Insulin therapy in pregnant women with diabetes mellitus. Features of the introduction of insulin and the calculation of its dose for pregnant women Diabetes mellitus during pregnancy inject insulin where

Insulin treatment for gestational diabetes

When diabetes occurs during pregnancy (pregnancy diabetes), then insulin treatment in some cases is not necessary, since it often proceeds according to the second type. In such cases, a diet low in rapidly absorbed carbohydrates (mainly sugar and sugar-containing foods) is often sufficient. But if it becomes necessary to prescribe insulin in gestational diabetes, then the regimen of insulin administration with a syringe / pen imitates the work of the pancreas: short insulin administered before meals imitates insulin secretion at meals, and prolonged insulin imitates basal insulin secretion between meals. Similarly, in the case of insulin dispenser treatment, the pre-meal insulin bolus and basal insulin regimen also mimic the activity of the pancreas. The type of insulin, its dosage and administration schedule is determined by your doctor. If the initially selected treatment regimen does not suit you, consult your doctor again and ultimately select the most convenient and effective treatment regimen.

Management of uncomplicated type 1 and 2 diabetes mellitus in pregnancy

A convenient classification has been proposed for choosing the treatment of diabetes mellitus during pregnancy. White P ( diabetes mellitus in preganacy . Clinic Perinatol 1:331-347,1974) ( table . VI.2 )

Table VI.2 .

Classification White

Classes	Definition
Class A1	Gestational diabetes mellitus; compensated by diet
Class A2	Gestational diabetes mellitus; insulin therapy
Class B	Diabetes before pregnancy; onset at age ≥20 years or duration <10 years
Class C	Diabetes before pregnancy; arose at the age of 10-19 years or lasted 10-19 years
Class D	Diabetes before pregnancy; onset before the age of 10 years or lasting more than 20 years
Class F	Diabetes before pregnancy; diabetic nephropathy
Class R	Diabetes before pregnancy; proliferative retinopathy
Class RF	Diabetes before pregnancy; retinopathy and nephropathy
Class H	Diabetes before pregnancy; ischemic heart disease
Class T	Diabetes before pregnancy; kidney transplant

The main provisions observed in the management of patients with diabetes mellitus during pregnancy and childbirth are presented in Table. VI.3 and include the following items:

blood glucose should be tested at least 4-7 times a day (for example, before and after each meal and at bedtime) throughout pregnancy;

target values of blood glucose 3.3-5.5 mmol/l before meals and 5.5-7.2 mmol/l after meals;

blood glucose 2 hours after eating less than 6.7 mmol / l;

the level of glycated hemoglobin (A1c), which must be monitored every 1-3 months, should be less than 6.5% (with monthly monitoring, the trend of change is assessed HbA 1 c ).

an ultrasound examination of the fetus should be performed as early as possible in order to calculate the gestational age and calculate the parameters of optimal fetal growth, with which to further compare;

at 18-22 weeks, everyone who had diabetes before pregnancy should have an ultrasound and ECG of the fetus to exclude developmental pathology;

it is desirable to be observed to assess the condition every 1-2 weeks (depending on the level of glycemic control) up to 34 weeks, after - weekly;

non-stress testing and/or biophysical profile should be performed weekly between 32 and 36 weeks of gestation;

fetal lung maturation should be monitored in women with poor control of diabetes or an uncertain date of conception when delivery is planned before 39 weeks gestation.

TableVI.3

Management of uncomplicated pregnancies in diabetes mellitus

State		Doing
Pregnancy	Classes B and C	-Self-monitoring of blood glucose 4-7 times a day - Daily doctor visit until 34 weeks, then weekly - Ultrasound: ~20 weeks, then every 4-6 weeks - A1c every 1-3 months - Daily assessment of fetal movements - Non-stress test at 32-34 weeks and then weekly - Fundus examination and observation depending on the results - 24-hour urine at the beginning and then every trimester to assess urinary protein and kidney function
Pregnancy	Classes D - FR	- All of the above plus an ECG at the beginning; uric acid, liver function tests, fibrinogen, coagulogram; may be required in each trimester
Timing of delivery	Classes A and B	≤42 weeks pregnant if good glycemic control
Timing of delivery	Classes C- FR	By the time the lungs mature
childbirth		- Glycemia is maintained at ≤5.0 mmol/l - Intravenous drip of saline at a rate of 7 ml/hour and glucose and/or insulin solutions are administered based on the results of an hourly glycemic study

insulin therapy

Indications for initiating insulin treatment in gestational diabetes (i.e., occurring during pregnancy):

Fasting capillary whole blood glucose on a diet >5.0 mmol/L (>5.5 mmol/L plasma)

One hour after ingestion >7.8 mmol/l (>8.3 mmol/l plasma)

2 hours after eating 6.7 mmol/l (>7.3 mmol/l plasma).

Regardless of the level of blood glucose in a pregnant woman on a diet, indications for the appointment of insulin are:

Ultrasound signs of fetal pathology

Increasing polyhydramnios

Before prescribing insulin therapy, a pregnant woman should:

Complete an additional training course (usually in a hospital setting) and additionally in a self-control diaryrecorded: doses of insulin andnotes (episodes of hypoglycemia, ketone bodies, blood pressure, etc.)

Be provided with means of self-management of diabetes mellitus.

P If self-monitoring is not possible, blood glucose is monitored in the laboratory (6 12 glycemic measurements per week or more).

In 1979, the Food and Drug Administration (FDA, foodanddrugAdministration) proposed a risk classification for the fetus of pharmaceuticals (table. VI.4). It builds on a system that was developed in Sweden a year earlier. The current classificationFDA medicines importance is attached to writing recommendations, in particular when prescribing insulin to pregnant women.

Table VI.4.

for pregnant
	Adequate and well-controlled studies have not shown a risk to the fetus in the first trimester of pregnancy (and no clear evidence has been obtained regarding the risk in subsequent trimesters
	In animal reproduction studies, no risk to the fetus has been shown and there are no adequate and well controlled studies conducted in pregnant women OR in animal studies have shown a risk to the fetus, but adequate and well-controlled studies in pregnant women have not shown a risk to the fetus in any trimester of pregnancy
	Animal studies have shown adverse effects on the fetus and there are no adequate and well-controlled studies in pregnant women, but the potential benefit justifies the use of the drug despite the potential risk.

Human insulin is approved for use during pregnancy without any restrictions. With respect to insulin analogs, indications for their use in pregnancy are currently formulated as follows:

. Insulin Aspart (Novorapid Penfil,Novomix 30 FlexPen) approved for use during pregnancy and lactation (European Medecines Agency, EMEA);

. Insulin Humalog is categorized as "B"

. Insulins Apidra (Glulisin), Lantus (Glargin) and Levemir (Detemir) are classified as category "C"

Pregnant and lactating women are contraindicated in the appointment of any hypoglycemic drugs, with the exception of insulin.

Insulin regimen in pregnant women:

For type 1 diabetes, the basis-bolus regimen of insulin therapy

For type 2 diabetes, traditional insulin therapy can be prescribed. A second short-acting insulin injection may be given before dinner and/or lunch, depending on blood glucose levels.

Ultrashort-acting insulins are increasingly being used to treat pregnant women, as they improve postprandial blood glucose levels and reduce the incidence of hypoglycemia.

Long-acting insulin analogues are not used during pregnancy, as they are classified as category C.

Insulin pumps are also used during pregnancy, but their advantage over a frequent injection regimen has not been proven in relation to the health of the newborn, average glycemia, A 1 c or the average amplitude of fluctuations in glycemia. Most often, pump therapy is chosen for pregnant women with type 1 diabetes who have poorly controlled hypoglycemia or an increased need for insulin in the morning hours (4-8 a.m.).

The hormone in question is of a peptide nature. It has a significant impact on almost many metabolic processes in the body: protein metabolism, glucose uptake, carbohydrate metabolism, glycogen synthesis, and so on. Fluctuations in glucose levels are unacceptable, because both a decrease and an increase in its concentration will immediately affect the entire body as a whole and most organs and systems in particular. The norm of insulin in women is from 2 to 27 mcU / ml. On an empty stomach - from 8 to 12 mcU / ml.

However, the female body has one feature that makes it rather difficult to calculate the normal level of the hormone - during pregnancy, a woman undergoes serious changes in glucose metabolism and in almost all metabolic processes in general.

insulin during pregnancy

During pregnancy, a woman should pay much more attention to her health. And if the expectant mother is sick with diabetes, she is simply obliged to be under the care and supervision of endocrinologists while waiting for the baby. You will have to measure insulin yourself.

It is worth noting that the rate of insulin in women depends on the timing of pregnancy:

Up to 15-16 weeks. At this stage, glucose is spent mainly on an increase in the uterus and on the development of the fetus. In this regard, insulin during pregnancy is prescribed in much smaller quantities. In this case, all manipulations must be carried out under the close supervision of specialists, and in parallel, constant monitoring of the concentration of glucose in the blood is carried out.

From 20 to 28 weeks. At this stage, you should be very careful. There is an active growth of the placenta, which provokes a stable increase in the concentration of glucose in the blood. Quite often, a woman is hospitalized and the dose of insulin she takes is increased.

Starting from week 28, the course of diabetes becomes more stable. Thanks to the correct schedule, it is possible to maintain and successfully control the norm of glucose in the blood. For example, the norm of fasting glycemia should be from 3.5 to 5.7 mmol / l, and after eating food - 5.1 and up to 7.7 mmol / l.

