Author of the article - an obstetrician Grigorieva Xenia S.
Gestational diabetes mellitus (GDM) - increase in blood sugar in pregnant women, which tends to disappear without a trace after delivery. The normal fasting sugar indicators comprise 3,3-5,5 mmol / l. When indications of 5.5 to 7.1 mmol / L indicate pre-diabetes. Indicators above indicate diabetes.
High blood sugar can cause problems for pregnant women and the fetus, therefore, necessary to consult an obstetrician-gynecologist and endocrinologist. With timely treatment to the doctor, and compliance with all the recommendations have every chance to make a healthy child and give birth naturally without complications.
Gestational diabetes develops rarely, its frequency of occurrence of all pregnancies is approximately 5%. It occurs mostly in the third trimester.
Causes of
Blood sugar levels in humans is controlled by the pancreas, which produces insulin. When glucose is ingested with food, it is under the action of the hormone enters the cell body, and the blood sugar level falls.
During pregnancy, the load on the pancreas is increased. This happens because the placenta secretes hormones acting opposite to insulin. Therefore, sometimes the pancreas can not cope with the work and the level of sugar in the blood increases. In this case the metabolism both in the mother and the fetus. Excess sugar in the blood crosses the placenta into the bloodstream of the child, thereby increasing the burden on the not yet fully matured pancreas.
risk groups
Women who have one or more of the following symptoms are most susceptible to the emergence of gestational diabetes. But it does not give 100% guarantee that will happen the development of this pathology. The risk group includes women who:
- transferred diabetes in a previous pregnancy;
- obesity;
- Polycystic ovary syndrome;
- genetic predisposition to diabetes;
- heightened the level of sugar in the urine;
- a stillborn child in history;
- polyhydramnios (Increased amount amniotic fluid);
- in the past, the birth of a large baby (over 4 kg).
Less prone to gestational diabetes pregnant women who are younger than 25 years, have normal weight and who do not have a genetic predisposition to the HSD.
Signs of diabetes in pregnancy
On the development of GDM and woman can not know, as the disease is rarely seen. It is possible to identify when a blood test for sugar.
- The normal fasting sugar indicators comprise 3,3-5,5 mmol / l.
- When indications of 5.5 to 7.1 mmol / L indicate pre-diabetes.
- Indicators above indicate diabetes.
The following symptoms may occur when severe gestational diabetes:
- constant thirst;
- frequent and copious;
- increased appetite;
- "Blurred" in the eyes.
If a pregnant woman finds a these signs without high blood sugar, do not rush to panic. The above symptoms often occur in the normal course of pregnancy. Regular visits to obstetrician and delivery of analyzes will help in time to prevent the development of diabetes.
Diagnostics
If a woman believes that she has signs of disease or are at risk, you should inform your doctor and go through additional screening. Routine diagnosis of disorders of carbohydrate metabolism is carried out 2 times during pregnancy.
For the first time carried out when registering for pregnancy in female consultation. Analysis of venous blood is taken on an empty stomach sugar (sometimes performed in conjunction with a biochemical blood analysis). This study is carried out on a mandatory basis for up to 24 weeks.
The second time - in the period 24-28 weeks of pregnancy.
If a pregnant woman is still convinced that she develops gestational diabetes, it is possible to carry out further analysis, which is called "oral test organism glucose tolerance."
Test for glucose tolerance
As he passes? You will need to drink a sweetish liquid, which contains 50 grams of sugar. After 20 min, then taken out of the vein and blood is determined by how well the body metabolizes glucose. If the analysis is written, 7.7 mmol / L or more, it indicates a high level of sugar. In this case, the doctor will suggest to do more analysis, but only this time on an empty stomach.
differential diagnosis
It is sometimes difficult to distinguish the true from the HSD type 2 diabetes. It is possible that the woman had a high sugar before pregnancy. I know it will be possible only after 6-12 weeks after delivery at the time re-analysis of the level of blood sugar. It should be noted that women who have had gestational diabetes have a higher chance of developing diabetes in the future. It is therefore recommended to be tested for sugar after delivery every 3 years for the timely diagnosis of disorders of carbohydrate metabolism.
GDM treatment
In order to avoid possible complications, you need to clearly and correctly follow the doctor's recommendations. The main activities for the treatment of gestational diabetes:
1. Regular examination by an obstetrician-gynecologist, internist and endocrinologist.
2. Controlling blood sugar levels using a special device - the meter. Control carried out 4 times a day (fasting and one hour after each meal).
3. The diet, which excludes digestible carbohydrates, ie sweet foods: candy, chocolate, cakes, sugar, cakes, dates, buns, soft drinks and so on. And should limit the use of fats. The meals are better divided into 4-5 times.
