Why is gestational diabetes mellitus dangerous in a pregnant woman? How does gestational diabetes mellitus occur during pregnancy: consequences, risks for the fetus. Tactics for managing women after childbirth

This is an increase in blood sugar above normal for the first time during pregnancy.

Normal blood sugar level pregnant women in the morning on an empty stomach (before meals) no more 5.0 mmol/l, 1 hour after eating no more than 7.0 mmol/l.

And after a glucose load when conducting a glucose tolerance test at 24-28 weeks of pregnancy: after 1 hour< 10,0 ммоль/л, через 2 часа < 8,5 ммоль/л.

Glucose loading cannot be performed if the morning fasting blood sugar level was already ≥ 5.1 mmol/l.

What you need to know about gestational diabetes.

Gestational diabetes mellitus (GDM) is a disease first identified during pregnancy and, as a rule, resolving after childbirth, characterized by an increase in blood sugar levels (hyperglycemia).

Due to physiological changes in a woman’s metabolism during this period, any pregnancy itself is a risk factor for the development of gestational diabetes mellitus. Especially if the pregnancy is multiple or after IVF, and excess weight before pregnancy and a large increase during it increase the risk of developing GDM. In the second half of pregnancy, the body's need for insulin increases due to the fact that some pregnancy hormones block its action. Sometimes it happens that the pancreas cannot produce enough insulin. Then the excess sugar is not removed from the blood, but remains in it in large quantities. From the mother's blood, glucose enters the fetal blood through the placenta, therefore, maternal hyperglycemia will lead to the development of fetal hyperglycemia. The fetal pancreas is stimulated, producing an increased amount of insulin, with the subsequent formation of insulin resistance (decreased sensitivity to insulin), which affects the development of diabetic changes in the child. It can also lead to complications during childbirth, respiratory disorders, hypoglycemia (low glucose levels) after birth, and neonatal jaundice. If GDM is not detected in a timely manner or the expectant mother does not take any action to treat it, then the risk of early aging of the placenta and, as a consequence, delayed fetal development, premature birth, as well as polyhydramnios, increased blood pressure, preeclampsia, the formation of a large fetus and the need to in caesarean section, traumatization of the woman and child during childbirth, hypoglycemia and respiratory failure in the newborn. The most serious complication of untreated GDM is perinatal fetal death.. Therefore, a modern health organization around the world recommends mandatory screening of ALL pregnant women for the earliest possible detection of GDM and its timely treatment.

If you have been diagnosed with GDM, then then there is no reason to despair. Without delay, you must take all measures to ensure that your blood sugar is within normal limits throughout the remaining period of pregnancy. Since the increase in blood sugar during GDM is very slight and is not subjectively felt, it is necessary to begin regular self-monitoring of blood sugar using a portable device - glucometer(during pregnancy, only glucometers calibrated by blood plasma are used - see the instructions for the device).

Blood sugar norms for pregnant: in the morning before meals 3.3-5.0 mmol/l, 1 hour after meals - less than 7.0 mmol/l.

Each sugar value must be recorded in self-control diary indicating the date, time and a detailed description of the contents of the meal after which you measured your sugar.

You should take this diary with you every time to an appointment with an obstetrician-gynecologist and endocrinologist.

Treatment of GDM during pregnancy:

1. Diet- the most important thing in the treatment of GDM

• Easily digestible carbohydrates are completely excluded from the diet: sugar, jam, honey, all juices, ice cream, pastries, cakes, baked goods made from high-grade white flour; rich baked goods (buns, buns, pies),
• Any sweeteners, for example, products containing fructose (sold in stores under the “diabetic” brand) are prohibited for pregnant and breastfeeding women,
• If you have excess body weight, then you need to limit all fats in your diet and completely exclude: sausages, sausages, sausages, lard, margarine, mayonnaise,
• Never go hungry! Nutrition should be evenly distributed over 4 to 6 meals throughout the day; breaks between meals should not be more than 3-4 hours.

2. Physical exercise. If there are no contraindications, then moderate physical activity for at least 30 minutes daily, for example, walking, swimming in the pool, is very useful.

Avoid exercises that increase blood pressure and cause uterine hypertonicity.

3. Diary self-control, in which you write:

• blood sugar in the morning before meals, 1 hour after each meal during the day and before bedtime - daily,
• all meals (in detail) - daily,
• ketonuria (ketones or acetone in urine) in the morning on an empty stomach (there are special test strips for determining ketone bodies in urine - for example, Uriket, Ketofan) - daily,
• blood pressure (BP should be less than 130/80 mm Hg) - daily,
• fetal movements - daily,
• body weight - weekly.

Attention: if you do not keep a diary, or do not keep it honestly, you are deceiving yourself (and not the doctor) and risking yourself and your baby!

1. If, despite the measures taken, blood sugar exceeds the recommended values, then it is necessary to start treatment with insulin (for this you will be referred for a consultation with endocrinologist).
2. Don't be afraid to prescribe insulin. You should know that insulin addiction does not develop, and after childbirth, in the vast majority of cases, insulin is discontinued. Insulin in adequate doses does not harm the mother; it is prescribed to maintain her full health, and the baby will remain healthy and will not know about the mother’s use of insulin - the latter does not pass through the placenta.

