Gestational diabetes: features of diabetes mellitus during pregnancy

What is its reason?

Diabetes mellitus in pregnant women develops due to the hormonal explosion associated with bearing a child. The hormonal cocktail entering the blood (cortisol, human chorionic gonadotropin, estrogens and progesterone) inhibits the action of insulin, which is required to ensure the flow of glucose from the blood into the cells. This happens because the body tries to save glucose for the growing fetus and provokes “insulin resistance,” when the mother’s cells stop responding to the usual amount of insulin. In response to increasing amounts of glucose in the blood, the pancreas is supposed to produce more insulin, but sometimes it fails. Gestational diabetes occurs.

Up to 39% of all pregnancies are complicated by GDM.

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.

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Who's at risk

Risk factors for gestational diabetes

How to treat diabetes in pregnant women?

First of all, it should be noted that the diagnosis of gestational diabetes cannot be based on just one blood test for sugar, which showed an elevated result. If during the examination it turns out that the expectant mother’s fasting glucose level is higher than normal, then the doctor should prescribe additional tests for her.

Among these will be:

• dynamic tracking of sugar levels, when blood is donated first on an empty stomach, then an hour after a meal, then another hour later;
• glucose tolerance test, in which you need to drink a provocative dose of glucose, and then monitor the dynamics of blood sugar levels after different periods of time (shows how well insulin copes with the utilization of large doses of sugar).

If both examinations show a disappointing result, then only the endocrinologist will be forced to ascertain the real development of gestational diabetes. After making a diagnosis, the doctor will first prescribe a special diet for the pregnant woman to help normalize the level of glucose in the bloodstream.

Gestational diabetes: diet

Therapeutic nutrition for gestational diabetes is based on the following principles:

1. The daily diet is divided into 5-6 meals (3 main meals and 2 snacks).
2. Portions should be small so that the pancreas can easily cope with the release of enzymes to digest food.
3. Gentle cooking methods are used: boiling, steaming, stewing without oil, baking in the oven and grilling (fried foods should be minimized or eliminated altogether).
4. 40-45% of the daily carbohydrate intake should be consumed at breakfast so that the body has time to utilize glucose. Preference should be given to complex carbohydrates: whole grain cereals, pasta and bread, legumes, leafy salads, vegetables, unsweetened fruits with a low glycemic index and low glycemic load.
5. It is necessary to completely avoid processed foods, fast food, carbonated drinks, store-bought juices, sweets, baked goods, fatty meats, sausages, instant cereals and snacks, sweet fruits and berries, mashed potatoes, pasta and bread made from premium flour.
6. The amount of simple and complex carbohydrates should not exceed the permissible limit, which will be established by an endocrinologist or nutritionist.
7. Any vitamin-mineral complexes are taken only as prescribed by a doctor, since most of them contain sugar or sugar substitutes.
8. The drinking regime is approximately 8 glasses of purified non-carbonated water per day (this norm can be revised only in the presence of edema or other symptoms that require restrictions on fluid intake).

Alternative treatment for gestational diabetes

To monitor gestational diabetes, your doctor may order periodic urine tests to check for ketone bodies. This is necessary in order to timely monitor the formation of pathological processes in the pancreas and prevent the development of complications.

To a certain extent, regular physical activity helps correct diabetes mellitus in pregnant women. During the training process, excess glucose received from food is consumed, the need for insulin is correspondingly reduced, and the pancreas stops working in stress mode.

As a result, blood sugar levels naturally decrease, metabolism improves, excess weight gain stops, and the fat burning process starts. And normalizing body weight is an important step in controlling diabetes.

Just remember that heavy strength training and active cardio are prohibited for pregnant women. Opt for swimming, brisk walking, yoga. Any exercises on the abs and abdominal muscles should be completely excluded.

If physical activity and the described therapeutic diet for gestational diabetes are ineffective, and the blood glucose level remains elevated as before, then the doctor will most likely prescribe the pregnant woman to take glucose-lowering medications, including insulin injections.

The dosage of hormonal correction is determined by the doctor depending on the average level of glucose in the blood, the weight of the expectant mother and the duration of her pregnancy. In most cases, the insulin dose is divided into 2 injections - in the morning on an empty stomach and before dinner. However, the scheme may be different.

It is worth understanding that the prescription of insulin therapy does not replace a therapeutic diet, adequate exercise and regular monitoring of glucose levels. A pregnant woman should always have a glucometer and test strips on hand.

Why is GDM dangerous?

GDM can cause various pregnancy complications, which is dangerous for both mother and baby.

