Diabetes mellitus during pregnancy causes. Gestational diabetes mellitus during pregnancy is a cause for concern. What can you eat if you have gestational diabetes during pregnancy?

After pregnancy occurs, a woman is registered and undergoes many diagnostic procedures, including detecting sugar levels in the blood and urine. Approximately 4% of all pregnant women experience moderately elevated and persistent glucose levels. This condition is called gestational diabetes during pregnancy. If elevated levels are detected and taken under the control of doctors on time, then nothing threatens the mother and child, and after childbirth this form of diabetes goes away on its own. Although this pathology is quite rare, it is better to take note of the features of this disease. Therefore, we will consider the causes, symptoms and treatment options for GDM.

The main trigger factor for gestational diabetes mellitus is pathological glucose tolerance. The cause of such disorders is overload of the pancreas. If in people outside of pregnancy such disruptions are caused by obesity and a sedentary lifestyle, then in pregnant women the nature of insulin resistance is completely different. The placenta actively secretes hormones with the opposite effect of insulin, thereby increasing the amount of glucose in the body. When certain factors are present in a woman, such as low physical activity or excessive weight gain, temporary diabetes appears. This occurs between 28 and 36 weeks of gestation.
Uncontrolled gestational diabetes can affect the overall course of pregnancy and even affect the poor development of embryonic organs. If the increase in sugar began in the first trimester, then the pregnancy will end in miscarriage or numerous congenital anomalies. The brain and cardiovascular system may be primarily affected.

On a note! Gestational diabetes mellitus during pregnancy affects the development of mental abilities and the usefulness of the nervous system only in the first trimester.

Insulin resistance in the 2nd and 3rd trimester provokes pathological feeding of the fetus and its intensive growth. The not yet formed pancreas begins to secrete a double dose of insulin to process all the sugar. But the baby needs a certain amount of glucose, and all the excess settles in the form of a fatty layer on the organs and under the skin. The baby’s internal organs—kidneys, liver, pancreas—begin to work harder, which will have a negative impact on health in the future. The fetus, receiving huge amounts of sugar from the mother (hyperinsulinemia), after birth begins to experience sugar hunger, and glucose levels begin to drop sharply. This condition is called diabetic fetopathy. This diagnosis can be made before the onset of labor using the results of an ultrasound examination. If it is confirmed, then an unplanned delivery is performed before the end of the gestation period.

Indirect signs of diabetic fetopathy:

1. Macrosomia (fetus over 4 kg).
2. Disproportion of the body (short limbs, abdominal circumference exceeds the volume of the head for several weeks, broad shoulders, swelling of the face).
3. Cardiomegaly (underdeveloped and greatly enlarged liver and kidneys).
4. Breathing disorders and decreased fetal activity.
5. A large number of developmental anomalies.
6. Excess subcutaneous fat.

Important! Uncorrected diabetes can result in premature birth, severe trauma to the woman, and perinatal death.

Why is gestational diabetes mellitus dangerous during pregnancy?

• Polyhydramnios progresses.
• The risk of miscarriage doubles.
• Infections in the birth canal often worsen and are also transmitted to the baby.
• Ketone bodies are present in the blood, causing intoxication in the body of mother and child.
• A large fetus causes a caesarean section or severe trauma for a woman after childbirth.
• Disruption of internal organs causes gestosis and fetal hypoxia.

Advice! A compensated amount of sugar during gestation eliminates the development of pathologies in the fetus and complications in the woman.

What causes gestational diabetes: determining the risk group

Even at the stage of pregnancy planning, a woman can independently or with the help of a therapist determine the likelihood of pathological glucose tolerance. Gestational diabetes mellitus during pregnancy occurs most often against the background of a history of the following diseases:

1. Excess weight (advanced forms of obesity).
2. Pregnancy planning for the age category 30+.
3. Stable weight gain after 18 years and until pregnancy.
4. Patients with diabetes mellitus along the ancestral line.
5. Hormonal imbalance (polycystic ovary syndrome).
6. Prediabetic state (slight increase in sugar above normal).
7. Endocrine disorders.
8. Previous pregnancy with gestational diabetes.
9. The first child was born weighing more than 4 kg.

Interesting! The chances of developing gestational diabetes are significantly higher in some ethnic groups, namely Hispanic, Native American and Asian women.

Diagnosis of gestational diabetes: symptoms and laboratory values

Laboratory diagnostics to detect latent gestational diabetes are mandatory for all women in an “interesting” position between 24 and 28 weeks of gestation. This form of diabetes manifests itself in the same way as other types, but in most cases there are no symptoms at all. How to suspect the development of GDM before a planned study:

• The woman begins to experience a constant desire to drink.
• Frequent urination appears.
• Appetite is disrupted (you want to eat all the time or, conversely, you cannot eat anything).
• Blood pressure rises.
• Severe fatigue is noted.
• There is cloudiness in the eyes.

The symptoms are quite superficial and can be present without an increase in glucose, but the presence of at least a few of them should prompt a visit to the gynecologist to clarify their nature.

Gestational diabetes is determined by a test called an oral glucose tolerance test. To get reliable test results, you need to properly prepare for donating blood. The material is collected first only on an empty stomach, then after taking 50 g of glucose (orally) after 1 hour and then after another 2 hours. The results obtained show how well the body copes with the received glucose.

Standard sugar levels:

• 1st blood draw - 5.49 mmol/l;
• 2nd sampling - 11.09 mmol/l;
• 3rd sampling - 7.79 mmol/l.

Gestational diabetes mellitus during pregnancy is confirmed by the following indicators:

• 1st sampling - 5.49-6.69 mmol/l;
• 2nd sampling - less than 11.09 mmol/l;
• 3rd sampling - more than 11.09 mmol/l.

A primary increase in sugar should not frighten a woman who is expecting a baby, since the endocrinologist will refer her for re-diagnosis in 10-12 days. The fact is that the following factors can influence the result:

1. Eating large amounts of sugar-containing foods on the eve of diagnosis.
2. Experienced stress or anxiety.
3. Eating less than 8 hours before blood collection.
4. Low or, conversely, strong physical activity.

