Gestational diabetes mellitus: causes, symptoms, treatment
Gestational diabetes is a type of diabetes that occurs or is first diagnosed during pregnancy. At the heart of the disease is a violation of the metabolism of carbohydrates of varying degrees, namely, a decrease in glucose tolerance in the body of a pregnant woman. It is also called pregnancy diabetes .
The results of epidemiological studies conducted in the United States have shown that gestational diabetes mellitus develops in 4% of all pregnant women. European researchers have sounded data according to which the prevalence of gestational diabetes mellitus ranges from 1-14% of the total number of pregnancies. About 10% of women after childbirth remain with signs of the disease, which subsequently transforms into type 2 diabetes mellitus. According to statistics, half of women who underwent gestational diabetes mellitus during pregnancy develop type 2 diabetes mellitus over the next 10-15 years.
Such high prevalence rates of this pathology and possible complications indicate a low awareness of women about the possible risks of developing gestational diabetes mellitus and its consequences, and, as a result, late seeking diagnosis and qualified help. For the timely detection of the disease in reproductive family planning centers and antenatal clinics, active educational work is currently being carried out, which allows maintaining the health of a woman and contributing to the birth of healthy offspring.
What is the threat of diabetes during pregnancy?
First of all, in a negative impact on the growth and development of the fetus. With the occurrence of gestational diabetes mellitus in the early stages of pregnancy, there was a significant increase in the risk of spontaneous abortion and the appearance of congenital malformations of the heart and brain structures of the fetus. If diabetes mellitus begins later in pregnancy (2-3 trimesters), it leads to excessive fetal growth (macrosomia) and hyperinsulinemia, and after birth it can be complicated by diabetic fetopathy. Signs of diabetic fetopathy of a newborn are overweight (over 4 kg), body imbalance, excess subcutaneous fat, respiratory distress, hypoglycemia, increased blood viscosity with a risk of thrombus formation.
How is gestational diabetes during pregnancy different from other types of diabetes?
Diabetes mellitus is a disease characterized by a gross violation of carbohydrate metabolism due to a deficiency of the pancreatic hormone, insulin, in the blood, which can be absolute or relative. Diabetes mellitus is almost always accompanied by an increased blood glucose – hyperglycemia and the detection of sugar in the urine – glucosuria. According to the WHO, there are several types of diabetes mellitus.
Type 1 diabetes occurs in childhood and adolescence as a result of the autoimmune breakdown of specific cells in the pancreas that produce insulin, which leads to a decrease or complete cessation of its production. Type 1 diabetes mellitus occurs in 15% of all diabetics. The disease is detected when a high starting level of glucose is detected in the blood at a young age, while antibodies to β-cells and insulin can also be detected in the blood. The level of insulin in the blood of these patients is reduced. For the treatment of patients with type 1 diabetes mellitus, insulin injections are used – unfortunately, there are no other ways.
Type 2 diabetes mellitus often develops in overweight people in the second half of life against the background of genetic defects, previous infectious diseases, acute and chronic pancreatitis, taking certain medications and chemicals. The disease is characterized by a hereditary predisposition. In laboratory diagnostics, an increase in glucose levels (> 5.5 mmol / l) is noted in the blood of patients. Treatment of such patients consists of the appointment of a special diet, physical activity and taking medications that lower blood glucose levels.
Causes of Gestational Diabetes Mellitus
Gestational diabetes mellitus during pregnancy develops as a result of a decrease in the sensitivity of cells and tissues of the body to its own insulin, that is, insulin resistance develops, which is associated with an increase in the blood level of hormones produced by the body during pregnancy. In addition, in pregnant women, the glucose level decreases more rapidly due to the needs of the fetus and placenta, which also affects homeostasis. The consequence of the above factors is a compensatory increase in the production of insulin by the pancreas. That is why insulin levels in the blood of pregnant women are most often increased. If the pancreas cannot produce insulin in the amount required by the pregnant body, gestational diabetes mellitus develops. The deterioration of the function of β-cells of the pancreas in gestational diabetes mellitus can be judged by the increased concentration of proinsulin.
Often, immediately after delivery, the woman’s blood sugar level returns to normal. But it is not necessary to completely exclude the likelihood of developing diabetes mellitus in this case.
Who is most susceptible to developing diabetes during pregnancy?