CHILDREN and GDM:

The timing and method of childbirth is determined individually for each pregnant woman. No later than 38 weeks of pregnancy, the obstetrician-gynecologist conducts a final examination of the mother and child and discusses the prospects for childbirth with the patient. Prolonging pregnancy beyond 40 weeks with GDM is dangerous; the placenta has few reserves and may not withstand the stress of childbirth, so earlier delivery is preferable. Gestational diabetes in itself is NOT an indication for cesarean section.

GDM after childbirth:

• following a diet for 1.5 months after childbirth,
• insulin therapy is canceled (if any),
• control of blood sugar in the first three days (normal blood sugar after childbirth: on an empty stomach 3.3 - 5.5 mmol/l, 2 hours after meals up to 7.8 mmol/l),
• 6-12 weeks after birth - consultation with an endocrinologist to conduct diagnostic tests to clarify the state of carbohydrate metabolism,
• women who have had GDM are at high risk for developing GDM in future pregnancies and type 2 diabetes in the future, so a woman who has had GDM needs to:
• - follow a diet aimed at reducing body weight if it is excess,
• - increase physical activity,
• - plan subsequent pregnancies,
• Children from mothers with GDM have an increased risk of developing obesity and type 2 diabetes throughout their lives, so they are recommended to have a balanced diet and sufficient physical activity, and supervision by an endocrinologist.

If GDM is detected, patients must completely stop using:

• all sweet products (this applies to both sugar and honey, ice cream, sweet drinks and the like);
• white bread, pastries and any flour products (including pasta);
• semolina;
• semi-finished products;
• smoked meats;
• fast food products;
• fast food;
• fruits containing a lot of calories;
• lemonades, juices in packages;
• fatty meat, jellied meat, lard;
• canned food, regardless of their type;
• alcohol;
• cocoa;
• cereals, diet bread;
• all legumes;
• sweet yoghurts.

You will also have to significantly limit your use of:

• potatoes;
• butter;
• chicken eggs;
• baked goods from uneatable dough.
• Products from the list of prohibited foods should be completely excluded from the diet. Even their small consumption can lead to negative consequences. Potatoes, butter, eggs and baked goods are allowed to be consumed in very limited quantities

What can pregnant women eat with gestational diabetes? The above products can be replaced:

• hard cheeses;
• fermented milk cottage cheese;
• natural yoghurts;
• heavy cream;
• seafood;
• green vegetables (carrots, pumpkin, beets, unlike cucumbers, onions and cabbage, must be consumed in limited quantities);
• mushrooms;
• soybeans and products made from it (in small quantities);
• tomato juice;
• tea.

There are several diet options that can be followed for gestational diabetes, but a low-carbohydrate diet is excluded.

This is due to the fact that if there is insufficient carbohydrate intake from food, the body will begin to burn fat reserves for energy.

The following products must be included in the diet:

• whole wheat bread;
• any vegetables;
• legumes;
• mushrooms;
• cereals - preferably millet, pearl barley, oatmeal, buckwheat;
• lean meats;
• fish;
• chicken eggs - 2-3 pieces/week;
• dairy products;
• sour fruits and berries;
• vegetable oils.

In most cases, doctors prescribe to their patients a diet containing more carbohydrates and moderate amounts of protein. Preference is given to unsaturated fats, the consumption of which, however, must also be limited. Saturated fats are completely excluded from the diet.

Sample menu for pregnant women with gestational diabetes:

Gestational diabetes mellitus during pregnancy is not a common pathology, however, occurs in 5% all women expecting a baby. Such a small percentage of the prevalence of this disease does not at all mean that it is mild and there are no risks for both the child and the expectant mother. It is also worth distinguishing between gestational diabetes and diabetes mellitus, which occurs not only in the female population, but also in men. All of the above parameters for considering the concept of “gestational diabetes mellitus” must be kept in mind when studying this serious pathology.

This pathological condition of a pregnant woman is characterized by changes in metabolic processes in her body with a violation, first of all, of carbohydrate metabolism.

The pancreas, which normally secretes the amount of insulin necessary for carbohydrate metabolism, carries out complete regulation in human peripheral blood. During pregnancy a “hormonal explosion” occurs, leading to changes in the intensity and amount of hormones, in particular insulin.

In connection with the formed insulin deficiency Excessive amounts of glucose circulate in the peripheral blood, and hyperglycemia develops. In addition, cells that perceive glucose with their specific receptors lose their sensitivity and become less susceptible to it, which also leads to a hyperglycemic picture of the blood.

Unlike regular diabetes mellitus type 1 or 2, gestational diabetes is one in which hyperglycemia was detected during pregnancy.

Without timely and adequately selected therapy the disease does not go away without a trace neither for the mother nor for the expected baby. There are a number of undesirable complications, some of which are completely dangerous to the health and life of the fetus or can lead to the formation of congenital defects of structure, growth and development.

Risks of diabetes for a child:

• The developing pancreas of the baby, which normally functions within the physiological level of glucose received from a healthy mother, releases excess insulin during hyperglycemia. Over time, the body adapts to such high levels of insulin and blood glucose. But after childbirth, there is a risk of a sharp drop, since the excess supply of carbohydrates from the mother is no longer carried out, and the pancreas still secretes a lot of its hormones.
• In connection with the above pathological mechanism, the child has a risk of disruption of the respiratory system and brain functioning (since glucose is the main substrate for its normal activity).
• Intrauterine weight and height gain.
• The development of diabetic fetopathy after birth, the manifestations of which include excess weight with an increase in the abdomen relative to the extremities, pastiness, jaundice of the skin and sclera, disorders of respiratory function and an increase in the content of platelets in the blood with the risk of increased formation of blood clots in the vascular bed.