A one-time rise in glucose is not a reason to panic. There is always a risk of error and non-compliance with blood donation rules. Only a twice confirmed increase in values ​​can confirm the presence of diabetes.

Principles of treatment of GDM in pregnant women

Since gestational diabetes during pregnancy affects the fetus, proper treatment of the woman is necessary before childbirth, and sometimes after it. The essence of therapy comes down to eliminating unfavorable factors that affect blood sugar levels and constant monitoring of its amount. Regular checks on the condition of the fetus are also carried out.

1. Continuous monitoring of glucose levels. At least 4-6 times a day: on an empty stomach, 1.5 hours after a meal, sometimes you need to check your sugar before eating.
2. Regular determination of ketone bodies in morning urine. Their presence indicates uncompensated diabetes.
3. A strictly balanced diet.
4. Individually selected physical activity taking into account the condition of the pregnant woman.
5. Maintaining optimal body weight (calculated individually based on body mass index).
6. Monitoring blood pressure indicators.
7. In severe forms of GDM, insulin therapy is indicated. Sugar-lowering tablets are not prescribed.

Gestational diabetes mellitus during pregnancy: diet and daily routine

The primary cure for gestational diabetes during pregnancy is diet. Since weight loss is not the most suitable treatment for pregnant women, you need to eat right. The menu for diabetes is compiled so that it is as nutritious as possible, and at the same time low in calories.

Drawing up a rational menu

• Control your carbs. The amount of carbohydrates should be less than 45% of the total caloric intake of the daily diet. It is preferable to eat foods that contain a lot of fiber (whole grain cereals, legumes). Instead of eating starchy foods (bread, potatoes, cookies, spaghetti), it is better to replenish carbohydrate reserves with vegetables (carrots, broccoli).
• Eat in small portions of 200-250 g. You need to eat in small portions 5-6 times a day. Add a small portion of salad or fresh vegetable juice to each meal. Choose green and yellow types of vegetables (pumpkin, carrots, lettuce, spinach, bell peppers, zucchini).
• Avoid fried foods that are high in fat. Eat boiled or baked foods without spicy or fatty sauces. Also avoid foods with a high glycemic index (baked goods, confectionery, regular wheat pasta, sweet fruits).
• Tame morning sickness with crackers and biscuits while eating breakfast in bed.
• Don't buy fast food products. This category of products, in addition to a mountain of preservatives, contains fast carbohydrates. Therefore, introduce a taboo in your kitchen for instant noodles and freeze-dried mashed potatoes.
• The amount of saturated fat should not exceed 10%. Cook only lean types of meat: poultry, rabbit, beef, lean pork, fish. Remove any available fat layers and remove the skin from the bird.
• Drink 1.5 liters of clean water per day if there are no contraindications.

Such products are strictly prohibited: margarine, spread, mayonnaise, sour cream, cream, butter, nuts and seeds (limited), sauces, sweet carbonated drinks, sweetened juices.

Allowed without restrictions: cucumbers, ginger, zucchini, radishes, beans, lettuce, zucchini, all kinds of mushrooms, all leafy vegetables, cabbage, tomatoes, citrus fruits.

Advice! In winter, to prevent vitamin deficiency, pregnant women are prescribed additional vitamin complexes.

Diabetes and exercise

Moderate exercise also helps keep sugar levels under control. To maintain weight, muscle tone and good health, you can attend yoga classes or fitness training for pregnant women, or you can simply do light exercises at home. Naturally, there can be no talk of doing abdominal exercises, cycling or jumping rope. All classes should be carried out only at will and in excellent health. If you didn't exercise before pregnancy, swimming, walking or running are fine. The optimal physical education regimen involves 20-minute sessions three times a week.

On a note! If you are on insulin therapy, you should check your sugar levels before and after exercise. Physical activity helps lower sugar. Therefore, temporary hypoglycemia may occur.

Physical exercise for pregnant women helps keep your weight within normal limits. If a woman did not suffer from extra pounds before pregnancy, then gaining 10-16 kg over the entire gestation period is considered acceptable. In case of obvious obesity, weight gain is limited to 7 kg.

Gestational diabetes: course of labor and postpartum control

During labor, glucose levels are monitored every 2-3 hours. If the level rises to a critical level, insulin is administered, and if it falls, glucose is administered. The fetal heartbeat and breathing rhythm are also monitored. In case of complications, an emergency caesarean section is performed.
The baby's glucose level is determined after birth. The excess insulin produced does not immediately return to normal, so the baby has a reduced amount of sugar. To stabilize the child's condition, he is given a glucose solution intravenously.
Gestational diabetes indicates a woman's predisposition to type 2 diabetes. After childbirth, glucose levels drop to normal levels within a few hours, but it is recommended to check their levels after 6 weeks and then every 3 months.

It is impossible to completely exclude the possibility of gestational diabetes in pregnant women. Therefore, if you are at increased risk of developing insulin resistance, immediately inform your doctor and eliminate all precipitating factors of this disease. Remember that GDM is not a death sentence and, if the recommendations are followed, does not affect pregnancy.

Gestational diabetes mellitus in pregnant women. Video

In ancient times, when there were no hospitals and pharmacies, humanity already knew about the existence of diabetes. The first mention of this disease dates back to the 15th century BC. Already in that distant era, it was noticed that diabetes mellitus adversely affects the condition of a pregnant woman and interferes with the normal development of her baby. How does the disease manifest itself in expectant mothers and what are the risks of its occurrence during pregnancy?

Types of Gestational Diabetes

Diabetes mellitus is a metabolic disease accompanied by increased blood glucose levels. The pathological process can develop as a result of absolute or relative insulin deficiency. During pregnancy, one of the types of pathology may make itself felt:

• diabetes mellitus type 1 or 2 that existed before pregnancy;
• gestational diabetes mellitus.