It is important to realize that during pregnancy, a woman should very carefully monitor the maintenance of blood glucose levels, regardless of the period. After all, any fluctuations have a strong impact on the health of the mother and the unborn baby. Moreover, with uncompensated diabetes, the risk of miscarriage in the early stages, the formation of preeclampsia and severe toxicosis significantly increases. Women can develop severe polyhydramnios, leading to various malformations in the development of the unborn baby. In addition, people with complicated diabetes have a significantly increased risk of various infectious diseases. It sometimes comes to the point that for a period of up to 12 weeks, doctors, with serious indications, may decide to terminate the pregnancy. Also, numerous studies have shown that if blood glucose is normal, the appearance serious complications unlikely.

Gestational diabetes (GDM)

5 (100%) voted 1

Gestational diabetes is a type of diabetes that women develop during pregnancy. The body of a woman is not able to provide herself and the child with insulin, which leads to an increase in blood glucose levels and constant hyperglycemia.

Causes of lack of insulin during pregnancy

insulin resistance. The tissues of a woman's body lose sensitivity to insulin. The body suffers from a lack of the hormone, although the cells of the pancreas continue to produce it in the required amount. This type of gestational diabetes is very similar to type 2 diabetes. After childbirth, tissue sensitivity is restored in 90% of cases.
Insufficient production of insulin. In this case, the pancreas is affected, and its islet cells are not able to provide increased insulin rates for a pregnant woman. This course of the disease resembles type 1 diabetes. After pregnancy, diabetes disappears in 95% of cases, as the load on the pancreas decreases, and the insulin produced by the body is enough to normalize sugar.
Impaired glucose tolerance. You can determine this by increasing the level of sugar only after eating. This type is called prediabetes. Almost always, prediabetes occurs long before pregnancy, but it is detected only when taking tests during preparation for childbirth. Prediabetes persists even after childbirth, so a woman will have to monitor her diet and consult doctors.
Having “full” diabetes. In 3% of cases, when taking tests, a pregnant woman is diagnosed with type 1, type 2 diabetes or its rarer forms. In such cases, some doctors generally recommend terminating the pregnancy, since the risks of miscarriage or the birth of a defective child are very high. The child is more likely to be born with type 1 diabetes.

Risk group for gestational diabetes

DM in pregnant women is more likely to develop 2-14% . There is a risk group, women of which are most prone to problems with sugar.

Excess body weight

Woman's age over 30

Past gestational diabetes

Family history of diabetes mellitus
The last child was big
Already had gestational diabetes

Symptoms of gestational diabetes

Often this type occurs without symptoms, but sometimes the following symptoms occur:

intense thirst
Frequent urination
vision problems
Fatigue

If you notice these symptoms, you need to undergo a series of tests. Doctors always prescribe a diagnosis for GDM to those who are at risk. If you have not been prescribed such an examination, you should take a closer look at who is conducting your pregnancy.

Diagnosis of GDM

Diagnosis is carried out using special glucose tolerance tests (GTT). Usually screening GTT is done between 24 and 28 weeks.

50 grams of pure glucose is dissolved in a glass of water and given to the patient to drink. An hour later, they take an analysis for sugar. If the sugar levels are above the established norm, the pregnant woman undergoes another test - a diagnostic GTT.

Stages of diagnostic GTT:

First, take blood from a vein on an empty stomach. Check it for sugar levels.
After the pregnant woman drinks 100 grams of water with glucose.
Every hour for 3 hours take blood from a vein for sugar.

If at least 2 test results out of 3 exceed the norm, the patient is diagnosed with gestational diabetes mellitus.

Treatment of gestational diabetes

IN 90% cases of GDM are helped to compensate by diet and physical exercise. Also, a pregnant woman will need to do an analysis for sugar levels 5 times a day.

Below is a table of sugar levels that are desirable during pregnancy.

Diet for gestational diabetes

There are a number of dietary rules that a pregnant woman must follow in order to avoid hyperglycemia:

Fractional food - 5-6 once a day, in small portions. Three meals are the main ones, and snacks can be taken between them.
It is forbidden to use flour products, sweets, potatoes and packaged juices. Useful diabetic recipes can be found in the section.
The diet should contain 30% carbohydrates, 20% fats and 50% proteins.
The average daily caloric intake is calculated by the formula - 30 kcal per 1 kg of your ideal weight.

Physical exercise

If you are overweight, your doctor will advise you to do prenatal exercises.

You will need at least every day 30 minutes do light exercise. Reducing body fat will help reduce tissue insulin resistance.

Below is a video with an example of gymnastics for pregnant women:

insulin for gestational diabetes

In 10% of cases, diet and exercise are not enough to normalize sugar. In such cases, injections are prescribed. You also need to remember that medicines in tablets for pregnant women are strictly prohibited.

Insulin therapy is prescribed only by attending physicians who have full picture diseases and information about the individual characteristics of pregnancy. In no case do not take insulin therapy from the Internet and do not self-medicate - this can lead to problems with the child.

The impact of diabetes on pregnancy

Gestational diabetes in pregnant women is dangerous because a very large amount of excess glucose enters the fetus.

As a result, it may develop macrosomia- excessive size and weight of the child. At the same time, the head and brain of the fetus develop normally, but the shoulder joints and body become large.

Macrosomia interferes with the normal resolution of the pregnancy. Doctors are left with two options - caesarean section or premature birth.

Doctors induce preterm labor to reduce the risk of injury to the baby or mother. But this entails another problem - the child may not be fully developed.

After birth, the baby may develop hypoglycemia or jaundice. Also, these children are more susceptible to diabetes in the future.

Gestational diabetes after childbirth

After giving birth, you will still need to take a blood sugar test once a year, even if the symptoms of diabetes have disappeared.

In 8% of women, gestational diabetes progresses to type 2 diabetes after childbirth, and only 2% to type 1 diabetes.

Conclusion

Gestational diabetes is a test that a pregnant woman can pass with dignity, following all the doctor's instructions and keeping her sugar normal.

It is important to remember that not only your health is at stake, but also the health of your unborn child. For good spirits, remind yourself that you will have to live with diabetes for 9 months, and many people live with it all their lives.

Diabetes that occurs during pregnancy (gestational) usually proceeds according to the second type, and diet and lifestyle changes are enough to normalize sugar. If these measures do not bring the desired result and insulin is not produced enough during pregnancy, then they resort to insulin therapy. This method of treatment is prescribed after many examinations and tests, it is an extreme measure in the treatment of this disease, but very effective and avoids complications for the mother and unborn child.

Diabetes during pregnancy

Insulin is a hormone produced by the pancreas and stimulates the process of reducing blood sugar, which tends to rise with the intake of the next portion of carbohydrates in the body. In response, the pancreas begins to produce a special hormone to process this glucose. To do this, it ensures its delivery to all cells and tissues of the body, suspending the process of its production in the liver. A healthy pancreas responds to a decrease in glycemia by stopping insulin production.

If insulin sensitivity is compromised, it begins to be produced in excess, which makes it difficult to deliver glucose to cells. Insulin is in the blood long time thereby slowing down the metabolism.

Another function of insulin is to stimulate protein synthesis in muscles. It also promotes the conversion of glucose into fat, inhibiting its breakdown and stimulating storage, which can contribute to obesity.

Observation of pregnant women with diabetes requires special monitoring both by doctors and by the women themselves.

Usually, in order to maintain sugar within the normal range, it is enough for pregnant women to follow a certain regimen, the basic rules of which are:

minimizing (or better - a complete refusal) the consumption of easily digestible carbohydrates;
fractional meals (three main meals and two or three snacks);
moderate physical exercise such as hiking, swimming in the pool.

For the timely detection of possible fetal disorders, pregnant women must strictly adhere to the ultrasound schedule.

15-20 weeks. During this period, during the study, gross malformations of the fetus should be excluded;
20-23 weeks. At this time, the fetal heart is carefully checked to exclude any pathologies;
28-32 weeks. At this time, the study is carried out to identify intrauterine growth retardation.

Indications for insulin therapy

In the case when, during pregnancy, diet and exercise alone fail to normalize glycemia, doctors resort to prescribing insulin injections.

Indications for this can also serve as signs of fetopathy of the unborn child, detected during ultrasound. The consequences of this disease can be very serious, so it is important to identify violations in the early stages.

The injection scheme is selected by the endocrinologist, based on the results of monitoring the level of glycemia and individual characteristics. It is recommended to measure sugar and record readings 8 times a day: on an empty stomach, before meals, an hour after eating, shortly before bedtime, at 03:00 and in case of poor health. Normal glycemic values for pregnant women range from 3.3-6.6 mmol / l.

Insulin administration is safe for mother and child, non-addictive, and immediately after birth is canceled, which does not entail harm.

The following glucose values may be the basis for the appointment of insulin therapy:

Such patients need to learn to control all important indicators:

the level of glycemia;
the dose of the administered substance;
the presence of acetone in the urine;
arterial pressure;
episodes of hypoglycemia.

It is necessary to keep a special self-observation diary, where all this information will be recorded. This notebook should be shown to the doctor during future examinations to monitor the condition and possibly adjust the prescribed treatment.

If a woman does not have the opportunity to independently take measurements, then she can do this in the laboratory. Testing is required 6-12 times a week or more often.

Insulin regimens

During the bearing of a child and the lactation period, the use of any sugar-lowering drugs, with the exception of insulin, is contraindicated.

To date, its preparations are known quite a lot, and they are classified according to the following criteria:

by the onset of action, “peak” and duration: (ultra-short, medium, prolonged, short);
by species (human, whale, pig, cattle);
according to the degree of purification: (traditional, monopeak, monocomponent).

There are two regimens of therapy: traditional and basal-bolus.

