The bearing of the child and his birth are accompanied by difficult loads for the woman’s body. This is especially true for women with serious chronic diseases. One of these insidious diseases is diabetes mellitus (DM). Before the invention of insulin, motherhood and diabetes were practically incompatible concepts. Now everything has changed. MedAboutMe will talk about the dangers of expectant mothers suffering from this disease and how to avoid the adverse effects of diabetes on the mother and the future baby.
Types of diabetes during pregnancy
Diabetes mellitus refers to diseases in which the metabolism is disturbed. It is accompanied by chronic elevated blood glucose (hyperglycemia). This is due to a violation of insulin production by the pancreas or a violation of its exchange. There is also a combination of these two factors.Hyperglycemia has an adverse effect on all human organs and tissues. The disease in many patients progresses with age and leads to complications.
In humans, there are two main types of diabetes. In addition to them, there are more rare forms of diabetes, caused by various mutations, diseases of the pancreas and other causes, as well as gestational diabetes.
Pregnancy and the birth of a child are becoming a serious test for the body of the future mother, suffering from diabetes. The most common types of diabetes in pregnancy include:
- Type 1 diabetes.
Usually, this diagnosis is a woman’s childhood. The disease is caused by damage to the cells of the pancreas that produce insulin. This leads to complete insulin deficiency. Saving a person can daily injection of insulin into the body.
- Type 2 diabetes.
The disease is caused by insulin metabolism. It can be produced in sufficient quantities, but the body’s tissues are not sensitive to it. This is called insulin resistance, which leads to an accumulation of glucose in the blood. Some patients may not have insulin resistance, but there is insufficient or impaired insulin production. Insulin and / or hypoglycemic agents are used in the treatment .
- Gestational diabetes.
This type of diabetes develops for the first time during pregnancy and passes after its termination. Doctors note that the occurrence of gestational diabetes mellitus is a significant risk factor for the development of type 2 diabetes in the mother in the future. When gestational diabetes produces insulin in the woman’s body is not enough, which leads to hyperglycemia.
What is dangerous diabetes for an unborn child?
Regardless of the type of the disease, the elevated blood glucose level of the expectant mother adversely affects the health of the future baby. The dangers of diabetes for the fetus lie in the following:
- Spontaneous termination of pregnancy at different periods;
- Premature labor;
- The birth of a dead fetus (20-30% probability);
- Increased risk of death of the child after birth;
- Formation of malformations of varying severity, including heart defects;
- Intrauterine growth retardation or excessive growth of the fetus in combination with its immaturity;
- The possibility of developing diabetes in a child in the future (with type 1 diabetes in both parents, the risk of diabetes in a child is 30-35%).
Adverse effects of the disease of the mother can be avoided or significantly reduce their manifestations with good diabetes control by the doctor and self-control. It is necessary to approach with full responsibility to the correction of existing problems and to medical observation. Only competent management of the patient during pregnancy and good correction of hyperglycemia can lead to a favorable outcome for both mother and baby.
Features of diabetes in the first trimester of pregnancy
The beginning of pregnancy is characterized by powerful hormonal changes in the female body. Under the influence of estrogen and progesterone (the number of which increases during pregnancy), hyperplasia of the pancreatic cells of the mother, producing insulin, occurs. Insulin as a result produces more.
In early pregnancy, the need for additional insulin is reduced, but only for a while. Then, placental hormones are produced, which thus affect the mother’s metabolism, which reduces the need for glucose for the woman’s body. Excess glucose must be disposed of, resulting in insulin deficiency. All these processes lead to an unstable amount of sugar in the mother’s blood.
Glucose easily penetrates from mother to baby, but insulin does not penetrate. If glucose to the fetus enters in excess, then it can lead to disruption of the formation of its organs and tissues, causing malformations. Hypoglycemia is also detrimental to the baby – a pregnancy can spontaneously end.
In the first trimester, a woman is required to be hospitalized for examination by specialists, diet correction and insulin therapy. It is necessary to resolve the issue of the possibility of carrying this pregnancy. Not all drugs are allowed during gestation (for example, hypoglycemic agents in tablets). A woman should be informed about this in order not to harm her baby.
What are the dangers of the second trimester of pregnancy in diabetes?
After 20 weeks of gestation, the fetus begins to produce insulin and dispose of glucose itself. The higher the glucose content in his blood, the more insulin will be needed. A condition called hyperinsulinism occurs . In addition, the cortex of the adrenal glands of the fetus begin to produce its hormones in excess. All these processes lead to increased production of protein and fat, accelerating the growth of the fetus. Macrosomia (increase in fetal size) can be seen with an ultrasound examination (US) of a pregnant woman.
The fetus increases the need for oxygen, which leads to chronic hypoxia. The fetus reacts to hypoxia by increased production of red blood cells. The iron content in the fetal tissues is redistributed, and the heart and brain begin to suffer from its deficiency.
Most pregnant women with diabetes are offered planned second-trimester hospitalization for the correction of diabetes therapy and treatment of beginning pregnancy complications.
