Pregnancy is a very exciting time for women. The upcoming changes in lifestyle, childbirth, and the health of the baby are also worrying. During this period, such an unexpected and formidable diagnosis as diabetes mellitus causes panic and many questions. Where did he come from? What to do? Is this for life? Will diabetes be passed on to the child?
Don't panic! Once you understand everything, it will become clear that pregnancy diabetes is not a death sentence, but a lifestyle change during pregnancy.
What is gestational diabetes and why does it occur?
During pregnancy, a woman's hormonal status changes greatly. The level of the hormone progesterone, cortisol, and prolactin increases. All of these hormones increase blood sugar. To keep sugar levels normal, the pancreas produces more insulin, the only hormone that lowers blood sugar. But not all women’s pancreas copes with such an increased load, and then diabetes develops. Gestational diabetes appears only during pregnancy and goes away immediately after childbirth.
The risk of developing diabetes during pregnancy is not the same for all pregnant women. It is much higher if:
- the woman is overweight
- I had gestational diabetes in previous pregnancies,
- immediate relatives (parents, brothers and sisters, children) suffer from diabetes,
- in previous births, children were born weighing more than 4 kg.
Why treat diabetes in pregnant women if it goes away on its own after childbirth?
Treatment is a must! Gestational diabetes without treatment leads to the development of complications in the child - the so-called diabetic fetopathy. A child is born larger than normal, which is accompanied by a high risk of injury during childbirth, both for the child and for the mother. After childbirth, children born to a mother with diabetes are much more likely to have respiratory problems that require intensive treatment, and often develop hypoglycemia - a sharp decrease in blood sugar. Only careful monitoring of the mother’s blood sugar and maintaining normal values throughout the pregnancy can prevent health problems for the newborn baby.
The main causes of increased blood glucose
To answer why the concentration of glucose in the blood of pregnant women increases, you need to understand what is happening in the female body. During gestation (pregnancy), the endogenous steroid and progestogenic sex hormone progesterone reaches high concentrations. Its main function is to maintain pregnancy and ensure the successful development of the fetus. Active production of progesterone partially or completely blocks insulin production.
In the second half of the perinatal period, the synthesis of placental hormones increases. The provisional (temporary) organ begins to perform its endocrine function. Hormonal imbalance has a negative impact on metabolic processes, in particular carbohydrate metabolism. Pregnant women have an increased need for glucose, since two organisms need to be provided with energy and nutrition (one of which requires permanent sugar replenishment, since it is in a state of growth).
The expectant mother begins to eat more foods containing simple carbohydrates (confectionery, chocolate, etc.). With such a glucose attack, the pancreas tries to compensate for the situation by increasing the production of insulin. Considering that in the 2-3 trimester, a woman’s physical activity decreases, cells and tissues lose sensitivity to the hormone, and the pancreas wears out greatly.
Insulin resistance occurs (insulin synthesis is maintained, but the ability to realize it is lost). As a result, glucose accumulates in the blood, sugar levels rise, and body tissues are left without the necessary nutrition. Both mother and child are “starving.” Additional causes of unstable glycemia (blood sugar) during gestation may include the following:
- chronic pathologies of the pancreas and hepatobiliary system (usually diagnosed before pregnancy);
- unstable functioning of the renal apparatus;
- a woman’s genetic predisposition to diabetes mellitus (hereditary predisposition);
- distress (constant stay in a state of neuropsychological discomfort);
- high BMI (body mass index), indicating obesity.
Clinical manifestations of hyperglycemia are moderate, therefore, women are not inclined to pay due attention to them
How is diabetes diagnosed in pregnant women?
When registering, pregnant women are prescribed a biochemical blood test, which, along with other indicators, determines sugar.
The normal blood sugar value in pregnant women is no higher than 5.0 mmol/l.
Even a single blood sugar result of 5.1 mmol/l or higher during pregnancy is diabetes mellitus.
If fasting blood sugar is within the range of 5.1-7.0 mmol/l, then a diagnosis of gestational diabetes is made, but if it is above 7.0 mmol/l, then most likely the woman suffered from diabetes before pregnancy, and such diabetes will not go away after the birth of the child.
For all pregnant women whose blood sugar was normal in the early stages, obstetricians prescribe a glucose tolerance test at 24-28 weeks of pregnancy. This is the most accurate way to detect gestational diabetes.
Normal test values during pregnancy: fasting blood sugar less than 5.1 mmol/l, 1 hour after taking glucose less than 10.0 mmol/l, after 2 hours less than 8.5 mmol/l.
If a woman has at least one blood sugar value above the norm, then diabetes mellitus is diagnosed. The test cannot be performed during acute infectious diseases, with certain diseases of the gastrointestinal tract, during bed rest, or with initially elevated fasting blood sugar.
In some cases, to clarify the diagnosis, a blood test from a vein for glycated hemoglobin is necessary.
What to do if gestational diabetes is diagnosed?
If an obstetrician suspects gestational diabetes, she refers the patient to an endocrinologist to confirm the diagnosis and treatment.