At healthy person the amount of insulin is constantly maintained at a stable level, which is the basic (basal) concentration for it. It is produced if the work of the gland is not disturbed, in a state on an empty stomach, it is partially consumed to maintain its base concentration, but its large component accumulates “for the future”. This is a food bolus.

It is useful during meals for the absorption of substances that nourish the body:

When prescribing a basal bolus regimen, it is meant to create a baseline concentration with the help of injections of a long-acting drug, either an average drug at night and / or in the morning.
To form the bolus concentration that the body will need after eating, injections are made before significant meals with short or ultrashort preparations. Thus, there is an imitation of the functioning of the pancreas in the body in the normal mode.

The traditional program differs in that the time and doses are strictly the same. Then measurements are rarely made. Along with this type of therapy, the patient must adhere to a certain diet and make sure that the amount of nutrients consumed from food remains unchanged every day.

This scheme is the least flexible, because adhering to it, the patient is forced to be highly dependent on both the diet and the schedule. With this approach, injections are usually given twice a day for two: short-acting and medium-acting drugs. Or in the morning and evening, a mixture of various types is injected with one injection.

Insulin regimens for pregnant women:

with DM1 - the program "basis-bolus";
with DM2, it is advisable to use the traditional scheme.

For the treatment of pregnant women, ultrashort-acting drugs are most often prescribed. This makes postprandial glycemia acceptable and reduces the incidence of hypoglycemia (sugar falls below 3.3 mmol/L).

Most drugs are injected into the subcutaneous fat (abdomen, shoulder, upper thigh). Such injections are carried out using special syringes or syringe pens.

There is also an insulin pump. This is a small portable device that works on the principle of an infusion system. With its help, a fast-acting drug is administered around the clock. This method is often used in type 1 diabetes, when the patient has poorly controlled hypoglycemia or the need for this hormone increases in the morning (4-8 hours).

Follow-up after childbirth and planning for the next pregnancy

Insulin administration is canceled for all diabetic patients after childbirth, which is completely safe for both mother and child. Within three days after giving birth, such patients take a blood test for sugar.

This is done in order to monitor the condition and not to miss possible violations.

Future pregnancies in these women should be carefully planned under the supervision of an obstetrician-gynecologist and an endocrinologist, as these patients are already at high risk for type 2 diabetes later in life. They should closely monitor their health and systematically visit an endocrinologist and an obstetrician-gynecologist.

After 2-3 months from the moment of delivery, such patients are recommended to:

if the level of glycemia on an empty stomach exceeds 7.0 mmol / l - a special test for glucose tolerance;
gradual increase in physical activity;
overweight diet.

The district pediatrician who observes a child born to a mother with diabetes should be informed about this in order to take this fact into account when observing a small patient and take preventive actions so that undesirable consequences do not occur in his development.

Diabetes mellitus is an endocrine pathology that has several causes of development and is characterized by a lack of insulin production, a violation of its action on peripheral cells and tissues, or a combination of both factors. There are several forms of the disease, but they all have the same clinical sign - hyperglycemia (high blood sugar).

If the disease occurs during the period of bearing a child, is accompanied by insulin resistance and formed in the second half of pregnancy, we are talking about gestational diabetes mellitus (GDM). However, there are options for detecting pathology in the early stages of pregnancy, then experts think about the pregestational form of the disease, which is much more severe and has serious Negative consequences for mother and fetus.

The consequences of diabetes mellitus during pregnancy, the tactics of managing women with endocrine pathology, as well as the effect of hyperglycemia on the fetus are discussed in the article.

Types of pathology in pregnant women

Pregestational diabetes, that is, the one that arose even before the conception of the baby, has the following classification:

a mild form of the disease is an insulin-independent type (type 2), which is supported by a low-carbohydrate diet and is not accompanied by vascular pathologies;
moderate severity - insulin-dependent or insulin-independent type of disease (type 1, 2), which are corrected drug treatment, with the initial stages of complications or without them;
a severe form of the disease is a pathology accompanied by frequent jumps in blood sugar up and down, frequent attacks of a ketoacidotic state;
pathology of any type, accompanied by severe complications from the renal apparatus, visual analyzer, brain, peripheral nervous system, heart and vessels of various sizes.

Diabetes also share:

to compensated (best controlled);
subcompensated (bright clinical picture);
decompensated (severe pathologies, frequent attacks of hypo- and hyperglycemia).

Gestational diabetes usually develops from the 20th week of pregnancy, is most often diagnosed with laboratory diagnostics. Women associate the appearance of symptoms of the disease (thirst, excessive urination) with their "interesting" position, without attaching serious importance to them.

How high sugar affects the mother's body

For any person, whether he is a woman, a man or a child, chronic hyperglycemia is considered a pathological condition. Due to the fact that a large amount of glucose remains in the bloodstream, the cells and tissues of the body suffer from a lack of energy. Compensatory mechanisms are launched, but, over time, they further aggravate the condition.

Excess sugar negatively affects certain parts of a woman's body (if we talk about the period of pregnancy). The processes of blood circulation change, as the erythrocytes become more rigid, clotting is disturbed. Peripheral and coronary vessels become less elastic, their lumen narrows due to clogging with atherosclerotic plaques.

Pathology affects the renal apparatus, provoking the development of insufficiency, as well as vision, sharply reducing the level of its sharpness. Hyperglycemia causes the appearance of a veil before the eyes, hemorrhages and the formation of microaneurysms in the retina. The progression of the pathology can even lead to blindness. Against the background of gestational diabetes, such serious changes do not occur, but if a woman suffers from a pregestational form, an urgent correction of the condition is required.

High sugar numbers also affect a woman's heart. The risk of developing coronary artery disease increases, since the coronary vessels are also exposed to atherosclerotic lesions. The pathological process involves the central and peripheral nervous system. Changes in the sensitivity of the skin of the lower extremities:

soreness at rest;
lack of pain sensitivity;
crawling sensation;
violation of the perception of temperature;
lack of sensation of vibrational perception or, conversely, its excess.

In addition, at some point in pregnant women, a ketoacidotic state may occur. This is an acute complication of the "sweet disease", which is characterized by critically high glucose levels in the bloodstream and the accumulation of ketone (acetone) bodies in the blood and urine.

Possible complications of pregnancy due to gestational diabetes

Women with the gestational form of the disease suffer from various complications during childbearing ten times more often than healthy patients. More often develops preeclampsia, eclampsia, swelling, damage to the renal apparatus. Significantly increases the risk of infectious processes of the urinary system, premature birth.

Puffiness of the body is one of the clearest signs of late gestosis. Pathology begins with the fact that the legs swell, then swelling of the abdominal wall, upper limbs, face, and other parts of the body appears. A woman may not have complaints, but an experienced specialist will notice a pathological increase in body weight in a patient.

Additional signs:

there is a significant mark on the fingers from the rings;
there is a feeling that the shoes have become small;
at night, a woman wakes up more often to go to the toilet;
finger pressure in the shin area leaves a deep recess.

Kidney damage is manifested as follows:

blood pressure numbers rise;
swelling occurs;
protein and albumin appear in urine analysis.

The clinical picture may be bright or sparse, as may the level of protein excreted in the urine. The progression of the pathological condition is manifested by an increase in the severity of symptoms. If there is similar situation, specialists make a decision on urgent delivery. This allows you to save the life of the baby and his mother.

Another complication that often occurs on the background of diabetes is preeclampsia. Doctors think about its development when the following signs appear:

severe cephalgia;
a sharp decrease in visual acuity;
flies before the eyes;
pain in the projection of the stomach;
bouts of vomiting;
disturbance of consciousness.

Women may suffer:

from high water;
premature detachment of the placenta;
uterine atony;
spontaneous abortions;
stillbirth.

The effect of hyperglycemia on the fetus

Not only the body of a woman, but also a baby suffers from chronic hyperglycemia. Children who are born from sick mothers are several times more likely to suffer from pathological conditions than everyone else. If the pregnant woman had a pregestational form of the disease, the child may be born with a congenital anomaly or malformation. Against the background of the gestational type of the disease, children are born with a high body weight, which is one of the symptoms of fetal fetopathy.

Chronic hyperglycemia of the mother is also dangerous for the child because his pancreas during fetal development is accustomed to producing a huge amount of insulin. After birth, his body continues to function in the same way, which leads to frequent hypoglycemic conditions. Children are characterized by high numbers of bilirubin in the body, which is manifested by jaundice in newborns, and a decrease in the number of all blood cells.

Another possible complication on the part of the child's body - respiratory distress syndrome. The baby's lungs do not have enough surfactant, a substance that prevents the alveoli from sticking together during respiratory functions.

Management of a pregnant woman with diabetes

If the patient has pregestational diabetes during the period of childbearing, the medical protocol for monitoring such patients emphasizes the need for three hospitalizations.

The first time a woman is hospitalized immediately after contacting a gynecologist about registration for pregnancy. The patient is examined, the state of metabolic processes is corrected, and an insulin treatment regimen is selected.
The second time - at 20 weeks. The purpose of hospitalization is considered to be the correction of the condition, monitoring the mother and child in dynamics, the implementation of measures that will prevent the development of all kinds of complications.
Third time - 35-36 weeks. A pregnant woman is being prepared for the birth of a baby.

There are also emergency indications, according to which a woman can go to the hospital. These include the appearance of a vivid clinical picture of the disease, a ketoacidotic state, critical numbers of glycemia (up and down), the development of chronic complications.

