How does gestational diabetes mellitus (diabetes during pregnancy) affect your baby?

Gestational diabetes mellitus: causes, symptoms, treatment

Gestational diabetes mellitus
is a type of diabetes that occurs or is first diagnosed during pregnancy.
The basis of the disease is a violation of carbohydrate metabolism of varying degrees, namely a decrease in glucose tolerance in the body of a pregnant woman. It is also commonly called gestational diabetes
.

The results of epidemiological studies conducted in the USA showed that gestational diabetes mellitus develops in 4% of all pregnant women. European researchers have announced data according to which the prevalence of gestational diabetes mellitus

ranges from 1-14% of the total number of pregnancies. About 10% of women after childbirth remain with signs of the disease, which subsequently transforms into type 2 diabetes mellitus. According to statistics, half of women who have gestational diabetes mellitus during pregnancy develop type 2 diabetes mellitus over the next 10-15 years.

Such high rates of prevalence of this pathology and possible complications indicate low awareness among women about the possible risks of developing gestational diabetes mellitus and its consequences, and, as a consequence, late seeking diagnosis and qualified help. To ensure timely detection of the disease, reproductive centers for family planning and antenatal clinics are currently carrying out active educational work to preserve the health of women and contribute to the birth of healthy offspring.

What to do if gestational diabetes is diagnosed?

If an obstetrician suspects gestational diabetes, she refers the patient to an endocrinologist to confirm the diagnosis and treatment.

The most important thing for gestational diabetes is diet.

This is not easy, but it is necessary for a successful pregnancy and the birth of a healthy child. You cannot eat sweets (sugar, candy, honey, cakes, fruit juices, bananas, grapes, etc.), baked goods made from white wheat flour, semolina and millet porridge, mashed potatoes. A pregnant woman with diabetes should eat small, frequent meals to avoid sudden fluctuations in blood sugar. At the appointment, the endocrinologist will create a detailed diet taking into account the individual characteristics of each patient.

Another important point in the treatment of gestational diabetes is regular measurement of blood sugar.

Each patient needs to independently measure her sugar using a glucometer at least 6-8 times a day. Measurements are taken on an empty stomach and 1 hour after meals, before bedtime, and sometimes at other hours if necessary. Only frequent monitoring of sugar allows you to achieve the ideal values ​​​​necessary during pregnancy - less than 5.1 before meals, less than 7.0 1 hour after meals.

Tablets that lower blood sugar cannot be used in pregnant women with diabetes; they are contraindicated. Therefore, if a woman cannot normalize her blood sugar with a diet, then insulin injections are prescribed. As a rule, insulin doses are selected in a hospital setting, where the patient is taught to administer insulin independently. It's not difficult and almost painless! There is no addiction to insulin! Insulin is discontinued immediately after birth, under the control of blood sugar levels.

What is the threat of diabetes during pregnancy?

First of all, it has a negative effect on the growth and development of the fetus. When gestational diabetes mellitus occurs in the early stages of pregnancy, there is a significant increase in the risk of spontaneous abortion and the appearance of congenital malformations of the heart and brain structures of the fetus. If diabetes mellitus begins later in pregnancy (2nd-3rd trimesters), it leads to excessive growth of the fetus (macrosomia) and hyperinsulinemia, and after birth it can be complicated by diabetic fetopathy. Signs of diabetic fetopathy in a newborn are excess weight of the child (exceeding 4 kg), body disproportion, excess subcutaneous fat, respiratory disorders, hypoglycemia, increased blood viscosity with the risk of thrombosis.

How does gestational diabetes during pregnancy differ from other types of diabetes?

Diabetes mellitus is a disease characterized by a gross disturbance of carbohydrate metabolism due to insufficiency of the pancreatic hormone - insulin - in the blood, which can be absolute or relative. Diabetes mellitus is almost always accompanied by an increased level of glucose in the blood - hyperglycemia and the detection of sugar in the urine - glucosuria. According to WHO, there are several types of diabetes.

