All fetal malformations occur before seven weeks of gestation. These are the vices that children do not survive:
- heart disease;
- development of the spine;
- microcephaly;
- anencephaly and others.
And women with decompensated diabetes often have ovarian dysfunction and can’t determine if she’s pregnant or not because she’s not menstruating. Meanwhile, the fetus, which is already beginning to develop, suffers.
To avoid this, diabetes must be compensated, and then there is no damage. And if the glycated hemoglobin is greater than 10%, then the damage is found in 25% of cases, which should be up to 6%. Therefore, the most important thing is a planned pregnancy.
Now there is even an opportunity to review the genetic predisposition for the development of vascular complications in the mother. From this analysis, it can be judged how high the risk of obstetric and diabetic complications is.
There are genetic tests to assess the risk of developing diabetes in an unborn child. This gives as much information as planning - it can be used to judge the fate of a future pregnancy.
How to prepare for pregnancy and childbirth
Pregnancy must be planned. Only in this case, various complications can be avoided. Planning is often understood only as the use of contraceptives - this is wrong.
It is necessary to conduct a complete diagnosis, ie to identify and treat all possible urogenital infections that are often found in diabetics. By identifying a pathogen, for example, pyelonephritis, you need to cure this disease before pregnancy.
These are patients with diabetic nephropathy, untreated with proliferative retinopathy, and with tuberculosis. Women whose husbands also have diabetes.
If the vascular complications are less, for example, there is microalbuminuria, then childbirth can be resolved. But if the patient has protein, edema,
women with type 2 diabetes
There are fewer of them, but there are. Pregnancy of this type takes place on insulin if they took pills before it. Pregnancy is possible in all types of diabetes.
During the journey of pregnancy, gestational diabetes emerges as a temporary visitor, fading away once the journey concludes. Its presence often manifests in the latter stages, when the pancreas finds itself overwhelmed.
Alongside their prenatal preparations, these expectant mothers navigate courses and sometimes insulin injections, while also facing the potential threat of nephropathy.
Who is at risk for gestational diabetes?
These are women with a burdened heredity, women with a history of having large children weighing more than 4.5 kg, women who have a dysfunctional obstetric history, or stillbirth of unknown etiology, miscarriages, polyhydramnios. At the age of 24 to 26 weeks, they should definitely check their blood sugar.
The difference between the diet of a woman with diabetes during pregnancy.
At this point, nutrition should be sufficient not only for the woman herself but also for the child. The minimum amount of carbohydrates should be 12 units of carbohydrates and 2000 kcal, of which 400 goes to fetal development. In addition, according to each month of pregnancy, you should receive certain vitamins.
It needs foods rich in calcium, and vitamin E with antioxidant and hormonal goals. If a woman with diabetes is malnourished during pregnancy, she will certainly have acetone. It is necessary to keep a self-monitoring diary, in which "sugar", XE, and insulin doses will be recorded daily.
How the pattern of diabetes changes over 9 months
Diabetes in pregnant women is wavy. In the first months, the need for insulin decreases, because the level of glycemia increases the risk of hypoglycemia. This is explained by the influence of many hormonal processes and the fact that the consumption of glucose in the periphery improves.
By the third trimester of pregnancy, the placenta begins to age, the consular effects are smoothed out, and the need for insulin decreases again. The early pregnancy of a woman with diabetes is not much different than usual.
But a spontaneously terminated pregnancy happens more often, even if the woman is well compensated: however, the spread of “sugar” in her is outside the normal range.
The second part of pregnancy is the most difficult because of different difficulties. This is late gestosis, when the pressure increases, edema appears. It is the most common obstetric pathology (from 50 to 80% of cases).
Very early, sometimes from 18-20 weeks, gestosis begins in women with vascular complications of diabetes. And that is often an indicator of miscarriage. Other complications include polyhydramnios and fetal hypoxia. Urinary tract infections often develop, and urogenital infections worsen.