How does childbirth proceed in the presence of a disease

The period of delivery is determined on an individual basis. Doctors assess the severity of the pathology, the level of sugar in the bloodstream, the presence of complications from the body of the mother and child. Vital indicators are necessarily monitored, the maturity of the structures of the baby's body is assessed. If there is a progression of damage to the renal apparatus or vision, obstetrician-gynecologists decide on delivery at 37 weeks.

In the normal course of pregnancy, a child's weight of 3.9 kg is an indication for his early birth through caesarean section. If the woman and the baby are not yet ready for childbirth, and the weight of the fetus does not exceed 3.8 kg, the pregnancy can be slightly extended.

Maternity ward

The best option is the birth of a baby through the natural birth canal, even if the mother has a “sweet disease”. Childbirth in gestational diabetes occurs with constant monitoring of blood glucose and periodic insulin injections.

If the birth canal of the pregnant woman is prepared, childbirth begins with a puncture of the amniotic bladder. Effective generic activity is considered an indication that the process of having a child occurs natural way. If necessary, the hormone oxytocin is administered. It stimulates uterine contractions.

Important! By itself, diabetes mellitus is not an indication for caesarean section.

When is operative delivery necessary?

incorrect presentation of the fetus;
macrosomia;
impaired breathing and heartbeat of the child;
decompensation of the underlying disease.

Planned caesarean section for diabetes mellitus

Starting from 12 o'clock at night, a woman should not consume water and food. 24 hours before the surgical intervention, the pregnant woman is canceled injections of prolonged insulin. Early in the morning, the level of glycemia is measured using express strips. The same procedure is repeated every 60 minutes.

If the glucose in the bloodstream exceeds the threshold of 6.1 mmol / l, the pregnant woman is transferred to a constant intravenous drip of insulin solution. Monitoring of glycemia indicators is carried out in dynamics. The very procedure of operative delivery is recommended to be carried out early in the morning.

postpartum period

After the baby is born, the doctor cancels insulin injections for the woman. During the first few days, blood sugar levels are necessarily monitored in order to correct metabolic disorders if necessary. If the patient had gestational diabetes mellitus, she automatically becomes a link in the risk group for developing an insulin-independent type of disease, which means she must be registered with a qualified endocrinologist.

After 1.5 and 3 months after childbirth, a woman must again donate blood to assess glycemia numbers. If the result makes the doctor doubt, a sugar load test is ordered. The patient is recommended to follow a diet, lead an active lifestyle, and if you want to get pregnant again, conduct a complete examination of the body and carefully prepare for conceiving and bearing a child.

diabetiko.ru

Characteristics of the condition during pregnancy

Gestational diabetes is a pathological condition that occurs exclusively in women during the period of bearing a child, it is characterized by a persistent increase in blood sugar against the background of hormonal changes in the body. The disease can develop both at an early stage, which indicates the presence of diabetes mellitus before pregnancy, and in the second trimester. After childbirth, the condition returns to normal, however, there is a risk of developing type 2 diabetes, especially in a pregnant woman with a aggravated history (obesity, age after 35 years).

At the beginning of pregnancy, every woman is registered in women's consultation, where a number of laboratory and instrumental studies are carried out to monitor the health of the fetus and mother. So, every month a mandatory analysis is the delivery of capillary blood and urine to determine the amount of sugar. If, during pregnancy, glucose levels are found above the norm once, then this condition is considered to be physiological. But, if an increase in glucose levels was observed in two or more cases, and sugar was detected in the urine (glucosuria) and in the blood (hyperglycemia), then the woman can be suspected of developing gestational diabetes.

This form of diabetes has a low incidence, only 3-4% of pregnant women suffer from it, however, if there is a risk of developing the disease, it is necessary to carefully prepare for pregnancy.

Causes of the disease

During pregnancy, many women may experience a pathological condition associated with a decrease in the sensitivity of cells and tissues of the body to the action of insulin. Thus, insulin resistance occurs, which is due to increased hormone production during pregnancy. The body of a pregnant woman begins to actively absorb glucose in order to provide adequate nutrition to the fetus, which is why hemostasis is negatively affected. As a result, the pancreas produces a large amount of insulin, trying to compensate for the insufficient supply of glucose. When the body stops producing enough insulin, gestational diabetes develops.

Thus, the main causes of the disease are:

Providing intrauterine nutrition. In the body of the expectant mother for 9 months, the fetus grows and develops; for its full formation, energy is needed, which it takes from glucose. Therefore, in order to cover all the energy costs of the fetus, the body of a pregnant woman makes great efforts to secrete it.
Change in hormonal background. To maintain pregnancy, the woman's body produces a large amount of the hormone progesterone, which affects the concentration of insulin in the bloodstream and partially counteracts its secretion.

At-risk groups

When planning a pregnancy, a woman can independently determine the likelihood of developing a pathological condition based on knowledge of risk groups.

In the presence of the following diseases in the history of a woman, the body's tolerance to glucose may occur:

Genetic predisposition (if there were cases of diabetes in the family history, then the risk of developing the disease increases).
Obesity (the risk group includes women before pregnancy with a body mass index of more than 20%).
Pregnancy aggravated by polyhydramnios (excessive accumulation amniotic fluid interferes with blood circulation in the uterus).
Adverse gynecological history (fetal malformations, miscarriage, miscarriage).
The first child was born large (body weight more than 4 kg).
Planning late pregnancy(age category 30–35 years).
Endocrine diseases (contribute to metabolic disorders).
Prediabetes (high blood sugar).

Features of the development of diabetes during pregnancy

The mechanism of development of diabetes in a pregnant woman consists of several stages, namely:

Physiological imbalance between the sugar-lowering effect of insulin and the sugar-increasing effects of another group of hormones.
Violation in the mechanism of the metabolic response of tissues to the action of insulin increases the symptoms of relative insulin deficiency.
The trigger mechanism in the development of diabetes is the increase in body fat mass, due to a decrease in the motor activity of a woman and poor nutrition.

A favorable condition for the violation of carbohydrate metabolism during the period of bearing a child is functional changes in metabolic processes. So, in the first trimester of pregnancy, a reorganization of the metabolism in the mother's body is already observed. If the fetus shows signs of carbohydrate starvation, a protective mechanism is activated that takes energy from reserve fat reserves. It provides an uninterrupted supply of glucose through the placenta even in the absence of available glycogen stores in the woman's liver.

At the beginning of gestation, such a mechanism is able to satisfy all its energy needs, however, in the future, in order to overcome tissue resistance to insulin, pancreatic cells are forced to work in an enhanced mode, as a result of which their hypertrophy occurs. The mother's excretory system is activated, destroying a large amount of secreted insulin. But in the second trimester, the placenta matures and takes over the endocrine function, which affects the metabolism of carbohydrates in the female body.

Gestotic diabetes can be detected using laboratory diagnostics already at the 20th week of pregnancy, when phytoplacental hormones, which act as insulin antagonists, are activated and increase.

According to the latest statistics, diabetes is not accompanied by the death of pancreatic cells, so the disorder of carbohydrate metabolism recovers on its own after pregnancy.

Possible consequences of diabetes during pregnancy

When gestational diabetes is detected during pregnancy, the question arises whether it is dangerous for the health of the child and mother, and what measures to take to treat it. As a rule, the disease does not pose a direct threat to the life of a pregnant woman and does not bring significant changes in her well-being. However, in the absence of adequate treatment, obstetric and perinatal complications may occur during childbirth.

The most common complications of diabetes during pregnancy are:

Oxygen starvation of the fetus (occurs due to impaired blood circulation in the tissues of the expectant mother).
Fetal obesity (impaired carbohydrate metabolism in a child due to atrophy of pancreatic cells).
Diabetic fetopathy (the child has a disorder in the functioning of the respiratory, digestive and cardiovascular systems).
Toxicosis of the third trimester (the condition is dangerous because it can be complicated by eclampsia, which causes irreversible vascular disorders).
Injuries of the birth canal (occur during the passage of a large fetus).
Polyhydramnios (a rapid increase in the amount of amniotic fluid leads to premature delivery).

If a woman had diabetes before pregnancy, this does not mean that the listed complications are absolute contraindications to bearing a child. To do this, it is recommended to carefully plan pregnancy. At the preparation stage, it is necessary to undergo a number of studies that will help clarify the state of carbohydrate metabolism and the readiness of the reproductive system for the process of bearing a fetus.

If a pregnant woman has a history of gestational diabetes, she must strictly follow all the recommendations of a specialist, and it is also important to take measures to correct the diet and normalize body weight through physical activity.

Condition symptoms

Gestational diabetes may be asymptomatic, however, some women present with symptoms that are characteristic of this form of the disease. The severity of clinical manifestations depends on the concentration of glucose in the bloodstream.

The most common symptoms of diabetes in women are:

severe dryness of the oral mucosa, a feeling of unquenchable thirst;
constant trips to the toilet due to frequent urge to urinate;
increasing weakness and fatigue;
sleep disorder associated with emotional instability;
increased appetite;
itching of the skin in the perineum;
dyspepsia.

Identification of the disease on the basis of the patient's complaints is difficult, since the above symptoms may be a manifestation of the pregnancy itself. Therefore, every woman, before the next visit to the local gynecologist, must undergo the necessary studies, which include the determination of glucose in the blood and urine.

You can read more about the symptoms of gestational diabetes in this article.

Diagnostic Measures

Laboratory studies are the basis for making a diagnosis of gestational diabetes.

Particular attention is paid to women who are at risk for developing the disease, they are prescribed special research methods already at the first visit to the doctor. If glucose tolerance is not determined early, tests are performed in the second trimester of pregnancy.

