Gestational diabetes is a special form of diabetes mellitus that develops in women during pregnancy due to hormonal imbalance. The main symptom of this disease is an increase in blood glucose levels after eating and maintaining the indicator normal on an empty stomach. Gestational diabetes poses a threat to the fetus, as it can cause the development of congenital anomalies of the heart and brain. For the purpose of early detection of pathology, a glucose tolerance test is indicated for women in the period of 24-28 weeks. Treatment of gestational diabetes involves adherence to a diet, work and rest regimen, in severe cases, insulin therapy is prescribed.
Gestational diabetes or diabetes of pregnant women is a disease that develops due to a violation of carbohydrate metabolism in a woman’s body against the background of insulin resistance (lack of susceptibility of cells to insulin). In obstetrics, this pathology is diagnosed in about 3-4% of all pregnant women. Most often, the primary increase in blood glucose levels is determined in patients whose age is less than 18 or more than 30 years. The first signs of gestational diabetes usually appear in the 2-3 trimester and disappear on their own after the birth of a child.
Sometimes gestational diabetes causes the development of type 2 diabetes in women after childbirth. This is observed in about 10-15% of patients with this diagnosis. According to research by scientists, gestational diabetes is more often diagnosed in dark-skinned female representatives. The danger of the disease for the fetus is that due to an increase in glucose in the mother’s blood, the baby’s body begins to actively produce insulin. Therefore, after birth, such children are prone to a decrease in blood sugar levels. In addition, gestational diabetes contributes to a rapid increase in fetal weight during intrauterine development.
The etiopathogenesis of gestational diabetes has not been reliably elucidated. Scientists suggest that the disease develops due to blocking the production of a sufficient amount of insulin by hormones that are responsible for the proper growth and development of the fetus. During pregnancy, a woman’s body needs more glucose, which is required not only for the mother, but also for the baby. There is a compensatory increase in insulin production. These factors become the main cause of gestational diabetes. Against the background of a disorder of the functions of the beta cells of the pancreas, an increase in the level of proinsulin is noted.
The cause of gestational diabetes can be autoimmune diseases that contribute to the destruction of the pancreas and, as a result, a decrease in insulin production. In patients whose relatives suffer from some form of diabetes mellitus, the risk of developing this pathology increases by 2 times. Another common cause of the disorder is obesity, since it already implies a violation of metabolic processes in the body of the expectant mother. Gestational diabetes can occur if, in the early stages of pregnancy, a woman suffered viral infections that contributed to a disorder of the pancreas.
The risk group for the development of gestational diabetes includes women suffering from polycystic ovary syndrome, prone to bad habits – smoking, alcohol and narcotic substances. Aggravating factors are the birth of a large fetus, stillbirth, a history of polyhydramnesis, gestational diabetes in previous pregnancies. A high risk of pathology is observed in patients younger than 18 and older than 30 years. Additionally, an unbalanced diet can provoke the development of a violation, involving the use of a large number of foods rich in fast carbohydrates.
Symptoms and diagnosis
Gestational diabetes has no specific symptoms. The main sign of pathology is an increase in the concentration of glucose in the blood, which was not observed in a woman before pregnancy. This disorder is most often diagnosed in patients after 20 weeks of gestation. Additionally, with gestational diabetes, there may be an excessive increase in the patient’s body weight (more than 300 g per week), a strong feeling of thirst, and an increase in daily diuresis. Also, patients complain of a decrease in appetite, fatigue that occurs quickly. On the part of the fetus, a sign of the development of gestational diabetes can be rapid weight gain, incorrect proportions of body parts, excessive deposition of fatty tissue.
The main method of detecting gestational diabetes is a blood test to determine glucose levels. When registering for pregnancy, an obstetrician-gynecologist directs all women to this analysis. The risk group for developing gestational diabetes includes patients who, when examining blood taken from a finger, the amount of glucose was 4.8-6.0 mmol/l, from a vein – 5.3 to 6.9 mmol/L. If such indicators are present, a woman is assigned a test with a glucose load, which allows to identify disorders of carbohydrate metabolism in the early stages.
