« A skilled baker put the sick woman to sleep,
I cut the womb without pain, looking in.
He turned the baby's head
And carefully removed it from there -
No one has seen such a miracle...»

This is how the poet and thinker Firduosi described it so enthusiastically and sublimely a thousand years ago. Caesarean section operation. According to legend, Gaius Julius Caesar was born in this way, hence the popular expression: “God’s things are God’s, Caesar’s things are Caesar’s”, hinting at the fact that those who are destined for great achievements in this world are not born into the light of day like mere mortals. . The hint, by the way, is not without foundation: “the heirs of Caesar” (Caesar), that is, those born by Caesarean section, as modern research confirms, more often than others succeed in their studies, scientific and business careers - perhaps precisely because their brain was not subjected to severe stress at birth.

But, of course, it is not for the sake of a future “prodigy” that a woman voluntarily lies down on the operating table - there are good reasons for this, dictated by the state of health of herself and the fetus. In recent years, the rate of caesarean sections has been increasing worldwide; it is now 15-20 percent.

And if a pregnant woman has diabetes mellitus, the likelihood of this obstetric operation being used on her increases to 60 percent.

Main indications for elective caesarean section sections for diabetes are:

• its labile (unstable) course,
• vascular complications,
• progressive fetal hypoxia,
• its position is wrong
• large fruit,
• severe gestosis,
• polyhydramnios,
• lack of biological readiness for childbirth.

In previous meetings under this section, dear readers, we talked in detail about how to try to avoid these complications during pregnancy. But in life, unfortunately, not everyone and not always everything works out according to the rules.

But as a result, our clinic, which is a center for the delivery of pregnant women with endocrine pathology, has the following statistics: approximately 50 percent of women with diabetes develop gestosis, 50 percent - polyhydramnios; 30 percent have pyelonephritis...

But speaking about why obstetricians so often resort to cesarean section these days, I want to emphasize: for many women it becomes not only a vital necessity, but also a happy opportunity to have a living, healthy child and remain able to raise and educate him, and maybe give your first-born a sister or brother in the future. I mean the achievements of medicine that today make it possible to diagnose and promptly correct disorders in a woman’s body and in the intrauterine state of the fetus at an early stage; implementation of a system for identifying high-risk groups for various types obstetric and concomitant pathologies, monitoring systems during childbirth and much more.

According to the technique of performing a caesarean section operation is not complicated, but in terms of moral burden for the doctor it is heavy and responsible. After all, there are two lives on the operating table in front of the surgeon, and it is impossible to give preference to either of them. Believe me, the excitement, I would even clarify: professional anxiety, subsides only when the mother, at the end of the operation, hears the first cry of her tiny Caesar.

But deadlines distinguish between planned caesarean section and emergency. In case of elective surgery, the woman is prepared for the operation in advance, appropriate medical and hygienic procedures are performed, and the operation is performed at the optimal gestational age. In case of diabetes mellitus with an uncomplicated course of pregnancy, it is usually 38 weeks, but in other cases it can fluctuate between 32-38 weeks.

An emergency caesarean section is performed, as a rule, when complications occur during childbirth (weak contractions, the appearance or increase of hypoxia, disproportion between the size of the fetus and the mother’s pelvis). Sometimes indications for unexpected surgery arise when the course of the mother’s illness worsens (decompensation of diabetes, cardiac activity, low assessments of the biophysical profile of the fetus).

The need to perform an emergency operation causes stress for both parties, the patient and the doctor, which is why it is important to enter the maternity hospital in advance with the direction of the local doctor.

Anesthesia during surgery- general, sometimes it is performed under epidural anesthesia.

Recently, the technique is usually used operations in the lower uterine segment, making an incision in the transverse direction - this way the vessels and muscle fibers are damaged to a lesser extent.

On average, the operation lasts 55-60 minutes, blood loss is 600-800 ml. Usually a woman wakes up from anesthesia already on the operating table - and she is told who was born, with what weight and height. She will have to spend several days in the postoperative hospital and undergo an appropriate course of treatment, which is aimed at preventing postoperative complications, healing the wound and developing further insulin therapy tactics.

The onset of a new, planned pregnancy after a cesarean section is acceptable no earlier than in 2 years when the suture on the uterus is securely healed. Therefore, already in the maternity hospital, doctors will definitely advise the young mother to think in advance about methods of contraception. However, on the eve of a planned cesarean section, a woman who no longer expects to give birth in the future may be offered sterilization, i.e., tubal ligation. And the one who has time to think about this proposal, and perhaps discuss it with her husband, by agreeing to this step, is reliably insured against unwanted pregnancy and devotes herself entirely to the joys of marriage and motherhood.

Olga Ovsyankina, Candidate of Medical Sciences.
Magazine "Diabetic" No. 6 for 1994.

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Gestational diabetes is a pathological condition of hyperglycemia, initially diagnosed during pregnancy. It is possible that it was preceded by a previously undetected disorder of carbohydrate metabolism.

The prevalence of HD is about 7% of the total number of pregnant women. Although exact statistics on the prevalence of the disease in the Russian Federation have not been established, since the study of this pathology according to international standards has not been carried out before, and activities for identifying and screening HD are also insufficiently organized.

Causes of the disease

During the maturation of the placenta and in accordance with the increasing duration of pregnancy, the amount of fetoplacental hormones (progesterone and lactogen) and maternal hormones (estrogens, cortisol and prolactin) increases in the patient’s blood, which are directly involved in the process of increasing insulin resistance of the pregnant woman.

The condition is aggravated by the increased calorie content of the pregnant woman's diet, decreased physical activity and increased body weight.

Increasing insulin resistance is accompanied by increased insulin production.

With an existing genetic predisposition to type 2 diabetes, body weight above normal and other factors, the insulin produced with increasing insulin resistance becomes insufficient and relative insulin insufficiency occurs, leading to hyperglycemia.

If type 1 diabetes or another type of diabetes manifests itself clinically for the first time during pregnancy, the pathogenesis of the diseases corresponds to diabetes in non-pregnant patients.

Symptoms of gestational diabetes mellitus

With gestational diabetes, there are usually no signs of high glycemia typical for diabetes: excessive urination, extreme thirst, itchy skin, weight loss. In the absence of symptoms, active screening for gestational diabetes is important.

Obstetric and perinatal consequences

Hyperglycemia in a pregnant woman causes diabetic fetopathy of the fetus, which is the central factor causing pathologies of the perinatal period in pregnant women with HD: fetal asphyxia, premature birth, neonatal diseases and mortality, problems of adaptation of the newborn to extrauterine conditions.

The likelihood of congenital malformations in the fetus during GD does not depend on the state of diabetes decompensation in the mother, because gestational diabetes appears mainly after 28 weeks (second half), when the process of organ formation in the fetus is completed.

Decompensated HD is dangerous due to complications in the form of perinatal death, preeclampsia and eclampsia, requiring emergency artificial birth (caesarean section).