How to perform a glucose stress test

3 days before the test, the patient should adhere to the usual diet, not excluding the intake of carbohydrate food and observe the usual mode of rest and work. On the evening before the study, you need to take a meal containing carbohydrates in the amount of 30–50 g. The load test should be performed in the morning after 8–12 hours of overnight fasting, with the exception of drinking water. For the test, venous blood is taken on an empty stomach, after which the results of the first test are evaluated, if the glycemic levels correspond to the diagnosis of diabetes in pregnant women, then the next stages of the study are completed. If the level of glycemia is in the normal range on an empty stomach, then the patient should drink a glucose solution, for this, 75 g of glucose dry matter must be dissolved in 300 ml of purified water. After drinking the solution, the second stage of the test begins. After two hours, repeated venous blood sampling is performed.

If the test results meet the diagnostic criteria for diabetes mellitus or insulin resistance in pregnant women, the diagnosis of gestational diabetes mellitus is made.

Principles of treatment

Women who are at risk for diabetes should be under the constant supervision of the attending physician, they can be observed both inpatient and outpatient. The method of treatment during pregnancy is based on the principles of dietary nutrition and moderate physical activity, in most cases this gives good positive results. If non-drug methods do not bring a tangible effect, it is necessary to start a course of treatment with insulin injections.

Principles of management of a pregnant woman with diabetes mellitus:

Joint observation by a gynecologist and an endocrinologist.
If necessary, the patient is scheduled to attend additional consultations.
Keeping a food diary that also records glucose levels.
Possibility of round-the-clock access to the endocrinologist.
Regular education of a woman about nutrition during pregnancy.
Dose selection for insulin therapy.
Monthly monitoring of body weight, test data and blood pressure.

Organization of diet therapy during pregnancy

Rational nutrition for illness during the period of bearing a child is the main method of treatment that allows you to normalize and control a constant level of sugar in the blood.

The diet of a pregnant woman has some features:

When compiling a diet, it is necessary to take into account the activity and initial body weight of the patient.
Nutrition should include all the essential substances for the normal functioning of the body of the mother and child.
Limiting simple carbohydrates in the diet and increasing the amount of protein foods.
Regular intake of fiber will help to improve the functioning of the digestive tract.
Organization of light snacks between main meals.
The calorie content of meals in the first half of the day is higher than in the second.
Refusal of carbohydrates in the evening time.

dietary types of meat and fish;
whole grain cereals;
gray bread with the addition of bran;
dairy products;
cold-pressed vegetable oils;
non-starchy fruits and vegetables;
seafood;
mild types of hard cheese;
Herb tea;
unsweetened compote and jelly from berries.

Tactics of conducting childbirth in diabetes mellitus

Delivery in gestational diabetes mellitus after 38 weeks of gestation is carried out only by caesarean section, since there is a risk of complications from both the mother and the child. Before surgery, it is necessary to monitor the level of glycemia every 2 hours before delivery and after, measurements are carried out until the indicators normalize.

For women who are on a diet, insulin is not administered in the preoperative period. During childbirth, it is recommended to avoid intravenous administration of glucose and lactate solution. Pregnant women who are on insulin therapy continue the administration of the hormone according to the standard scheme.

After childbirth, to reduce the risk of developing type 2 diabetes, you need to be constantly monitored by a specialist, as well as healthy lifestyle life, which includes diet therapy and physical activity to maintain normal body weight.

Thus, timely detection and treatment of diabetes during pregnancy can stabilize the condition of the mother and fetus, as well as reduce the risk of complications in the postoperative period.

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Gestational diabetes during pregnancy: consequences and risks

Diabetes during pregnancy can adversely affect the development of the fetus. If it arose in the early stages pregnancy, the risk of miscarriage increases, and, even worse, the appearance of congenital malformations in the baby. Most often, the most important organs of the crumbs are affected - the heart and brain.

Gestational diabetes onset in the second and third trimesters pregnancy, causes overfeeding and overgrowth of the fetus. This leads to hyperinsulinemia: after childbirth, when the child will no longer receive such an amount of glucose from the mother, his blood sugar levels drop to very low levels.

If this disease is not detected and treated, it can lead to the development diabetic fetopathy- a complication in the fetus that develops due to a violation of carbohydrate metabolism in the mother's body.

Signs of diabetic fetopathy in a child:

large sizes (weight more than 4 kg);
violation of body proportions (thin limbs, large belly);
swelling of tissues, excessive deposits of subcutaneous fat;
jaundice;
respiratory disorders;
neonatal hypoglycemia, increased blood viscosity and risk of blood clots, low levels of calcium and magnesium in the blood of the newborn.

How does gestational diabetes occur during pregnancy?

During pregnancy, not just a hormonal surge occurs in the female body, but a whole hormonal storm, and one of the consequences of such changes is violation of the body's tolerance to glucose Some are stronger, some are weaker. What does this mean? The blood sugar level is high (above the upper limit of normal), but still not enough to make a diagnosis of diabetes mellitus.

In the third trimester of pregnancy, as a result of new hormonal changes, gestational diabetes may develop. The mechanism of its occurrence is as follows: the pancreas of pregnant women produces 3 times more insulin than other people - in order to compensate for the action of specific hormones on blood sugar levels.

If she does not cope with this function with an increasing concentration of hormones, then there is such a thing as gestational diabetes mellitus during pregnancy.

Risk group for developing gestational diabetes during pregnancy

There are certain risk factors that make a woman more likely to develop gestational diabetes during pregnancy. However, the presence of even all these factors does not guarantee that diabetes will still occur - just as the absence of these adverse factors does not guarantee 100% protection against this disease.

Overweight observed in a woman before pregnancy (especially if the weight exceeded the norm by 20% or more);
Nationality. It turns out that there are certain ethnic groups in which gestational diabetes is observed much more often than others. These include Blacks, Hispanics, Native Americans, and Asians;
High blood sugar on urinalysis;
Violation of the body's tolerance to glucose (as we have already mentioned, the sugar level is above normal, but not enough to make a diagnosis of "diabetes");
Heredity. Diabetes is one of the most serious hereditary diseases, its risk is increased if someone close to you in your line was diabetic;
Previous birth of a large (over 4 kg) child;
Previous birth of a stillborn child;
You have already been diagnosed with gestational diabetes during a previous pregnancy;
Polyhydramnios, that is, too much amniotic fluid.

Diagnosis of gestational diabetes

If you find yourself with several signs that are at risk, tell your doctor about it - you may be prescribed an additional examination. If nothing bad is found, you will be tested again along with all the other women. All others pass screening examination for gestational diabetes between the 24th and 28th weeks of pregnancy.

How would this happen? You will be asked to do a test called an oral glucose tolerance test. You will need to drink a sweetened liquid containing 50 grams of sugar. After 20 minutes, there will be a less pleasant stage - taking blood from a vein. The fact is that this sugar is quickly absorbed, after 30-60 minutes, but individual indications vary, and this is what doctors are interested in. In this way, they find out how well the body is able to metabolize the sweet solution and absorb glucose.

In the event that in the form in the column "analysis results" there is a figure of 140 mg / dl (7.7 mmol / l) or higher, this is already high level. You will be given another test, but this time after several hours of fasting.

Treatment of gestational diabetes

The life of diabetics, frankly, is not sugar - both literally and figuratively. But this disease can be controlled if you know how and strictly follow medical instructions.

So, what will help to cope with gestational diabetes during pregnancy?

Blood sugar control. This is done 4 times a day - on an empty stomach and 2 hours after each meal. You may also need additional checks - before meals;
Urinalysis. Ketone bodies should not appear in it - they indicate that diabetes mellitus is not controlled;
Compliance with a special diet that the doctor will tell you. We will consider this issue below;
Reasonable physical activity on the advice of a doctor;
Control over body weight;
Insulin therapy as needed. At the moment, during pregnancy, only insulin is allowed to be used as an antidiabetic drug;
Blood pressure control.

Diet for gestational diabetes

If you have been diagnosed with gestational diabetes, you will have to reconsider your diet - this is one of the conditions for the successful treatment of this disease. Weight loss is usually recommended for diabetics (this contributes to increased insulin resistance), but pregnancy is not the time to lose weight, because the fetus must receive all the nutrients it needs. So, you should reduce the calorie content of food, while not reducing its nutritional value.

1. Eat small meals 3 times a day and 2-3 more snacks at the same time. Don't skip meals! Breakfast should be 40-45% carbohydrates, the last evening snack should also contain carbohydrates, about 15-30 gr.

2. Avoid fried and fatty, as well as foods rich in easily digestible carbohydrates. These include, for example, confectionery, as well as pastries and some fruits (banana, persimmon, grapes, cherries, figs). All these foods are quickly absorbed and provoke a rise in blood sugar levels, they are few in nutrients, but high in calories. In addition, to offset their high glycemic effect, they require too much insulin, which is a luxury in diabetes.

3. If you feel sick in the morning, keep a cracker or cracker on your bedside table and eat a few before you get out of bed. If you're on insulin and feel sick in the morning, make sure you know how to deal with low blood sugar.

4. Don't eat fast foods. They are industrially pre-processed to reduce their preparation time, but their effect on increasing the glycemic index is greater than that of their natural counterparts. Therefore, exclude freeze-dried noodles, soup-lunch “in 5 minutes” from a bag, instant porridge, freeze-dried mashed potatoes from the diet.

5. Pay attention to foods rich in fiber: cereals, rice, pasta, vegetables, fruits, whole grain bread. This is true not only for women with gestational diabetes - every pregnant woman should eat 20-35 grams of fiber per day. Why is fiber so good for diabetics? It stimulates the intestines and slows down the absorption of excess fat and sugar into the blood. Other fiber-rich foods are high in essential vitamins and minerals.

