In the perinatal period, all systems of the female body operate with a double load, changing tastes and gastronomic preferences. In this respect, small fluctuations in blood glucose levels are allowed.
If the blood sugar level in pregnant women is seriously exceeded, it may indicate the development of GDM (gestational diabetes mellitus), a condition of prediabetes, or a manifestation of manifest type 2 diabetes (DM). Glucose indicators should be carefully monitored for the timely diagnosis of the disease at birth.
Under the pregnancy management program, a woman undergoes three mandatory examinations (one in each trimester) during the gestation period. During the complete examination, laboratory parameters (blood and urine) and ultrasound examinations are prescribed.
If necessary, the gynecologist directs the pregnant woman to additional diagnostic procedures. In an uncomplicated pregnancy, glycemia (blood sugar level) is measured as part of a biochemical or general clinical screening test. In case of a tendency to deviate glucose from the norm, monitoring is carried out regularly.
General normative indicators of blood glucose and norms for pregnant women
The upper limit of reference values of blood sugar for women of childbearing age is 5.5 mmol / L (millimoles per liter), the lower - 3.5 mmol/liter. After a meal, these indicators increase by an average of 2.2 mmol / l.
The concentration of sugar increases due to the breakdown of food by enzymes, the formation of glucose, and its resorption (absorption) into the systemic circulation. Glycemia reaches its maximum value an hour after a meal, then the indicators decrease, and after three hours they return to normal. With a healthy carbohydrate metabolism, in a non-pregnant woman, the sugar curve is as follows:
The number of venous blood is 12% higher than capillary blood (from the finger). This is necessarily taken into account when evaluating the results. In the perinatal period, the indicators change. The norm of blood sugar during pregnancy is:
Deviations from the norm
Deviations of blood glucose from normal upwards, otherwise hyperglycemia during the perinatal period, indicate a malfunction of carbohydrate metabolism and a violation of the hormonal background. The changes can be as follows:
- Persistently slightly elevated sugar indicates impaired glucose tolerance - a condition of prediabetes;
- A stable excess of indicators of more than 1.5 mmol / l, characteristic of the development of gestational diabetes;
- Persistent non-compliance with a glucose norm greater than 2 mmol / l indicates the manifestation of manifest type 2 diabetes, which was first diagnosed during pregnancy.
Hypoglycemia (low blood glucose) in pregnant women is rare, but just like hyperglycemia, it is considered a pathology. Once elevated blood sugar is not a cause for concern. The pathological condition is diagnosed only by the results of several examinations and additional laboratory tests.
Preparation and diagnostics
Determination of glucose concentration is performed primarily when a pregnant woman is reported to a pre-Christmas clinic. To properly prepare for the procedure, you must:
- Refuse the use of simple carbohydrates (sweet foods and beverages) prior to analysis;
- Limit physical activity;
- Adhere to the fasting regime for at least 8 hours before the test.
The analysis is performed exclusively on an empty stomach. If, according to the test results, an excess or deficiency of blood sugar is determined, another test is prescribed. When confirming deviations from the reference values (increase), a glucose tolerance test is performed. PGTT (oral glucose tolerance test) is a marker of carbohydrate absorption in the body.
The research algorithm includes:
- Fast blood sampling on time;
- "Glucose load" (75 g. Glucose dissolved in 200 ml of water);
- Repeated measurement of sugar levels in an hour;
- Blood test two hours after exercise.
The table shows the fasting and post-glucose values for the diagnosis of gestational diabetes.
In order to confirm the diagnosis of GDS and manifested diabetes mellitus, the analysis of glycosylated (glycosylated) hemoglobin - HbA1C is prescribed. This compound of glucose and the protein component of red blood cells (hemoglobin) retains its structure for 120 days.
This calculates how much blood sugar a lady has had in the last four months. Acceptable limits of HbA1C vary from 6.5 to 7%. Norms of glycated hemoglobin especially for pregnant women have not been developed. The reference values are identical for all categories of women.
Causes of unstable glycemia during pregnancy
To answer the question of why in the perinatal period blood glucose exceeds normal limits, it is necessary to identify the changes through which the body of the future mother suffers.