The fetus receives the glucose necessary for maturation through the placenta. At the same time, ketone bodies pass through the placenta to the fetus. Glycemia above normal and ketonemia trigger the mechanism of increasing diabetic fetopathy.

Sustained hyperglycemia also causes morphological disturbances in the placenta: placental vessels thicken, the size of the placenta increases. All this contributes to slow blood circulation and chronic oxygen deficiency of the fetus.

Penetration of an increased-than-normal amount of glucose into the fetus causes hyperplasia and enlargement of beta cells and causes fetal hyperinsulinemia, which causes the development of subsequent pathological disorders in the fetus.

Insulin is detected in the amniotic fluid and umbilical cord plasma of a fetus with macrosomia.

The progression of diabetes in the first half of pregnancy, on the contrary, causes degeneration of beta cells in the fetus, a decrease in the amount of insulin, which contributes to a slowdown in intrauterine development.

After 28 weeks of pregnancy, the fetus begins to produce triglycerides on its own, and subcutaneous fat is formed. During this period, fetal hyperinsulinemia activates the synthesis of fatty acids and promotes active intrauterine growth of the fetus, ahead of schedule.

Ultrasound reveals that the fetus is in excess of the normal size, more than two weeks ahead of the present term. Ultrasound also reveals other symptoms of diabetic fetopathy: polyhydramnios, swelling of the fetus and disproportions in its size.

All this is the result of fetal hyperinsulinemia, the cause of which was decompensation of diabetes in the mother.

As a result of fetal hypoxia, compensatory production of fetal hemoglobin increases when immature blood cells appear.

In combination with chronic hypoxia, this contributes to the worsening oxygen starvation and increased production of red blood cells in the fetus. This causes enlargement of the liver and spleen (organomegaly). Maturation of fetal lung tissue lags behind.

In the 3rd trimester, a transient increase in glycemia in a pregnant woman greater than 7.8 mmol/l in whole blood can cause intrauterine fetal death.

Diabetic fetopathy caused by HD is dangerous because even a full-term fetus is born with signs of functional and morphological immaturity, prone to neonatal diseases that require step-by-step therapy.

External symptoms of diabetic fetopathy in a newborn are similar to signs of hypercortisolism syndrome: abnormally large size, dysplastic obesity, moon-shaped face with swollen eyes, short neck, short limbs, elongated torso, enlarged liver and spleen, cardiomyopathy, hypertrichosis.

Macrosomia (newborn weight more than 4 kg) is the main cause of birth trauma and the use of cesarean section for delivery. In pregnant women with HD, fetal macrosomia occurs in 25-42%; during normal pregnancy, this occurs in 8-14% of cases.

Birth injuries during natural childbirth: shoulder dislocation, clavicle fracture, phrenic nerve palsy, pneumothorax, asphyxia, injuries to internal organs, head and neck. The consequences of asphyxia are dysfunction of the kidneys, lungs and central nervous system of the fetus.

Pulmonary immaturity in the fetus causes the appearance of respiratory distress syndrome (pathology of hyaline membranes) - the main cause of postpartum fetal death in HD. In newborns from a mother with HD, the risk of developing RDS is 5.6 times greater than in others.

The occurrence of RDS is directly dependent on the severity of diabetes decompensation in the mother.

When a patient with gestational diabetes gives birth prematurely, the likelihood of RDS in the fetus increases 5 times. Additional causes of respiratory dysfunction in newborns may be: pneumothorax and tachypnea, diaphragmatic hernia, cardiomyopathy.

Fetal hyperinsulinemia of the fetus, caused by high glycemia in the mother, causes neonatal hypoglycemia (the amount of glucose is less than 2.2 mmol/l). In newborns, the production of glycogen in the liver is hampered, the production of glucagon is reduced in the pancreas, and the function of gluconeogenesis in the liver is reduced.

To control glycemia in newborns in the department emergency care HemoCue laboratory express analyzers are used, allowing for fairly accurate diagnosis at the point of observation of the newborn. For glycemic control, 5 μl of whole blood is sufficient.

Symptoms of hypoglycemia in newborns:

• apathy
• unusual crying
• apnea or tachypnea
• convulsions and tremors
• heart failure
• cyanosis
• hypotension and hypothermia
• agitation or lethargy

The degree of glycemia in a woman in labor exceeding 6.9 mmol/l causes hypoglycemia in the newborn 0.5 hours after birth. Hypoglycemia may reverse within 48 hours or appear 24 hours after birth. Low blood glucose levels in newborns are observed in 21-60% of cases, and clinical signs of hypoglycemia appear in 25-30% of children.

Complications during childbirth

Pregnant women with HD develop typical pregnancy pathologies more often than others. Preeclampsia occurs 4 times more often, even if it is not preceded by characteristic vascular complications. Early rupture of membranes and premature birth, urogenic infections also occur more often.

Macrosomia, dysfunctional state of the fetus and preeclampsia are direct indications for artificial childbirth. Overdistension of the uterus caused by polyhydramnios and macrosomia in pregnant women with HD often leads to postpartum hemorrhage.

Diagnostics

Pregnant women with two or more signs from the risk group for diabetes (diabetes in relatives, glucosuria, excess body weight, changes in carbohydrate metabolism) are at risk of developing HD. Patients are given an oral glucose tolerance test with 75 g of sugar. If the readings are negative, the test is repeated between 24 and 28 weeks.

In patients with an average likelihood of developing HD, the test is performed between 24 and 28 weeks.

In patients with a low risk of HD, a glucose tolerance test is not performed.

Method of oral glucose tolerance testing with 75 g of sugar. For three days before the test, the pregnant woman follows a normal diet and motor activity. During dinner on the eve of the test, food with 50 g of carbohydrates is taken. During an overnight fast (8-14 hours), you are only allowed to drink water. Testing is carried out in the morning.

During testing, you must remain calm, do not smoke, and exclude active movement. Possible factors that can distort test data are taken into account: taking medications, associated infections. First, the first portion of blood is taken from a vein on an empty stomach and examined.

After receiving the results (normoglycemia or hyperglycemia), the patient should drink a glucose solution within five minutes: 75 g of dry substrate per glass of water. After two hours, venous blood is taken for re-analysis.

If results typical for HD are obtained after the first blood draw, testing is not continued.

The blood is taken into a tube with a preservative and centrifuged. Plasma should be examined within 0.5 hours after collection to avoid spontaneous glycolysis (glycemia levels may decrease by more than 10%). In cases where plasma is not immediately examined, it can be frozen.

The diagnosis of gestational diabetes is established if glycemic parameters meet the criteria for diabetes or impaired glucose tolerance. Patients with impaired fasting glucose (IFG) should undergo an oral glucose tolerance test.

If parameters are normal, testing is repeated at 24-28 weeks.