6. Saturated fat in the daily diet should not be more than 10%. In general, eat less foods containing "hidden" and "visible" fats. Eliminate sausages, wieners, sausages, bacon, smoked meats, pork, lamb. Lean meats are much preferable: turkey, beef, chicken, and also fish. Remove all visible fat from meat: lard from meat, and skin from poultry. Cook everything in a gentle way: boil, bake, steam.

7. Cook food without fat, and on vegetable oil, but it should not be too much.

8. Drink at least 1.5 liters of fluid per day(8 glasses).

9. Your body does not need such fats like margarine, butter, mayonnaise, sour cream, nuts, seeds, cream cheese, sauces.

10. Tired of bans? There are also products that you can have no limit They are low in calories and carbohydrates. These are cucumbers, tomatoes, zucchini, mushrooms, radishes, zucchini, celery, lettuce, green beans, cabbage. Eat them in the main meals or as snacks, better - in the form of salads or boiled (boil in the usual way or a couple).

11. Make sure your body is provided with a full range of vitamins and minerals needed during pregnancy: ask your doctor if you need extra vitamins and minerals.

If diet therapy does not help, and blood sugar remains at a high level, or if ketone bodies are constantly detected in the urine at a normal sugar level, you will be prescribed insulin therapy.

Insulin is only injected because it is a protein, and if you try to put it in tablets, it will be completely destroyed by our digestive enzymes.

Disinfectants are added to insulin preparations, so do not wipe the skin with alcohol before injection - alcohol destroys insulin. Naturally, you need to use disposable syringes and follow the rules of personal hygiene. All other subtleties of insulin therapy will be told to you by your doctor.

Exercise for gestational diabetes in pregnancy

Do you think it's not needed? On the contrary, they will help maintain good health, maintain muscle tone, and recover faster after childbirth. In addition, they improve the action of insulin and help not to gain excess weight. All this contributes to maintaining optimal blood sugar levels.

Engage in the usual activities that you enjoy and enjoy: walking, gymnastics, exercising in the water. No stress on the stomach - for now, you will have to forget about your favorite “abs” exercises. You should not engage in sports that are fraught with injuries and falls - horseback riding, cycling, skating, skiing, etc. Read more about exercises for pregnant women→

All loads - according to well-being! If you feel bad, there are pains in the lower abdomen or in the back, stop and catch your breath.

If you are on insulin therapy, it is important to be aware that hypoglycemia can occur during exercise, as both exercise and insulin lower blood sugar levels. Check your blood sugar levels before and after your workout. If you started exercising an hour after eating, you can eat a sandwich or an apple after class. If more than 2 hours have passed since the last meal, it is better to have a snack before training. Be sure to bring juice or sugar with you in case of hypoglycemia.

Gestational diabetes and childbirth

The good news is that gestational diabetes usually goes away after childbirth – it only develops into diabetes in 20-25% of cases. True, the birth itself due to this diagnosis can be complicated. For example, due to the already mentioned overfeeding of the fetus, the child may be born very large.

Many, perhaps, would like a "hero", but the large size of the child can be a problem during labor and childbirth: in most of these cases, a caesarean section is performed, and in the case of natural delivery, there is a risk of injury to the child's shoulders.

Children with gestational diabetes born with low levels blood sugar, but this is fixable simply by feeding. If there is no milk yet, and the child does not have enough colostrum, the child is supplemented with special mixtures to raise the sugar level to a normal value. Moreover, the medical staff constantly monitors this indicator, measuring the glucose level quite often, before feeding and 2 hours after.

As a rule, no special measures will be needed to normalize the blood sugar level of the mother and child: in the child, as we have already said, sugar returns to normal thanks to feeding, and in the mother - with the release of the placenta, which is the “irritating factor”, because produces hormones. The first time after childbirth still have to follow for nutrition and periodically measure the level of sugar, but over time everything should return to normal.

Prevention of gestational diabetes

There is no 100% guarantee that you will never encounter gestational diabetes - it happens that women who, according to most indicators, fall into the risk group, do not get sick when they become pregnant, and vice versa, this disease happens to women who, it would seem, did not have no preconditions.

If you already had gestational diabetes during a previous pregnancy, it is very likely that it will come back. However, you can reduce your risk of developing gestational diabetes during pregnancy by maintaining a healthy weight and not gaining too much during those 9 months. Physical activity can help keep your blood sugar at a safe level, as long as it's regular and doesn't cause you discomfort.

You also remain at risk of developing a permanent form of diabetes called type 2 diabetes. You will have to be more careful after childbirth. Therefore, it is undesirable for you to take drugs that increase insulin resistance: nicotinic acid, glucocorticoid drugs (these include, for example, dexamethasone and prednisolone).

Please note that some birth control pills may increase the risk of diabetes - for example, progestin, but this does not apply to low-dose combination drugs. In choosing a contraceptive after childbirth, be guided by the recommendations of your doctor.

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How is the disease progressing?

In medicine, it is customary to distinguish 3 types of this endocrine disease - insulin-dependent, insulin-independent and gestational diabetes. It is the 3rd type of the disease that occurs in pregnant women at the 28th week of gestation, it manifests itself in a violation of the utilization of glucose by the woman's body.

Despite the fact that the gestational type of the disease occurs most often during pregnancy, it is still not uncommon for a woman to be diagnosed with type 1 diabetes. As a rule, in such cases, diabetes in a pregnant woman was already at the time of conception. With the course of pregnancy and gestational diabetes mellitus at the same time on different terms pregnancy, the following changes are noted:

First trimester. In most cases, in the first weeks of pregnancy, the signs of the disease do not change. Sometimes, on the contrary, the process of glucose uptake improves, as a result of which it is necessary to reduce the dose of insulin administration. The course of pregnancy with diabetes mellitus is noted without any complications, however, with the exception of spontaneous miscarriage. At the same time, it is very difficult to take any measures aimed at maintaining pregnancy even before the onset of a threat, since it comes suddenly, without any forerunners.
Second trimester. In the body of a woman, hormones such as glucagon, placental lactogen, prolactin begin to be intensively produced, which cause signs of diabetes in pregnant women. At this time, the dose of insulin should be increased. Also, diabetes in a pregnant woman in the second half of the term can cause a number of complications - late preeclampsia, polyhydramnios, fetal hypoxia, urinary tract infection.
Third trimester. At the end of pregnancy in diabetes mellitus, a decrease in contra-insular hormones is again noted, due to which an improvement in well-being occurs, all signs disappear.

During childbirth, if there was diabetes mellitus during pregnancy, high hyperglycemia or a hypoglycemic state may occur. The course of the disease in the expectant mother inevitably affects the development of the fetus of the child. A baby born from an insulin-dependent mother has the following signs:

round moon-shaped face;
overdeveloped subcutaneous tissue;
a large number of hemorrhages on the skin of the face and extremities;
large body weight;
puffiness;
functional immaturity of many internal organs.

If a woman has not been treated for this type of diabetes during pregnancy, the likelihood of death increases in most cases.

Gestational type of disease: causes

If during pregnancy a woman's blood sugar rises, it is customary to talk about the gestational type of the disease. Unlike ordinary diabetes, it occurs only during childbearing, and after childbirth, all its signs disappear. That is why this type is known in endocrinology as gestational diabetes. A large amount of glucose leads to the fact that the child begins to rapidly gain weight, and this, as you know, can make childbirth difficult. In addition, the baby often experiences oxygen starvation - hypoxia.

Gestational type of diabetes during pregnancy occurs due to the fact that during this period hormones are produced in the female body that increase sugar levels, so insulin often cannot cope with such an amount of glucose.

Excess sugar disrupts the metabolism not only in the mother’s body, but also in the child himself: glucose enters the baby’s bloodstream through the placenta, putting a heavy burden on his pancreas. Such a process after the birth of a child can have very unpleasant consequences, dangerous not only for his health, but also for his life. The pancreas in such conditions begins to work several times more intensively, assimilating glucose. It is from this that the child begins to increase body weight, often complicating childbirth. An accelerated metabolism requires a much greater supply of oxygen, but it is limited. Therefore, such consequences as fetal hypoxia develop.

Pregnancy diabetes occurs infrequently, but, nevertheless, women with the following symptoms are at risk:

obesity;
diabetes in a previous pregnancy;
the presence of sugar in the urine;
polycystic ovaries;
hereditary predisposition.

The risk of developing the disease in women who fall under the following criteria is practically eliminated:

age up to 25 years;
normal constant weight;
close relatives do not have the disease;
never had high blood sugar;
complications during pregnancy were not observed.

Symptoms of the gestational type of the disease

Very often, pregnant women are not even aware of the presence of diabetes mellitus, since in the early stages of the course it very rarely manifests itself without the usual symptoms. That is why during pregnancy it is so important to take blood tests for sugar, because timely measures taken will help to eliminate unpleasant consequences.

To identify the presence of diabetes in pregnant women in the initial stages, it is necessary to undergo such a study as a “glucose tolerance test”, or “sugar curve”. The analysis is carried out not on an empty stomach, as is customary, but after drinking a glass of water with dissolved glucose. As you know, blood sugar levels can change throughout the day, so it may not always give reliable data. In such cases, it is advisable to perform another test called glycated hemoglobin.

With the course of pregnancy and diabetes mellitus of this type in more severe forms, a woman may experience the following symptoms:

constant thirst;
profuse and frequent urination;
strong feeling of hunger;
blurred vision.

But such symptoms are considered characteristic of pregnancy, so it is important to undergo a comprehensive examination.