Risks of diabetes for mother:

• Development of renal failure.
• Deterioration of the visual analyzer.
• Late birth due to a large baby.
• Inability to give birth naturally.
• Referring to this, it can be argued that early diagnosis and properly selected therapy for gestational diabetes mellitus is extremely important for the affected pregnant woman.

Causes of gestational diabetes in pregnant women

The etiological basis for this pathology has not been fully studied in the current period of scientific development. However, a certain role is given to such possible reasons, How:

• genetic predisposition;
• autoimmune processes;
• carriage of a viral infection;
• wrong way of life.

Also highlighted risk factors, under the influence of which the development of gestational diabetes mellitus in pregnant women is possible. These include:

• smoking;
• alcohol abuse;
• age over 30 years;
• increased body weight both before and during pregnancy;
• a history of regular diabetes mellitus.

Exist special risk groups for gestational diabetes mellitus in pregnant women, which includes women who have:

• excess body weight;
• family history of diabetes;
• specific ethnicity (blacks, Asians, Hispanics, Americans);
• previously diagnosed gestational diabetes;
• hyperglycemia in a biochemical blood test and glycosuria according to the results of a general urine test;
• early birth of a high birth weight baby;
• history of stillbirth.

Symptoms of gestational diabetes mellitus during pregnancy

The entire clinical picture related to this pathological condition in a woman is not specific to this particular type of diabetes.

There is only a number of general somatic signs poor health and the presence of diabetes mellitus: general fatigue and decreased performance, fatigue, decreased visual acuity, constant or intermittent thirst and a feeling of dryness in the mouth, frequent urge to urinate with the release of large amounts of urine (polyuria).

Assessment of symptoms by pregnant women themselves very often complicates diagnostic measures, since they usually women don't pay attention to all the signs diseases and refer their occurrence to the fact of pregnancy.

The first activity that is absolutely necessary for the pregnant woman herself is constant monitoring of her daily condition and an indispensable seeking help from a leading obstetrician-gynecologist when the first signs appear. It is the timely attendance at an appointment with a specialist by a woman with a set of complaints that is the starting point for the doctor’s further diagnostic tactics.

Additional research methods include: general blood test, general urinalysis, biochemical blood test.

Highly informative specialized oral glucose tolerance test. A woman needs to drink a glass of sweet water containing 50 grams of glucose. After 15-20 minutes, blood is drawn from a vein to determine the level of sugar in peripheral blood. Based on the obtained glucose level, experts assess the utilization capacity of the human body in relation to carbohydrates. An increased level of glucose in the blood means a prerequisite for identifying a pathological condition.

Upon completion of all tests a pregnant woman should live in her usual rhythm of life and eat in accordance with her usual menu in order to eliminate false negative or false positive results of diagnostic tests.

Treatment of gestational diabetes mellitus during pregnancy

All therapeutic measures are reduced to eliminating symptoms and possible complications for the woman and the unborn baby, that is, symptomatic therapy is carried out. It certainly includes nutritional correction, specially designed physical exercises, the use of medications and monitoring of laboratory parameters of biological fluids of the body (primarily glucose levels).

Optimal diet for gestational diabetes mellitus in pregnant women

A pregnant woman should not direct her diet towards reducing body weight, since a new life is developing in her body.

A child requires a sufficient amount of nutrients to carry out plastic and energy metabolism in its cells of various organs and systems. But, as is known, losing body weight increases the body’s resistance to pathologically elevated glucose levels in the peripheral blood. Therefore, a woman is recommended to use those foods that are low in calories and depleted of all essential nutrients.

What is the menu for gestational diabetes in pregnant women? You should eat regularly in small portions, excluding fried and too fatty foods, carbohydrate foods. Admission is limited confectionery, sweets, bananas, persimmons, grapes, figs and cherries. Instant dishes (choux purees, noodles, soups) are also excluded from the diet.

It is recommended to take fiber (vegetables, fruits, cereals, pasta, bread) due to its stimulating effect on the intestines and slowing down the absorption of carbohydrates in the small intestine. It is absolutely indicated to pay special attention to taking everything in your daily diet for gestational diabetes.

Physical exercise

Performing a series of physical exercises not only helps in reducing excess body weight in a woman, but also strengthens her muscular system. In some research works, physical activity is considered one of the factors that stimulate normal insulin function and help reduce excess insulin in the peripheral blood, which reduces the symptoms of gestational diabetes mellitus. Physical activity should be dosed according to how you feel, excluding all abdominal exercises (directly due to pregnancy).

Drug therapy

Insulin therapy is applicable using parenteral (intradermal) administration of insulin preparations. The dosage and type of drug are selected individually for each pregnant woman with gestational diabetes mellitus. Insulin is not used in tablet form, since, being a protein, it is broken down in the gastrointestinal tract under the action of the body's enzymatic systems.

Childbirth is the point at which gestational diabetes usually disappears. However, complications of this pathology, which have already been mentioned above, may occur.