Gestational diabetes refers to a condition that first appears during actual pregnancy. Before conceiving a child, the woman did not notice any changes in her body and did not make any special complaints. It also happens that the expectant mother simply did not know about her disease, because before pregnancy she was not examined by an endocrinologist or therapist. It is possible to clearly understand whether diabetes mellitus is gestational or a manifestation of true diabetes only after the birth of the child.

Before talking about the characteristics of the disease in expectant mothers, you should understand how diabetes manifests itself outside of pregnancy. The causes, development mechanisms and treatment principles are determined by the type of diabetes mellitus. The symptoms of the disease will be similar, and only targeted diagnosis makes it possible to distinguish between the types of this pathology.

Diabetes mellitus type 1 is a typical autoimmune disease. In most cases, it occurs against the background of infection with a particular virus. Inflammation develops, leading to the destruction of beta cells of the thyroid gland. It is these cells that produce insulin, a hormone involved in all metabolic processes in the body. When more than 80% of the thyroid cells are affected, symptoms of type 1 diabetes appear.

Diabetes mellitus type 2 occurs against the background of a genetic predisposition. Factors that provoke its appearance include:

• obesity;
• eating disorder;
• sedentary lifestyle;
• stress.

In type 2 diabetes, insulin levels remain normal, but the body's cells are not able to perceive this hormone. Insulin resistance develops, leading to numerous health problems. A characteristic feature of patients with type 2 diabetes is excess body weight. Obesity in this form of the disease is associated with impaired lipid metabolism as a result of high levels of insulin in the blood.

Gestational diabetes mellitus is essentially similar to type 2 diabetes. High levels of female sex hormones and cortisol (adrenal hormone) during pregnancy lead to the development of physiological insulin resistance. In other words, while expecting a child, all women, to one degree or another, develop insensitivity of body cells to insulin. Moreover, in 5-10% of expectant mothers, this condition leads to the formation of gestational diabetes mellitus, while in other women the disease does not develop.

Symptoms of diabetes during pregnancy

Gestational diabetes mellitus is asymptomatic in most cases. The woman does not present any special complaints, and only routine examinations during pregnancy reveal elevated blood glucose levels. Typical symptoms of diabetes in expectant mothers occur quite rarely.

Signs of gestational diabetes include:

• polydipsia (constant thirst);
• polyuria (frequent urination);
• polyphagia (increased appetite up to constant insatiable hunger).

All these symptoms are not very specific and can be mistaken for normal symptoms of pregnancy. Many women, while expecting a baby, feel very hungry and notice a significant increase in appetite. Thirst often occurs in expectant mothers in the later stages, especially if this period occurs in spring and summer. Finally, frequent urination occurs in all pregnant women, and it is not possible to distinguish it from symptoms of diabetes.

Diagnosis of gestational diabetes

During pregnancy, all women have their blood sugar levels determined. This analysis is taken from a vein on an empty stomach twice during pregnancy: at the first appearance and at 30 weeks. This approach allows you to identify the disease in time and take all measures to prevent its complications in expectant mothers.

When interpreting a blood glucose test, the following results are possible:

• from 3.3 to 5.5 mmol/l – normal;
• from 5.6 to 7.0 – impaired glucose tolerance;
• more than 7.1 – diabetes mellitus.

Impaired glucose tolerance is called prediabetes. This condition is on the border between normal and pathological, and the expectant mother needs to make every effort to maintain health in this situation. When determining a blood sugar level of more than 5.6 mmol/l, a pregnant woman should definitely see an endocrinologist.

If diabetes is suspected, a glucose tolerance test is performed. The analysis consists of two stages. First, blood is taken from a vein from a patient strictly on an empty stomach, after which the woman is asked to drink 75 ml of a sweet drink (glucose diluted in water). After 1-2 hours, blood is taken again to determine the sugar level. Based on the test results, the following conclusions are made:

• up to 7.8 mmol/l – normal;
• from 7.9 to 11.0 mmol/l – impaired glucose tolerance;
• more than 11.1 mmol/l – diabetes mellitus.

At the same time as determining blood glucose levels, pregnant women take a urine test. If sugar is detected in the urine, the development of gestational diabetes is indicated. Also, with this pathology, acetone (ketone bodies) can be detected in the urine. Acetone itself cannot be the basis for diagnosis, since this element is found in many pathological processes (for example, toxicosis in early pregnancy).

Complications of pregnancy with gestational diabetes

In the first trimester of pregnancy, spontaneous miscarriage can occur due to diabetes. This complication most often occurs after 6 weeks and is caused by pathological processes occurring in the altered vessels. It is worth noting that this complication is more typical of true diabetes mellitus, which existed even before pregnancy.

Gestational diabetes mellitus is common complicated by placental insufficiency after 20 weeks. This complication is also associated with impaired microcirculation, which ultimately leads to an insufficient supply of oxygen and nutrients to the baby. In the third trimester of pregnancy, gestational diabetes very often leads to the development of fetal hypoxia and intrauterine growth retardation.

One of the most severe complications of pregnancy due to gestational diabetes is premature placental abruption. The same microcirculation disorders resulting from vasospasm are to blame for the occurrence of this pathology. In turn, the narrowing of the lumen of blood vessels is explained by numerous metabolic disorders against the background of developed insulin resistance.

All of these mechanisms lead to the placenta leaving the uterine wall earlier than expected. Normally, the fetal place is born immediately after the birth of the child. Placental abruption during pregnancy can cause massive bleeding and even fetal death.

70% of women with gestational diabetes develop gestosis. This specific complication of pregnancy is characterized by increased blood pressure and impaired renal function. In diabetes, gestosis manifests itself quite early, and already at 24-26 weeks, many women notice the first symptoms of this disease. The combination of gestosis and diabetes is quite unfavorable and provokes multiple problems throughout pregnancy.