Before 24 weeks, HD, as a rule, does not appear, and diagnosing diabetes after 28 weeks does not help to avoid diabetic fetopathy of the fetus. All pregnant women at risk for HD should undergo OGTT even with normal glycemic parameters.

To diagnose gestational diabetes, which does not require additional studies to confirm the diagnosis, the following parameters are sufficient: the degree of glycemia during the day in plasma or whole blood is more than 11.1 mmol/l, fasting glucose in plasma is more than 7.0 mmol/l, in whole blood more than 6.0 mmol/l.

Self-monitoring of glycemia is not used to diagnose and monitor gestational diabetes. HbA1c measurement is not considered informative for HD.

Analysis to identify the amount of glycated proteins for diagnostic purposes in pregnant women has a number of problems:

fasting glucose is lower in pregnant women, and postprandial (after eating) glycemia is higher than in non-pregnant women;

the HbA1c concentration in pregnant women is 20% less than normal, which is caused by accelerated erythropoiesis;

The duration of probable impaired glucose tolerance may be very short when screening for HD.

Glucosuria is not considered a diagnostic indicator for HD. Pregnant women may normally experience glucosuria several times throughout the day.

This is explained by accelerated glomerular filtration and decreased reabsorption of glucose during pregnancy. But glucosuria in combination with signs from a risk group is a reason to be examined for the degree of glycemia.

Management scheme for pregnant women with gestational diabetes

Pregnant women at risk for HD and with confirmed gestational diabetes undergo outpatient monitoring at the specialized center “Pregnancy and Diabetes Mellitus”.

Necessary activities:

visiting the center once every two weeks until 29 weeks, after - once a week;

the pregnant woman is observed simultaneously by an obstetrician-gynecologist and an endocrinologist;

Additional visits by the patient to the doctor are possible if necessary;

the pregnant woman keeps a self-monitoring diary, entering self-monitoring data into it every day, which is discussed with the doctor during scheduled or unscheduled visits to the center;

To enable emergency consultation, there must be a mobile connection with an endocrinologist;

All patients with HD are given an individual selection of treatment, advice is given on dietary nutrition and physical activity, and if required by the condition, insulin therapy is prescribed.

For patients with gestational diabetes, a diet limited in simple carbohydrates is recommended to maintain optimal glycemia. In patients with normal body weight, the daily calorie intake should not exceed 30 kcal/kg.

If your weight is 120-150% higher than normal, the daily caloric intake should be within 25 kcal/kg and 12-15 kcal/kg if your body weight is more than 150%.

Simple carbohydrates are excluded from the diet. Complex carbohydrates containing a large number of dietary fiber does not exceed 45% of daily calories, proteins - 25%, fats - 30%. Carbohydrates should be distributed over three main meals and 2-3 intermediate meals. Breakfast should include a minimum amount of carbohydrates.

Patients with HD need to independently monitor glycemia 4 times a day: on an empty stomach and one to two hours after meals. If the patient is on insulin therapy, then she additionally controls glycemia before meals, before bedtime and at 3 am.

Patients following a low-calorie diet should have their morning urine or whole blood tested for ketone bodies every day to rule out caloric or carbohydrate deficiencies.

If the diet fails to achieve the required glycemic parameters within a week, the pregnant woman with HD is transferred to insulin therapy. For pregnant women, only human genetically engineered ultra-short or short-acting insulin (aspart, lispro) is used.

It is possible to introduce fixed insulin mixtures. Taking tableted hypoglycemic drugs is not allowed.

Insulin therapy is carried out in a multiple injection mode before each meal, which includes carbohydrates. A combination of short and ultra-short insulins is used taking into account the carbohydrate ratio of the diet and insulin sensitivity. The drug is administered subcutaneously. Insulin syringes or pens are used.

If the daily dose of the drug exceeds 100 units, you can install an insulin pump for continuous insulin infusion. The dosage and regimen of insulin therapy may change taking into account self-monitoring data, the amount of HbA1c, and fetal growth.

The need for insulin therapy appears when symptoms of diabetic fetopathy are detected on ultrasound, an increase in insulin in the amniotic fluid in pregnant women with HD using diet therapy.

For each patient, an individual program of physical activity is drawn up, taking into account the capabilities of the pregnant woman.

All necessary tests During pregnancy, patients are treated at the center or at the antenatal clinic at their place of residence.

Delivery with gestational diabetes

Gestational diabetes as such is not a direct indication for artificial labor (caesarean section) or childbirth before 38 weeks of pregnancy. But after the 38th week of pregnancy, complicated by decompensation of diabetes, the risk of developing fetal macrosomia increases. This explains the need for HD delivery no later than 38 weeks.

Hypoglycemic therapy in the perinatal period is carried out taking into account treatment during pregnancy and the method of delivery. During childbirth, blood glucose levels should not exceed 6 mmol/l.

During vaginal delivery, whole blood glucose monitoring is carried out every two hours with normal glycemia and every hour with a tendency to hyper- or hypoglycemia.

Women in labor who have undergone insulin therapy during pregnancy are given an intravenous infusion of short-acting insulin during natural childbirth. If there is a tendency to hypoglycemia, a glucose-potassium mixture is administered intravenously.

After the placenta has passed in women with HD, insulin treatment is stopped. If there is a tendency to hypoglycemia, an intravenous infusion of a glucose-alium mixture is prescribed.

At the end of delivery, the permissible glycemic parameters are: on an empty stomach and before meals - 4.0-6.0 mmol/l, after meals two hours later - 6.0-7.8 mmol/l, at night - 5.5 mmol/l.

During artificial delivery by cesarean section, the level of glycemia is checked before surgery, after the fetus is removed, and after the placenta is expelled.

Further, in accordance with the degree of gliemia: with normal parameters, the blood is checked every two hours, with a tendency to hypo- or hyperglycemia - every hour, until the patient returns to independent enteral nutrition.

Women in labor who were treated with diet therapy before birth do not use insulin during childbirth.

Intravenous administration of glucose solutions is also not used.

For women in labor who were on constant subcutaneous insulin infusion using an insulin pump during pregnancy, the administration of the drug in the standard mode continues during childbirth.

After the placenta has passed, the rate of insulin administration should be reduced by half and the intravenous administration of a glucose-potassium mixture should begin. Then insulin can be stopped.

If during the development of pregnancy a patient with HD did not experience decompensation of carbohydrate metabolism, and pregnancy and childbirth were managed in accordance with the protocol, the prognosis for the mother and fetus is positive.

Gestational diabetes is high blood sugar in women who are pregnant. It is rare and usually disappears on its own after childbirth. But a pregnant woman is at risk of developing regular diabetes in the future.

Clinical picture

What doctors say about diabetes

Doctor of Medical Sciences, Professor Aronova S. M.

I have been studying the problem of DIABETES for many years. It's scary when so many people die and even more become disabled due to diabetes.

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What is the danger of pathology?

