Gestational diabetes mellitus during pregnancy
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms of gestational diabetes
- Diagnostics
- Treatment
- Diet for gestational diabetes during pregnancy
- Possible complications and consequences
- Forecast
- Prevention
Gestational diabetes mellitus during pregnancy is a form of diabetes that can pose a threat to the developing fetus. The disease is diagnosed in 3-4% of cases of the total number of pregnancies, the most susceptible to it are pregnant women under 18 and over 30 years of age.
Source: magicworld.su
Gestational diabetes usually debuts in the second or third trimester and disappears on its own after childbirth. In 10-15% of cases, the disease causes the development of type 2 diabetes mellitus in a patient after giving birth, but even when this does not happen, the increased risk persists for 15 years. In the long-term period, after 10-12 years, type 2 diabetes mellitus develops in 40-60% of women who have had gestational diabetes.
Causes and risk factors
The etiopathogenesis of gestational diabetes mellitus during pregnancy is not fully understood. It is assumed that its development is due to the blocking of the production of a sufficient amount of insulin by hormones responsible for the correct growth and development of the developing fetus. During pregnancy, hormonal and biological changes occur in the woman's body associated with the formation of the placenta, which secretes chorionic gonadotropin, corticosteroids, estrogens, progesterone, placental lactogen into the mother's bloodstream. These hormones reduce the sensitivity of peripheral tissues to endogenous insulin. The developing violation of the metabolic response to endogenous insulin causes an increase in lipolysis, while the use of glucose by insulin-sensitive tissues decreases, which, in the presence of risk factors, can cause the development of diabetes.
Autoimmune diseases contribute to the development of gestational diabetes, in which the pancreas is destroyed and, accordingly, insulin production decreases. In women whose close relatives have any form of diabetes mellitus, the risk of developing gestational diabetes mellitus during pregnancy doubles.
Other risk factors include:
- genetic predisposition;
- viral infections in early pregnancy;
- recurrent candidiasis;
- polycystic ovary syndrome;
- stillbirth, the birth of a large fetus, a history of polyhydramnios, gestational diabetes mellitus in previous pregnancies;
- high blood pressure;
- overweight;
- bad habits;
- physical or mental stress;
- unbalanced nutrition (in particular, the use of large amounts of quickly digestible carbohydrates).
Forms of the disease
Diabetes mellitus in pregnant women is subdivided into pregestational, in which disorders of carbohydrate metabolism appear in a woman before pregnancy, and actually gestational, in which the disease first manifests itself during pregnancy.
Gestational diabetes mellitus is subdivided into diet-compensated diabetes and insulin-compensated diabetes combined with diet. Depending on the degree of compensation of pathology, compensated and decompensated gestational diabetes mellitus is distinguished.
Symptoms of gestational diabetes
Gestational diabetes mellitus proceeds in waves, its symptoms depend, among other things, on the duration of pregnancy. In some cases, the disease does not have clear clinical manifestations and is detected only during laboratory diagnostics, which is carried out as part of the monitoring of pregnancy.
The main symptom of gestational diabetes mellitus during pregnancy is an increase in the concentration of glucose in the blood of a pregnant woman (usually diagnosed after the 20th week), in the absence of indications of diabetes mellitus in a woman before pregnancy. Other manifestations of gestational diabetes include excessive weight gain, frequent and profuse urination, itchy skin, including genital itching, dry mouth, constant thirst, decreased appetite, weakness, and fatigue.
Diagnostics
As part of the diagnosis of diabetes mellitus in pregnant women, complaints and anamnesis are collected, with special attention to the presence of diabetes mellitus in family history.
The main methods are blood tests for glucose and glycosylated hemoglobin content, as well as a general urine analysis with the determination of glucose and ketone bodies. The glucose tolerance test detects disorders of carbohydrate metabolism in the early stages of development. Typically, a standard glucose tolerance test is performed by taking 75-100 g of glucose orally and then measuring the blood glucose level. If the patient has hyperglycemia, the test is contraindicated.