Why is this happening?
Of course, this is due to poor compensation for diabetes and reduced immunity. If the patient's diabetes is compensated, even before pregnancy, then, of course, these complications develop less.
With high sugar the uteroplacental circulation is disturbed, and oxygen and nutrients are poorly delivered to the fetus. Of course, the problem is much wider, not everything can be determined by blood sugar alone. But still, it is the main thing.
What are the difficulties in childbirth?
One of the most common complications of birth is a weakness of labor. Mothers with diabetes have a small energy reserve. It does not depend on muscles but on anabolic processes.
Blood sugar often drops because contractions require glucose intake. They always have a dropper - glucose with insulin. Sugar is controlled by the hour. Same thing during surgery.
Which is used more often, cesarean section or natural childbirth
In most cases (from 60 to 80%) - operational delivery. After all, women usually come already with vascular complications. Juvenile diabetes begins in childhood and by the time of conception.
It already happened over 10-15-20 years. There are many more contraindications against natural childbirth in diabetics.
But every year more and more people are born, especially those who are planning a pregnancy and compensating for diabetes. Before doctors began to compensate well for diabetes, there was a very high perinatal mortality.
Sugar was rarely taken - 2-3 times a week. The fact that diabetes compensation was poor did not allow termination of pregnancy until term, and women were “born” at 36 weeks and sometimes earlier. Babies are born immature and can die after birth.
Perinatal mortality in the 1980s was 10%. Today there are the best blood glucose meters, good insulins, and syringe pens. Now they are born on time, in 38-40 weeks, with no children with severe fetopathy.
Mentally, children are no different than the rest of us. However, as kids reach puberty, they are at a higher risk of acquiring fat. And such children are in danger of developing diabetes. According to foreign studies, this risk is 4%.
The development of diabetes in the offspring is influenced not only by genes received from the parents but also by poorly compensated diabetes during pregnancy, which damages the child's islet apparatus. All these children were observed in the endocrinology dispensary.
How dangerous is it for a woman?
Abortion is full of the same complications as in every woman: hormonal failure, and risk of infection, but it has reduced immunity, so it is more dangerous for her. Leading experts in this field believe that there is now every opportunity to avoid pregnancy and abortion.
Special intrauterine devices are designed for diabetics - round, with antiseptics, without antennae (which are carriers of the infection). You can use birth control pills that do not interfere with carbohydrate metabolism.
They cannot be used only by women with vascular complications. There are contraceptives for women with a history of geostationary diabetes that contain only progestin. Some may do sterilization if they already have children.
Diabetes in pregnant women: prognosis
Gestational diabetes in pregnant women develops in about 14% of all pregnancies. Diabetes is caused by the pancreas's inadequate synthesis of the hormone insulin. This hormone regulates blood sugar, which is a source of energy in the body.
If the sugar stays above normal for a long time, gestational diabetes will develop. This disease in pregnant women usually disappears within a few hours or days after delivery. The reasons for the development of gestational diabetes in pregnant women are not fully understood.
Symptoms of diabetes in pregnant women
Diabetes mellitus in pregnant women is usually asymptomatic, but sometimes the following symptoms may occur:
- intense thirst;
- strong hunger;
- excessive urination;
- reduced vision.
During pregnancy, any suspicious symptoms should be reported to your gynecologist, who will, if necessary, prescribe analysis for latent diabetes in pregnant women. Observing symptoms such as extreme thirst or hunger does not yet indicate disease.
Any pregnant woman can get gestational diabetes, but it affects them the most:
- women with a body mass index greater than 30;
- women who have developed gestational diabetes in previous pregnancies;
- women whose close relatives have diabetes;
- women who give birth to children weighing more than 4.5 kg;
- history of polycystic ovary syndrome.
Risk factors for gestational diabetes encompass being aged 25 or older, experiencing a previous miscarriage, or encountering a stillbirth in a prior pregnancy.
