Diabetes and childbirth. Caesarean section for diabetes

It is known that pregnancy, which occurs against the background of diabetes, is 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% of ideal body weight)
• 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 during 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 in the mother is reduced when diabetes is well controlled, especially before conception. According to research, the frequency of congenital malformations, premature birth and fetal death when the level of glycated hemoglobin is more than 8% is 2 times higher than the frequency of these complications when the HbAic level is 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 physical activity- very important elements of treatment of any type of diabetes during pregnancy.

Nutrition for pregnant women with diabetes

Pregnant women should take in enough nutrients and calories to normal development fetus and maternal life.

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.

Calories are calculated based on body weight 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 in overweight women. Obese pregnant women have an increased risk of cardiovascular diseases associated with insulin resistance and increased levels of 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 exercised before pregnancy, exercise can be continued under strict blood sugar monitoring.

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

Conclusions:

• Exercise is a great way to control blood sugar during pregnancy;
• Activities that work best include low-impact aerobics, swimming, hiking, 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 peak-less 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 and the risk of hypoglycemia is minimal.

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 high blood pressure and edema occur in a woman. later 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 maximum compared to the period before pregnancy. The point 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 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.

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.

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, all of a woman’s internal organs are subject to stress, 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 the high risk of developing type 2 diabetes.

Causes

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.

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 of a child or a large baby whose body weight is over 4 kg.
• Congenital malformation 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.

When the disease occurs, the patient is worried 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 urinate. bladder. Typically, this symptom torments pregnant women in the later stages, 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?

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. Doctors consider the most suitable option long walks on foot.
• 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 food cannot cope with the pathology, the doctor prescribes insulin therapy. The hormone is administered through injections. Drugs that lower blood sugar levels are not prescribed during pregnancy, as they can harm the fetus.

Diet food

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 the 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 several problems: their amniotic fluid breaks prematurely, labor begins prematurely, and during the birth of the child, the mother feels severe weakness in her 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 preventive measure is following the rules of nutrition during pregnancy.

If a woman has already had diabetes in the past while expecting a baby, then next child it is necessary to plan. It is allowed to give birth no earlier than 2 years after the last birth. To prevent a recurrence 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.

Should not be taken medicines 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.

« 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 for God, Caesar’s things are for Caesar,” 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 the most capable of raising and raising him, and maybe even giving her 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 pathology, 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.

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.

I hasten to report good news - the Endocrinological Research Center of the Russian Academy of Medical Sciences managed to develop a medicine that completely cures diabetes mellitus. At the moment, the effectiveness of this drug is approaching 100%.

Another good news: the Ministry of Health has achieved the adoption special program, which reimburses the entire cost of the drug. In Russia and the CIS countries, diabetics to can get the remedy FOR FREE.

Find out more>>

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, all of a woman’s internal organs are subject to stress, 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 the immune system of the expectant mother, which 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 the high risk of developing type 2 diabetes.

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.

What should people with diabetes do? The Endocrinological Research Center of the Russian Academy of Medical Sciences succeeded make a remedy completely cures diabetes mellitus.

Currently, the Federal program “Healthy Nation” is underway, within the framework of which this drug is given to every resident of the Russian Federation and the CIS FOR FREE. For detailed information, see official website MINISTRY OF HEALTH.

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 of a child or a large 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.

Our readers write

Subject: Defeated diabetes

From: Lyudmila S ( [email protected])

To: Administration my-diabet.ru

At the age of 47, I was diagnosed with type 2 diabetes. In a few weeks I gained almost 15 kg. Constant fatigue, drowsiness, feeling of weakness, vision began to fade. When I turned 66, I was already steadily injecting myself with insulin, everything was very bad...

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When the disease occurs, the patient is worried 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 torments pregnant women in the later stages, 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 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?

Stories from our readers

Conquered diabetes at home. It's been a month since I forgot about sugar spikes and taking insulin. Oh, how I used to suffer, constant fainting, calls to the ambulance... How many times have I gone to endocrinologists, but they only say one thing - “Take insulin.” And now it’s been 5 weeks and my blood sugar levels are normal, not a single injection of insulin, and all thanks to this article. A must read for anyone with diabetes!

Read the full article >>>

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. Doctors consider long walks to be the most suitable option.
• 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. Drugs that lower blood sugar levels are not prescribed during pregnancy, as they can harm the fetus.

Diet food

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 several problems: their amniotic fluid breaks prematurely, labor begins prematurely, and during the birth of the child, the mother feels severe weakness in her 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 preventive measure is following the rules of nutrition 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 recurrence 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.

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Today, childbirth with diabetes is no longer as scary as it used to be. At the same time, the risk that the baby will inherit the disease is minimal. Women with diabetes should plan their pregnancy, carefully monitor the slightest changes throughout the entire period of gestation, and responsibly approach the issue of choosing a specialized maternity hospital.

Types of diabetes in pregnant women

Childbirth with diabetes and pregnancy itself can negatively affect the development of the fetus: the risks of congenital pathologies and perinatal diseases increase, and there are cases of intrauterine death of the baby.

There are three types of diabetes mellitus in pregnant women:

• insulin dependent - type 1;
• non-insulin dependent - type 2;
• Gestational diabetes is type 3 diabetes, it can develop only after 28 weeks of pregnancy.