In the majority of expectant mothers, gestational diabetes leads to the development polyhydramnios. With this pathology, the volume of amniotic fluid increases to 2 liters at 36-37 weeks. Polyhydramnios adversely affects the condition of the fetus, disrupting its normal position in the uterus. Often, excess amniotic fluid leads to the fact that the fetus takes an oblique or transverse position, and it can only be removed from the uterus through a caesarean section.

Consequences of gestational diabetes for the fetus

Throughout pregnancy, the baby suffers from a lack of oxygen and essential nutrients. Constant hypoxia primarily affects the development of his nervous system. Lack of oxygen affects the brain, which ultimately leads to perinatal encephalopathy and other serious diseases that develop immediately after the birth of the child.

A specific complication of gestational diabetes is diabetic fetopathy. Children born to mothers with this pathology have a characteristic appearance:

• heavy weight (more than 4 kg at birth);
• purple or bluish skin tone;
• a large amount of cheese-like lubricant on the skin;
• swelling of the skin and soft tissues;
• puffiness of the face;
• petechial rash (small hemorrhages under the skin).

Despite their large size, babies are born weak. Many children experience shortness of breath and even apnea (stopping breathing) in the first hours of life. Characterized by prolonged jaundice associated with pathological changes in the liver of the newborn. Most children experience various neurological disorders (decreased muscle tone, adynamia or hyperexcitability, suppressed reflexes).

A particularly dangerous condition that occurs in a newborn in the first days of life is hypoglycemia (low blood glucose). The thing is that in utero the baby received a large amount of sugar from the mother’s blood. The fetal pancreas is accustomed to working in an enhanced mode, and cannot always quickly switch to a different rhythm. After birth, the supply of maternal sugar to the baby stops, while insulin levels still remain high. Hypoglycemia develops - a sharp decrease in blood sugar levels. This condition can have serious consequences, including coma and death.

Treatment of gestational diabetes mellitus

If gestational diabetes is detected, the woman is placed under the supervision of an endocrinologist. It is recommended to visit your doctor every two weeks (unless there are complications). If adverse consequences of diabetes develop, treatment of a pregnant woman can be continued in hospital.

Treatment of diabetes during pregnancy is aimed at preventing various complications associated with metabolic disorders. Treatment begins with the selection of an optimal diet, balanced in essential nutrients. In this case, dietary recommendations should take into account the real needs of the mother and fetus in accordance with the duration of the actual pregnancy.

For gestational diabetes from a woman's diet easily digestible carbohydrates are excluded:

• cakes, pastries and other sweets;
• jam;
• products made from white flour;
• sweet fruits;
• juices and syrups;
• carbonated drinks.

To prevent excess weight gain, fats are also limited in a pregnant woman's diet. Meals for gestational diabetes mellitus should be frequent, up to 5-6 times a day, but in fairly small portions. This scheme allows you to avoid stress on the digestive tract and prevent the development of hyperglycemia (increased blood glucose levels) after eating.

Sharp dietary restrictions and fasting are prohibited. A pregnant woman's diet should be balanced, containing the optimal amount of vitamins and microelements. The total weight gain during pregnancy should be no more than 12 kg for women with normal weight and no more than 8 kg in case of obesity.

The criterion for the effectiveness of diet therapy is determination of blood sugar levels. Normally, glucose should be no more than 5.5 mmol/l on an empty stomach and no more than 7.8 mmol/l two hours after eating. If these indicators are exceeded, the issue of insulin therapy is decided.

The selection of insulin and determination of its dosage is carried out by an endocrinologist. It is worth considering that most women suffering from gestational diabetes mellitus retain the ability to synthesize their own insulin. To maintain normal metabolism, such women only need a very small dose of the hormone daily. The need for insulin may increase as pregnancy progresses.

Management of childbirth with gestational diabetes mellitus

The optimal time for delivery for gestational diabetes is 37-38 weeks of pregnancy. It makes no sense to delay beyond this period. By 37 weeks, the fetus is already fully formed and can exist safely outside the mother’s womb. Further prolongation of pregnancy can be quite dangerous due to insufficient functioning of the placenta and depletion of its resources after 38 weeks.

Experts recommend that women give birth to a child in a specialized obstetric hospital. Such maternity hospitals have all the necessary equipment to provide care to a newborn. Also, experienced therapists and endocrinologists work here around the clock, able to solve any problems associated with the progression of diabetes.

Women with gestational diabetes usually give birth vaginally. Indications for cesarean section are very large fetal sizes, as well as gestosis, nephropathy and other complications of pregnancy. In many cases, insulin therapy is administered during childbirth or during surgery.

Gestational diabetes goes away on its own after childbirth without additional treatment. It is possible that the situation will recur during the second and subsequent pregnancies. Maintaining high blood glucose levels after childbirth indicates the development of true diabetes mellitus. In this case, the woman is recommended to undergo a full examination by an endocrinologist and begin treatment for the disease as soon as possible.

During pregnancy, chronic diseases may worsen or signs of previously unknown problems may appear. Gestational diabetes can become such a problem.

According to the World Health Organization classification, “gestational diabetes” is diabetes mellitus detected during pregnancy, as well as impaired glucose tolerance (the body’s perception of glucose), also detected during this period. Its cause is reduced sensitivity of cells to their own insulin (insulin resistance), which is associated with high levels of pregnancy hormones in the blood. After childbirth, blood sugar levels most often return to normal. However, the possibility of developing type 1 and type 2 diabetes during pregnancy cannot be ruled out. Diagnosis of these diseases is carried out after childbirth.

After analyzing data obtained from multiple studies, doctors concluded that more than 50% of pregnant women with gestational diabetes develop true diabetes later in life.

Why is gestational diabetes dangerous?

Gestational diabetes in most clinical situations develops in the interval up to. Disorders of carbohydrate metabolism detected earlier, as a rule, indicate previously undetected pregestational (“pre-pregnancy”) diabetes.

Of course, it is better to learn about chronic diseases before pregnancy, and then it will be possible to compensate for them as much as possible. It is for this reason that doctors strongly recommend planning a pregnancy. In terms of preparing for pregnancy, a woman will undergo all basic examinations, including screening for diabetes. If carbohydrate metabolism disorders are detected, the doctor will prescribe treatment and give recommendations, and the future pregnancy will proceed safely and the baby will be born healthy.