Complications of diabetes can appear not only in the postpartum period, but also immediately before it, which will radically change the course of the birth process. For example, in the case where the child has developed large, natural childbirth is contraindicated due to the risk of injury when passing through the birth canal, and Caesarean section is used.

Of course, following a pregnant woman’s diet after childbirth and carefully monitoring the baby’s condition is an unquestioning requirement for doctors to manage such clinical cases. Especially Measuring blood glucose levels is important mother and child.

Prevention of gestational diabetes mellitus

It is impossible to completely eliminate the likelihood of gestational diabetes using preventive measures. But any pregnant woman can follow a number of rules, which will provide some assistance in preventing this pathology.

• A woman should be monitored, especially during the entire period of pregnancy.
• Regular ones that do not cause discomfort to the pregnant woman are not excluded.
• You should look at your birth control pills with special interest (if you are taking them) - some drugs can contribute to the development of the disease.

Video about gestational diabetes

To get better acquainted with problem of gestational diabetes mellitus We suggest watching a video from which you can once again learn about the possible causes of this disease, symptoms, methods of timely diagnosis and its adequate treatment. The video also talks about preventive measures regarding diabetes in pregnant women, which is no less important for a pregnant woman or a woman planning a pregnancy.

- a type of diabetes that occurs exclusively in women during pregnancy. After giving birth, after some time, it usually goes away. However, if such a disorder is not treated and left untreated, then the problem can turn into a serious disease - type 2 diabetes (and this is a lot of difficulties and unpleasant consequences).

Every woman who becomes pregnant registers with the antenatal clinic at her place of residence. Thanks to this, throughout the entire period of gestation, the health of the woman and her fetus is monitored by specialists, and periodic blood and urine tests are mandatory for monitoring.

If suddenly an increase in glucose levels is detected in the urine or blood, then a single such case should not cause panic or any fears, because for pregnant women this is considered a physiological norm. If the test results show more than two such cases, and glucosuria (sugar in the urine) or hyperglycemia (sugar in the blood) are detected not after meals (which is considered normal), but in tests done on an empty stomach, then we can already talk about gestational diabetes mellitus in the pregnant woman.

Causes of gestational diabetes, its risk and symptoms

According to statistics, approximately 10% of women suffer from complications during pregnancy, and among them there is a certain risk group who may develop gestational diabetes mellitus. These include women:

• with a genetic predisposition,
• overweight or obese
• with ovarian diseases (for example),
• with pregnancy and childbirth after 30 years of age,
• with previous births accompanied by gestational diabetes mellitus.

There may be several reasons for the occurrence of GDM, but this is mainly due to a violation of loyalty to (as with type 2 DM). This is explained by the increased load on the pancreas during pregnancy, which may not be able to cope with the production of insulin, which controls normal sugar levels in the body. The “culprit” of this situation is the placenta, which secretes hormones that resist insulin, thereby increasing glucose levels (insulin resistance).

“Resistance” of placental hormones to insulin usually occurs at 28-36 weeks of pregnancy and, as a rule, this occurs due to a decrease in physical activity, which is also explained by natural weight gain during gestation.

Symptoms of gestational diabetes during pregnancy are the same as for type 2 diabetes:

• increased feeling of thirst,
• lack of appetite or constant feeling of hunger,
• discomfort from frequent urination,
• possible increase in blood pressure,
• blurred vision.

If any of the above symptoms are present, or you are at risk, be sure to inform your gynecologist so that he can examine you for GDM. The final diagnosis is made not only by the presence of one or more symptoms, but also on the basis of tests that must be taken correctly, and for this you need to eat foods that are included in your daily menu (do not change them before taking the test!) and lead a normal lifestyle .

The norm for pregnant women is:

• 4-5.19 mmol/liter- on an empty stomach,
• no more than 7 mmol/liter- 2 hours after eating.

If the results are questionable (i.e. the increase is insignificant), a glucose load test is performed (5 minutes after taking the test on an empty stomach, the patient drinks a glass of water in which 75 g of dry glucose is dissolved) to accurately determine a possible diagnosis of GDM.

How dangerous is gestational diabetes mellitus (GDM) for a child?

For the safety of the fetus in the placenta, hormones such as cortisol, estrogen and lactogen are necessary. However, these hormones are forced to resist insulin, which disrupts the normal functioning of the pancreas, and because of this, not only the mother suffers, but also her baby.

The formation of the fetus occurs in the first trimester of pregnancy, and therefore GDM that appears after 16-20 weeks cannot lead to any abnormalities in organ development. Moreover, timely diagnosis is quite capable of helping to avoid complications, but there remains the danger of diabetic fetopathy (DF) - “feeding” of the fetus, the symptoms of which are associated with impaired development.

The most common symptom of DF deviation in GDM is macrosomia - an increase in fetal size in weight and height. This happens due to the large amount of glucose supplied for fetal development. The child’s pancreas, which is not yet fully developed at this moment, produces its own insulin in excess, which converts excess sugar into fat. As a consequence of this, with normal sizes of the head and limbs, the shoulder girdle, heart, liver, and abdomen increase, and the fat layer is expressed. And what are the consequences of this:

• due to obstructed passage of the child’s shoulder girdle through the birth canal, a difficult birth occurs;
• for the same reason - damage to the mother’s internal organs and possible injuries to the child;
• due to the enlargement of the fetus (which may not yet fully develop) causing premature birth.