Improving performance
The blood of pregnant women is greatly affected by the hormone progesterone, which is responsible for the preservation of the fetus and its successful development. Progesterone partially inhibits the activity of insulin, a hormone that delivers glucose to the cells of the body. In addition, in the second half of pregnancy, a temporary organ in a woman's body - the placenta - begins to produce its own hormones.
The woman's hormonal background is strongly shifted, which affects the plasma glucose concentration. In order for two organisms to provide the necessary energy at once, a woman needs more glucose. The expectant mother begins to consume a lot of simple carbohydrates. In contrast, the pancreas generates extra insulin to compensate for the imbalance.
However, no matter how hard she tries, against the background of rapid weight gain and reduced physical activity, the tissues stop absorbing insulin. There is insulin resistance. Glucose accumulates in the blood, glycemia increases, the cells of the female body and fetus do not receive proper nutrition.
Associated causes that increase glycemic values:
- Chronic diseases of the pancreas;
- Hereditary predisposition to impaired glucose tolerance;
- Obesity;
- Renal pathology.
A high concentration of sugar can be observed with trouble, ie with a prolonged stay of a woman in a state of psychological stress.
Decreased performance
Low blood sugar during pregnancy is characterized by an unstable intake of simple carbohydrates in the body, with normal or increased insulin production. The lack of sugar in the diet alternates with its excessive consumption, as insulin is produced more than needed and glucose levels are reduced.
Other reasons why a pregnant woman lowers glucose include:
- Eating disorders (eating at long intervals);
- Eating behavior (low-calorie diet, unacceptable in the perinatal period);
- High physical activity that does not correspond to the health condition (more often observed in professional athletes).
Hypoglycemia can occur with severe toxicosis when carbohydrates do not have time to be absorbed by the body.
Possible consequences
High blood sugar during pregnancy threatens gestational diabetes. If a woman does not receive timely treatment, the consequences of hyperglycemia negatively affect the health of the child. The baby's nervous system and brain are "laid down" during the first part of the perinatal period.
High glycemic levels can cause psychopathological disorders and mental disorders in a child. Persistent intrauterine poisoning of the unborn child with toxic glucose breakdown products creates a risk of hypoxia (oxygen starvation), cerebral ischemia (insufficient blood supply), and fetal obesity.
If sugar is constantly elevated, uncompensated hyperglycemia can cause the following complications:
- Fetal pallor, miscarriage, premature or complicated delivery;
- Fetoplacental insufficiency;
- Polyhydramnios (increase in amniotic fluid volume);
- Preeclampsia (severe toxicosis in later stages);
- Retinopathy (damage to the vascular system of the organs of vision);
- Nephropathy (impaired renal vascular function).
Stably lowered sugar levels mean “fasting” of the fetus. As a result, the baby may be born prematurely, i.e., be born prematurely, have a birth weight loss, or have congenital endocrine pathology.
Glycemic stabilization
The main method for removing impaired glucose tolerance is diet therapy. You can lower your blood sugar by changing your eating habits. To do this, you must:
- Exclude from the daily menu products consisting of simple carbohydrates (sweet pastries, confectionery, chocolate, and sweets are allowed only with a compensated condition and in scarce quantities);
- Increase the number of foods in the diet, with an abundance of fiber (fresh vegetables, cereals, and legumes), as well as protein foods (seafood, turkey, chicken, fish);
- Refuse fatty foods (pork, goulash, sausages, mayonnaise-based sauces, fast food, etc.);
- Enter in the menu products that reduce the concentration of glucose in the blood (blueberries, Jerusalem artichoke, ginger, Momordica
You should limit the use of butter to 10-15You should restrict your butter consumption to 10-15 g each day. g. per day. Dairy products should also not have a high percentage of fat. A pregnant woman prone to HDS must control the glycemic index of the food consumed and the total daily calorie intake. In the daily diet, the allowable value is 40 units of glycemic index and 40 kcal per 1 kg of weight in accordance with the energy value of all foods consumed daily.
A strict diet will help stabilize glycemia without the use of insulin injections. Insulin therapy is prescribed to women if it is impossible to compensate for high sugar. Injections made into the stomach can quickly lower glucose levels. Hypoglycaemic (hypoglycaemic) tablets are not used in the perinatal period due to their teratogenic effects on the fetus.