Consequences of the disease

Gestational diabetes during pregnancy has a very dangerous effect on the baby's body. There are high risks of developing various fetal pathologies, which most often occurs in the early stages of bearing a child. This process is caused by the fact that the fetus receives a large amount of glucose, but at the same time, enough insulin does not enter his body. An increased level of sugar requires a lot of energy, in the absence of which there is an underdevelopment of internal organs and systems.

In the second trimester, when the baby already has its own pancreas, due to the development of diabetes in pregnant women, excessive production of insulin can occur, which leads to the development of hyperinsulinemia. With this phenomenon, disturbances in the activity of the respiratory system often occur, which cause asphyxia.

In addition, for the life of a child, a great danger is not only an increased level of sugar in the blood, but also a low one, the consequences of which are malnutrition of the brain, which entails a delay in mental development baby.

Also, during pregnancy and diabetes of this type, such serious consequences can occur at the same time:

The risk of miscarriage increases.
The development of polyhydramnios.
The occurrence of preeclampsia, which leads to malnutrition of the fetus of the child.
Persistent hyperglycemia causes the development of a genital tract infection, which causes infection of the fetus.
Often there is ketoacidosis, which leads to poisoning of the body, both mother and child.
Kidney function is impaired and vision deteriorates.

Due to the fact that with gestational diabetes in pregnant women, the fetus reaches large sizes, childbirth is usually scheduled for 37-38 weeks of pregnancy. In such cases, childbirth is carried out only by caesarean section.

All complications can be avoided by normalizing blood sugar levels. To do this, a pregnant woman must adhere to a special diet and follow the recommendations of endocrinologists.

What should be the diet for any type of disease?

The main treatment for gestational diabetes during pregnancy is diet therapy. The diet is designed to be able to maintain normal sugar levels before and after meals. To avoid sudden drops in sugar, you need to eat at least 5 times a day. It is advisable to exclude the use of sugar, sweets, jams. A specific menu and calorie content should be compiled by a nutritionist.

Also, the diet should be observed taking into account the following principles:

eat in small portions;
avoid fried and fatty foods;
exclude the use of fast food;
eat foods rich in fiber;
saturated fat should not exceed 10% per day;
cook food in vegetable oil;
drink at least 1.5 liters of water per day.

There are no specific actions aimed at preventing gestational diabetes in pregnant women. The only thing a woman who is at risk of developing the disease needs to do is to adhere to proper nutrition and regularly take tests to determine the level of sugar. It is known that pregnancy and diabetes are incompatible concepts, so it is important to monitor your health in order to give birth to a healthy baby.

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diabetes during pregnancy

Diabetes is a disease that greatly increases the risk of complications during pregnancy and childbirth in women. Therefore, it is important to pay special attention to the concentration of glucose in the blood and ensure that its content does not outgrow the norm. Otherwise, the mother will face serious consequences:

Increased risk of miscarriage;
The development of complications of diabetes, which leads to other diseases;
The possibility of getting an infection after childbirth;
polyhydramnios;
Gestosis (toxicosis of pregnant women).

The fetus can also suffer damage as a result of maternal diabetes:

High risk of death during childbirth;
The presence of health complications in the early stages of life;
Possibility of lifelong type 1 diabetes mellitus;
Macrosomia (uncontrolled excessive growth of the fetus in the womb);
Congenital anomalies of further development.

The risk of complications depends on the following factors:

The duration of diabetes in humans;
Age at which the disease began;
The presence of complications during pregnancy.

The essence of insulin therapy

Insulin therapy is an event whose action is aimed at stabilizing the level of glycemia in the blood and eliminating the development of diabetes. The procedure is carried out by artificially introducing a preparation containing a hormone into the blood. The insulin used in pregnant patients is a soluble hormone with a short duration of effect. Its use is prescribed in two forms:

repeated introduction;
Regular introduction.

The endocrinologist takes into account that the duration of exposure different types insulin varies depending on the characteristics of the patient, therefore it evaluates it individually. Regardless of which type of insulin therapy was chosen for a pregnant woman, the hormone should be injected subject to a certain regimen.

The need to inject the drug occurs in various situations: during a critical deterioration in the state of health of a pregnant woman or during childbirth. Therefore, the types of products containing insulin were developed specifically for a specific case, and their main difference from each other is the duration of the effect.

The main mission that insulin therapy aims to achieve is to maintain the blood glucose level in a pregnant woman at a healthy level. This will make it possible to prevent the likely risks of complications during pregnancy and childbirth.

Due to the fact that diabetes during pregnancy leads to irreversible results, insulin therapy should be supplemented with a set of measures:

Regular examination of the patient by an obstetrician-gynecologist, endocrinologist, nutritionist, nephrologist, ophthalmologist and cardiologist;
Passing an ECG;
Self-measurement of pressure;
Maintaining physical activity;
Avoidance of excessive physical and mental stress;
Blood tests for alpha-fetoprotein, hemoglobin and hormones;
Compliance with the diet recommended by the endocrinologist and nutritionist;
Passage of ultrasound at various stages of pregnancy.

It is important to undergo an ultrasound examination in order to identify probable complications during gestation in advance. This must be done at the following intervals:

15-20 weeks (detection of malformations of the child);
20-23 weeks (determining the presence of heart disease in a child);
25-30 weeks (the ability to exclude fetal growth retardation in the womb).

Nutrition for insulin therapy

In order to protect the health of the child, as well as their own, it is important for future diabetic mothers to pay attention to a strict diet. The purpose of this event coincides with the mission of insulin therapy: maintaining blood sugar levels at the level inherent in a healthy person.

The main principle of the diet prescribed for diabetes is to reduce the consumption of products containing carbohydrates. After all, it is she who contributes to dynamic interruptions in glycemia, therefore it will not work to cope with diabetes by conducting insulin therapy without following a diet.

The daily norm of calories consumed by a pregnant woman should be in the range of 1800-2400 kcal. The low carb diet looks like this:

Fats - 30%;
Proteins - 25%;
Carbohydrates - 45%.

Follow the rules of a low-carbohydrate diet:

Give up sugar and replace it with a sweetener or non-caloric sweeteners;
Adhere to fractional (fractional) nutrition, that is, eat portioned in small quantities 6 times a day;
Inject a dose of insulin before meals;
Refusal of alcoholic products;
Take into account the lists of prohibited and allowed products;
Avoid products with chemical additives, replace it with home-cooked food.

The list of prohibited products includes:

Sugar and products with its high content;
Alcoholic drinks;
flour products;
High-calorie sugar analogues (jam, honey);
Dairy and sour-milk products of high fat content;
Sweet sodas;
Soups in meat or fish broth;
Sausages;
Ham;
Bacon;
Pasta;
Chocolate.

You should supplement your diet with the following foods:

Soups in vegetable broth;
Vegetables;
Fruits and dried fruits;
Berries;
Greenery;
Nuts;
legumes;
Kashi;
Water and mineral non-carbonated water;
Juices;
Smoothies.

Choice of drugs

Insulin therapy involves the introduction into the blood of drugs containing the hormone insulin. There are several types of them, which differ in duration of action. For each patient, the doctor prescribes the remedy individually, based on the characteristics of his body and the degree of the disease.

In addition to injections, insulin pumps are used in the treatment of diabetes in pregnant women. In comparison with injections, their effectiveness and safety for the life of the fetus has not been proven. Insulin pump therapy is indicated if the patient's blood sugar is uncontrollable, or if there is a high need for a hormone dose in the morning.

Gestational diabetes in a pregnant woman should be treated with diet. Only in the event that the dietary regimen prescribed by the nutritionist does not bring results, you can switch to intensive hormone therapy.

When a patient suffers from diabetes, regardless of the type of disease, she is prescribed enhanced insulin treatment. Thanks to this, you can lower the blood sugar level to normal, and protect the health of the child and mother.

Injection of insulin into the blood should be done with specialized syringes, drawing the drug from vials.

Pregnant hormone is allowed to enter without restrictions. But when using drugs similar to insulin, there are a number of indications:

Aspart is prescribed during pregnancy and lactation;
Humalog is intended for class B;
Apidra is used for class C.

The safety of their use in the fight against diabetes during pregnancy has not been proven, therefore, they can only be used as directed by an endocrinologist.

With an adequate preparation of the diabetes treatment complex, the patient does not fall under the irreversible consequences of the disease. One of the main goals of treatment is to reduce the risk of acquiring ketoacidosis, the acute stage of hypoglycemia and hyperglycemia.

The nuances of the therapy

Before injecting the drug at home, a diabetic should prepare for therapy:

Complete self-healing training;
Obtain the value of the insulin dose from the medical institution;
Get equipment to help control your blood sugar levels.

The dosage of the hormone prescribed by the endocrinologist depends on the mental stress of the patient.

To control glycemia, pregnant women are advised to keep a special notebook. You need to place a list of prohibited and allowed foods for diabetes in it, and record the amount of calories, fats, proteins, carbohydrates consumed and the level of physical activity. The doctor analyzes such records, identifies the mistakes made by the patient, and makes recommendations for further treatment.

The task of the endocrinologist is to compensate for carbohydrate metabolism as much as possible. Then jumps in glycemia will occur less frequently, and complications of diabetes will not overtake a pregnant woman.

When using the hormone, you can use one of the following treatment methods:

Traditional. The drug should be injected daily in an equal dosage. In this case, a drug with a short and medium duration of exposure is used. The patient consumes 2/3 of the daily norm on an empty stomach before breakfast, and the rest before dinner;
Intensive. It is necessary to inject 2 injections (before breakfast and before dinner). In this case, a hormone of short and medium duration is used.