Diagnosis of gestational diabetes
Pregnant women are diagnosed with diabetes using special glucose tolerance tests. In a pregnancy from 24 to 28, a woman is given a drink of glucose solution (50 g of glucose per 200 ml of water), and then after an hour, the blood sugar value is measured.
If this level is higher than normal, then another test is performed: the woman should donate blood from a vein on an empty stomach, then drink 100 g of glucose with water, and after 3 hours donate blood from a vein again. If in this case, the sugar level is above normal, then diabetes is diagnosed.
If gestational diabetes has been diagnosed during a previous pregnancy, then the likelihood of recurrence of this disease is high. Therefore, the analysis for gestational diabetes can be scheduled as early as 16 weeks of gestation, and then again - at 28 weeks.
Complications of gestational diabetes
If the symptoms of diabetes in pregnant women are confirmed by test results, it means that you should strictly control your blood sugar. With increased blood glucose levels, metabolism is disrupted in both the expectant mother and the fetus.
At the same time, the fetal pancreas is exposed to a large load, releasing a large amount of insulin, which is why glucose is processed into fat and stored in the fetus.
The danger for the fetus, in this case, is that his weight becomes overweight, which threatens complications during childbirth. The fetus may also develop hypoxia.
When diagnosing gestational diabetes, a woman may be prescribed an unplanned ultrasound to determine the amount of amniotic fluid and whether the fetal rate is deviating from the norm.
Women with gestational diabetes usually give birth on their own, but if the fetus has grown too large, a cesarean section can be performed.
During childbirth, if the glucose level is too high, the woman may be given a glucose dropper and insulin will be given intravenously. Fetal heartbeats during childbirth complicated by the presence of gestational diabetes are monitored by CTG, and if disturbed, a cesarean section is performed.
Modern methods of treating gestational diabetes are such that with timely diagnosis and adherence to the recommendations of a doctor, a woman has a high chance of having a healthy child.
Treatment of gestational diabetes
Usually, the treatment of gestational diabetes is limited to prescribing exercise and diet. In the case of such a diagnosis, it is necessary to devote at least 30 minutes a day to moderate physical exertion, such as walking in the fresh air.
The diet for gestational diabetes in pregnant women includes lean foods and grains. A strict restriction is needed on foods that contain a large number of light carbohydrates (sweet). It is recommended that 50% of the diet be composed of complex carbohydrates.
In 10-20% of cases, such treatment will not have the appropriate effect. In this case, insulin injections may be prescribed. Fear not: completely unprepared people can make such injections using special devices.
Taking insulin is safe for both the woman and the fetus if taken regularly in the doses recommended by the doctor. Insulin dependence does not occur, it is canceled after childbirth without consequences for the body of the woman and child.
After giving birth, you should have more time to see a doctor: on your first visit to the clinic after giving birth, you will be given a diabetes test. In most cases, gestational diabetes disappears spontaneously immediately after birth.
In some cases, gestational diabetes during pregnancy is the beginning of the development of type 1 or type 2 diabetes, triggered by a hormonal shift in a woman’s body.
There are three types of diabetes in pregnant women:
A sign of obvious diabetes in pregnant women is increased blood glucose levels and its appearance in the urine. With a mild form, the sugar level does not exceed 6.66 mmol / L, and the normalization of its level is achieved by diet.
With an average grade, the glucose level is up to 12.21 mmol / L (diet is also used for treatment), and in severe cases, the glucose level is higher than 12.21 mmol / L.
A severe grade is dangerous for the development of complications such as angiopathy (retinal damage, damaged kidney, damage to the large blood vessels of the lower extremities).
Transient diabetes is diagnosed in half of the cases of diabetes in pregnant women. It passes immediately after birth and can occur during the next pregnancy.
Latent diabetes does not manifest itself in any way, except for elevated blood glucose levels, and does not bother pregnant women.