The main condition for managing pregnancy complicated by diabetes (both gestational and its other forms) is maintaining blood glucose levels within normal limits (3.5-5.5 mmol/l). Otherwise, mother and baby find themselves in very difficult conditions.

What threatens mom? Premature birth and stillbirth are possible. There is a high risk of developing (with diabetes it develops more often and earlier - up to 30 weeks), hydramnios, and consequently, fetal malnutrition. It is possible to develop diabetic ketoacidosis (a condition in which there is a sharp increase in glucose levels and the concentration of ketone bodies in the blood), genital tract infections, which are registered 2 times more often and cause infection of the fetus and. It is also possible for microangiopathies to progress, resulting in impairment of vision, kidney function, impaired blood flow through the vessels of the placenta, and others. A woman may develop weakness in labor, which, in combination with a clinically narrow pelvis and a large fetus, will make delivery by cesarean section inevitable. Women with diabetes are more likely to have infectious complications in the postpartum period.

Dangers for the baby

The peculiarities of carbohydrate metabolism between mother and child are such that the fetus receives glucose from the mother, but does not receive insulin. Thus, hyperglycemia (excessive amount of glucose), especially in the first trimester, when the fetus does not yet have its own insulin, provokes the development of various defects fetal development. Afterwards, when the unborn baby’s body produces its own insulin, hyperinsulinemia develops, which threatens the development of asphyxia and trauma during childbirth, respiratory disorders (respiratory distress syndrome) and hypoglycemic conditions in newborns.

Is there a way to prevent these difficulties? Yes. The main thing is awareness of the problem and its timely correction.

Diagnosis of GDM during pregnancy

The first step in diagnosing gestational diabetes is to assess the risk of its development. When registering a woman with the antenatal clinic, a number of indicators are assessed, for example, the age and weight of the pregnant woman, obstetric history (presence of gestational diabetes during previous pregnancies, birth of children weighing more than 4 kg, stillbirth, etc.), family history (presence of diabetes in relatives) and so on. The following table is filled in:

Let us pay attention to the parameter “Birth of a child weighing more than 4 kg”. It is no coincidence that it is included in the assessment of the risk of developing gestational diabetes. The birth of such a baby may indicate the development of both true and gestational diabetes in the future. Therefore, in the future, it is necessary to plan and constantly monitor your blood sugar levels.

Having determined the risk of developing diabetes mellitus, the doctor chooses management tactics.

The second step is to draw blood to determine your sugar level, which should be done several times during your pregnancy. If at least once the glucose level exceeds 5 mmol/l, further examination is carried out, namely a glucose tolerance test.

When is a test considered positive? When performing a test with a load of 50 g of glucose, the glycemic level is assessed on an empty stomach and after 1 hour. If fasting glucose exceeds 5.3 mmol/l, and after 1 hour the value is higher than 7.8 mmol/l, then a test with 100 g of glucose is necessary.

The diagnosis of gestational diabetes mellitus is made if fasting glucose is more than 5.3 mmol/l, after 1 hour - above 10.0 mmol/l, after 2 hours - above 8.6 mmol/l, after 3 hours - above 7.8 mmol/l. Important: an increase in just one of the indicators does not provide grounds for making a diagnosis. In this case, the test must be repeated again after 2 weeks. Thus, an increase in 2 or more indicators indicates diabetes.

Test rules:

1. 3 days before the examination, the pregnant woman eats her usual diet and adheres to her usual physical activity
2. The test is performed in the morning on an empty stomach (after an overnight fast of at least 8 hours).
3. After taking a blood sample on an empty stomach, the patient should drink a glucose solution within 5 minutes, consisting of 75 grams of dry glucose dissolved in 250-300 ml of water. A repeat blood sample to determine blood sugar levels is taken 2 hours after the glucose load.

Normal glycemic values:

1. fasting glucose - 3.3-5.5 mmol/l;
2. glycemia before meals (basal) 3.6-6.7 mmol/l;
3. glycemia 2 hours after eating 5.0-7.8 mmol/l;
4. glycemia before going to bed 4.5-5.8 mmol/l;
5. glycemia at 3.00 5.0-5.5 mmol/l.

If the results of the study are normal, then the test is repeated when the hormonal levels change. At earlier stages, GDM is often not detected, and establishing a diagnosis later does not always prevent the development of complications in the fetus.

However, pregnant women face more than just high blood sugar levels. Sometimes a blood test “shows” hypoglycemia—low blood sugar. Most often, hypoglycemia develops during fasting. During pregnancy, the consumption of glucose by cells increases and therefore long breaks between meals should not be allowed and in no case should you “go on” a diet aimed at losing weight. Also, sometimes in tests you can find borderline values, which always indicate a higher risk of developing the disease, so it is necessary to strictly monitor blood counts, adhere to the doctor’s recommendations and follow the diet prescribed by a specialist.

A few words about the treatment of gestational diabetes

A pregnant woman facing diabetes mellitus needs to master the technique of self-control of glycemia. In 70% of cases, gestational diabetes is corrected by diet. After all, insulin production occurs, and there is no need for insulin therapy.

Basic principles of the diet for GDM:

1. The daily diet must be divided between carbohydrates, fats and proteins - 35-40%, 35-40% and 20-25%, respectively.
2. Calorie content in overweight conditions should be 25 kcal per 1 kg of weight or 30 - 35 kcal per 1 kg with normal weight. Women who are overweight are given recommendations on how to reduce or stabilize it. It is necessary to reduce caloric intake with special attention, without taking drastic measures.
3. Easily digestible carbohydrates, that is, any sweets, are excluded from the daily menu.
   Should a healthy woman sound the alarm if she craves sweets? “Love for sweets” should alert you if there are changes in the tests. But in any case, you should follow the nutritional recommendations and not overdo it with sweets or anything else. You need to remember that you want to eat “something sweet” more often out of a desire to simply enjoy it. Therefore, “sweets” can be replaced with fruit.
4. Reduce the amount of fat consumed by enriching the diet with fiber (fruits and vegetables) and proteins up to 1.5 g/kg.