The method is prescribed by the doctor, starting from the degree of the disease and the characteristics of the patient.

The rate of absorption of insulin into the bloodstream depends on the following nuances:

Type of drug;
Dosage;
Place of injection;
The speed of blood circulation;
muscle activity;
Body temperature in the area of the intended injection.

Insulin is injected into the subcutaneous fat intramuscularly and intravenously.

There are indications for starting insulin therapy during gestation:

Glucose of whole capillary blood on an empty stomach >5.0 mmol/l
One hour after ingestion >7.8 mmol/l;
2 hours after eating - 6.7 mmol / l.

The dose of the drug is calculated based on the trimester:

The first one is 0.6 U/kg;
The second - 0.7 U / kg;
Third 0.8 U / kg.

There is a principle according to which 2/3 of the daily dose of the drug should be injected on an empty stomach before breakfast, and the rest before dinner.

On the day of the appointment of childbirth, the amount of hormone administered is ¼ of the waste rate. You should prick it with the subsequent introduction of 2-3 units per hour, as well as monitor blood sugar levels. After the birth of a child, the dose of the hormone should be reduced by a factor of three.

If surgery was allowed during the extraction of the fetus, then after the completion of the birth, the patient should not be fed, and the drug should not be injected throughout the day. During the operation, when the blood sugar level is higher than 8 mmol/l, a hormone with a short duration of effect is used.

After 5 days after the operation, the patient is transferred to drugs with a longer effect.

Insulin resistance and its consequences

Insulin resistance is a disorder that is accompanied by a negative response of the body to insulin. It occurs with artificial administration and with the natural production of the hormone by the pancreas.

Insulin resistance can be identified by the presence of the following symptoms:

Increase in body weight in the waist area;
Hypertension (high blood pressure);
Adverse cholesterol and triglyceride test results;
Proteinuria (the presence of protein in the urine).

The best way to get rid of the syndrome is to go through a diet aimed at reducing the amount of carbohydrates consumed. Such a measure is not a direct method of getting rid of the disease, but helps to restore the body's metabolic processes.

5 days after the transition to a new diet, patients notice an increase in well-being. After 7 weeks from the day they started the diet, their cholesterol and triglyceride levels in the blood return to normal. Thus, the likelihood of developing atherosclerosis decreases.

The diet for insulin resistance syndrome is similar to the diet for lowering glycemia. The main thing is to follow the rules of the diet and the daily intake of calories, proteins, lipids and carbohydrates.

Thus, it can be concluded that diabetes during pregnancy will not interfere with the birth of a healthy child with appropriate treatment.

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What is gestational diabetes and how common is it?

Pregnancy diabetes, also called gestational diabetes, is diabetes that is first diagnosed during pregnancy and in most cases goes away shortly after the baby is born.

According to various sources, gestational diabetes develops in 2-14 women out of a hundred (that is, in 2-14%). This is one of the most common pregnancy complications.

Who is at increased risk for gestational diabetes?

Gestational diabetes is more likely to develop if:

Pregnant for over 35 years;
The woman was overweight before pregnancy;
The woman has already given birth to a child whose birth weight was more than 4000 grams;
The woman is taking corticosteroid hormones;
Close relatives of the pregnant woman (parents, brothers or sisters) have type 2 diabetes;
Before pregnancy, the woman was diagnosed with polycystic ovary syndrome.

Causes of diabetes in pregnant women

Diabetes mellitus develops if the pancreas does not produce enough of the hormone insulin, or if there is enough insulin, but it loses its ability to act on the cells of the body.

As a result of a decrease in the level of insulin (or its ineffectiveness), the level of glucose in the blood rises. Constantly high blood glucose levels affect not only the course of pregnancy, but also the growth and development of the unborn child.

How does gestational diabetes affect pregnancy?

In most pregnant women, gestational diabetes mellitus proceeds favorably and is well controlled with diet and, if necessary, medication.

However, if diabetes mellitus was not detected in time, or if the pregnant woman does not follow the doctor's recommendations, this disease can lead to serious consequences in the form of high blood pressure and preeclampsia, which is considered one of the most dangerous complications of pregnancy, threatening the life of both the pregnant woman and her future child.

Is diabetes during pregnancy dangerous for the unborn child?

The presence of diabetes in a pregnant woman can adversely affect the growth and development of her unborn child:

Large birth weight

Pregnant women with gestational diabetes have an increased risk of having a baby weighing more than 4000 grams. The large size of the fetus can prevent it from moving through the birth canal, increase the risk of the fetus getting stuck in the birth canal and an emergency caesarean section.

Premature birth and breathing problems

Elevated blood glucose may be the cause premature birth when the lungs of the fetus have not yet matured and are not ready for independent breathing.

Low blood glucose (hypoglycemia) shortly after birth

Due to the increased level of glucose in the mother's blood, the body of the fetus produces more insulin than necessary. Shortly after the baby is born, when the mother's blood glucose is no longer ingested and insulin levels are still high, the baby's blood sugar drops dramatically, which can lead to seizures.

Increased risk of developing diabetes in the future

Children born to mothers with gestational diabetes are more likely to develop obesity and type 2 diabetes in adulthood.

Untreated gestational diabetes can cause intrauterine fetal death, or the death of a child shortly after birth. Fortunately, due to the timely diagnosis and treatment of diabetes in pregnant women, such complications are extremely rare in our time.

Symptoms and signs of diabetes in pregnancy

Gestational diabetes mellitus is very often asymptomatic and is detected incidentally during a routine examination in the second trimester of pregnancy. This type of diabetes is often referred to as "hidden" because it can only be identified through a special examination.

However, the following symptoms and signs of the disease may indicate gestational diabetes:

Excessive thirst
Very frequent urination
blurred vision
Excessive fatigue

But even the presence of all these symptoms does not necessarily mean that a pregnant woman has diabetes. Therefore, for the timely diagnosis of this disease, doctors prescribe an analysis for gestational diabetes mellitus.

Analysis for diabetes in pregnant women

Most medical institutions All pregnant women between 24 and 28 weeks of gestation are offered screening for gestational diabetes. If a pregnant woman has risk factors for gestational diabetes mellitus (listed above), then an analysis for diabetes mellitus can be prescribed already at the first visit of a pregnant woman to a doctor (in the first trimester of pregnancy).

If screening for diabetes in pregnant women reveals an increase in fasting blood glucose, then the pregnant woman is recommended to undergo a second test.

The second test is called the glucose tolerance test (TGT) or glucose tolerance test. If this test also reveals an increase in blood glucose levels, the diagnosis of gestational diabetes is confirmed. We have a separate article on our website dedicated to this topic: Glucose tolerance test during pregnancy.

Treatment of diabetes in pregnant women

Generally, gestational diabetes is successfully controlled with diet, but in some cases, a pregnant woman may need medication in the form of insulin injections.

Diet for diabetes in pregnancy

Proper nutrition is one of the most effective methods treatment of gestational diabetes mellitus.

It is important to understand that the gestational diabetes diet is not aimed at weight loss. Pregnant women are generally not recommended to "lose weight", as this can affect the health of the fetus. The main purpose of the diet is to prevent an excessive increase in blood glucose levels, as well as to prevent the rapid weight gain of the pregnant woman.

The menu of a pregnant woman with gestational diabetes should include vegetables, fruits and whole grains (whole grain bread, pasta and cereals). At the same time, you need to avoid fast carbohydrates, which include any sweets, sugary drinks, honey, fruit juice concentrates, etc.

We also note that there is no special diet for diabetes that would suit all pregnant women. If necessary, the doctor will appoint you a consultation with an endocrinologist or a nutritionist who will create a menu that is right for you (depending on your pre-pregnancy and current weight, blood sugar levels, your degree of physical activity, your eating habits, etc.) .

Physical exercise in the treatment of diabetes mellitus in pregnant women

Regular physical activity during pregnancy not only improves blood glucose control, but also has a positive effect on the well-being of the pregnant woman and her unborn child. If your doctor has not recommended bed rest for you, then try to remain moderately active throughout your pregnancy. Take up swimming, yoga, Pilates, prenatal fitness, or just go out more often.

Insulin injections for diabetes in pregnancy

If blood glucose levels remain high despite diet and exercise, insulin treatment by injection may be recommended for the pregnant woman until delivery. Insulin injections will help you maintain normal blood sugar levels, which will be beneficial for your health and the health of your unborn child.

The expectant mother should not worry that insulin can somehow harm the unborn child: insulin practically does not cross the placenta, therefore it does not adversely affect the fetus. Thus, the risk of taking insulin during pregnancy is much less than the risk of complications if the pregnant woman refuses treatment.

What are the features of pregnancy management in gestational diabetes mellitus?

You will likely need to visit your doctor a little more often so that he can monitor your blood glucose levels. You can monitor your glucose levels yourself with a home glucometer (a device that measures blood sugar at home).

In the third trimester of pregnancy, the doctor may recommend several examinations aimed at finding out the condition and well-being of the unborn child. These examinations include ultrasound to determine the biophysical profile, as well as the size of the fetus.

If the ultrasound shows that the fetus is large, you may be asked to induce labor slightly. ahead of schedule(before the 40th week of pregnancy), or, with very large fetus sizes, the doctor may insist on delivery by planned caesarean section.

What are the consequences of diabetes in pregnancy?

As a rule, gestational diabetes mellitus passes without a trace for both the woman and her child immediately after childbirth. However, women who have had gestational diabetes have an increased risk of developing type 2 diabetes in the future. However, diabetes can be avoided by adjusting your diet, physical activity, and normalizing your weight.