Gestational diabetes requires strict adherence to all recommendations of the attending physician. Otherwise, the disease will negatively affect both the development of the baby and the health of the mother herself.

The activity of a woman’s pancreas is disrupted, since the organ functions fully only when the required amount of glucose in the blood is produced by the body. If the sugar level increases, excess insulin is produced.

During pregnancy, everyone is stressed internal organs women, and with high glucose levels their work becomes more difficult. This has a particularly negative effect on the functioning of the liver: the disease leads to liver failure.

Diabetes of gestational etiology undermines immune system the expectant mother, who is already weakened. This causes the development of infectious pathologies that adversely affect the life of the fetus.

After the baby is born, glucose levels can drop sharply, which also affects the body. The main danger of gestational diabetes after childbirth is high risk development of type 2 diabetes mellitus.

During pregnancy, any woman can get GDM: tissues become less sensitive to insulin produced by the body. As a result, insulin resistance begins, in which the content of hormones in the blood of the expectant mother increases.

The placenta and baby need a lot of sugar. But its active use adversely affects the process of homeostasis. The pancreas begins to produce excessive insulin to make up for the glucose deficiency.

Due to the high content of the hormone, organ cells fail. Over time, the pancreas stops producing the required level of insulin, and gestational diabetes develops.

After the baby is born, the mother’s blood sugar levels return to normal. But this fact is not a guarantee that the disease will not overtake the woman in the future.

be careful

According to WHO, every year 2 million people die from diabetes and its complications around the world. In the absence of qualified support for the body, diabetes leads to various kinds of complications, gradually destroying the human body.

The most common complications are: diabetic gangrene, nephropathy, retinopathy, trophic ulcers, hypoglycemia, ketoacidosis. Diabetes can also lead to the development of cancer. In almost all cases, a diabetic either dies fighting a painful disease or becomes a real disabled person.

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Risk factors during pregnancy

• Increased glucose levels in urine.
• Failure in carbohydrate metabolism.
• Excess body weight, accompanied by metabolic disorders.
• Age over 30 years.
• Heredity – the presence of type 2 diabetes mellitus in close relatives.
• Preeclampsia, severe toxicosis, observed in previous periods of pregnancy.
• Pathologies of the heart and blood vessels.
• Gestational diabetes in the past.
• Miscarriage, stillbirth, or big baby, whose body weight is over 4 kg.
• Congenital malformation of the nervous system, blood vessels, heart in previous children.

If a woman falls into at least one of these categories, then the gynecologist carries out special monitoring of her condition. The patient will need frequent monitoring of her blood sugar levels.

Signs and symptoms

It is not always possible to determine gestational diabetes in a pregnant woman based on symptoms. This is due to the fact that manifestations of pathology can also occur in a healthy woman.

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From: Lyudmila S ( [email protected])

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When the disease occurs, the patient is concerned about rapid fatigue, blurred vision, a feeling of dry mouth, and a constant desire to drink in any weather conditions.

Ladies also complain of an increased urge to empty the bladder. Typically, this symptom plagues pregnant women. later, but with diabetes it also occurs in the first trimester.

Diagnostics

To detect gestational diabetes, your doctor will order a laboratory blood test to check your glucose levels. Analysis is carried out every 3 months. Normal indicator blood sugar is no more than 5.1 mmol/l.

If the study shows a value greater than this value, then the doctor prescribes a glucose tolerance test.

For this purpose, blood is taken from the patient in the morning on an empty stomach, then given a glass of sweet water to drink, and the test is performed a second time an hour after the first test. This diagnosis is carried out again after 2 weeks.

How is the treatment carried out?

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If the diagnosis of gestational diabetes mellitus in a pregnant woman is confirmed, then treatment is carried out in a comprehensive manner. Therapy is carried out until the baby is born.

• The pathology control plan includes:
• Dietary nutrition is the main method of treatment. Moderate physical activity. Most suitable option
• Doctors consider long walks.
• Daily monitoring of blood glucose levels.
• Systematic laboratory testing of urine.

Monitoring blood pressure.

For most women carrying a child, following a diet is enough to get rid of the disease. If the patient follows the recommendations of the attending physician, then it is possible to do without the use of medications.

If dietary nutrition does not cope with the pathology, then the doctor prescribes insulin therapy. The hormone is administered through injections. Medications that lower blood sugar levels are not prescribed during pregnancy, as they can harm the fetus.

Successful treatment of gestational diabetes is not complete without adherence to a diet - this is the basic rule of treating pregnant patients. Food should be varied and balanced. It is prohibited to sharply reduce the energy value of the menu.

Doctors advise eating 5-6 times a day and in small portions. Most food is taken in the first half of the day. It is necessary to prevent the feeling of hunger.

It is necessary to remove carbohydrates that are easily digestible from the diet. Such foods include pastries, cakes, buns, bananas, and grapes. Eating these foods quickly increases your blood sugar levels. You will also have to give up tasty but unhealthy fast food - fast food.

You will also need to minimize the consumption of butter, mayonnaise and other high-fat foods. The percentage of saturated fat intake should not exceed 10. Sausage, pork, and semi-finished products should be excluded from meat dishes. Instead, it is recommended to use low-fat varieties - beef, poultry, fish.

The daily menu should contain foods containing a large amount of fiber: bread, cereals, green vegetables, herbs. In addition to fiber, they contain many vitamins and microelements necessary for the functioning of the human body.

How does childbirth occur with GDM?

After examining the woman, the doctor determines how childbirth should proceed with gestational diabetes mellitus. There are only two options: natural delivery and caesarean section. The choice of technique depends on the stage of the pathology in the pregnant woman.

If labor began unexpectedly or stimulation was carried out, then the birth of a child naturally is possible only in the following cases:

• The size of the baby's head coincides with the parameters of the mother's pelvis.
• The child's body weight does not exceed 4 kg.
• The correct presentation of the fetus is upside down.
• The ability to visually observe the condition of the fetus during birth.
• The baby does not have severe hypoxia or congenital malformations.

Women suffering from gestational diabetes mellitus during pregnancy face some problems: they lose their babies prematurely. amniotic fluid, labor begins prematurely, during the birth of the child the mother feels severe weakness in the body, which prevents her from making efforts in the process of pushing.

If a woman suffers from diabetes during pregnancy, she should be in a hospital under the supervision of doctors.

Usually, after birth, the baby does not need an insulin injection. But the child should be kept under the supervision of doctors for 1.5 months and his tolerance to sugar should be checked, which will make it possible to find out whether the disease has caused harm to the baby.

Prevention It is almost impossible to completely protect yourself from the occurrence of gestational diabetes and its complications during pregnancy. Often expectant mothers who are not even at risk suffer from pathology. The most important preventative measure

– compliance with nutritional rules during pregnancy.