Type 1 diabetes mellitus occurs in childhood and adolescence as a result of the autoimmune breakdown of specific pancreatic cells that produce insulin, which leads to a decrease or complete cessation of its production. Type 1 diabetes mellitus occurs in 15% of all patients with diabetes mellitus. The disease is detected when a high starting level of glucose is detected in the blood at a young age, and antibodies to β-cells and insulin can also be detected in the blood. The level of insulin in the blood in such patients is reduced. To treat patients with type 1 diabetes, insulin injections are used - unfortunately, there are no other ways.

Type 2 diabetes mellitus more often develops in overweight people in the second half of life against the background of genetic defects, previous infectious diseases, acute and chronic pancreatitis, and taking certain medications and chemicals. The disease is characterized by a hereditary predisposition. Laboratory diagnostics show an increase in glucose levels in the blood of patients (>5.5 mmol/l). Treatment of such patients consists of prescribing a special diet, physical activity and taking medications that lower blood glucose levels.

Causes of Gestational Diabetes

The exact mechanism of the disease is still not completely clear.
Doctors are inclined to believe that the hormones responsible for the proper development of the fetus block the production of insulin, which leads to disruption of carbohydrate metabolism. During pregnancy, more glucose is required for both the woman and the baby. The body compensates for this need by suppressing insulin production. There are other possible causes of gestational diabetes, such as autoimmune diseases that destroy the pancreas. In principle, any pancreatic pathology can increase the risk of diabetes during pregnancy.

Causes of gestational diabetes mellitus

Gestational diabetes mellitus during pregnancy develops as a result of a decrease in the sensitivity of the body's cells and tissues to its own insulin, i.e., insulin resistance develops, which is associated with an increase in the blood level of hormones produced by the body during pregnancy. In addition, in pregnant women, glucose levels decrease more rapidly due to the needs of the fetus and placenta, which also affects homeostasis. The consequence of the above factors is a compensatory increase in insulin production by the pancreas. This is why insulin levels in the blood of pregnant women are most often elevated. If the pancreas cannot produce insulin in the amount required by the pregnant woman’s body, gestational diabetes mellitus develops. The deterioration of pancreatic β-cell function in gestational diabetes mellitus can be judged by the increased concentration of proinsulin.

Often, immediately after delivery, a woman's blood sugar levels return to normal. But even in this case, the possibility of developing diabetes cannot be completely ruled out.

What is gestational diabetes and why does it occur?

During pregnancy, a woman's hormonal status changes greatly. The level of the hormone progesterone, cortisol, and prolactin increases. All of these hormones increase blood sugar. To keep sugar levels normal, the pancreas produces more insulin, the only hormone that lowers blood sugar. But not all women’s pancreas copes with such an increased load, and then diabetes develops. Gestational diabetes appears only during pregnancy and goes away immediately after childbirth.

The risk of developing diabetes during pregnancy is not the same for all pregnant women. It is much higher if:

• the woman is overweight
• I had gestational diabetes in previous pregnancies,
• immediate relatives (parents, brothers and sisters, children) suffer from diabetes,
• in previous births, children were born weighing more than 4 kg.

Why treat diabetes in pregnant women if it goes away on its own after childbirth?

Treatment is a must! Gestational diabetes without treatment leads to the development of complications in the child - the so-called diabetic fetopathy. A child is born larger than normal, which is accompanied by a high risk of injury during childbirth, both for the child and for the mother. After childbirth, children born to a mother with diabetes are much more likely to have respiratory problems that require intensive treatment, and often develop hypoglycemia - a sharp decrease in blood sugar. Only careful monitoring of the mother’s blood sugar and maintaining normal values ​​throughout the pregnancy can prevent health problems for the newborn baby.

Who is most susceptible to developing diabetes during pregnancy?