If it is not possible to correct the glycemic level with diet alone, insulin therapy is required, which is calculated and titrated (corrected) by the attending physician.

Gestational diabetes is so called not only because it manifests itself during pregnancy. Another feature is that its symptoms disappear after childbirth. However, if a woman has had gestational diabetes during pregnancy, the risk of developing true diabetes increases by 3-6 times. Therefore, it is important to monitor the woman after childbirth. 6 weeks after birth, it is necessary to conduct a study of the state of the mother’s carbohydrate metabolism. If no changes are detected, monitoring is prescribed once every 3 years, and in case of impaired glucose tolerance, nutritional recommendations and monitoring are prescribed once a year.

In this case, all subsequent pregnancies must be strictly planned.

Nadezhda Ermilova

During pregnancy, girls often experience hormonal surges, as a result of which metabolism is disrupted and gestational diabetes mellitus (GDM), which is also called preeclampsia, appears. This happens even in very young female representatives; the disease is diagnosed during a standard examination in the 2nd trimester.

In pregnant women, the gestational type of diabetes mellitus goes away after childbirth, but it is dangerous for the child due to its complications and the sooner the first signs of the disease are detected, the fewer consequences there will be for the baby. It is worth noting that a fasting blood test for this type of diabetes is usually within the normal range, but 2 hours after eating its level increases significantly, as in people in a prediabetic state. This phenomenon occurs due to the body’s incorrect perception of glucose, and to confirm or refute their fears, doctors prescribe a glucose tolerance test (GTT).

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

Signs of GDM:

• Intense thirst;
• Constant 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 specified by the specialist for taking 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 the health of the baby!

Risk group

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

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

Causes of Gestational Diabetes

Diabetes occurs due to poor production or perception of the pancreatic hormone (insulin). Because of this, blood sugar levels rise, and doctors call this condition hyperglycemia. In a normal state, insulin serves to move glucose into the body's cells and this is how it receives energy, but if it does not respond to the hormone, then the concentration of sugar becomes greater, and this is dangerous for a person. Over time, the walls of the vessels will begin to collapse and become clogged, which will impair patency.

Diabetes mellitus in pregnant women occurs due to hormonal changes in a woman’s body, so when the cause is eliminated, there is no need to worry about whether the disease goes away after childbirth or not.

It is important to remember that the pathological process begins due to an increase in the concentration 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, pregnant women often develop this type of diabetes.

Diagnosis of the disease

Gestational diabetes is most often diagnosed around 25-27 weeks of pregnancy, as it is during this time period that doctors prescribe a glucose tolerance test. To begin with, the girls will be given a fasting blood test, and then given some sugar and a repeat test 2 hours later. The last collection of material will be performed in another 1 hour to consolidate the examination result. Gestational diabetes during pregnancy has the following indicators:

• Empty stomach 5.1 mmol/l;
• 2 hours after the GTT test, 10 mmol/l;
• The reference value is 8.5 mmol/l.

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

• There is no need to prepare specially, go on grueling diets and exercise, you need to do everything as always and three days before donating blood, eat according to your daily diet;
• Blood is drawn on an empty stomach, that is, eating anything is prohibited 8 hours before. As for drinks, you can drink as much water as you like;
• When you pass the basic test on an empty stomach, you need to drink a glass of diluted glucose and repeat the procedure two hours later.

The effect of GDM on the baby

Diabetes mellitus that begins during pregnancy will have consequences for the child. Due to the disease, the fetus will grow faster, so during childbirth there may be complications associated with the child’s overdeveloped shoulder girdle. This situation often leads to injury and is especially dangerous for a child. For this reason, doctors induce premature labor with medication to avoid complications, but the fetus is not always ready for them, so the baby may be born premature or may be lost.

There are other consequences of this pathology, for example, the child may have problems with the respiratory system. This happens because gestational diabetes in the mother can affect the development of surfactant deficiency in the baby’s lungs. The production of this substance is slowed down by insulin, which is in excessive amounts in the mother’s blood due to elevated sugar levels. Treatment of such a syndrome in a child is mainly carried out in special incubators and, if necessary, artificial ventilation is used.

In addition, gestational diabetes causes a symptom called diabetic fetopathy, which means low blood sugar (hypoglycemia). The moment the doctor cuts the umbilical cord, glucose levels drop sharply, but the insulin produced by the baby's pancreas takes longer to return to normal levels. Such children need a special approach, and 2-3 hours after 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 this point, then as the baby ages, neurological problems will begin. In addition, mental retardation is sometimes observed.

It is impossible not to note the chronic lack of magnesium and calcium in a child if the mother had gestational diabetes. It is necessary to take care of saturating the young body with these elements, otherwise the baby will face complications in the future, for example, liver disease, heart disease or neuralgia.

Course of therapy

Gestational diabetes is not a death sentence and its impact on the fetus can be reduced through diet and exercise. For this reason, mothers are advised to adjust their diet according to these rules:

• You need to take at least 5 meals a day and the portions should be small;
• You need to create a menu for the week, and select products according to the glycemic index (GI), which has a scale from 0 to 100. The lower it is, the longer the feeling of fullness will remain and the less sugar will rise, so its indicator should not exceed 70;
• If doctors have 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 compiling your daily menu, you need to ensure that your food contains no more than 45% carbohydrates and up to 30% fat. As for products with a high protein concentrate, they can be eaten virtually without restrictions (up to 60%);
• For such a disease, it will be useful to consume a large amount of coarse fiber, as it helps lower blood sugar levels;
• Pregnant women are advised to eat more fruits and vegetables to replenish their supply of nutrients. In addition, it won’t hurt to drink a vitamin complex.