Blood sugar levels during pregnancy can be unstable. This is due to a change in a woman’s hormonal status and a failure in carbohydrate metabolism. Stably high blood glucose threatens the health of women and children. They were overestimated> 5.5 mmol / L on an empty stomach.
A slight excess of the norm after a meal is allowed (up to 8.9 mmol / L - one hour after a meal, up to 7.8 mmol / L - two hours later, up to 6 mmol / L - three hours later). With stable hyperglycemia, gestational diabetes is diagnosed. In order to diagnose its development in a timely manner, it is necessary to donate blood for glucose tolerance. Strict adherence to dietary rules helps reduce blood sugar.
What should be the blood sugar level in pregnant women?
A lot of surprises, especially unpleasant ones, await pregnant women in this sweet and difficult period. One of them is the rise in blood sugar, which is discovered completely suddenly and unexpectedly in the future mother. Why do tests sometimes show elevated glucose levels and why is this research being conducted?
Why do pregnant women determine their blood sugar?
In the phase of planning a pregnancy, a woman undergoes a huge number of examinations and undergoes a series of tests, which seem to be completely useless. However, the doctor knows exactly what needs to be done, so measuring blood sugar is a must in preparation for conception. Thus, it is possible to determine impaired glucose tolerance, which is especially important for women who are overweight, predisposed to being overweight, or have large children.
The goal of a blood sugar test during pregnancy is one - to identify the likelihood of problems with the endocrine system, kidneys, and pancreas. Many women during this period have a predisposition for various complications, so it is important for the doctor to understand whether it is diabetes or gestational diabetes.
If the amount of glucose in the blood exceeds the allowable norm, ketone bodies that have increased toxicity begin to be synthesized. This is exactly the danger to the growing fetus. Sometimes glucose levels increase with certain pathologies, for example, pancreatic diseases, hormonal imbalance, chronic and acute pancreatitis, severe intoxication, epilepsy.
Low blood sugar can also indicate the occurrence of diseases related to the liver, metabolic processes, and blood vessels.
Analysis of blood sugar during pregnancy is carried out repeatedly: first - at registration, and then - the 30th week. Between these procedures, a glucose reaction test is performed.
How to donate blood for sugar during pregnancy?
Giving blood for sugar during pregnancy should be the same as it is usually donated by children and adults. You can choose a laboratory method or an express test. It is currently an express method that allows you to achieve results at home, but it is better to give preference to laboratory tests during pregnancy.
Preparation for the analysis consists of several steps: Last meal - no later than 8 hours before the analysis.
- Water 1 day before the analysis, under the ban you can drink only boiled or bottled without gas, mineral water, and baking soda.
- The day before the delivery of the material, it is recommended to refuse to drink alcoholic beverages.
- The day before the procedure, you must stop taking any medications.
- On the day of blood donation, do not clean your teeth in the morning.
The analysis is given in the morning on an empty stomach, from 8:00 to 12:00. For the test, a small amount of blood is taken from the finger and subjected to a laboratory examination, after which the results are stated on a form and given to the doctor who is conducting the pregnancy. He, in turn, explains the obtained data to the patient, gives recommendations.
The results are not always true: there are factors that can affect the reThe results are not always correct: there are elements that might impact the analysis's dependability. liability of the analysis. For example, the use of fatty, fried, and sweet foods, strong stress the day before, taking medication, active sports, physiotherapy, or x-rays. All this must be warned by the doctor in advance and, if necessary, postponed.
Gestational diabetes mellitus (patient note)
Gestational diabetes mellitus (GDM) is an abnormally high blood sugar level that occurs for the first time during pregnancy.
The norm of blood sugar in pregnant women in the morning on an empty stomach (before meals) is not more than 5.0 mmol / l, 1 hour after meals not more than 7.0 mmol / l.
And after glucose filling during the glucose tolerance test in 24-28 weeks of pregnancy: 1 hour in the morning before meals 3.3-5.0 mmol / l, 1 hour after meals less than 7.0 mmol / l.