Gestational diabetes mellitus during pregnancy develops in the case of a genetic predisposition, which is realized under the influence of a number of risk factors, such as:

- overweight, obesity with signs of metabolic syndrome;

- other carbohydrate metabolism disorders;

- increased sugar levels in urine;

- type 2 diabetes mellitus in direct relatives;

- woman’s age over 30 years;

— arterial hypertension and other diseases of the cardiovascular system;

- history of severe toxicosis and gestosis;

- hydramnios, birth of a previous child with excess weight (more than 4.0 kg), stillbirth in previous pregnancies;

— congenital malformations of the cardiovascular and nervous systems in previous children;

- chronic miscarriage of previous pregnancies, characterized by spontaneous abortions in the first two trimesters;

- gestational diabetes mellitus in previous pregnancies.

Why does diabetes occur?

Gestational diabetes is a disease characterized by high blood sugar levels that is first diagnosed during pregnancy.

Why does pregnancy provoke the development of diabetes?

Insulin is responsible for the level of glucose in the blood and its absorption in the body. The disease develops due to the fact that the action of insulin is blocked by progesterone and placental lactogen. Due to mutations in one or two genes, these hormones can be produced in excess. The result is a sharp increase in blood sugar levels - hyperglycemia. This condition is manifested by increased thirst, urination, dry mouth, blurred vision, and excessive fatigue. In severe cases, arrhythmia, dehydration, confusion, and even coma may occur.

One of the manifestations of hyperglycemia that a woman cannot track at the level of her own sensations is a sharp increase in free radicals, up to oxidative stress. Free radicals, in turn, damage insulin and other hormones, disrupt energy production processes, which provoke further development of the disease and deterioration of the woman’s condition. A vicious circle arises.

Diabetes mellitus during pregnancy: symptoms and signs

There are no specific manifestations of gestational diabetes mellitus, so the only criterion for diagnosis is laboratory screening of pregnant women. Women who are at risk, at the first visit to the antenatal clinic, should be tested for fasting blood sugar levels against the background of a normal diet and physical activity. If the blood sugar level taken from a finger prick is 4.8-6.0 mmol/l, it is recommended to undergo a special glucose load test.

To detect gestational diabetes mellitus, all pregnant women undergo an oral glucose tolerance test between the sixth and seventh months, which shows the quality of glucose absorption by the body. If the level of glucose in blood plasma taken on an empty stomach exceeds 5.1 mmol/l, an hour after a meal - more than 10.0 mmol/l, and after a couple of hours - more than 8.5 mmol/l, then the doctor has reason to diagnose GSD. If necessary, the test can be performed repeatedly.

With timely diagnosis of the disease and subsequent observation and compliance with all doctor’s recommendations, the risk of having a sick child is reduced to 1-2%.

Analyzes and their indicators

Usually, when registering, at a period of 10-13 weeks, all women undergo health screening, which should identify the main abnormalities of pregnancy, including disorders of carbohydrate metabolism. As part of this screening, a study of the level of glycated hemoglobin is carried out, as well as a study of venous plasma glucose on an empty stomach and during the day. This test allows you to determine whether a woman had diabetes before pregnancy. For the diagnosis to be confirmed, the value of glycated hemoglobin must exceed 6.5%.

Between 24 and 28 weeks of pregnancy, women in whom no abnormalities were previously detected are given a repeat test to determine gestational diabetes (Fig. 2). This analysis is called the “glucose tolerance test” and is carried out according to the following scheme:

• In the morning, a woman donates blood for glucose on an empty stomach,
• Then she is given a concentrated glucose solution (75 g of glucose) to drink.
• 1 and 2 hours after the load (drinking the solution), a repeat blood test is performed.

Figure 2. Conducting a glucose tolerance test.
Source: CC0 Public Domain Test results are considered positive if at least one of the following signs is detected:

• Fasting glucose level is above 5.1 mmol/l,
• Glucose level 1 hour after exercise is above 10.0 mmol/l,
• Glucose level 2 hours after exercise is above 8.5 mmol/l.