Gestational diabetes mellitus during pregnancy develops in the case of a genetic predisposition, realized under the influence of a number of risk factors, such as:
– overweight, obesity with signs of metabolic syndrome;
– other disorders of carbohydrate metabolism;
– increased sugar levels in the urine;
– type 2 diabetes mellitus in direct relatives;
– the woman’s age is over 30;
– arterial hypertension and other diseases of the cardiovascular system;
– a history of severe toxicosis and gestosis;
– hydramnios, the birth of a previous overweight child (over 4.0 kg), stillbirth in previous pregnancies;
– congenital malformations of the cardiovascular and nervous systems in previous children;
– chronic miscarriage of previous pregnancies, characterized by spontaneous abortions in the first two trimesters;
– gestational diabetes mellitus in previous pregnancies.
Diabetes mellitus during pregnancy: symptoms and signs
There are no specific manifestations in gestational diabetes mellitus, so the only criterion for making a diagnosis is laboratory screening of pregnant women. Women at risk, at the first visit to the antenatal clinic, should be tested for fasting blood sugar levels against the background of a normal diet and physical activity. If your finger stick blood sugar is 4.8-6.0 mmol / L, a special glucose load test is recommended.
To detect gestational diabetes mellitus, an oral glucose tolerance test is performed for all pregnant women between the sixth and seventh months, which shows the quality of glucose uptake by the body. If the level of glucose in blood plasma taken on an empty stomach exceeds 5.1 mmol / L, an hour after a meal – more than 10.0 mmol / L, and after a couple of hours – more than 8.5 mmol / L, then the doctor has a reason to diagnose GDM. The test can be repeated multiple times if necessary.
With timely diagnosis of the disease and subsequent observation and implementation of all the doctor’s recommendations, the risk of having a sick child decreases to 1-2%.
Diabetes mellitus treatment during pregnancy
The course of pregnancy in diabetes mellitus is complicated by the fact that a woman will have to constantly monitor blood glucose levels (at least 4 times a day). In addition, to correct gestational diabetes mellitus, it is necessary to adhere to a diet that includes three main meals and two or three snacks, while limiting the daily amount of calories consumed to 25-30 per kilogram of body weight. It is very important to control that the diet is as balanced as possible in terms of the content of basic nutrients (proteins, fats and carbohydrates), vitamins and trace elements, since the full growth and development of the fetus directly depends on this.
Taking medications that lower blood glucose levels during pregnancy is contraindicated. If the diet prescribed by the doctor, along with moderate physical activity, does not give the expected results, you will have to resort to insulin therapy.
Diet of patients with gestational diabetes mellitus
Diabetes mellitus during pregnancy requires mandatory diet therapy, since it is proper nutrition that can be the key to successful treatment of this disease. When developing a diet, it is important to remember that the emphasis must be on reducing the calorie content of food, without lowering its nutritional value. Doctors recommend following a number of simple but effective dietary guidelines for GDM:
– eat in small portions at the same hours;
– exclude from the diet fried, fatty foods saturated with easily digestible carbohydrates (cakes, pastries, bananas, figs), as well as fast food and fast food;
– enrich the diet with cereals from various cereals (rice, buckwheat, pearl barley), salads from vegetables and fruits, bread and pasta made from whole grains, i.e. foods rich in fiber;
– eat lean meats, poultry, fish, exclude sausages, small sausages, smoked sausages, which contain a lot of fat
– prepare food using a small amount of vegetable oil;
– drink enough liquid (at least one and a half liters per day).
Exercise for gestational diabetes during pregnancy
Exercise is very beneficial for pregnant women, as, in addition to maintaining muscle tone and maintaining vigor, it improves the action of insulin and prevents the accumulation of excess weight. Naturally, physical activity for pregnant women should be moderate and consist of walking, gymnastics, water exercises. You should not abuse active physical activity, such as cycling or skating, horse riding, as this is fraught with injuries. It is important to regulate the number of loads, based on the current state of health at a given time.
Preventive measures to prevent the development of diabetes during pregnancy
Preventing the development of gestational diabetes mellitus is most likely difficult. Often, women at risk do not develop diabetes mellitus during pregnancy, and pregnant women who do not have any prerequisites may develop the disease. However, planning a pregnancy with gestational diabetes mellitus already suffered once should be responsible and possibly no earlier than 2 years after the previous birth. To reduce the risk of recurrence of gestational diabetes mellitus several months before the expected pregnancy, you should start monitoring your weight, include exercise in your daily routine, and monitor your blood glucose levels.
The intake of any medications must be agreed with the attending physician, since the uncontrolled use of certain medications (birth control pills, glucocorticosteroids, etc.) can also provoke the subsequent development of gestational diabetes mellitus.
1.5-2 months after childbirth, women who have had gestational diabetes need to be tested to determine the level of glucose in the blood and to conduct a glucose tolerance test. Based on the results of these studies, the doctor will recommend a specific diet and exercise regimen, as well as determine the timing for control tests.