Diabetes mellitus and pregnancy

Diabetes mellitus and pregnancy - from planning to childbirth

What is diabetes?

To maintain life to the cells of the human body requires glucose (sugar). It is a kind of fuel that gets into the cell, thanks to insulin (the hormone of the pancreas). Sugar in the blood (glucose) is formed in two cases: from food containing carbohydrates, and as a result of the decay of the stock of glucose (glycogen) that is in the liver.

Diabetes is a disease in which there is an absolute or relative lack of insulin in the body, but at the same time, there is an increased level of sugar (glucose) in the blood. In this case, the metabolism is disrupted, and pathological changes occur in various organs and tissues. For example, in diabetes mellitus, lesions of small vessels of the eyes (possible blindness), kidneys, skin, muscles, nervous system, gastrointestinal tract are noted. Moreover, in diabetes mellitus, the immune system is weakened, which, perhaps, is one of the causes of frequent bacterial complications. All this leads to the fact, that patients with diabetes complain of dry mouth, thirst, consumption of increased amounts of fluid, excessive urination, increased or decreased appetite, weakness, weight loss, itching of the skin, especially in the perineum, sleep disturbance. They have a tendency to pustular skin diseases, furunculosis.

Why does gestational diabetes develop?

Gestational diabetes mellitus (DMD) or gestational diabetes is a violation of carbohydrate metabolism that first appears or is first recognized during pregnancy. In general, the change in carbohydrate metabolism during pregnancy is justified. This is due to the fact that a growing fetus needs energy material, mainly in glucose. Furthermore, partially blocked the effect of insulin as a result of an increase in the level of hormones of pregnancy (primarily, progesterone), which is strongly manifested after the 20th week of pregnancy. To maintain blood sugar within normal limits, the pancreas of a healthy pregnant woman produces an increased amount of insulin. If the cells of the pancreas do not cope with the increased load for them, then there is a relative or absolute deficiency of insulin and develops gestational diabetes mellitus.

But it is worth noting that gestational diabetes does not develop in everyone. To its development there is a predisposition, which is realized under the influence of some risk factors. These include overweight or obesity, diabetes mellitus in the immediate family, the mother's age is more than 25 years, belonging to a particular ethnic group (Asians, Africans, Spaniards), a burdened obstetric anamnesis. In addition, the risk of developing diabetes in pregnant women occurs if the previous baby at birth weighed more than 4-4.5 kg, or if the woman has a habitual miscarriage (more than 3 spontaneous abortions in the first or second trimesters of pregnancy).

Peculiarities of diabetes mellitus in pregnant women

Pregnancy has a significant effect on the course of diabetes mellitus. First, in the first trimester of pregnancy, there is an improvement in the course of the disease (the blood glucose level decreases). At this time, the dose of insulin is reduced by 1/3. But already at the beginning of the second trimester (from the 13th week), on the contrary, there is a worsening of the course of the disease, and the dose of insulin has to be increased. Already in the third trimester (from the 32nd week until the birth), it is again possible to improve the course of diabetes and the appearance of hypoglycemia. Therefore, the dose of insulin is reduced by 20-30%.

During the delivery period, blood sugar can fluctuate both in one direction and in the other direction. For example, under the influence of emotional influences (pain, fear), its number may increase. At the same time, childbirth is a complex physical process that leads to fatigue. As a result of energy expenditure, the sugar level can be significantly reduced. This all leads to the fact that during labor, doctors check the blood glucose level of a woman every two hours. After giving birth, sugar in the blood rapidly decreases and then gradually rises, reaching the level that was before pregnancy by the 7th-10th day of the postpartum period.

Management of pregnancy in diabetes

Pregnancy management in patients with diabetes mellitus is carried out in outpatient and inpatient care. If the state of health of a pregnant woman is satisfactory, she is hospitalized in a hospital three times.