If in the past a woman has already had diabetes while expecting a baby, then the next child must be planned. It is allowed to give birth no earlier than 2 years after the last birth. To prevent a relapse of gestational disease, it is necessary to start monitoring your body weight 6 months before conception, exercise daily, and regularly undergo laboratory tests for blood glucose levels.

You should not take medications without a doctor's recommendation. Some drugs, when taken arbitrarily, can lead to the development of the pathology in question.

Gestational diabetes mellitus can lead to adverse consequences for a pregnant woman and her baby. Therefore, it is extremely important to plan your pregnancy and follow all doctor’s recommendations.

Drawing conclusions

If you are reading these lines, we can conclude that you or your loved ones have diabetes.

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If all drugs were given, it was only a temporary result; as soon as the use was stopped, the disease sharply intensified.

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It is known that pregnancy, which occurs against the background of diabetes, is more often accompanied by severe complications on the part of the mother and child.

What is diabetes mellitus?

This is a condition where the level of glucose (sugar) in the blood is constantly elevated.

What type of diabetes occurs during pregnancy?

Pregnant women have

• pregestational (the one that was before pregnancy)
• gestational diabetes (those that appeared during pregnancy)

Gestational diabetes

This is an impairment of glucose tolerance (glucose tolerance) of any degree that occurs during pregnancy and passes after childbirth.

Pregestational diabetes

Pregestational diabetes occurs in 0.3-0.5% of pregnant women and includes type 1 and type 2 diabetes. The majority of cases (75-90%) are type 1 diabetes, a smaller proportion are type 2 diabetes (10-25%).

Diabetes mellitus type 1 associated with the destruction of pancreatic beta cells that produce insulin. Due to a large lack of insulin, glucose (sugar) is not absorbed by body tissues and accumulates in the blood. The disease occurs with a tendency to ketoacidosis and late complications in small vessels (eyes, kidneys).

Type 2 diabetes caused by the body's insensitivity to insulin and its insufficient production. Ketosis and ketoacidosis are rare. Late complications mainly affect the legs, brain, and heart.

Do diabetes and pregnancy affect each other?

Diabetes and pregnancy affect each other negatively.

On the one hand, pregnancy complicates the course of diabetes and leads to the appearance or progression of its complications. The tendency to ketoacidosis increases, even without high blood sugar, and severe hypoglycemia is more common, especially in the first trimester.

On the other hand, diabetes mellitus increases the risk of pregnancy complications such as polyhydramnios, the threat of miscarriage, and late toxicosis. They occur more often and are worse in women with diabetic vascular damage (angiopathies).

What complications can occur during pregnancy with diabetes?

Complications of pregnancy due to maternal diabetes mellitus:

Caesarean section, preeclampsia, high blood pressure, postpartum hemorrhage, death.

Complications of pregnancy due to diabetes mellitus on the part of the child:

Congenital malformations, macrosomia (“big baby”), fetal and newborn death, hypoglycemia of newborns.

Overall, 25% of pregnancies in women with diabetes have an unsatisfactory outcome.

However, everything is not so gloomy:

The risk of complications can be significantly reduced if you plan your pregnancy, normalize your blood sugar, and maintain diabetes compensation before conception and during pregnancy.

How to prepare for pregnancy if you have diabetes

It has been established that the risk of having a child with developmental defects is reduced by 9 times (from 10.9% to 1.2%) if a woman has undergone preparation before pregnancy (counseling on blood sugar control, nutrition). DeclineHbAic for every 1% reduces the risk of an unfavorable pregnancy outcome by 2 times.

IN real life the situation is much worse: very few women prepare for pregnancy in advance and strictly control their blood sugar. Studies have shown that only 35% of patients with diabetes consulted a doctor about diabetes and pregnancy before conception, and 37% monitored their blood sugar for a long time (6 months) before pregnancy.

Conclusions:

• if you have diabetes, pregnancy should be planned in advance
• At least six months before pregnancy, you need to maintain good blood sugar (diabetes compensation)

Read more about gestational diabetes

Pregnancy is a powerful diabetogenic factor. Glucose metabolism in all pregnant women is similar to that in diabetes mellitus. And if a woman has a certain tendency, she is at high risk of developing gestational diabetes.

Risk factors for gestational diabetes :

• Close relatives have diabetes
• Had gestational diabetes during a previous pregnancy
• Excess weight (more than 120% ideal weight body)
• Large baby from previous pregnancy
• Stillbirth
• Polyhydramnios
• Glucosuria (sugar in urine) twice or more

Gestational diabetes occurs in 2-12% of women. Carbohydrate metabolism is completely normalized 2-6 weeks after birth, but there remains a high risk of relapse of gestational diabetes in the next pregnancy and the risk of developing type 1 or 2 (more often) diabetes in the future. Thus, within 15 years, 50% of women with gestational diabetes develop “real” diabetes. This disease leads to an increased risk of birth defects, fetal and newborn death.

How to detect gestational diabetes

1. For women at high risk (see risk factors above), blood sugar levels are determined at the first visit to the doctor about pregnancy;
2. In order to confirm gestational diabetes, a glucose tolerance test (GTT) must be performed;
3. All pregnant women without risk factors should have their blood sugar checked after the 20th week of pregnancy.

Gestational diabetes has more stringent diagnostic criteria. Thus, “prediabetes” during pregnancy refers to gestational diabetes.

Diagnosis of gestational diabetes

International Diabetes Association (IDF)

Medical organizationDiagnosisSugar level (in venous blood plasma)Random measurementOn an empty stomachAfter GTTWHO, IDFDiabetes?7 mmol/lor?11.1 mmol/lNTG<7,0 ммоль/л And> 7.8 mmol/lADADiabetes?7 mmol/lor?11.1 mmol/l 2 hours after 75 g glucoseDiabetes>11.1 mmol/lGestational diabetes (after GTT with 75 g glucose)?5.3 mmol/l2 out of 4 tests (fasting and after GTT) are positive?10.0 mmol/l after 1 hour

?8.6 mmol/l after 2 hours

?7.8 mmol/l after 3 hours

Gestational diabetes (after GTT with 100 g glucose)?5.3 mmol/l?10.0 mmol/l after 1 hour

?8.6 mmol/l after 2 hours

Good blood sugar control is essential to reduce the risk to mother and fetus during pregnancy with diabetes.

The risk of harm to the unborn baby and complications for the mother is reduced when diabetes is well controlled, especially before conception. According to research, the incidence of birth defects, premature birth and fetal death with a glycated hemoglobin level of more than 8% is 2 times higher than the frequency of these complications with a HbAic level of less than 8%. The higher the mother’s blood sugar, the more common are cesarean sections, “big babies,” and hypoglycemia in the child:

Treatment of diabetes during pregnancy

Proper nutrition and exercise are very important elements treatment of any type of diabetes mellitus during pregnancy.

Nutrition for a pregnant woman with diabetes

Pregnant women must take in sufficient amounts of nutrients and calories for the normal development of the fetus and the life of the mother.