Danger of GDM for mother

The health risk to the expectant mother is associated with excess glucose in the blood and its deposition in tissues and organs. Like any type of diabetes, GDM can contribute to:

1. Diabetic retinopathy – damage to blood vessels and retinal receptors with gradual deterioration of vision (Fig. 1).
2. Diabetic nephropathy is damage to the glomerular and tubular apparatus of the kidneys, in which blood plasma is filtered to form urine. As a result, chronic renal failure develops.
3. Arterial hypertension is high blood pressure that occurs due to damage to blood vessels, kidneys and changes in hormonal levels with the development of diabetes. All this increases the risk of miscarriage and abnormalities in the fetus.

Figure 1. Diabetic retinopathy. Source: WikiMedia

Risk to the child

An increased level of glucose in the blood of a pregnant woman can harm not only herself, but also the unborn child, contributing to:

• diabetic fetopathy (a disorder of carbohydrate metabolism in an unborn child, which can develop into neonatal, infant diabetes mellitus);
• the birth of a large fetus - macrosomia (increases the risk of cesarean section and injury to the child during childbirth);
• neonatal hypoglycemia (low blood sugar in the newborn and respiratory problems, which can lead to death);
• intrauterine fetal death (this is the worst consequence of GDM);
• polyhydramnios (dangerous due to premature birth, incorrect position of the fetus, loss of umbilical cord loops and their compression, placental abruption due to rupture of the membranes);
• an increase in the size of the liver and heart in the fetus.
• disruption of the growth and development of the child after birth.

GDM also increases the risk of miscarriage - the blood vessels of the placenta are “saturated” with glucose, which leads to impaired blood flow and hypoxia (oxygen starvation) of the fetus, which provokes premature labor in the uterus.

The dangers of diabetes during pregnancy

This pathological condition threatens the health of both mother and child.
Even before birth, the fetus begins to actively produce insulin to compensate for the increased glucose in the mother’s blood. Such children are prone to low blood sugar from birth, and they have a higher risk of obesity and type II diabetes in adulthood. Gestational diabetes increases the risk of high blood pressure, as well as preeclampsia, a severe form of preeclampsia. It manifests itself as headaches, nausea, vomiting, blurred vision, lethargy, drowsiness or insomnia. This is one of the most severe disorders during pregnancy, affecting the central nervous system.

Another alarming factor is that diabetes during pregnancy contributes to rapid weight gain in the baby during the prenatal period (macrosomia). This causes difficulties during childbirth and poses a threat to the mother. A child over 4 kg is considered large. These babies have a higher risk of birth injuries and are more likely to require a caesarean section. Due to the large size of the fetus, early delivery may be required. At the same time, the risk of premature birth is high.

Also, high sugar in pregnant women increases the risk of cardiovascular and nervous pathologies of the fetus, increases the risk of respiratory distress syndrome in the baby (a condition that makes breathing difficult) and generally increases the frequency of complications during pregnancy and childbirth.

Symptoms

Photo: ruslangaliullin / freepik.com
The clinical picture of gestational diabetes mellitus is quite poor; a woman may not have any complaints at all. It is worth paying attention to the following signs:

• Unmotivated weakness
• Thirst, dry mouth,
• Frequent urination
• Blurred vision.

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.

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.

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.

Are there any contraindications to the test?

Yes, I have. Absolute and relative.

Absolute contraindications include:

• Allergy and/or glucose intolerance,
• Diabetes mellitus in the acute phase (then a test is not needed),
• Diseases of the gastrointestinal tract in which normal glucose absorption is disrupted (exacerbation of pancreatitis, gastric surgery).

Relative (temporary) contraindications:

• Early toxicosis (gestosis) of pregnant women,
• Exacerbation of chronic diseases

Important! It is very important to determine the presence of GDM in a timely manner. Screening is recommended for all pregnant women. The glucose tolerance test does not harm the liver and is not something to be afraid of.

When diagnosing GDM, additional tests are sometimes used, including:

• General urine analysis (glucosuria - detection of glucose in the urine, which normally should not be there, as well as ketone bodies - products of impaired glucose metabolism),
• Ultrasound of the fetus (presence of fetopathy - fetal development disorders).

Treatment during pregnancy

Treatment of GDM is a complex and complex task. The drugs are selected so as not to harm the fetus. And treatment, if necessary, can continue after childbirth.

Diet

Following a special diet is the first step towards getting rid of gestational diabetes. Drug treatment for GDM will not be effective without diet. What you need to pay attention to:

1. It is necessary to exclude fast carbohydrates (sweets, pastries, white bread, cakes, fruits), and also limit fats,
2. There should be several meals, you should eat every 2-3 hours,
3. You should consume enough protein and reduce your intake of foods high in starch (rice, bread, pasta, potatoes, corn),
4. It will be useful to increase the consumption of vegetables and herbs, vegetable oils and other foods rich in unsaturated fats,
5. It is important to maintain a balance of proteins, carbohydrates and fats, as well as monitor the caloric content of your diet.