The most important thing for gestational diabetes is diet.
This is not easy, but it is necessary for a successful pregnancy and the birth of a healthy child. You cannot eat sweets (sugar, candy, honey, cakes, fruit juices, bananas, grapes, etc.), baked goods made from white wheat flour, semolina and millet porridge, mashed potatoes. A pregnant woman with diabetes should eat small, frequent meals to avoid sudden fluctuations in blood sugar. At the appointment, the endocrinologist will create a detailed diet taking into account the individual characteristics of each patient.
Another important point in the treatment of gestational diabetes is regular measurement of blood sugar.
Each patient needs to independently measure her sugar using a glucometer at least 6-8 times a day. Measurements are taken on an empty stomach and 1 hour after meals, before bedtime, and sometimes at other hours if necessary. Only frequent monitoring of sugar allows you to achieve the ideal values necessary during pregnancy - less than 5.1 before meals, less than 7.0 1 hour after meals.
Tablets that lower blood sugar cannot be used in pregnant women with diabetes; they are contraindicated. Therefore, if a woman cannot normalize her blood sugar with a diet, then insulin injections are prescribed. As a rule, insulin doses are selected in a hospital setting, where the patient is taught to administer insulin independently. It's not difficult and almost painless! There is no addiction to insulin! Insulin is discontinued immediately after birth, under the control of blood sugar levels.
Signs
Pregnant women often attribute symptoms of high glucose to a change in the general condition of the body. At a routine appointment with a doctor managing a pregnancy, expectant mothers rarely complain about the manifestation of primary signs of hyperglycemia. A high glucose level is detected only during routine screening.
If your blood sugar has increased, the following symptoms should attract your attention:
- Polydipsia (permanent thirst). The desire to drink water arises regardless of the consumption of salty foods. Increased amounts of glucose in the blood require additional fluid, and the body tries to prevent dehydration (dehydration).
- Pollakiuria (frequent urination). It occurs, firstly, due to impaired absorption of free fluid by the kidneys, characteristic of hyperglycemia. Secondly, because of the growing baby (the enlarged uterus puts pressure on the bladder). Thirdly, due to the constant replenishment of water supplies (quenching thirst).
- Polyphagia (increased appetite) or anorexia (lack of appetite). Impaired insulin perception negatively affects the functioning of the hypothalamus, an area of the brain that regulates homeostasis and hunger. Eating behavior is out of control.
- Chronic fatigue syndrome (CFS). Fatigue and weakness are caused by a lack of energy and tissue nutrition, since the delivery of glucose is stopped (or the cells refuse to absorb it).
External signs of high glucose levels: loss of elasticity and dryness of the skin, slow skin regeneration after damage, swelling, brittle hair and nails, telangiectasia (spider veins on the legs). If sugar increases by 2 or more mmol/l, manifestations of hyperhidrosis (increased sweating), cephalgic syndrome (headache), and increased heart rate (tachycardia) are possible.
Important! You should tell your doctor about all your sensations. A seemingly insignificant change in condition may be a sign of hyperglycemia.
Will diabetes be forgotten after giving birth?
You should not forget about gestational diabetes immediately after the birth of your child. 1.5-2 months after birth, it is advisable to perform a glucose tolerance test again. If all indicators are normal, then you are healthy. However, it is known that women who had diabetes during pregnancy are more likely to develop type 2 diabetes in later years. Given this increased risk, it is necessary to take a blood sugar test once a year on an empty stomach and 2 hours after meals. You can reduce your risk of developing diabetes by normalizing your body weight.
Possible consequences
High sugar during pregnancy is, first of all, dangerous for the further development of gestational diabetes mellitus, for the treatment of which they often resort to insulin therapy (glucose compensation through injections of medical insulin). Undiagnosed, and therefore uncompensated, GDM threatens serious complications for the woman and the unborn baby.
Symptoms of high blood sugar in women
Hyperglycemia in the first half of pregnancy can negatively affect the process of “laying” the brain and nervous system of the child. The risk of having a baby with mental disabilities and neuropsychological disorders increases.
High blood sugar can cause the following pregnancy complications:
- spontaneous interruption (miscarriage) or fading of the gestation process;
- increased volume of amniotic fluid (polyhydramnios) and fetoplacental insufficiency;
- premature or complicated delivery;
- preeclampsia (severe late toxicosis);
- vascular lesions of the organs of vision (retinopathy);
- failure of the kidneys (nephropathy).
Neglecting the symptoms of hyperglycemia can lead to the development of type 2 diabetes. A high level of glucose in a mother’s blood does not go unnoticed for the unborn baby. The risk of intrauterine growth retardation, child intoxication with ketones (toxic products of glucose metabolism), and fetal obesity increases. Severe complications include:
- oxygen starvation (hypoxia);
- insufficient blood supply to the brain (ischemia);
- intrauterine death.
Important! Early diagnosis of hyperglycemia is a chance to avoid the development of gestational diabetes mellitus and negative consequences.