Pregnancy for diabetes
If a woman becomes pregnant after she has been diagnosed with diabetes, it threatens the development of congenital abnormalities in the fetus. To reduce the likelihood of developing pathologies, it is advisable to take an increased dose of folic acid before conception.
Blood sugar should be constantly monitored and kept within normal limits. If you have diabetes and are planning a pregnancy, you should definitely consult an endocrinologist: they may adjust their medication regimen.
Severe diabetes can lead to miscarriage, late toxicosis, polyhydramnios, development of urinary tract inflammation.
Children born to women with diabetes before pregnancy differ in metabolism and appearance (high body weight). Also, such children have reduced brain weight, pancreatic hypertrophy, and enlarged hearts.
The most common complications are underdevelopment of the lower extremities and immaturity of the child's organs and systems. The frequency of congenital anomalies during pregnancy, in this case, is 6-8%, perinatal mortality - 5-10%, and maternal mortality - low.
Contraindications to continuing pregnancy in a woman with diabetes include:
- the presence of diabetes in both mother and father;
- the presence of rhesus conflict;
- the presence of tuberculosis in the mother;
- insulin-resistant diabetes complicated by ketoacidosis.
The frequency of cesarean section during pregnancy of a woman with diabetes reaches 50%. At the same time, early childbirth is recommended - at 35-38 weeks of pregnancy.
Diabetes prevention
If you detect signs of diabetes in pregnant women, then after childbirth you will be at risk of developing type 2 diabetes. To reduce the likelihood of such a development, you need to monitor your weight and diet, and regularly engage in any sport.
Words in Simple about the diagnosis of gestational diabetes during pregnancy
Gestational diabetes mellitus during pregnancy (HD) is a kind of diabetes that arises in women during the third trimester as a result of hormonal imbalances. As a result, blood sugar rises after meals and decreases on an empty stomach.
Pathology is a danger to the child because it can cause congenital diseases.
To prevent this from happening, at the age of 24-28 weeks, women are recommended to take an analysis for gestational diabetes, and in case of diagnosing the disease, to adhere to certain rules of diet and lifestyle. In some cases, drug therapy is needed, which can only be prescribed by a doctor.
Gestational diabetes was assigned an ICD code of 10 - about 24.
causes
The causes of gestational diabetes in pregnant women have not been determined. However, more and more experts are inclined to the version that the pathology develops on the background of hormonal failure. As a result, hormones block insulin production.
However, the body cannot tolerate such a situation because the mother and baby need glucose for the normal functioning of organs and systems. As a result, there is a compensatory increase in insulin synthesis. This is how gestational diabetes develops.
Autoimmune pathologies are one of the possible causes of HD. Such diseases adversely affect the condition of the pancreas. The result is a reduction in insulin synthesis.
Risk groups
Some factors increase the risk of HD:
- obesity.
- Nationality Scientists have proven that some nationalities suffer from gestational diabetes more often than others. These include blacks, Asians, Latinos, and natives.
- Increased glucose concentration in urine.
- Impaired glucose tolerance.
- Genetic disposition. If someone in the family has suffered from this pathology, then there is a possibility that such a disease will be diagnosed in a woman.
- Previous birth, if the child's weight exceeded 4 kg.
- Previous pregnancy was accompanied by gestational diabetes.
- A large amount of amniotic fluid.
Symptoms
Some signs indirectly indicate the onset of gestational diabetes:
- sharp weight gain;
- frequent urination and the smell of acetone in the urine;
- fatigue even after prolonged rest and lack of exercise;
- a constant need to drink;
- loss of appetite.
If you ignore these symptoms and do not consult a doctor, the disease will progress and the following symptoms will appear:
- confusion of consciousness;
- states of unconsciousness;
- increase in blood pressure;
- heart pain, which can eventually lead to a stroke;
- kidney problems;
- visual impairment;
- slow wound healing of the epidermis;
- stiffness of the lower extremities.