What to look for in the third trimester of pregnancy with diabetes
The third trimester of pregnancy is normally characterized by the fact that the fetus is growing rapidly, gaining weight, all organs and tissues mature. With severe diabetes, the mother’s blood circulation sometimes suffers so much that he may be born with developmental delay. When the mother has no vascular complications, and the state of hyperglycemia constantly accompanies the pregnancy, the fetus is born large, but immature.
Pregnant women with diabetes are advised to go to the maternity hospital in advance in order to prepare for the upcoming delivery. This is also due to the fact that during diabetes the pregnancy is often complicated by the layering of infections, high water and preeclampsia (increased blood pressure, the appearance of edema and protein in the urine). Vascular disorders may progress, which affects the vision, the work of the heart and kidneys in the mother, as well as other organs.
Diet and lifestyle for diabetes during pregnancy
Drugs in pills that reduce blood sugar levels are prohibited during gestation . Therefore, the main directions of treatment of diabetes in pregnant women are insulin therapy and a certain diet.
- You must completely abandon refined sugar;
- Maximum limit simple carbohydrates, salty and fatty foods;
- It is necessary to eat more foods that contain fiber (vegetables, unsweetened fruits, bran);
- Vegetable soups or soups on weak meat broth are useful;
- The use of dairy and lactic acid products, low-fat cheeses is recommended;
- Fish dishes to cook low-fat fish;
- Meat for cooking choose low-fat;
- Bread choose rye wholemeal;
- Of the drinks preferred compotes, dogrose infusion, tea, mineral water.
Proper lifestyle with diabetes is very important. It is recommended to walk more often (at least 2 hours a day), to go in for physical culture. It is worth quitting smoking and taking alcohol.
It is very important to have a blood glucose meter at home and monitor blood sugar levels in order to promptly correct the “malfunction” in the body.
Features of childbirth
The optimal term for the birth of a baby in a woman with diabetes is 38-40 weeks. In the absence of contraindications, it is recommended to give birth in a natural way. At birth, the blood glucose level of the woman in labor is carefully monitored. A cesarean section is carried out according to all indications adopted in obstetrics, as well as with pelvic presentation of the fetus and with pronounced complications of diabetes.
Childbirth in women with diabetes is characterized by the risk of increased injuries to the mother and child. This is explained by the fact that a large fetus is moving through the birth canal.
Problems of the newborn from the mother with diabetes
When the mother’s diabetes mellitus was not under proper control, was not detected at all, or if the woman did not follow the recommendations of the doctors, the child could be born with serious problems. Not only the health, but also the life of the baby may be at risk.
Such children are diagnosed with “diabetic fetopathy ” or “diabetic embryopathy ” (if there are malformations). In the International Classification of Diseases X revision (ICD-10), these conditions are referred to as P 70. Knowledge of possible problems in a newborn child makes it clear how important it is to keep blood sugar levels within acceptable limits.
Some pathological conditions in children born to mothers suffering from diabetes:
- Excessive blood sugar in the mother causes an increased insulin production in the unborn child. Under the influence of an excess of insulin in the fetus, very important metabolic processes are disturbed. This often leads to improper formation of organs and tissues of the fetus.
- Excess glucose in the body of the fetus is converted into fat. Despite the fact that the child may be born overweight (from 4 to 6 kg), his organs are immature.
- Problems with the adaptation of the baby to life outside the mother’s body can start from the delivery room. Newborns from mothers with diabetes often require resuscitation at birth. This is due to the immaturity of the lung tissue, the inability to adequately breathe after birth. Some children require conversion to artificial respiration and other types of breathing support.
- After crossing the umbilical cord, the flow of glucose from the mother to the baby stops, although its pancreas continues to produce insulin in large quantities. This leads to a sharp drop in the blood glucose level in the child. This condition sometimes requires treatment in the neonatal intensive care unit by intravenous administration of glucose solutions to the child. Hypoglycemia (low blood sugar) has an adverse effect on the nervous system of the baby.
- Children born to women with diabetes often have poor heat retention and require special care. They are edematous, which makes it difficult to position a venous catheter after birth. Many children have a protracted jaundice requiring long-term treatment.
- Possible violations in the cardiovascular system, caused by immaturity, heart defects, or dysregulation of the heart.
- Frequent pathology in the blood coagulation system: a tendency to thrombosis, insufficient blood supply to vital organs, etc.
- In children with diabetic fetopatia , difficulties of feeding and digestion often occur. Finding a child in the intensive care unit for newborns and separation from the mother aggravates nutritional problems.
Neonatologists and resuscitators are engaged in the treatment of children with diabetic fetopathy . The main areas of treatment are the stabilization of the child’s condition, the correction of water and electrolyte disorders, the normalization of blood sugar levels, the provision of adequate breathing and other measures.
Many young patients cannot be discharged home from the maternity hospital. They require transfer to the neonatal pathology department for in-depth examination, identification of possible malformations, and consultation with narrow specialists. It takes time to breastfeed and prepare the baby to stay at home.
Thus, pregnancy in diabetes requires mandatory supervision by competent specialists. This is necessary for the correct treatment of diabetes, early detection of incipient complications and the choice of tactics of childbirth. Pregnant women with diabetes are observed and give birth in maternity hospitals and perinatal centers that specialize in the management of women with chronic diseases.