Another symptom of DF is difficulty breathing in the newborn after birth. This happens due to a decrease in surfactant, a substance in the lungs (this is due to GDM in a pregnant woman), and therefore, after the birth of the child, they can be placed in a special incubator (incubator) under constant monitoring, and if necessary, they can even perform artificial respiration using a ventilator.

Treatment and prevention of gestational diabetes mellitus

As we have already said, the main cause of GDM is an increase in sugar, and therefore treatment, as well as the prevention of the disease, is based on controlling this indicator in the body.

The task of a pregnant woman is to undergo regular tests and strictly follow the recommendations of the attending gynecologist. In addition, you should monitor (or even change) your diet and lifestyle.

As doctors’ practice and statistical data show, the main key to the health of a mother and her child is proper nutrition, which is needed not for weight loss (losing weight), but to normalize glucose levels. And here it is important to eat less calorie, but at the same time nutritious food. And this means:

• exclude baked goods and confectionery from your diet, but do not exclude carbohydrates from your diet altogether (this is a source of energy);
• limit or exclude certain types of fruits that contain easily digestible carbohydrates;
• stop eating semi-finished and instant foods (noodles, soups, cereals, purees, sausages);
• stop eating smoked meats, margarine, mayonnaise, butter, pork;
• do not forget about protein foods: they are very important for the body;
• when preparing food, it is preferable to boil, stew, bake or steam food;
• Meals should be in small portions, but every 3 hours.

In addition, the expectant mother will benefit from:

• special classes,
• walking in the fresh air away from the roadway.

Physical activity promotes effective neutralization of sugars (less glucose accumulates in the blood and its level decreases), good metabolism and has a beneficial effect on overall well-being.

Gestational diabetes: find out everything you need to know. The signs and diagnosis of this disease are described below. Treatment with diet and insulin injections is described in detail. Read the blood glucose standards for pregnant women, how to reduce morning sugar, what you can eat, in what cases you need to inject insulin, what doses are prescribed. Using the treatments described in this article, you will most likely be able to do without insulin.

Gestational diabetes is high blood sugar that is first detected in a woman during pregnancy. As a rule, this problem occurs in the second half of pregnancy. Sugar increases due to natural physiological reasons against the background of a woman’s predisposition and the presence of risk factors. The diagnosis of gestational diabetes assumes that the patient's glucose levels were normal before conception. Planning and management of pregnancy in women who already have type 1 or type 2 diabetes is discussed in the article “”.

Below you will learn how to normalize sugar during pregnancy, carry and give birth to a healthy baby, and protect yourself from type 2 diabetes in subsequent years.

Gestational diabetes is a complication of pregnancy that occurs with an incidence of 2.0-3.5%. Its risk factors:

• overweight, obesity;
• the pregnant woman is over 30 years old;
• diabetes mellitus in one of your relatives;
• polycystic ovary syndrome;
• pregnancy with twins or triplets;
• During a previous pregnancy, a large baby was born.

This page describes in detail the diagnosis of high blood sugar in pregnant women, as well as treatment with diet and insulin injections. Answers are given to questions that women often have about this disease.

What are the signs of gestational diabetes in pregnant women?

This metabolic disorder has no external signs until an ultrasound shows that the fetus is too large. At this point, you can still start treatment, but it’s too late. It is better to start treatment in advance. Therefore, all women are routinely required to take a glucose tolerance test between 24 and 28 weeks of pregnancy. High blood sugar in a pregnant woman can be suspected if the woman gains excessive weight. Sometimes patients note increased thirst and frequent urge to urinate. But that rarely happens. You cannot rely on these symptoms. A glucose tolerance test must be taken in any case.

Diagnostics

The above are risk factors for gestational diabetes. Women who have them need to undergo a glucose tolerance test at the stage of pregnancy planning. During this examination, a blood test is taken on an empty stomach, then the patient is given a glucose solution to drink, and the blood is taken again after 1 and 2 hours. In people with impaired carbohydrate metabolism, sugar levels increase after consuming glucose. The test may detect previously undiagnosed type 1 or type 2 diabetes. In the absence of risk factors, a glucose tolerance test is taken not at the planning stage, but already during pregnancy, at the beginning of its third trimester.

What is the test for diabetes mellitus in pregnant women?

You need to take a laboratory test for glucose tolerance. It takes 2 or 3 hours and requires several blood draws. Different doctors conduct this test using a solution of 50, 75 or 100 grams of glucose. Analysis for glycated hemoglobin is more convenient, but in this case it is not suitable because it gives too late results.

Acceptable blood sugar levels during pregnancy

After taking a glucose tolerance test, a diagnosis of gestational diabetes mellitus is made if at least one of the values ​​exceeds the specified threshold. Subsequently, insulin dosages are adjusted in such a way as to reduce glucose levels on an empty stomach and 1 and 2 hours after meals to normal. Let us repeat that impaired glucose metabolism is hidden. It can only be detected in time with blood sugar tests. If the disease is confirmed, you also need to monitor your blood pressure and kidney function. To do this, the doctor will prescribe additional blood and urine tests and advise you to buy a tonometer for home.

Normal blood sugar levels in pregnant women

When is insulin prescribed for gestational diabetes?