More often, pregnant women are diagnosed with type 1 diabetes. Non-insulin-dependent diabetes occurs mainly in women over thirty. Gestational diabetes is an extremely rare occurrence.

In the first half of pregnancy, complications do not occur as often. Sometimes only the threat of miscarriage persists. Pregnancy in the second half can be complicated by gestosis, polyhydramnios, threat of premature birth, fetal hypoxia and other pathologies.

The doctor plans what the delivery will be like. He looks first of all at general indicators assessment of the woman’s well-being and existing pregnancy complications. The best option is natural birth.

Childbirth with type 1 diabetes

Labor should not last longer than ten hours, as prolongation weakens labor forces. If during this time the woman has not given birth, then doctors decide on a caesarean section.

A combination such as diabetes and childbirth carries certain risks for mother and baby, so their condition is under constant supervision by doctors who take measures to prevent asphyxia. During labor, gestosis may increase.

Pain, anxiety and fatigue often provoke decompensation of diabetes - hypoglycemia or ketoacidosis.

Complications during childbirth in women that can occur with type 1 diabetes:

• premature rupture of water;
• weakening of generic forces (primary or secondary);
• increasing risk of developing fetal hypoxia;
• at the final stage of labor, fetal asphyxia may develop.

The final stage of childbirth in the presence of diabetes mellitus is given increased attention.

To avoid complications during childbirth with any method of delivery, a woman’s blood sugar level is measured every hour. For prevention purposes, a glucose-potassium mixture with insulin is usually administered.

Delivery in women with type 1 diabetes can also be performed by cesarean section.

Indications for surgery:

• multiple hemorrhages;
• development of ketoacidosis;
• kidney disease;
• severe gestosis;

• the location of the fetus in the pelvis or its large size;
• bleeding;
• placental abruption;
• scars on the uterus;
• narrow birth canal.

On the eve of the operation (at night), the woman in labor is given a dose of long-acting insulin in the usual dosage. At six o'clock in the morning, a mixture of glucose and potassium is prescribed, and insulin is also administered. The drugs are administered in parallel, depending on the level of glucose in the patient’s blood.

Childbirth with type 2 diabetes

Expectant mothers who are diagnosed with type 2 diabetes are at high risk for developing complications during childbirth and the postpartum period. Not only the woman herself, but also the baby can suffer.

To ensure that the birth goes smoothly and without sad consequences, doctors take some measures:

1. During childbirth, glucose concentration is determined. This should be done once every two hours.
2. The mother's blood pressure and the baby's heartbeat are monitored using a special device.

Doctors initially set up a woman in labor for a natural birth. However, if complications develop, abdominal surgery will be prescribed - cesarean section (planned or emergency).

Generally accepted indications for cesarean delivery:

• if a woman currently has complications of diabetes mellitus that are progressing (failures in kidney function, visual impairment, etc.);
• incorrect location of the fetus (in the pelvic area or oblique);
• the fruit is too large;
• fetal hypoxia.

During a natural birth, a woman is given an IV in the morning, which is used to stimulate the birth. Insulin can be administered through the same IV or intravenously every four or six hours.

For diabetes of any type, the birth canal must be prepared in advance. For this, doctors use hormonal drugs and antispasmodics.

A woman undergoing a caesarean section receives insulin therapy throughout the entire period. Due to such a delivery, the child is considered premature.

In the first hours it is observed with special care, since there is a risk of developing complications from the central nervous system and respiratory organs. Doctors can also prevent the onset of acidosis or glycemia.

When is a planned caesarean section performed:

• if a pregnant woman is diagnosed with “hydramnios”;
• a woman is carrying a large baby;
• the fetus experiences oxygen starvation;
• the woman developed late gestosis;
• diabetes in pregnancy is severe;
• the woman suffers from diseases of the vascular system.

The operation is usually scheduled, but sometimes it has to be done urgently. If a caesarean section is planned, then the woman must be prepared for it.

When the pregnancy does not have complications, a cesarean section is usually planned for the 38th week.

If complications arise, surgery can be performed at 32 weeks.

An emergency operation is performed if childbirth is accompanied by the following complications:

• the fetus cannot pass through the birth canal on its own;
• the risk of fetal suffocation increases;
• weak labor activity.

During the operation, the woman is given an epidural or general anesthesia. A planned operation involves a transverse incision; in this case, blood loss is small.

Postpartum period

During the postpartum period, a woman's need for insulin decreases. The patient may not be given insulin for two days.

Then the injections are resumed. During the first week, blood sugar levels should be monitored every three hours.

What is the connection between diabetes and breastfeeding?

Usually:

1. Both type 1 and type 2 diabetes have no contraindications to breastfeeding. Immediately after birth, the baby is brought to the mother and placed on the chest.
2. During feeding, blood glucose levels decrease. To prevent glycemia from developing, a woman should eat one bread unit's worth of food before feeding.

An obligatory moment after childbirth is the choice of a reliable method of contraception. Pregnancy and diabetes are very strong tests for the body. Therefore, after a natural birth, a woman is advised to wait at least a year to get pregnant again, and after abdominal surgery - three years.

Childbirth and diabetes create a situation of particular risk, which requires close monitoring and a professional approach by gynecologists. Only competent observation and management of the entire pregnancy and childbirth will help to avoid serious complications not only for the expectant mother, but also for the child.