Each sugar value should be recorded in a self-monitoring diary with the date, time, and detailed description of the food intake, after which you measured the sugar.
You should take this diary with you every time you see an obstetrician-gynecologist and endocrinologist.
GDM treatment during pregnancy:
Diet is the most important thing in the treatment of GDM
Easily digestible carbohydrates are completely excluded from food: sugar, jam, honey, all juices, ice cream, cake, pastries, bakery products made of high-quality white flour; rich pastries (pastries, pastries, pies),
Any sweeteners, such as fructose products (sold in stores under the "diabetic" brand), are prohibited for pregnant and breastfeeding women.
1. If you are overweight, then in the diet you must limit all fats and completely eliminate: sausages, sausages, sausages, bacon, margarine, mayonnaise,
In no case do not starve! Food should be evenly distributed over 4 to 6 meals throughout the day; breaks between meals should not be longer than 3-4 hours.
2. Physical activity. If there are no contraindications, moderate physical activity of at least 30 minutes a day, for example, walking, swimming in the pool, is very useful ..
Avoid exercises that cause high blood pressure and cause uterine hypertension.
3. Self-control diary in which you write:
blood sugar in the morning before meals, 1 hour after each meal during the day and at bedtime - daily,
all meals (in detail) - daily,
ketonuria (ketones or acetone in the urine) in the morning on an empty stomach (there are special test strips to determine ketone bodies in the urine - for example, "Uriket", "Ketofan") - daily,
- Blood pressure (blood pressure should be less than 130/80 mm RT. art.) - daily,
- Fetal movements - daily,
- Bodyweight - weekly.
Attention: if you do not keep a diary or do not keep it honestly, you are deceiving yourself (not the doctor) and risking yourself and the child!
If despite the measures taken, the blood sugar exceeds the recommended values, then it is necessary to start insulin treatment (for this you will be referred to an endocrinologist).
Don’t be afraid to prescribe insulin. You should know that insulin dependence does not develop, and after childbirth in the vast majority of cases, insulin is canceled. Insulin in appropriate doses does not harm the mother, it is prescribed to maintain her complete health, and the child will remain healthy and will not learn about the use of insulin from the mother - the latter does not pass through the placenta.
BIRTH and GDM:
The date and manner of delivery are determined individually for each pregnant woman, and no later than 38 weeks of pregnancy, the gynecologist-obstetrician conducts a final examination of the mother and child and discusses the prospects of childbirth with the patient. Prolonging pregnancy for more than 40 weeks with GDM is dangerous, the placenta has several reserves and may not be able to bear the load of childbirth, so earlier births are desirable. Gestational diabetes alone is NOT an indication for a cesarean section.
GDM after childbirth:
- Diet 1.5 months after birth,
- Insulin therapy is canceled (if any),
- Control of blood sugar in the first three days (blood sugar rate after childbirth: on an empty stomach 3.3 - 5.5 mmol / l, 2 hours after meals up to 7.8 mmol / l),
- 6-12 weeks after birth - consulting an endocrinologist for diagnostic tests to clarify the state of carbohydrate metabolism,
- Women who have undergone GDM are included in a high-risk group for the development of GDM in the following pregnancies and type 2 diabetes in the future, so a woman who undergoes GDM must:
- Follow a diet aimed at losing weight with its excess,
- Expand physical activity,
- Plan subsequent pregnancies,
- Children of mothers with GDM have an increased risk of developing obesity and type 2 diabetes throughout their lives, so they are recommended a balanced diet and appropriate physical activity, observation by an endocrinologist.
- If GDM is detected, patients should completely discontinue use:
- all sweet foods (this includes sugar and honey, ice cream, sweet drinks, etc.);
- white bread, pastries, and flour products (including pasta);
- Griz;
- Semi-finished products;
- Smoked meat;
- Fast food products;
- Fast food;
- High-calorie fruit;
- Soft drinks, juices in bags;
- Fatty meat, aspic, fat;
- Canned food, regardless of their type;
- Alcohol
- Cocoa;
- Cereals, diet bread;
- All legumes;
- Sweet yogurt.
You will also need to significantly limit your use:
- Potatoes;
- Butter;
- Chicken eggs;
- Baking dough.