Before the start of the second trimester of pregnancy, calorie content does not increase, and only after the 12th week should the calorie content of the daily diet be increased by 300 kcal.

The number of calories is calculated depending on the body weight of the expectant mother:

• if a pregnant woman’s weight is 80-120% of her ideal weight, she needs 30 kcal/kg per day
• if the weight is 120-150% of the ideal, you need 24 kcal/kg/day
• if the weight is more than 150% of the ideal, the calorie content of the daily diet should be 12 kcal/kg per day.

The main advice on nutrition for pregnant women with diabetes is to avoid large meals; you should not include many simple carbohydrates at one time in order to avoid a strong increase in blood sugar after eating. To maintain a satisfactory level of sugar after eating in the morning, it is usually recommended to eat some carbohydrates at breakfast.

For the best way to distribute carbohydrates and calories throughout the day, see the table:

(Jovanovic-Peterson L., Peterson M., 1996)

EatingTime% carbohydrates from caloric intake% of daily caloriesBreakfast07:00 33 12,5 Lunch10:30 40 7,5 Dinner12:00 45 28,0 Afternoon snack15:30 40 7,0 Dinner18:00 40 28,0 Second dinner20:30 40 7,0 For the night*22:30 40 10,0

*If a snack at night does not help remove acetone in the urine in the morning on an empty stomach, the calorie content of this snack

it is necessary to reduce by 5% and introduce an additional snack at 3:00 with a calorie content of 5%.

Important: If you take insulin, the amount of carbohydrates in each meal and snack should be constant.

More:

• The diet should be individualized, so it would be good to consult a nutritionist
• Be sure to measure your blood sugar both before and after meals (after 2 hours).

It has been established that with type 1 diabetes, pregnant women additionally need to take folic acid (at least 400 mcg per day).

Physical activity during pregnancy with diabetes

Physical activity is especially beneficial during pregnancy due to type 2 diabetes and gestational diabetes. As we already know, the main link in the chain of development of type 2 diabetes and gestational diabetes is the body’s poor sensitivity to insulin (insulin resistance). It is especially pronounced when overweight women. Obese pregnant women have an increased risk of cardiovascular disease associated with insulin resistance, increased level fats in the blood. Physical activity improves insulin sensitivity and increases the performance of the heart and blood vessels.

The effect of diet and exercise on blood sugar control in women with gestational diabetes

During exercise, carbohydrate stores are used first, resulting in a decreased need for insulin. The risk of hypoglycemia during exercise in pregnant women with type 2 diabetes is small.

In type 1 diabetes, exercise must be done carefully to avoid hypoglycemia. If the patient regularly performed physical exercise, classes can be continued under strict blood sugar control.

Studies have shown that exercise combined with diet for gestational diabetes lowers blood sugar more than diet alone:

Conclusions:

• Physical exercise - excellent remedy to control blood sugar during pregnancy;
• Activities that work best include low-impact aerobics, swimming, walking and yoga.

Medicines to treat diabetes during pregnancy

Type 1 diabetes is treated only with insulin.

For low blood sugar levelstype 2 diabetes and gestationaldiabetestreated with diet. If it is not possible to achieve compensation with diet and physical activity, the pregnant woman is prescribedinsulin.

Antihyperglycemic tablets are not used to treat type 2 diabetes and gestational diabetes during pregnancy.

When should insulin be prescribed for gestational diabetes and type 2 diabetes?

If fasting blood sugar is above 5.6 mmol/l, and after eating 8 mmol/l, insulin is prescribed.

During pregnancy, short-acting human insulins are used in combination with long-acting insulins in a multiple-injection mode or ultra-short-acting insulin analogues in combination with peakless insulin analogues. During pregnancy, the insulin dose changes. Read more about read insulin therapy during pregnancy here...

The main goal of insulin treatment is to maintain a blood sugar level at which complications will not develop with minimal risk of hypoglycemia.

Goals of insulin treatment during pregnancy:

• Blood sugar on an empty stomach is 4-6 mmol/l and after meals 4-8 mmol/l;
• To prevent fetal macrosomia (“big baby”), blood sugar after meals is below 7 mmol/l;
• Minimal risk of severe hypoglycemia episodes

Administering insulin using a pump

Continuous subcutaneous insulin injection pumps (insulin pumps) deliver insulin approximately as it is secreted in a healthy body. The pump allows patients to plan meals and regimens more freely. Although the insulin pump keeps blood sugar within a tighter range, a regimen of multiple insulin injections can provide fairly good blood sugar control.

Adequate sugar control is necessary, and it is not so important how the insulin is administered.

Monitoring blood sugar before and after meals

Blood sugar during the day in a woman with diabetes should be the same as in a healthy pregnant woman. To achieve this, careful monitoring is necessary. It has been noticed that those women who keep a diabetes diary and record test results have sugar closer to normal.

It is important to measure your blood sugar both on an empty stomach and after meals. There are studies that show that sugar after meals has a stronger effect on the incidence of pregnancy complications than sugar on an empty stomach. The better this indicator, the less often there are high pressure and edema in women in late pregnancy and obesity in young children.

Hypoglycemia during pregnancy

On early stages pregnancy, the frequency of severe hypoglycemia increases 2-3 times. At 10-15 weeks of pregnancy, the risk of hypoglycemia is greatest compared to the period before pregnancy. The fact is that unborn child receives through the placenta as much glucose as it needs, regardless of its level in the mother’s blood. In this regard, the highest risk of hypoglycemia is between meals and during sleep.

Hypoglycemia during pregnancy occurs more often in the following cases:

• There were already severe hypoglycemia before pregnancy;
• Long experience of diabetes;
• Level of glycated hemoglobin HbAic ? 6.5%;
• Large daily dose of insulin.

What are the dangers of hypoglycemia during pregnancy?

Severe hypoglycemia in early pregnancy can lead to birth defects and developmental delays in the baby.

High blood pressure

High blood pressure or preeclampsia occurs in 15-20% of pregnant women with diabetes, compared with 5% in pregnancies without diabetes.

In patients with type 1 diabetes, increased blood pressure is usually associated with diabetic kidney damage (nephropathy).

Kidney damage

Elevated blood sugar and high blood pressure impair kidney function and can accelerate the development of diabetic nephropathy. If protein is detected in the urine in the early stages of pregnancy, the risk of premature birth is increased. In order to prevent complications, it is necessary to treat high blood pressure as early as possible.

Eye damage

It is known that maintaining blood sugar at a good level for a long time delays the development of diabetic damage to the retina and blood vessels of the eyes (angioretinopathy). However, if blood sugar drops suddenly, retinopathy temporarily worsens. This is why, in cases of severe diabetic retinopathy, blood sugar should be reduced less quickly in early pregnancy.

