry about whether the disease passes after childbirth or not.

It is important to remember that the pathological process begins due to an increase in the concentrate of certain hormones, for example, estrogen and progesterone, as a result of which insulin resistance increases.

In general, this process is natural, since the fetus needs more glucose in order to grow, but not every pancreas is able to withstand such an increased load for 9 months. For this reason, this type of diabetes often develops in pregnant women.

Diagnosing the disease

Gestational diabetes is most often diagnosed at about 25-27 weeks of pregnancy, since it is during this time period that doctors prescribe a glucose tolerance test. To begin with, the girls will have a fasting blood test, and then they will give a little sugar and after 2 hours they will do a second test. The last sampling of the material will be carried out after another 1 hour in order to consolidate the examination result. Gestational diabetes during pregnancy has the following indicators:

• Empty stomach 5.1 mmol / L;
• 2 hours after the test for GTT 10 mmol / l;
• The benchmark is 8.5 mmol / L.

It is worth noting that sugar in girls on an empty stomach is usually not elevated during this period, so the main information will be given by its indicator after GTT. In addition, you need to know how to prepare for the tests:

• You do not need to specially prepare, sit on exhausting diets and train, you need to do everything as always and eat according to your daily diet three days before donating blood;
• Blood is taken on an empty stomach, that is, it is forbidden to eat anything 8 hours before. As for drinks, you can drink water as much as you like;
• When the basic fasting test is passed, you need to drink a glass of diluted glucose and repeat the procedure two hours later.

Influence of GDM on the baby

Diabetes mellitus that started during pregnancy will have consequences for the baby. Due to the disease, the fetus will grow faster, therefore, during childbirth, there may be complications associated with an overly developed shoulder girdle of the child. This situation often leads to injuries and is especially dangerous for the child. For this reason, doctors medically cause premature birth to avoid complications, but the fetus is not always ready for them, so the baby may be born prematurely or may be lost.

There are other consequences of this pathology, for example, a child may have problems with the respiratory system. This is due to the fact that gestational diabetes in the mother can affect the development of surfactant (surfactant) deficiency in the baby's lungs. It slows down the production of this substance, insulin, which in the mother's blood is excessive due to increased level Sahara. Treatment of such a syndrome in a child is mainly carried out in special incubators (incubators) and, if necessary, artificial ventilation of the lungs is used.

In addition, gestational diabetes is the cause of the symptom diabetic fetopathy, which means low blood sugar levels (hypoglycemia). The moment the doctor cuts the umbilical cord, the glucose intake drops sharply, but the insulin produced by the baby's pancreas takes longer to come to normal levels. Such children need a special approach, and 2-3 hours after giving birth, they need to be fed with glucose, gradually reducing its amount. If the birth was premature or the baby does not want to eat it, then this process is performed intravenously. Over time, the insulin level will return to normal and such actions will not be required, but if you ignore such a moment, then with age, the baby will begin to have neurological problems. In addition, mental retardation is sometimes observed.

A chronic lack of magnesium and calcium in a child should also be noted if the mother had gestational diabetes. It is necessary to take care of the saturation of the young organism with these elements, otherwise the baby will face complications in the future, for example, liver disease, heart disease or neuralgia.

The course of therapy

Diabetes in pregnancy is not a death sentence and the effects on the fetus can be reduced through diet and exercise. For this reason, mothers are advised to adjust their diet according to these rules:

• At least 5 meals should be taken per day and portions should be small;
• It is necessary to make a menu for a week, and select products according to the glycemic index (GI), which has a scale from 0 to 100. The smaller it is, the longer the feeling of satiety will remain and the less sugar will rise, so its indicator should not exceed 70;
• If doctors diagnosed gestational diabetes, then you should try to remove foods with fast carbohydrates from your diet, for example, confectionery, flour products and potatoes (due to starch);
• You need to measure your sugar level 1-2 hours after each meal and a glucometer is ideal for this;
• When composing your daily menu, you need to watch that food contains no more than 45% carbohydrates and up to 30% fats. As for products with a high protein concentrate, they can be eaten practically without restrictions (up to 60%);
• With such a disease, it will be beneficial to eat a lot of coarse fiber, as it helps to lower blood sugar levels;
• Pregnant women are advised to eat more fruits and vegetables to replenish their supply of nutrients. In addition, it will not hurt to drink a vitamin complex.

Gestational diabetes is a temporary pathology and the body eventually returns to normal after childbirth, as the concentration of hormones will return to acceptable levels. If the concentration of sugar does not decrease even with a strict diet and playing sports, then doctors will recommend injections of fast-acting insulin after meals. This solution will help stabilize your blood glucose levels.