Products from the banned list should be completely excluded from the diet. Even a small consumption of them can lead to negative consequences. Very limited quantities of potatoes, butter, eggs, and pastries are allowed
What can pregnant women eat with gestational diabetes? The above products can be replaced:
- Hard cheeses;
- Sour-milk curds;
- Natural yogurts;
- Greasy cream;
- Fish;
- Green vegetables (carrots, pumpkins, beets, unlike cucumbers, onions and cabbage must be consumed in limited quantities);
- Mushroom;
- Soybeans and products thereof (in small quantities);
- Tomato juice;
- Tea.
There are several dietary options that can be followed in gestational diabetes, but a low-carbohydrate diet is excluded.
This is due to the fact that when there is not enough carbohydrate intake from food, the body will start burning fat for energy.
The diet must contain the following products:
- whole-wheat bread;
- any vegetables;
- legumes;
- mushroom;
- cereals - preferably millet, pearl barley, oats, buckwheat;
- lean meat;
- fish;
- chicken eggs - 2-3 pcs./week .;
Dairy Products;
- sour fruits and berries;
- vegetable oils.
In most cases, doctors prescribe to their patients a diet that contains a large number of carbohydrates and a moderate amount of protein. Preference is given to unsaturated fats, the use of which must also be limited. Saturated fats are completely excluded from the diet.
What is the norm of blood sugar during pregnancy?
The birth of a child is a pleasant but very responsible period in a woman’s life. A serious attitude about the condition of organs and systems is a prerequisite for the birth of a healthy baby and maintaining all bodily functions in good condition.
The norm of blood sugar in pregnant women is necessarily controlled because it characterizes the condition not only of the future mother but also of her baby. Often changes caused by additional load and rearrangement of all structures lead to negative manifestations. This requires the woman to strictly follow all the doctor’s recommendations.
The most important of these is the need for regular medical supervision and timely examination using a variety of laboratory methods.
The role of normal indicators
An increase in blood glucose, as well as a decrease, indicates serious disorders in the body.
The biological function of carbohydrates is to supply all the cells of the body with the necessary nutrients, ie sugar is the main source of energy.
Glucose levels are especially important for a woman when her body has an obligation to preserve the fetus.
Significant changes caused by pregnancy lead to the fact that not all organs have been able to cope with the double burden.
Pancreatic failure becomes a major cause of insufficient insulin production. This leads to a disorder of excess glucose management, which always leads to an increase in its level in the blood.
The need to maintain the norm of this indicator during pregnancy requires constant monitoring, which allows not to start the disease, by adjusting the value on time.
Causes of violations
It should be noted that the increase in sugar associated with the birth of a child is a fairly common phenomenon, caused by the activation of pathological processes that were previously present in the body, but was not felt.
Gestational diabetes, observed only in pregnant women, usually passes after birth without a trace. But even this type of pathology threatens the mother and the child, so it is unacceptable to leave it unattended.
Among the main causes of increased sugar during pregnancy should be noted:
Significant increase in load on the pancreas and decrease in the effectiveness of natural insulin.
- Increased glucose due to changes in hormonal levels.
- Gestational diabetes experienced in previous pregnancies.
- Older than 30 years.
- Overweight.
- Policistični ovary.
- Urine glucose.
- Large fruit sizes.
- Hereditary predisposition to diabetes.
- Young women are less at risk of developing diabetes during pregnancy.
Additional circumstances
In addition to the described factors that can lead to deviations from the norm, other reasons should be pointed out.
- Excessive emotionality, stress, typical of pregnant women;
- The presence of infection in the body;
- Violation of the rules for preparation for analysis.
- Detection of up / down deviation is an indicator of retesting.
Abnormal glucose
- Obese, polycystic ovary;
- Older than 30 years;
- Give birth in previous pregnancies to a child weighing more than 4 kg;
- With a family history of diabetes;
- Not enduring previous pregnancies.
Signs of hyperglycemia during pregnancy
- Increased appetite;
- Increased thirst;
- dry mouth
- Blurred vision;
- Frequent urination;
- Blood pressure spikes;
- Drowsiness during the day;
- Rapid fatigue.
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