Pregnancy is a period of increased functional load on most organs of a pregnant woman. In this case, a number of diseases may decompensate or new ones may appear. pathological conditions. One of these pregnancy-related disorders is gestational diabetes mellitus. It usually does not pose a significant threat to the life of the expectant mother. But in the absence of adequate treatment, gestational diabetes negatively affects the intrauterine development of the child and increases the risk of early infant mortality.

What is diabetes mellitus?

Diabetes mellitus is an endocrine disease with a severe disturbance, primarily of carbohydrate metabolism. Its main pathogenetic mechanism is the absolute or relative deficiency of insulin, a hormone produced by special cells of the pancreas.

Insulin deficiency may be caused by:

• a decrease in the number of β-cells of the islets of Langerhans in the pancreas, responsible for insulin secretion;
• disruption of the process of converting low-active proinsulin into a mature active hormone;
• synthesis of an abnormal insulin molecule with an altered amino acid sequence and reduced activity;
• changes in the sensitivity of cellular receptors to insulin;
• increased production of hormones, whose action is opposed to the effects of insulin;
• discrepancy between the amount of incoming glucose and the level of the hormone produced by the pancreas.

The effect of insulin on carbohydrate metabolism is due to the presence of special glycoprotein receptors in insulin-dependent tissues. Their activation and subsequent structural transformation leads to increased transport of glucose into cells with a decrease in sugar levels in the blood and intercellular spaces. Also, under the influence of insulin, both the utilization of glucose with the release of energy (the process of glycolysis) and its accumulation in tissues in the form of glycogen are stimulated. The main depots in this case are the liver and skeletal muscles. The release of glucose from glycogen also occurs under the influence of insulin.

This hormone affects fat and protein metabolism. It has an anabolic effect, inhibits the process of fat breakdown (lipolysis) and stimulates the biosynthesis of RNA and DNA in all insulin-dependent cells. Therefore, with low insulin production, a change in its activity, or a decrease in tissue sensitivity, multifaceted metabolic disorders occur. But the main signs of diabetes are changes in carbohydrate metabolism. In this case, there is an increase in the basic level of glucose in the blood and the appearance of an excessive peak in its concentration after meals and a sugar load.

Decompensated diabetes mellitus leads to vascular and trophic disorders in all tissues. In this case, even insulin-independent organs (kidneys, brain, heart) are affected. The acidity of the main biological secretions changes, which contributes to the development of dysbiosis of the vagina, oral cavity and intestines. The barrier function of the skin and mucous membranes is reduced, and the activity of local immune defense factors is suppressed. As a result, with diabetes mellitus, the risk of infectious and inflammatory diseases of the skin and genitourinary system, purulent complications and disruption of regeneration processes increases significantly.

Types of disease

There are several types of diabetes mellitus. They differ from each other in etiology, pathogenetic mechanisms of insulin deficiency and type of course.

• type 1 diabetes mellitus with absolute insulin deficiency (insulin-requiring incurable condition), caused by the death of cells of the islets of Langerhans;
• type 2 diabetes mellitus, characterized by tissue insulin resistance and impaired insulin secretion;
• gestational diabetes mellitus, in which hyperglycemia is first detected during pregnancy and usually resolves after childbirth;
• other forms of diabetes caused by combined endocrine disorders (endocrinopathies) or dysfunction of the pancreas due to infections, intoxications, drug exposure, pancreatitis, autoimmune conditions or genetically determined diseases.

In pregnant women, one should distinguish between gestational diabetes and decompensation of previously existing (pregestational) diabetes mellitus.

Features of gestational diabetes

The pathogenesis of diabetes in pregnant women consists of several components. The most important role is played by the functional imbalance between the hypoglycemic effect of insulin and the hyperglycemic effect of a group of other hormones. Gradually increasing tissue insulin resistance aggravates the picture of relative insulin insufficiency. And physical inactivity, an increase in body weight with an increase in the percentage of adipose tissue and the often noted increase in the total calorie content of food become provoking factors.

The background for endocrine disorders during pregnancy is physiological metabolic changes. Already in the early stages of gestation, metabolic restructuring occurs. As a result, at the slightest sign of a decrease in glucose supply to the fetus, the main carbohydrate pathway of energy exchange quickly switches to the reserve lipid pathway. This protective mechanism is called the rapid starvation phenomenon. It ensures constant transport of glucose across the fetoplacental barrier, even when the available reserves of glycogen and substrate for glucneogenesis in the maternal liver are depleted.

At the beginning of pregnancy, such metabolic changes are sufficient to meet energy needs developing child. Subsequently, to overcome insulin resistance, hypertrophy of β-cells of the islets of Lagnerhans and an increase in their functional activity develops. The increase in the amount of insulin produced is compensated by the acceleration of its destruction, due to increased kidney function and activation of placental insulinase. But already in the second trimester of pregnancy, the maturing placenta begins to perform an endocrine function, which can affect carbohydrate metabolism.

Insulin antagonists are steroid and steroid-like hormones synthesized by the placenta (progesterone and placental lactogen), estrogens and cortisol secreted by the mother's adrenal glands. They are considered potentially diabetogenic, with fetoplacental hormones having the greatest effect. Their concentration begins to increase from 16-18 weeks of gestation. And usually, by the 20th week, a pregnant woman with relative insulin insufficiency begins to show the first laboratory signs of gestational diabetes. Most often, the disease is detected at 24-28 weeks, and the woman may not present typical complaints.

Sometimes, only a change in glucose tolerance is diagnosed, which is considered prediabetes. In this case, a lack of insulin manifests itself only with an excess intake of carbohydrates from food and with some other provoking factors.

According to modern data, diabetes in pregnant women is not accompanied by the death of pancreatic cells or changes in the insulin molecule. That is why endocrine disorders that occur in a woman are reversible and most often self-limited soon after childbirth.

How dangerous is gestational diabetes for a baby?

When a pregnant woman is diagnosed with gestational diabetes, questions always arise about what effect it has on the baby and whether treatment is really necessary. After all, most often this disease does not pose an immediate threat to the life of the expectant mother and does not even significantly change her well-being. But treatment is necessary primarily to prevent perinatal and obstetric complications of pregnancy.

Diabetes mellitus leads to impaired microcirculation in maternal tissues. Spasm of small vessels is accompanied by damage to the endothelium in them, activation of lipid peroxidation, and provokes chronic disseminated intravascular coagulation syndrome. All this contributes to chronic placental insufficiency with fetal hypoxia.

Excessive glucose supply to a child is also not a harmless phenomenon. After all, his pancreas does not yet produce the required amount of the hormone, and maternal insulin does not penetrate the fetoplacental barrier. And uncorrected glucose levels lead to discirculatory and metabolic disorders. And secondary hyperlipidemia causes structural and functional changes in cell membranes and aggravates fetal tissue hypoxia.