Also, to determine the functionality of the pancreas and the risk of this disease, an oral glucose tolerance test is routinely prescribed to all pregnant women at 24-28 weeks. First, a blood test is taken from a vein on an empty stomach, after which a woman should drink 75 g of glucose diluted in 300 ml of water. After 2 hours, the blood sampling is repeated. The diagnosis of “gestational diabetes” is established if the first glucose level indicator is more than 7 mmol / l, the second is more than 7.8 mmol / L. to confirm it, the pregnant woman is prescribed another analysis on the same day a few hours later.
In case of gestational diabetes, treatment is carried out on an outpatient basis. First of all, the patient is recommended to revise the diet. The diet is aimed at reducing blood glucose levels, so a woman should exclude from her menu foods containing fast carbohydrates: confectionery, starchy vegetables. Fruits should be consumed in moderation and not very sweet. Fatty and fried dishes, fast food, store-bought sauces, muffins are banned in gestational diabetes. You can replace these products with cabbage, mushrooms, zucchini, legumes, greens. In addition, with gestational diabetes, it is necessary to include low-fat fish and meat, cereals, cereal porridges, hard pasta, vegetables in the menu. Once a week, you can allow the presence of red fish in the diet.
When making up a diet for a pregnant woman with gestational diabetes, it is important to ensure a sufficient supply of vitamins and minerals necessary for proper growth and development of the fetus. Carbohydrates should make up 45% of the value of the diet, fats – 30%, proteins – 25%. With gestational diabetes, a pregnant woman should eat small portions, but often – 3 main meals and 2-3 snacks. It is necessary to prepare easily digestible dishes, the best options are boiled products, steamed, baked. The drinking regime involves the use of at least 1.5 liters of liquid per day.
Moderate physical activity is recommended for patients with gestational diabetes. They allow you to keep the body in good shape, prevent excessive weight gain. In addition, exercise increases the activity of insulin, which is important in gestational diabetes. Physical activity involves gymnastics, walking, swimming. It is necessary to avoid sudden movements, exercises aimed at the work of the abdominal muscles. The level of load is determined by the endurance of the woman and is set by the doctor.
A woman with this disease should monitor blood glucose levels daily, measurements are taken on an empty stomach and 60 minutes after each meal. If diet therapy in combination with physical exercises does not give a positive effect, a patient with gestational diabetes is prescribed insulin injections. The dosage of the drug is determined by a specialist. Pregnancy management with such a diagnosis is continued up to 38-40 weeks. Delivery is most often carried out by caesarean section, since the fetus is large, which poses a threat of complications during the natural development of the birth process.
With gestational diabetes, a child is born with a low level of glucose in the blood, but the indicator returns to normal with normal breast milk or adapted mixtures. Be sure to monitor the concentration of sugar in the blood of the mother and child. After giving birth, a woman with gestational diabetes should follow the diet prescribed during pregnancy for some time and measure glucose levels in order to avoid the development of type 2 diabetes mellitus. As a rule, the indicators return to normal in the first months after the birth of the baby.
Prognosis and prevention
In general, with disease, the prognosis for mother and child is favorable. With such a disease, there is a risk of developing macrosomia – excessive fetal growth, as well as an increase in a woman’s body weight. With macrosomy, the child’s brain retains its natural size, and the shoulder girdle increases. These consequences of gestational diabetes can cause injuries during natural childbirth. If a large fetus is detected on ultrasound, the doctor may recommend premature delivery, which also poses a certain danger, since, despite the large size, the baby remains insufficiently mature.
Prevention of gestational diabetes consists in planning pregnancy and controlling body weight. A woman should eat right, give up bad habits. It is necessary to adhere to an active lifestyle, since moderate physical activity can reduce the likelihood of developing gestational diabetes. It is important that the exercises are regular and do not cause discomfort to the pregnant woman.