For the first time - in the early stages of pregnancy. Then a complete examination is carried out and, based on the results, a decision is made about the desirability of maintaining a pregnancy. Then decide what should be preventive treatment and how to compensate for diabetes.

The question of whether or not it is possible to maintain pregnancy is raised because there are a number of contraindications to diabetes mellitus. Among them are various conditions and diseases. For example, rapidly progressing vascular complications, the presence of insulin-resistant and labile forms of diabetes mellitus, the presence of diabetes in both parents, the combination of diabetes mellitus and rhesus-sensitization of the mother, the combination of diabetes and active pulmonary tuberculosis.

The second hospitalization in the hospital is performed at a period of 20-24 weeks. As we noted above, this period is characterized by a worsening of the course of diabetes and the appearance of complications of pregnancy. At this time, it is necessary to conduct appropriate treatment and careful correction of the dose of insulin. Third time, a pregnant woman with diabetes mellitus is hospitalized at 32-34 weeks for careful monitoring of the fetus, treatment of obstetric and diabetic complications, choice of the term and method of delivery.

Diabetes during pregnancy is not the same in all patients. Approximately 15% of patients throughout the pregnancy have no special changes in the picture of the disease.

What complications can the disease cause during pregnancy?

In such women, the risk of developing late toxicosis of pregnant women (edema, increased blood pressure, impaired renal function and cerebral circulation) is significantly higher. Often, the disease affects the genitals, which is why women have spontaneous abortions, premature birth, fetal death.

How does the disease affect the development of the fetus and the condition of the child after birth?

Unfortunately, the elevated blood sugar level in the mother has a negative effect on the development of the fetus. He has complications, called diabetic fetopathy. The most frequent complication is a large fetus, in which most organs are structurally underdeveloped and partially unable to perform their functions. All this leads to a number of disorders in the baby (respiratory, neurological, cardiovascular). Also these children have low blood sugar, which requires the infusion of glucose and other special solutions within a few hours after birth. In 20% of cases at birth, on the contrary, there is another extreme - a small body weight.

In the first days of life in children born to mothers with GDM, the development of jaundice manifests itself, there is a significant loss of body weight and a slow recovery. These kids have a lot of hemorrhages on the skin of the face and limbs, puffiness, cyanoticity. The most severe manifestation of diabetic fetopathy is the high perinatal mortality of children. If the pregnant woman during the bearing of the child did not receive proper care and treatment, the mortality in the firste weeks after birth is observed in 70-80% of cases. If the woman was followed by a specialized observation, then this figure is reduced to 15%.

To prevent the effect of gestational diabetes on pregnancy and fetal development, careful blood sugar levels, proper diet and treatment are needed.

Treatment of diabetes

If a patient with diabetes miscarriage does not interrupt pregnancy, the necessary administration of insulin and compliance with a special diet is prescribed. The diet assumes that the diet of a pregnant woman with a GDD should contain a reduced amount of carbohydrates (200-250 g), fats (60-70 g) and a normal or even increased amount of proteins (1-2 g per 1 kg of body weight). The total calorie content of a daily diet should be 2500-3000 kcal. The diet should be full of vitamins. The food should be fractional (preferably 8 times a day). During pregnancy, a patient with diabetes should add in weight not more than 10-12 kg.

All patients with diabetes should receive insulin during pregnancy. It is very important to strictly observe the necessary time interval between injection and food intake.

Drugs used to treat diabetes mellitus during pregnancy are contraindicated. However, with mild forms of the disease, the use of phytotherapy is acceptable. For example, you can prepare such a decoction: 60 g of blueberry leaves pour a liter of boiling water, insist 20 minutes, strain and drink 100 ml 4-5 times a day.

Pregnant for normalizing the level of sugar recommended light exercise and walking.

Natural birth or cesarean section?

The choice of the method of delivery should be individual, taking into account the state of the mother, fetus and obstetric history. In 50% of cases in diabetic patients, babies are born by means of caesarean section.

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