Hyperglycemia provokes in a child hypertrophy of pancreatic β-cells or their earlier depletion. As a result, the newborn may experience severe disturbances in carbohydrate metabolism with critical life-threatening conditions. If gestational diabetes is not corrected even in the 3rd trimester of pregnancy, the fetus develops macrosomia (high body weight) with dysplastic obesity, spleno- and hepatomegaly. In this case, most often at birth there is immaturity of the respiratory, cardiovascular and digestive system. All this applies to diabetic fetopathy.

The main complications of gestational diabetes include:

• fetal hypoxia with intrauterine growth retardation;
• premature birth;
• intrauterine fetal death;
• high infant mortality among children born to women with gestational diabetes;
• macrosomia, which leads to a complicated course of labor and increases the risk of birth injuries in the child (clavicle fracture, Erb's palsy, phrenic nerve palsy, injuries to the skull and cervical spine) and damage to the mother's birth canal;
• , preeclampsia and eclampsia in a pregnant woman;
• often recurrent urinary tract infections during pregnancy;
• fungal infections of the mucous membranes (including the genitals).

Some doctors also consider spontaneous abortion in the early stages to be a complication of gestational diabetes. But most likely the cause of miscarriage is decompensation of previously undiagnosed pregestational diabetes.

Symptoms and diagnosis

Pregnant women suffering from diabetes rarely present complaints characteristic of this disease. Typical symptoms are usually mild, and women usually consider them to be physiological manifestations of the 2nd and 3rd trimesters. Dysuria, thirst, itching, and insufficient weight gain can occur not only with gestational diabetes. Therefore, laboratory tests are key in diagnosing this disease. A obstetric ultrasound helps to clarify the severity of placental insufficiency and identify signs of fetal development pathology.

A screening test is to determine the fasting blood glucose level of a pregnant woman. It is carried out regularly starting from the 20th week of gestation. Once threshold glycemic values ​​are obtained, a test is prescribed to determine glucose tolerance. And in pregnant women at high risk for developing gestational diabetes, it is advisable to carry out such a test at the first appointment and again at 24-28 weeks, even if normal level fasting glucose.

Glycemia from 7 mmol/l on an empty stomach in whole capillary blood or from 6 mmol/l on an empty stomach in venous plasma are diagnostically reliable laboratory indicators for gestational diabetes. Also a sign of the disease is the detection of hyperglycemia above 11.1 mmol/l when measured randomly during the day.

Carrying out a glucose tolerance test () requires careful compliance with the conditions. For 3 days, a woman should follow her usual diet and physical activity, without restrictions recommended for diabetes. Dinner the day before the test should contain 30-50 g of carbohydrates. The analysis is carried out strictly on an empty stomach, after 12-14 hours of fasting. During the test, smoking, taking any medications, physical activity (including climbing stairs), eating and drinking are excluded.

The first sample is blood taken on an empty stomach. After this, the pregnant woman is given a freshly prepared glucose solution to drink (75 g of dry matter per 300 ml of water). To assess the dynamics of glycemia and identify its hidden peaks, it is advisable to take repeated samples every 30 minutes. But often only the blood glucose level is determined 2 hours after taking the test solution.

Normally, 2 hours after a sugar load, glycemia should be no more than 7.8 mmol/l. A decrease in tolerance is indicated at levels of 7.8-10.9 mmol/l. And gestational diabetes mellitus is diagnosed with a result of 11.0 mmol/l.

Diagnosis of gestational diabetes mellitus cannot be based on testing glucose in the urine (glucosuria) or measuring glucose levels with home glucose meters with test strips. Only standardized laboratory blood tests can confirm or exclude this disease.

Treatment issues

Insulin therapy

Self-monitoring of glucose levels in peripheral venous blood using glucometers is necessary. A pregnant woman carries out the analysis independently on an empty stomach and 1-2 hours after eating, recording the data along with the calorie content of the food taken in a special diary.

If a hypocaloric diet for gestational diabetes does not lead to normalization of glycemic levels, the doctor decides to prescribe insulin therapy. In this case, short- and ultra-short-acting insulins are prescribed in multiple injection mode, taking into account the calorie content of each meal and glucose level. Sometimes insulins with an intermediate duration of action are additionally used. At each appointment, the doctor adjusts the treatment regimen, taking into account self-monitoring data, the dynamics of fetal development and ultrasound signs of diabetic fetopathy.

Insulin injections are given with special syringes subcutaneously. Most often, a woman does not need outside help for this; the training is carried out by an endocrinologist or the staff of the Diabetes School. If the required daily dose of insulin exceeds 100 units, a decision may be made to install a permanent subcutaneous insulin pump. The use of oral hypoglycemic drugs during pregnancy is prohibited.

As an auxiliary therapy, drugs to improve microcirculation and treat placental insufficiency, Chophytol, and vitamins can be used.

Nutrition for gestational diabetes mellitus

During pregnancy, the mainstay of treatment for diabetes and impaired glucose tolerance is diet therapy. This takes into account the woman’s body weight and physical activity. Dietary recommendations include adjustments to diet, food composition and calorie content. The menu of a pregnant woman with gestational diabetes mellitus should, in addition, ensure the supply of essential nutrients and vitamins and help normalize the functioning of the gastrointestinal tract. Between the 3 main meals you need to have snacks, and the main calorie content should come in the first half of the day. But the last snack before bedtime should also include carbohydrates in the amount of 15-30 g.

What can you eat if you have gestational diabetes? These are lean varieties of poultry, meat and fish, fiber-rich foods (vegetables, legumes and grains), greens, low-fat dairy and fermented milk products, eggs, vegetable oils, nuts. To determine which fruits can be introduced into the diet, you need to evaluate the rate of rise in blood glucose levels shortly after eating them. Usually apples, pears, pomegranates, citrus fruits, and peaches are allowed. It is acceptable to consume fresh pineapple in small quantities or pineapple juice without added sugar. But it is better to exclude bananas and grapes from the menu; they contain easily digestible carbohydrates and contribute to a rapid peak increase in glycemia.

Delivery and prognosis

Childbirth with gestational diabetes mellitus can be natural or by cesarean section. Tactics depend on the expected weight of the fetus, maternal pelvic parameters, and the degree of compensation for the disease.

During spontaneous childbirth, glucose levels are monitored every 2 hours, and if there is a tendency to hypoglycemic and hypoglycemic conditions, every hour. If a woman was on insulin therapy during pregnancy, the drug is administered during childbirth using an infusion pump. If diet therapy was enough for her, the decision to use insulin is made in accordance with the glycemic level. At caesarean section Glycemic monitoring is necessary before surgery, before removing the baby, after removing the placenta, and then every 2 hours.

If gestational diabetes is detected in a timely manner and stable compensation of the disease is achieved during pregnancy, the prognosis for mother and child is favorable. Nevertheless, newborns are at risk for infant mortality and require close monitoring by a neonatologist and pediatrician. But for a woman, the consequences of diabetes during pregnancy can appear several years after a successful birth in the form of type 2 diabetes or prediabetes.