Important! ONLY the glucose tolerance test is suitable for diagnosing GDM. The glycated hemoglobin test is not used, since this test often gives a false negative result. In addition, it cannot be used to track the degree of increase in blood glucose after eating.

Treatment of diabetes mellitus during pregnancy

The course of pregnancy with diabetes is complicated by the fact that a woman will have to constantly monitor her blood glucose levels (at least 4 times a day). In addition, to correct gestational diabetes mellitus, it is necessary to adhere to a diet that includes three main meals and two or three snacks, while limiting the daily amount of calories consumed to 25-30 per kilogram of body weight. It is very important to ensure that the diet is as balanced as possible in terms of the content of essential nutrients (proteins, fats and carbohydrates), vitamins and microelements, since the full growth and development of the fetus directly depends on this.

Taking medications that lower blood glucose levels is contraindicated during pregnancy. If the diet prescribed by the doctor, along with moderate physical activity, does not produce the expected results, you will have to resort to insulin therapy.

Treatment of diabetes in pregnant women

The first step in treating GDM is a balanced diet and moderate exercise.
The main goal of the diet is to reduce sugar to normal values, so the expectant mother will have to give up sweets and fast carbohydrates. Pregnant women are recommended:

• Eat little, but often.
• Exclude foods with a high glycemic index (sugar, honey, potatoes, white bread, baked goods, bananas, grapes).
• Avoid fast food and fatty sweet pastries.
• Drink enough fluids if there are no contraindications from the kidneys.
• Diversify your diet with fresh vegetables, lean meats, and cereals.

Like all pregnant women, it is important for patients with GDM to receive the full range of vitamins and minerals that are necessary to maintain their own health and the proper development of the fetus.
Walking, swimming, water gymnastics, physical therapy for pregnant women - any light activity will be beneficial.

If diet and exercise do not help lower blood sugar levels, insulin therapy is prescribed.

Important: with high sugar, a woman should check her glucose level daily. Measurements are taken on an empty stomach and an hour after each meal using a home glucometer.

Diet of patients with gestational diabetes mellitus

Diabetes mellitus during pregnancy requires mandatory diet therapy, since proper nutrition can be the key to successful treatment of this disease. When developing a diet, it is important to remember that the emphasis should be on reducing the calorie content of food, without reducing its nutritional value. Doctors recommend following a number of simple but effective recommendations regarding diet for GDM:

- eat small portions at the same hours;

- exclude from the diet fried, fatty foods rich in easily digestible carbohydrates (cakes, pastries, bananas, figs), as well as instant foods and fast food;

- enrich the diet with porridges from various cereals (rice, buckwheat, pearl barley), salads from vegetables and fruits, whole grain bread and pasta, i.e. foods rich in fiber;

- eat lean meats, poultry, fish, exclude sausages, sausages, smoked sausages, which contain a lot of fat

- cook food using a small amount of vegetable oil;

- drink enough liquid (at least one and a half liters per day).

Physical activity for gestational diabetes in pregnant women

Physical exercise is very beneficial for pregnant women, because, in addition to maintaining muscle tone and maintaining a cheerful state of health, it improves the action of insulin and prevents the accumulation of excess weight. Naturally, physical activity for pregnant women should be moderate and consist of walking, gymnastics, and water exercises. You should not overuse active physical activity, such as cycling, skating, or horse riding, as this can lead to injury. It is important to regulate the amount of exercise based on your current state of health.

Preventive measures to prevent the development of diabetes mellitus during pregnancy

It is quite difficult to prevent the development of gestational diabetes mellitus with a high degree of probability. Often, women at risk do not develop diabetes mellitus during pregnancy, but pregnant women who do not have any prerequisites may develop the disease. However, planning a pregnancy if you have already had gestational diabetes mellitus once must be done responsibly and perhaps no earlier than 2 years after the previous birth. To reduce the risk of recurrence of gestational diabetes mellitus, several months before the expected pregnancy, you should begin to monitor your weight, include physical exercise in your daily routine, and monitor your blood glucose levels.