Gestational diabetes is a temporary pathology and the body returns to normal over time after childbirth, as the concentration of hormones returns to acceptable levels. If the sugar concentration does not decrease even when following a strict diet and exercising, doctors will recommend injecting rapid-acting insulin after meals. This solution will help stabilize blood glucose levels.

Unfortunately, pregnancy does not always go smoothly for everyone.

Sometimes during this period, chronic diseases worsen against the background of a general decrease in immunity and hormonal changes in the body, or completely new problems and diseases appear that the woman has not even encountered before.

For example, if a pregnant woman’s blood sugar suddenly rises, she is diagnosed with gestational diabetes mellitus. Statistics say that it manifests itself in only 3-5% of cases, besides, if you have not suffered from diabetes before, then after giving birth this problem should disappear on its own. However, you should not neglect it, because the disease also carries certain risks.

Gestational diabetes mellitus is also called “diabetes during pregnancy”, since this disease is considered one of the variants of diabetes, which can occur or be first diagnosed only during pregnancy.

The problem manifests itself if a carbohydrate metabolism disorder occurs: the child develops and grows, demanding and taking more and more from the mother’s body. As a result, all a woman’s organs work under increased load.

The pancreas, which secretes the hormone insulin to control blood sugar levels, often cannot cope with its function. In addition, some hormones secreted by the placenta work to increase blood sugar, that is, their effect is exactly the opposite of the action of insulin. At some point, blood glucose levels exceed normal levels and diabetes begins to develop.

Symptoms: how does the disease manifest itself?

Often, this type of diabetes is detected at the beginning of the second trimester of pregnancy (no earlier than 15-16 weeks) or later, since only by this period the placenta will be fully formed, which will begin to produce estriol and lactogen (hormones with counter-insulin properties).

Also in the maternal body the level of diabetogenic hormones increases: estrogens, cortisol,.

Another reason for the occurrence of the disease is increased insulin resistance, which can be provoked by a decrease in a woman’s physical activity, sudden weight gain, excessive consumption of high-calorie foods, etc.

At the same time, if the disease was detected at the very beginning of pregnancy or in its early stages, then doctors will be inclined to conclude that the woman began to develop regular or type diabetes even before conceiving the child.

If the hormone insulin begins to increasingly regulate blood sugar levels and its effect on your body is disrupted, this may manifest itself in the following signs (usually there are no symptoms characteristic of a normal disease):

• vision deteriorates, its sharpness decreases;
• the woman feels increased fatigue, fatigue;
• there are complaints about frequent and copious urination;
• severe hunger or, conversely, loss of appetite and weight;
• A pregnant woman may experience severe dry mouth and constant thirst.

Very often a woman perceives these signs as features of her situation, and therefore does not attach due importance to them. As a result of this, the disease is diagnosed and detected too late, when it is already in the phase of active development, which means it can lead to complications and irreversible consequences.

Who is at risk?

Almost any woman can experience the onset and development of the disease.

In addition to a sharp decrease in the sensitivity of cells and tissues to insulin, which is produced by the body, there are other causes or risk factors that can provoke the disease (almost all of them depend on genetics and the individual characteristics of the female body):

• the risk of diabetes, as a rule, directly depends on the severity of obesity, that is, the greater it is, the more likely it is to develop the disease;
• heredity can be considered almost the main factor, therefore, if your direct line relatives had (or are suffering from) type 2 diabetes, then you are at risk;
• Women who are carrying a child over the age of 33-35 also need to be careful;
• gestational diabetes can occur again (that is, if you had it in a previous pregnancy), and doctors also note a high percentage of the disease in those women who were bothered or worried during a previous pregnancy;
• As for previous pregnancies, doctors take into account their course (the presence or pathologies - miscarriage, spontaneous abortions or miscarriages, stillbirth, etc.), as well as delivery (the birth of a child weighing more than four kilograms, children with congenital malformations of the cardiovascular or nervous systems);
• a high risk of developing the disease in women suffering from various disorders of carbohydrate metabolism, problems with the cardiovascular and endocrine systems;
• unhealthy lifestyle (bad habits - alcohol, smoking, low level of physical activity, unbalanced diet, etc.).

Among the causes that provoke the onset of the disease may be viral infections that damage the pancreas, autoimmune processes, and some other triggering factors.

You can assess your risk of developing the disease. If you are at risk, it is better to undergo the necessary examinations and detect carbohydrate metabolism disorders as early as possible.

How is the problem diagnosed?

Based on medical standards, a woman undergoes blood and urine tests for sugar throughout her pregnancy. But to determine the risk or detect gestational diabetes mellitus, an oral glucose tolerance test is performed between 24 and 28 weeks.

Tests (blood is taken from a vein) are taken on an empty stomach, and at least eight hours must pass after your last meal.

Then you need to dilute 50-75 g of dry glucose in a glass of water and drink. After consuming glucose, a repeat test is taken one hour later and two hours later.

It should be noted that sugar tests taken on an empty stomach are usually not very informative, since the blood sugar level in such cases is almost always normal. Therefore, a “load” of glucose is done so that the study shows the real picture.

Normal indicators for pregnant women during analysis:

• if blood is taken on an empty stomach, then the sugar level can fluctuate between 4.0-5.0 mmol/l, but not exceed 5.1 mmol/l;
• after an hour after the “load” - no higher than 10.0 mmol/l;
• after two hours – no more than 8.5 mmol/l.

If a pregnant woman's blood sugar level exceeds these numbers, the doctor diagnoses gestational diabetes. You may be referred to repeat the test in 10-14 days.

How dangerous is this disease for a child?

Diabetes mellitus can have a very negative impact on the growth and development of the baby. Because of this and due to the peculiarities of carbohydrate metabolism between the mother’s body and the child’s body, the fetus will receive glucose, but will be without insulin.

This condition is a threat to his health and life, especially if gestational diabetes manifests itself in the first trimester, when the baby does not yet produce its own insulin hormone. It is for this reason that hyperglycemia or an excess amount of glucose develops, which leads to the emergence and development of various defects and pathologies in the child (as a rule, brain structures and the heart suffer).