If a pregnant woman is diagnosed with high blood sugar, the doctor can immediately prescribe insulin injections. Sometimes doctors say that you can’t get by with just one drug, and you need to inject two at once. This can be long-acting insulin in the morning or evening, as well as a quick-acting drug before meals.

Instead of starting insulin injections right away, switch to. Completely give up everything, including fruits. Over the course of 2-3 days, evaluate the effect it has on your blood glucose readings. It may turn out that insulin injections are not necessary. Or you can limit yourself to minimal doses, many times lower than those to which doctors are accustomed.

What insulin is used for GDM?

First of all, they start injecting extended-release insulin. The drug most often prescribed. Because this type of insulin has received convincing evidence of its safety for pregnant women. You can also use one of the competing drugs or. It is not advisable to inject medium insulin Protafan or any of its analogues - Humulin NPH, Insuman Basal, Biosulin N, Rinsulin NPH.

In severe cases, you may need additional injections of short-acting or ultra-short-acting insulin before meals. They may prescribe the drug Humalog, Apidra, Novorapid, Actrapid or some other drug.

Read about short-acting and ultra-short-acting insulin preparations:

Pregnant women on a low-carb diet generally do not need to inject rapid insulin before meals. Except in rare cases, type 1 diabetes is mistaken for gestational diabetes.

At the moment, it is better to avoid domestically produced types of insulin. Use a high-quality imported drug, even if you have to buy it with your own money. Let us repeat that compliance reduces the required doses of insulin by 2-7 times compared to those to which doctors are accustomed.

How is insulin discontinued after childbirth for gestational diabetes?

Immediately after childbirth, the need for insulin in diabetic women drops significantly. Because the placenta stops secreting substances that reduce the body’s sensitivity to this hormone. Most likely, it will be possible to completely cancel insulin injections. And blood sugar will not rise despite this cancellation.

If you continue to inject insulin after birth in the same doses as during pregnancy, your glucose levels may drop significantly. Most likely it will happen. However, doctors are usually aware of this danger. They reduce their patients' insulin doses in time to prevent it.

Women who have had gestational diabetes are advised to remain on a low-carbohydrate diet after giving birth. You are at significant risk of developing type 2 diabetes after age 35 to 40. Eliminate unhealthy carbohydrates from your diet to avoid this disaster.

Gestational diabetes (diabetes mellitus in pregnant women) is a fairly rare phenomenon, but not harmless. In approximately 4% of pregnancies, women first encounter problems with elevated glycemic levels. This condition is caused by a violation of carbohydrate metabolism in the body. Every woman should be aware of the possible occurrence of GDM and stop and normalize glucose levels at the first sign.

The consequences of gestational diabetes, or diabetes in pregnant women, are severe for both mother and fetus. Many women, not knowing such a disease, having never previously encountered high sugar levels, can simply correlate the signs of the disease with their new situation. This can lead to disastrous results and affect the health and even life of the baby.

Signs of GDM

The symptoms of this disease are no different from ordinary diabetes, although sometimes it can be almost asymptomatic. That's why pregnant women undergo blood and urine tests so often. Early detection of the disease helps to deal with the problem faster. After all, if gestational diabetes usually goes away after childbirth and the woman lives a normal life, then latent diabetes mellitus during pregnancy (manifest) can develop into regular diabetes of the 1st or 2nd type.

You need to pay attention to the following symptoms:

1. Dry mouth.

2. Feeling of bladder fullness, frequent and copious urination.

3. Fatigue and constant feeling of tiredness.

4. A strong feeling of hunger, but at the same time there may be a sharp weight loss or, conversely, a sharp increase in body weight.

5. Itching may occur in the perineal area.

6. Thrush.

7. Drowsiness.

The signs of gestational diabetes in pregnant women, as can be seen from the list, are not very obvious, so it is better to play it safe and consult a doctor.

Risk factors

A good gynecologist can determine in advance the possible risk of GDM during pregnancy, only by taking a history of a pregnant woman during registration. Overweight women are more likely to be at risk if their immediate family members have type 1 or type 2 diabetes; if the previous pregnancy was accompanied by periodic increases in glycemic levels or there was polyhydramnios.

The result also depends on the gestation of the previous fetus. For example, if there was a previous stillbirth, miscarriages, or the child was born very large (more than 4 kg). Also at risk are women whose children from previous pregnancies have developmental defects.

Studies have shown that even certain national groups of the population are susceptible to the disease. These are blacks, Asians, Latinos, Indians. More often, the disease may occur in a woman who becomes pregnant for the first time after 30-35 years.

Danger of GDM for women

If diabetes is not compensated in time, pregnancy can result in a number of complications for the mother. There are frequent urinary tract infections, preeclampsia develops, which affects the blood vessels of the body, and this can lead to malnutrition of the fetus.

The resulting polyhydramnios can affect the functioning of the kidneys, causing inflammatory processes. Vision suffers. Sometimes ketoacyanosis occurs, which leads to poisoning of the body. Constantly elevated glucose levels cause infection of the genital tract, which is subsequently transmitted to the fetus.

Due to the predominance of adipose tissue in overweight pregnant women, the level of cytokines produced by the cells of the body's immune system is disrupted. Dysregulation leads to a range of metabolic, vascular and inflammatory reactions in the body.

Gestational diabetes mellitus in pregnant women and cytokines that are synthesized in adipose tissue cause overexpression of inflammatory genes. This may result in premature delivery or surgery (caesarean section).