Taking any medications must be coordinated with your doctor, since uncontrolled use of certain medications (birth control pills, glucocorticosteroids, etc.) can also provoke the subsequent development of gestational diabetes mellitus.

1.5-2 months after birth, women who have had gestational diabetes need to be tested to determine blood glucose levels and undergo a glucose tolerance test. Based on the results of these studies, the doctor will recommend a specific diet and physical activity regimen, and will also determine the timing for control tests.

Treatment of GDM

How to treat diabetes in pregnant women is decided by the doctor. But diabetes control methods applied to pregnant women have long been developed:

• Diet: this is the first and most effective method of treatment, which is most often sufficient. The main goal of the diet is to control the amount of glucose that enters the blood, so the diet includes so-called slow carbohydrates - fruits, cereals, whole grains, vegetables. Fast carbohydrates such as flour and sweets, carbonated drinks should be excluded from the diet. A doctor monitoring the pregnant woman monitors her diet; assistance from an endocrinologist or nutritionist may also be required.
• Physical activity: Daily exercise for about half an hour reduces blood sugar and contributes to the normal course of pregnancy.
• Insulin injections: they are resorted to when the above measures are insufficiently effective. Insulin does not harm the fetus because it does not come into direct contact with it.

Medicines prescribed to patients with diabetes are usually contraindicated for pregnant women. They can be replaced with herbal infusions, which strengthen the immune system and have a beneficial effect on the condition of important body systems.

Management of pregnancy during GDM

Diagnosed gestational diabetes mellitus makes changes in pregnancy management. There is a need for outpatient and inpatient monitoring, and during the normal course of pregnancy, a hospital is needed only three times:

• Beginning of pregnancy: it all starts with a complete medical examination, after which the question of whether to continue the pregnancy is decided. If the risk of complications is high, pregnancy becomes deadly. If it is decided to save the fetus, treatment for gestational diabetes is developed;
• 20–24 weeks: characterized by a worsening of the disease and the possibility of complications, so the pregnant woman needs a repeat examination. At this time, an ultrasound examination will be required to determine the biophysical profile of the fetus. This will allow you to obtain detailed information about its condition and size.
• 32–34 weeks: at this time, the child’s condition is monitored in a hospital setting and complications are treated, and the issue of the timing and method of delivery is also decided. With macrosomia, childbirth is most likely to be postponed to an earlier date. The doctor may also prescribe a cesarean section instead of a normal birth.

Since each pregnant woman with gestational diabetes mellitus develops the disease differently, close medical supervision is necessary throughout the entire pregnancy. At home, you need to use a glucometer to monitor your blood sugar.

Prevention of GDM

If a woman is at risk of developing diabetes, preventive measures will help avoid its occurrence:

• Proper nutrition: usually it comes down to eliminating fast carbohydrates. A nutritionist, whom you should visit regularly, will help you balance your diet. Often this simple measure is enough.
• Physical exercises are also indicated during normal pregnancy; they also effectively prevent the occurrence and development of diabetes. It is better to give preference to special gymnastics for pregnant women.
• Walking on the street: it is advisable to choose a place for them away from highways.
• Weight control when planning pregnancy and throughout it: it is better to enlist the support of a nutritionist.
• Visiting a doctor: Don't underestimate the help of a doctor who can tell you how best to avoid developing GDM.
• Taking medications: Following your doctor's instructions will reduce your risk of developing the disease.
• Quitting bad habits: Smoking, alcohol and other bad habits not only harm the development of the fetus, but also increase the risk of gestational diabetes.

If you have any incomprehensible symptoms or ailments, you should immediately seek medical help. The same recommendations are relevant for women who have already been diagnosed with one of the types of diabetes. Preventive measures will eliminate or minimize the impact of diabetes on the course of pregnancy.

Make an appointment