Treatment
Treatment for gestational diabetes during pregnancy is usually done on an outpatient basis. Blood glucose should be monitored daily. The measurement of this indicator is carried out first on an empty stomach, and then one hour after each meal.
First of all, the patient is advised to revise the diet. In addition, moderate physical activity is recommended to prevent excessive weight gain and keep the body in good shape. In addition, during exercise, muscles, which are insulin-independent, consume glucose, which helps to reduce glycemia. Physical activity can include gymnastics for pregnant women, swimming, walking. In this case, it is necessary to avoid sudden movements, as well as exercises aimed at working the muscles of the anterior abdominal wall. The level of load is selected by the doctor who leads the pregnancy, or by a specialist in exercise therapy.
Treatment of gestational, if necessary, may include herbal medicine (flaxseed, burdock root, blueberry leaves, etc.), taking hepato- and angioprotective drugs.
In the absence of a positive effect from the diet in conjunction with a set of physiotherapy exercises, insulin injections are indicated. Other hypoglycemic drugs are contraindicated in gestational diabetes due to their possible teratogenic effects.
The term of delivery is established taking into account the severity of the disease, the condition of the fetus and the presence of obstetric complications. The optimal period is the 38th week of pregnancy, since the lungs of the fetus are already mature and there is no risk of developing respiratory disorders.
In case of severe gestational diabetes mellitus and / or the development of complications, early delivery is recommended, the optimal period of which is the 37th week of pregnancy.
With the normal size of the woman's pelvis, the small size of the fetus and its head presentation, delivery through the vaginal birth canal is recommended. Delivery by cesarean section is usually performed when complications occur, as well as when the fetus is large.
Diet for gestational diabetes during pregnancy
The diet for gestational diabetes during pregnancy is primarily aimed at lowering blood glucose levels. A diet containing 40-45% carbohydrates and 20-25% fat is recommended. The amount of protein food is calculated based on the ratio of 2 g of protein per 1 kg of body weight. Starchy vegetables, confectionery, fatty and fried foods, liver, honey, eggs, instant food, mayonnaise and other industrial sauces are excluded from the diet. Fruits and berries should be consumed in moderation, preferring not very sweet ones (currants, gooseberries, green apples, cherries, cranberries). The diet is recommended to include lean meat, fish and cheese, cereals, durum pasta, cabbage, mushrooms, zucchini, bell peppers, legumes, herbs. Patients with gestational diabetes mellitus during pregnancy need to ensure that the body receives a sufficient amount of vitamins and minerals necessary for the development of the fetus.
Meals should be fractional (6-8 meals per day in small portions). Preference should be given to boiled, baked and steamed dishes, as well as fresh vegetable salads. In addition, it is recommended to consume at least 1.5 liters of liquid per day.
A patient with gestational diabetes after pregnancy is advised to stick to a diet and control blood glucose for some time to reduce the risk of developing type 2 diabetes. Indicators of carbohydrate metabolism, as a rule, normalize during the first month after childbirth.
Possible complications and consequences
Gestational diabetes increases the risk of complications and poor outcomes for both the pregnant woman and the fetus. The disease is dangerous due to the development of hyperinsulinemia in the fetus, which, in turn, can lead to impaired respiratory function. Also, the pathological process can become the cause of diabetic fetopathy, manifested by macrosomia, which necessitates a cesarean section. In addition, gestational diabetes increases the risk of stillbirth or neonatal death in the early neonatal period.
In patients with gestational diabetes during pregnancy, infectious diseases of the urogenital tract, preeclampsia, eclampsia, premature rupture of amniotic fluid, premature birth, postpartum hemorrhage and other complications of pregnancy are more common.
Forecast
With timely diagnosis and adequate therapy, the prognosis for gestational diabetes mellitus is favorable for both the pregnant woman and the unborn child.
Prevention
In order to prevent the development of gestational diabetes mellitus, it is recommended:
- monitoring the condition of a woman during pregnancy;
- correction of excess body weight;
- balanced diet;
- rejection of bad habits;
- sufficient physical activity.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