Complications for the fetus

Gestational diabetes (diabetes mellitus in pregnant women) in the early stages of fetal development can lead to various malformations. After all, the child receives nutrition in the form of glucose, but he does not yet produce insulin, since his pancreas has not yet formed, and he does not receive enough of it from his mother. This causes a lack of energy and leads to underdevelopment of the baby's organs.

Subsequently, at a later date, when the child has his own pancreas, it begins to produce double amounts of insulin for its body and the mother’s. This leads to hyperinsulinemia, which threatens asphyxia, that is, a violation of the child’s respiratory functions. The presence of a large accumulation of amniotic fluid also causes asphyxia of the child.

Frequent changes in blood glucose levels can lead to malnutrition of the child’s brain, which will slow down his mental development. Excess sugar, when exposed to insulin, turns into fat deposits, so children are born very large, suffering from fetopathy.

Fetal fetopathy

With gestational diabetes mellitus in pregnant women, babies are born with an appearance characteristic of the disease. Firstly, they have a very large weight, sometimes reaching more than 6 kg. The skin has a bluish tint due to the presence of subcutaneous hemorrhages, the so-called petechial rash. There is a large amount of cheese-like lubricant on the body. The face is puffy and the whole body is swollen, due to the presence of excessive deposition of fatty tissue in the body. The body of a newborn has broad shoulders and short limbs.

At birth, there is a lack of synthesis of surfactant in the lungs, which is involved in straightening the lungs and producing the first breath. In the initial hours of life, breathing problems are possible, from temporary stoppage to shortness of breath.

With diabetic fetopathy, the child develops jaundice, caused by liver pathology and requiring therapeutic treatment. Also, when a child is born to a pregnant woman with GDM, activity, muscle tone, and the sucking reflex may initially be reduced. Sometimes there is tremors of the limbs and restless sleep.

In those born with fetopathy, a blood test shows an increased number of red blood cells, hemoglobin levels and low glycemia.

Treatment of fetopathy

Since the newborn’s sugar level is reduced, in order to avoid hypoglycemia, the child needs to be given a 5% glucose solution half an hour after birth. Such a child is fed every two hours. If there is a lack of milk, mothers use expressed milk from other women in labor.

If respiratory function is impaired, artificial ventilation is performed. If necessary, a surfactant is administered, which is necessary to take the first breath and open the child’s lungs. For disorders of the nervous system, calcium and magnesium are prescribed.

Yellowness of the skin and eye sclera is treated with ultraviolet radiation. The eyes are covered with a bandage during the procedure. The procedure time is carefully monitored by doctors to avoid possible burns.

To ensure that the child does not suffer from such a disease and is born healthy, a mother who has gestational diabetes (diabetes mellitus in pregnant women) must do everything necessary to lower blood sugar levels, undergo the necessary examinations, follow a diet, then the child will be born without such problems.

Diagnosis of GDM

Knowing the symptoms of the disease, at the first sign or doubt, a woman should contact her treating gynecologist. You will need to take a blood test from a finger or vein. The analysis is taken on an empty stomach, before which you do not need to limit yourself in food, activity or be nervous, otherwise the result may be questionable.

Also, in the early stages of pregnancy, you can be tested for latent diabetes mellitus with a special glucose load. It will help identify disorders of carbohydrate metabolism in the body. The test is also carried out on an empty stomach. After taking blood for the first time, you need to drink a solution consisting of 75 g of glucose or regular sugar mixed in 300 ml of clean still water. After 2 hours, a repeat blood test is given.

The next time you check your glucose levels is later in pregnancy (weeks 24-28). During this period, hormone levels are activated.

Treatment of gestational diabetes

First of all, pregnant women who are overweight should begin to fight them. An active lifestyle and a properly formulated diet will help you cope with this.

You need to constantly monitor your blood sugar levels. Measurements are taken on an empty stomach and 2 hours after eating. Only 4 times a day. You should also take urine tests to check your ketone bodies. Be sure to monitor your blood pressure.

In those rare cases when glycemic compensation does not occur by normalizing nutrition, the doctor prescribes insulin therapy. During pregnancy, the use of sugar-lowering drugs is contraindicated; therefore, treatment of gestational diabetes mellitus in pregnant women is carried out with insulin injections. The prescription is given only in cases where the diet for 2 weeks has not given a positive result or in the presence of fetal suffering, according to ultrasound diagnostic indications. After childbirth there is no need for them.

Nutrition for GDM

The diet for pregnant women with gestational diabetes mellitus will have to be radically revised. Excess weight reduces insulin resistance. But the time of bearing a child requires energy and additional strength for a woman. Therefore, both mother and fetus must be provided with the nutrients the body needs. But the calorie content of food needs to be significantly reduced.

During the entire pregnancy, a woman gains weight from 10 to 15 kg. You can calculate your calorie intake per day. It is recommended to eat whole grain products. For normoglycemia, a low-carbohydrate diet is needed, but during pregnancy, the body really needs carbohydrates; without them, the formation of ketone bodies will begin, which negatively affects the unborn child.