4. Moderate exercise (walking, morning exercise, swimming).
5. Control of blood pressure.
6. Control of fetal movements, his body weight.
7. Keeping a diary in which to record all daily measurement data.
8. Keeping a food diary (record everything eaten).
Diet
The most important problem in the treatment of gestational diabetes - the maintenance of blood sugar levels normal.
It is recommended to eat small portions, fractional, a day 4-6 times. This is done in order to avoid a spike in blood sugar. The diet is based on the fact to avoid eating sugar, sweets, cakes, jams and so on. One word - sweet (simple carbohydrates). Complex carbohydrates (legumes, cereals, fruits, berries, etc.) Is recommended to limit to 50% of the total food.
For women with normal weight per day is recommended to consume 30 kcal / kg overweight - 25 kcal / kg, obesity - to 15 kcal / kg.
Fatty and fried foods is also better to avoid them almost no nutrients, but a lot of calories. It is recommended to eat foods with fiber. These include: cereals, rice, vegetables, fruit, pasta and others. Fiber is useful not only to patients, but also for all pregnant women, as it stimulates the bowels and reduces the absorption of excess sugar in the blood. In addition, it contains many vitamins and minerals.
You should try to avoid eating hot dogs, sausages, smoked meats, pork, bacon, lamb. These products contain a lot of visible and hidden fats. Preferred lean meats (turkey, chicken, beef) and fish. Products, it is desirable to take boiled or steamed.
Excluded from the diet butter, margarine, mayonnaise, sour cream, nuts, sauces and so forth.
It is recommended to drink at least 1.5 liters of fluid a day.
insulinotherapy
When the poor diet, pregnant with gestational diabetes administered insulin. Do not be scared, if all the recommendations of the doctor and the insulin is safe for a pregnant woman, and for her baby. For it is not developing addiction, so after birth it can be easily undone.
As insulin when administered GDM
Insulin is administered intravenously. Before applying the skin does not need to be disinfected, since insulin is destroyed under the influence of alcohol. But syringes, of course, must be disposable and hygiene practices are met.
It is important to comply with all the rules of insulin therapy and the treating physician. It is impossible to miss and change the dose yourself.
During treatment often have to measure blood sugar using a glucometer. All readings will need to write down in a notebook and show the doctor.
Indications for insulin:
- poor diet for two weeks;
- signs of disease on fetal ultrasonography (large fruit, enlarged liver and spleen, edema, and thickening of the subcutaneous fat layer, cardiopathy, thickening of cervical folds);
- polyhydramnios resulting in gestational diabetes.
Important! Tablets hypoglycemic drugs are contraindicated during pregnancy and lactation.
delivery
Uncomplicated gestational diabetes is not an indication for early delivery and cesarean section.
Cesarean operation is performed only in the case of diabetic pronounced signs of fetal disease. For example, when large amounts (to avoid birth trauma). As well as for other indications, which are not related to gestational diabetes.
Observation postpartum
After delivery, all the patients insulin therapy is canceled. During the three days shows the mandatory control of blood sugar.
Most sluchaevGSD resolves after delivery without a trace. Yet, these women are at risk for the emergence of type 2 diabetes in the future. 6-12 weeks after delivery is recommended to visit an endocrinologist and to hand over the venous blood sugar on an empty stomach.
Pediatrician should be informed about the transferred diabetes during pregnancy.
possible complications
GDM can adversely affect fetal development. Therefore it is necessary to note once again how important it is to take the time to carry out tests and prescribing physician.
In early pregnancy increases the risk of miscarriage. You must comply strictly with diet prescribed by your doctor, do not succumb to stressful situations and measure the blood glucose meter blood sugar.
such a complication as a large fruit (occurs more frequently than others) may appear in the second and third trimester. It grows at the expense of large amounts of glucose. It is important to note that for these children after birth need a mandatory special inspection pediatrician. Separated from his mother, he no longer receives so much glucose, and performance in its blood sugar can be reduced greatly. Such a condition is corrected feeding breast milk or special mixtures.
Possible complications that can occur in the case of undiagnosed illness or if left untreated:
- violation of the child's body proportions (big belly and skinny arms, legs);
- tissue edema;
- jaundice;
- hypoglycemia;
- hypoxia.
Some studies in pregnancy
- Smears during pregnancy.
- Tests during pregnancy by trimester.
- Ultrasound during pregnancy.
- Urinalysis in pregnancy.
- Coagulation.
- Installing pessary.
- Glucose tolerance test.
- Homocysteine in pregnancy.
- Amniocentesis.
- Anesthesia during childbirth.
- Fetal CTG (cardiotocography)
- Cordocentesis.
- Epidural anesthesia during childbirth.
