Pregnancy is the most joyful period in a woman’s life. But sometimes it can be clouded by health problems. Half a century ago, doctors believed that pregnancy and diabetes were incompatible and did not advise patients to give birth in the presence of this disease.
The presence of diabetes mellitus significantly complicates gestation and childbirth. But today there are methods that allow women to carry healthy children. They demand from the patient a serious attitude towards herself, great willpower and a clear understanding that a significant part of this amazing time will have to be spent in the hospital under the strict supervision of doctors.
Pregnancy planning
If a woman has diabetes, only a carefully planned pregnancy is possible. This is important, because if pregnancy occurs by accident, then the woman will find out about it, being already at 4-5 weeks. In these few weeks, all the organs and systems of the unborn child are laid. And if at this time blood sugar “skips”, the likelihood of fetal pathologies or spontaneous miscarriage will increase significantly.
Preparation involves:
- Constant self-monitoring of blood glucose levels. In preparation for and after pregnancy, this indicator will have to be carefully monitored. To do this, you need to get a good glucometer and keep a measurement diary.
- Elimination of bad habits – alcohol, nicotine, diabetes and pregnancy are incompatible.
- Measurement of blood pressure.
- Compliance with a diet with restriction of “fast” carbohydrates. You need to eat often – at least 5-6 times a day, but in small portions. This is necessary so that the energy evenly enters the body.
- Mandatory consultation with an endocrinologist. It is strictly forbidden to take hypoglycemic drugs during preparation for pregnancy and after it occurs. You will have to switch to insulin injections – the endocrinologist will help you choose the necessary dose to compensate. A visit to this doctor is also mandatory while carrying a child.
- Visit to the gynecologist for examinations for the presence of infections of the genitourinary system and their treatment.
- Consultation with an ophthalmologist to assess the state of the retinal vessels. If there is a threat of rupture, moxibustion is performed.
- A visit to a general practitioner to identify and treat extragenital pathologies.
Visiting narrow specialists is necessary to take into account all the risks during the course of pregnancy and to prepare for possible complications.
It is necessary to start preparing for pregnancy with diabetes no later than 3-4 months before the planned conception. Contraception can be canceled only when all examinations have been completed, the necessary treatment has been carried out and all specialists have given their permission for pregnancy.
Unfortunately, in some situations, pregnancy can pose a huge threat to the health and life of a patient with diabetes.
Possible contraindications for pregnancy:
- Diabetes in both parents.
- Combination of diabetes and Rh-conflict.
- Combination of diabetes and active tuberculosis.
- Vascular lesions of the retina of the eyes and kidneys (nephropathy).
- Chronic renal failure.
Types of diabetes during pregnancy
Carrying a baby can be accompanied by the following types of diabetes:
1. Explicit
Typically, this diagnosis is made even before pregnancy on the basis of hyperglycemia (high blood sugar) and glucosuria (the appearance of sugar in the urine). This type of diabetes has three forms:
- Light – blood sugar does not exceed 6.6 mmol / l.
- Average – blood glucose does not exceed 12.21 mmol / l.
- Severe – the blood sugar level is above 12.21 mmol / l, ketone bodies are present in the urine, ketosis develops. The retina of the eyes is affected, nephropathy, arterial hypertension, skin lesions (trophic ulcers, boils) occur.
2. Latent
With this type of diabetes mellitus, there are no clinical manifestations of the disease (latent diabetes), the diagnosis is made solely on the basis of the results of a blood test for the body’s sensitivity to glucose.
3. Gestational (transient)
This is a specific form of diabetes mellitus, characteristic only for the period of pregnancy. It occurs in 3-5% of all pregnant women after 20 weeks. The gestational form of diabetes is closely related to carrying a child – all its signs disappear after childbirth, but relapses are possible with subsequent pregnancies.
The exact reasons for the development of transient diabetes are not known to science. Most doctors are of the opinion that it develops due to the fact that placenta hormones are released in large quantities into the blood of the expectant mother and block the insulin located in the same place. As a result, the body’s sensitivity to this hormone decreases and the level of glucose in the blood rises.
4. Threatening
This group includes all pregnant women with a tendency to diabetes – with a burdened family history, overweight, age 30 years and older, who have given birth to children weighing more than 4.5 kg.
All patients from this group are under close medical supervision and regularly take a blood sugar test. If the indicator is higher than 6.66 mmol / l, a glucose tolerance test is performed. In addition, the threatening form of diabetes requires regular monitoring of the level of sugar in the urine – almost 50% of patients with this type of disease are diagnosed with glucosuria.
Symptoms of diabetes during pregnancy
Diabetes mellitus is often asymptomatic, but specific manifestations are also possible. A pregnant woman should tell her doctor as soon as possible about symptoms such as:
- Constant desire to drink.
- Frequent, profuse urination.
- Weight loss and weakness associated with increased appetite.
- Itchy skin.
- Ulcers and boils on the skin.
Why diabetes during pregnancy is dangerous
The main danger of diabetes for a woman is the risk of developing preeclampsia, or late toxicosis of pregnant women. This is a formidable complication associated with the disruption of the work of many organs and systems of the body. Its most severe consequences are acute renal or heart failure, edema of the brain or lungs, coma, premature detachment of the placenta, acute hypoxia and fetal death. But if a woman takes herself seriously, registers early at the antenatal clinic, takes all the necessary tests and regularly goes to the doctor’s office – you can not only predict the possibility of this pathology development, but also not miss the symptoms, thereby saving the life of the mother and child …
Other possible dangers of diabetes for a pregnant woman:
- Risk of miscarriage.
- Polyhydramnios.
- Urinary tract infections (pyelonephritis is especially dangerous).
- Weak labor activity.
- Increased risk of birth trauma.
- Premature discharge of amniotic fluid.
- Increased risk of endometritis in the postpartum period.
The danger to the fetus lies in the emergence of a complex of disorders called diabetic fetopathy. This complication is primarily associated with the large size of the fetus and, as a result, with an increased risk of birth trauma. Other dangers are highlighted:
- The risk of death in childbirth and in the first weeks of life.
- Intrauterine oxygen starvation.
- The risk of congenital malformations (pathologies of the heart, brain, genitourinary system, skeletal imbalances).
- Breech presentation.
- Immaturity of internal systems and organs.
- Congenital weakness of reflexes.
- Propensity to bacterial and viral infections.
- The likelihood of diabetes in childhood.
Pregnancy management in diabetes
At first, a pregnant woman visits her doctor weekly, and if complications develop, every day or she is admitted to a hospital. During the entire period of pregnancy, a woman is hospitalized 4 times:
- Upon initial registration – a complete examination, including genetic, identification of the risk of complications, contraindications to the continuation of pregnancy.
- 8-12 weeks – correction of insulin doses, identification of fetal pathologies.
- 21-25 weeks – identification of possible complications, treatment.
- 34-35 weeks – this time the woman is in the hospital until the very birth.
Diabetes itself does not interfere with natural childbirth, but sometimes complications develop, which only a cesarean section can help to cope with. These include breech presentation, large fetus, or various diabetic complications in the mother and child (gestosis, risk of retinal detachment, and others).
Conclusion
The happiness of becoming a mother is not easy for a woman with diabetes. The possibilities of modern medicine give high chances to endure and safely give birth to a baby. The patient herself must take her pregnancy with all responsibility – carefully monitor the blood sugar level, inform the doctor in time about everything that worries her, take all tests, do not miss visits to the doctor and not refuse planned hospitalization. Compliance with all the recommendations of doctors and faith in yourself is the key to a successful birth and the birth of a healthy child.