You only need to significantly reduce so-called fast carbohydrates (or completely abandon them). This includes sugar and honey, jams and cakes, juices and sweet fruits (figs, bananas, persimmons, mangoes, dates), berries, especially grapes and raisins. If you really want something sweet - and you always want something that is not allowed - then during pregnancy it is prohibited to substitute sugar substitutes. You can sometimes use fructose, but if these are flour products such as waffles or baked goods with fructose, then it is better to abstain. Because of the flour, there are so many carbohydrates.

Carbohydrates with a glycemic index are also found in bread, potatoes, cereals, semolina and rice cereals. In general, the diet for gestational diabetes mellitus in pregnant women is not much different from normal healthy food for people interested in the correctness of their diet. This is an ordinary healthy food that is beneficial for absolutely everyone.

Under no circumstances should you consume instant foods, 1-minute soups, porridges and noodles in bags, or puree powder. Avoid drinking carbonated soda water and packaged juices. You should also not eat sausages or small sausages.

How to prepare dietary foods?

In case of gestational diabetes mellitus in pregnant women, the consumption of animal fats is not recommended. Fatty meats such as pork and lamb can be replaced with dietary ones: beef, veal. Lean sea fish and meat can be baked, steamed, or boiled. Steamed veal cutlets with the addition of carrots are an excellent replacement for the usual ones fried in a frying pan.

Replace lard with vegetable oils, pour vegetable salad with olive oil instead of mayonnaise or rich sour cream, buy cottage cheese and kefir only in low-fat form. Get used to vegetable dishes, with the rare inclusion of potatoes. Vegetables can be stewed, boiled, steamed, baked in the oven and grilled.

For gestational diabetes mellitus in pregnant women, what can you eat from meat dishes? Any lean meat and offal, but meat and fish are very tasty to cook in the oven, baking with vegetables. And of course, under no circumstances should you eat fried, spicy, salty, smoked, or spicy foods. Spices and ketchups won't do any good either.

Can be consumed in small quantities

The diet for gestational diabetes mellitus in pregnant women allows the consumption of the following foods, but only in small portions:

• bread made from rye flour;
• sour fruits such as orange, cherry, apples, lemon;
• chicken or quail eggs;
• durum wheat pasta;
• sunflower seeds;
• beets and peas, lentils;
• butter;
• nuts;
• fructose-based sweets and chocolate;
• berries can be sour, such as blueberries, strawberries, currants, gooseberries.

Basic consumer products

The basis of the menu for gestational diabetes mellitus in pregnant women should be vegetables: cucumbers and tomatoes, carrots and zucchini, parsley, dill, celery, lettuce, eggplant, radish and radish. You can cook mushrooms. For salads, sunflower, corn or olive oil is used.

Meat products are consumed boiled, baked and steamed, and only low-fat. Veal and rabbit, poultry and beef, offal (beef liver and tongue), or chicken liver. Only low-fat sea fish is suitable. For example, flounder, perch, notothenia, hake, cod. You can have a variety of seafood: shrimp, mussels, squid, crabs. Of the river fish, only catfish is suitable.

The diet for gestational diabetes mellitus in pregnant women may also include low-fat fermented milk products. Kefir and cottage cheese should be low-fat (0% fat), milk can sometimes be bought, but only 1%. You can add buckwheat and rolled oats (oatmeal) to vegetable broth soups.

How should you eat?

The menu for gestational diabetes mellitus in pregnant women should be divided into several parts, consisting of main meals and light snacks at regular intervals.

For breakfast you should eat up to 40% carbohydrates. Before bed, your last evening snack should also contain a small amount of carbohydrates. Skipping meals is strongly discouraged. You need to drink up to 1.5 liters of clean water per day.

If you are worried about nausea in the morning, but want to lie down a little more, then put some cookies, unsweetened fructose crackers, on the nightstand near your bed before going to bed. It is enough to chew a few pieces to feel much better.

You should also consult with your doctor about the need to take a vitamin complex, replenishing your supply of vitamins and minerals.

The diet for gestational diabetes mellitus in pregnant women includes a mandatory daily intake of fiber (from 20 to 35 g). It is included in cereals, pasta, whole grain bread, and vegetables. These foods also contain large amounts of vitamins and minerals.

Physical exercise

Gestational diabetes mellitus, according to reviews from pregnant women, will not cause complications for either the health of the mother or the health of the baby if, in addition to diet and regulation of blood sugar levels, you lead a healthy lifestyle. Many pregnant women perceive their condition as an illness and spend most of the day lying in bed. But it's not right.

An active lifestyle improves insulin action. Slow walking, a walk in the fresh air, a set of special exercises designed for different periods of pregnancy - all this not only helps to reduce the weight of obese women, but also improves pulmonary ventilation, delivering the necessary oxygen to the developing body.

The only thing you need to remember is that a woman herself must regulate her well-being. If the pulse noticeably accelerates or nagging pain appears in the lower back or abdomen, stop gymnastics immediately. You also need to remember that it is strictly prohibited to perform any exercises with power loads, abdominal exercises and jumping.

If the doctor has prescribed insulin therapy, which reduces the level of glycemia, then during physical activity it can drop critically, so you need to take a sandwich or some fruit, such as an apple, with you for training. You should also not skip a scheduled meal (before or after training).

After giving birth, for safety reasons, so that gestational diabetes does not develop into regular diabetes, you need to be monitored by an endocrinologist and gynecologist, monitor your weight, and continue to follow a healthy diet. If you need birth control, talk to your doctor, as many of them can cause an increase in glucose levels.