The development of diabetes in the second and third trimesters, when the baby’s own pancreas is already functioning, leads to hyperinsulinemia (that is, too much of the hormone is produced in order not only to utilize glucose in the body, but also to help normalize its level in the mother’s body) .

If this disease is not detected in time and the necessary measures are not taken, then complications arise in the form of a hypoglycemic state in the newborn, or diabetic fetopathy develops.

Here are the signs that characterize this complication:

• breathing difficulties or respiratory disorders, asphyxia;
• jaundice;
• blood with increased viscosity, a high probability of blood clots, magnesium and calcium deficiency in a newborn baby;
• the child’s tissues are very swollen, and subcutaneous fat is deposited in great excess;
• development occurs with a violation of proportions (very large belly, too thin and small limbs);
• very large size of the child (over four kilograms).

If a pregnant woman has a high concentration of glucose in her blood, then at the end of the third trimester there is a very high risk of developing macrosomia, that is, an excessive increase in fetal weight and growth (and although the size of the head may be normal, the shoulder girdle becomes too large, and this becomes a serious difficulty during childbirth).

Many children are at high risk of becoming obese and developing type 2 diabetes in adulthood.

What are the dangers of gestational diabetes during pregnancy?

Gestational diabetes can be very dangerous for women too.

• Firstly, the disease poses a serious threat to the normal course of pregnancy. It can provoke the development of polyhydramnios and the occurrence of gestosis, which is fraught with various complications for the child.
• Secondly, high blood sugar levels lead to disorders in the vascular system (retinopathy, nephropathy, neuropathy).
• Thirdly, as the disease develops, genital tract infections may worsen, which leads to intrauterine infection of the baby.
• Blood flow may also be disrupted, which means that it will develop and the child will suffer from.
• Cases of premature birth, stillbirth or intrauterine fetal death are very common.

As mentioned above, uncontrolled diabetes sometimes leads to the development of a very large baby, which makes natural childbirth impossible and forces doctors to resort to cesarean section.

Complications are possible in the form of diabetic kidney damage, heart disease, and vision disorders. There are cases when, after pregnancy with gestational diabetes, a woman developed regular diabetes mellitus (usually type 2).

If the diagnosis is verified and confirmed, the doctor will prescribe individual complex therapy, which you will have to strictly adhere to.

As a rule, it includes:

• correction of the diet and strict adherence to diet rules;
• Regular monitoring of blood sugar levels (daily);
• continuous blood pressure measurement;
• constant monitoring of body weight;
• moderate physical activity (exercise, walking, etc.);
• healthy lifestyle, adherence to daily routine;
• regular testing (urine for the presence of ketone bodies, blood for sugar).

If the results of this therapy are unsatisfactory, the doctor will be forced to prescribe additional drug treatment.

Diet therapy or proper balanced nutrition is one of the most important points of treatment, compliance with which in most cases is sufficient to lower blood sugar levels and prevent the progression of the disease.

The basic rule of the diet is to make it complete, balanced and dietary at the same time, without reducing the energy value of the food.

1. Your menu should not contain easily digestible carbohydrates, which can cause a sharp rise in blood sugar.

These include: baked goods, confectionery, baked goods, honey, some very sweet fruits and dried fruits (figs, bananas, grapes).

1. Make your meals fractional - it is better to eat less, but more often (up to 5-6 times a day in small portions).
2. Limit or completely eliminate fat intake.

This applies not only to butter or margarine, but also to sour cream or high-fat milk, cream cheese, mayonnaise, etc., since the ketone bodies that these products contain will poison your body due to a lack of insulin.

When cooking, you can use vegetable oil in small quantities.

1. Eat plenty of high-fiber foods rich in vitamins and beneficial elements.

These are greens, vegetables, bran, grains, cereals, fruits.

1. Eliminate fast food products, semi-finished products, as well as fried, spicy, salted and smoked foods from the menu.

Instead, eat poultry, fish and lean meats.

1. Drink enough fluids.

If you have problems with excess weight, carefully monitor the calorie content of your foods.

Physical exercise

If you have never played sports or any physical exercise, you should be especially careful during pregnancy.

Be sure to consult your doctor to determine the severity of the load and intensity of exercise.

Doctors insist that walking, swimming, water aerobics and other moderate physical activity are very beneficial for pregnant women, as they help maintain good health, maintain muscle tone, prevent weight gain and improve the action of insulin.

Do not overuse exercises - they must be performed in good health. Check your blood sugar before and after exercise.

Do you need medications?

Insulin therapy may be prescribed by a doctor if diet and exercise have failed to bring sugar levels back to normal. There are special insulin therapy regimens, and only your doctor will be able to calculate or adjust it for you.

Women who take insulin also have to measure their blood sugar levels with a glucometer several times a day.

All readings must be recorded so that the doctor can later look at them and assess the dynamics of the disease.

There are special diabetes pills that lower sugar, but taking them during pregnancy is strictly prohibited.

How will the birth proceed?

If there are appropriate obstetric indications (hypoxia, developmental delay, etc.), then the woman will have a cesarean section.

If there are no prerequisites for the operation, then a natural birth will occur, during which specialists will constantly monitor sugar levels (regulate it with glucose or insulin injections if necessary), and check other indicators.

A baby may be born with low blood sugar, but this problem should resolve itself during breastfeeding. Doctors will monitor glucose levels and, if necessary, advise you to supplement your baby with formula.

After giving birth, a woman's blood sugar is monitored: as a rule, elevated levels should return to normal within a few days. Also, after a month and a half, you should do a glucose test and then be observed by an endocrinologist for some more time to exclude the development of type 2 diabetes.

Instead of a conclusion

If you have gestational diabetes during pregnancy, this may indicate your body's poor sensitivity to insulin, that is, insulin resistance. This means that you should take care of diabetes prevention and undergo medical examinations and testing from time to time so as not to encounter the disease in the future.