Important! You can’t prescribe your own diet! It should be compiled by a specialist taking into account the needs of the expectant mother and baby.

In addition to dietary changes, incorporate moderate, regular physical activity into your daily routine. Exercise at least 150 minutes a week; swimming is very beneficial.

Blood Sugar Tracking

The second step in the fight against GDM is daily monitoring of blood sugar. It is needed to understand whether the diet helps.

To determine your glucose, you do not need to go to the doctor; for this there is a special device - a glucometer (Fig. 3).

Figure 3. A set of a glucometer, a skin-piercing pen, a set of test strips and needles for a cartridge pen. Source: WikiMedia

With its help, patients with GDM check their glucose levels on an empty stomach and 1-2 hours after meals every day for a week, recording the data in a journal. Based on the results obtained, the endocrinologist decides whether drug treatment is required, or whether GDM has already been controlled through dietary restrictions. Medicines are prescribed if one third or more of the results indicate glucose levels:

• on an empty stomach - more than 5.3 mmol/l,
• an hour after eating - more than 7.2-7.8 mmol/l,
• 2 hours after eating - more than 6.5 mmol/l.

Sometimes your doctor will also ask you to keep a diary of your blood pressure, body weight, and nutrition. You can also monitor sugar in your urine using test strips.

Important! Devices without a needle have already appeared - it is replaced by a sensor in the form of a patch that is glued to the skin. The glucometer reads its readings continuously. You can configure the device so that the data is sent to your mobile phone or immediately sent to the doctor.

Drug treatment: insulin

To control glycemic levels, hypoglycemic drugs are prescribed:

• In case of uncontrolled glycemia and the presence of fetopathy, insulin is used first. It is safe for the fetus; the dose and mode of administration are determined by the endocrinologist on an individual basis.
• In some cases, an insulin pump is installed for better glycemic control.
• Tablets of hypoglycemic drugs are used strictly according to indications.

During treatment, blood sugar control is not interrupted; all data on drug doses and blood glucose levels are recorded so that the doctor can adjust the dosage regimen.

Important! Insulin is considered the best treatment for GDM. To date, there is not enough data to judge the delayed effects of other glucose-lowering drugs.

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).

After childbirth

Gestational diabetes is a disease characteristic of pregnancy. After childbirth, GDM goes away as hormonal levels return to normal.

However, we must not forget that GDM is a risk factor for the development of type 2 diabetes mellitus and recurrent disease during the next pregnancy.

Immediately after birth, if insulin therapy was prescribed, it is canceled. During the first days, glucose levels are monitored by collecting venous blood. If there are no abnormalities, a glucose tolerance test is performed 6–12 weeks after birth to rule out type 2 diabetes.

If GDM was diagnosed during pregnancy, it is necessary to follow a diet and engage in dosed physical activity. Otherwise, there are no restrictions; after GDM you can breastfeed as usual.

Diagnosed diabetes

Even before pregnancy, the woman had diabetes mellitus type 1 or 2; she was notified of the presence of this disease and was treated for it under the supervision of a doctor. Comprehensive preparation for the upcoming pregnancy comes to the fore; during the gestation period, it is necessary to undergo diagnostics on a regular basis, visit a medical facility for observation, contact a gynecologist and endocrinologist, another mandatory condition is to undergo an examination in a hospital setting. You can sign up for a paid appointment in the gynecology department using the form on our clinic’s website or by phone, choosing a suitable day for a visit to a specialist.

Forecast

Timely treatment of GDM with insulin reduces the risk of complications by 98%. Severe consequences after the disease are observed if the diagnosis is not made in time and there is no treatment.

Important! GDM occurs unnoticed, but can cause great harm to the child, causing:

• various fetal malformations,
• Macrosomia (large fetal size),
• Hypoglycemia and respiratory disorders in a newborn,
• Cardiovascular and neurological diseases,
• Metabolic syndrome (carbohydrate metabolism disorder).

The worst outcome is intrauterine fetal death and miscarriage.

However, GDM increases the risk of developing type 1 and type 2 diabetes in the future. The probability of developing type 1 diabetes is 5.7% over the next 7 years, type 2 - up to 50%.

A child born to a mother with GDM also has an increased risk of obesity and diabetes.

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.

Prevention

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The main measure to prevent GDM is weight control and careful planning of pregnancy.

Obesity is one of the main risk factors for the development of GDM. The more fat there is in the body, the less responsive its cells become to insulin's commands to capture glucose from the blood.

Important! Trying to lose weight during pregnancy is not worth it. You must eat enough so that the fetus does not suffer from lack of nutrients.

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.