To avoid this, regular visits to specialists are recommended.
Diagnostic
A blood test is prescribed to diagnose gestational diabetes. For the result to be reliable, it is recommended to follow the rules for the delivery of biomaterials:
- three days before the study, it is not recommended to adjust the food system and you should adhere to your usual physical activity;
- they give blood on an empty stomach so that after dinner and in the morning you are not allowed to eat or drink tea or other beverages, except pure water without gas.
- the patient takes biomaterial;
- a woman drinks water with glucose;
- after two hours the biomaterial is collected again.
Indicators of analysis
Blood sugar level:
- from the finger - 4.8-6 mmol / l;
- from the vein - 5.3-6.9 mmol / l.
Accordingly, gestational diabetes is diagnosed with the following indicators of analysis:
- from finger to empty stomach - above 6.1 mmol / l;
- from a vein on an empty stomach - above 7 mmol / l;
- after drinking water with glucose - above 7.8 mmol / l.
If the study showed normal or low glucose levels, then a second test is prescribed after 24-28 gestations. This is because at an early stage, the analysis can show an unreliable result.
Diabetes during pregnancy has several types, depending on the time of onset:
pre-registered diabetes - this type of diabetes is diagnosed before pregnancy (this variety, in turn, is divided into the diabetes of the first and second types);
Gestational diabetes, in turn, has its own classification, depending on the prescribed therapy:
- compensates by diet therapy;
- compensated by dietary therapy and insulin.
Therapy is prescribed, depending on the type of diabetes and the severity of the pathology.
Treatment
How to treat gestational diabetes? There are two main ways - diet therapy and insulin therapy. Only a physician can determine if a patient needs clinical advice.
Insulin therapy
Insulin therapy is prescribed if the diet does not bring the desired result and the blood glucose level does not return to normal for a long time.
In this case, insulin intake is a necessary measure to prevent fetopathy.
The doctor also prescribes this type of treatment with a normal concentration of sugar, but with a high weight of the child, with a large amount of amniotic fluid or soft tissue swelling.
The introduction of the drug is recommended to be carried out on an empty stomach and before a night's rest. However, the exact dose and schedule of injections are determined by the physician, based on the severity of the pathology and the individual characteristics of the patient.
Insulin injections are given with a special syringe. The drug is administered subcutaneously. The woman usually performs the injection on her own after consulting a specialist.
If an increased daily dose of insulin is required, your doctor may administer a subcutaneous insulin pump.
Diet
The main component of successful treatment of pathology is adherence to certain dietary rules. This helps to normalize blood sugar levels. Here is the dietary principle that is recommended to adhere to these types of pathology:
- smoked foods, sausages, fatty sauces, nuts, seeds, butter, margarine, as well as fatty meats should be excluded from the diet;
- it is recommended to include lean meat, poultry, and lean fish in the menu;
- you cannot fry food; when cooking you must give preference to steaming, boiling, and baking;
- the use of milk and milk products with a minimum fat content is recommended;
- it is necessary to introduce fresh vegetables, herbs, and mushrooms into the diet;
- they should switch to a fractional diet, ie eat food 5-6 times a day in small meals;
- you can eat no more than 1800 kcal per day.
Effect on the fetus
What is the risk of diagnosis for the unborn child? Let's think.
Gestational diabetes during pregnancy negatively affects the development of the child.
If the pathology is diagnosed in the first weeks, then there is a risk of miscarriage. The disease can also lead to congenital diseases in newborns.
Most often, the brain and heart suffer from diseases.
If the pathology arose in the second or third trimester, then it leads to excessive growth of the child and his weight gain. As a result, after birth, the baby's sugar drops below normal, which can cause health problems.
If a pregnant woman develops gestational diabetes but there is no complete therapy, it is very likely to be a fetal fatality.
Such pathology threatens the child with the following consequences:
- child weight greater than 4 kg;
- imbalances in the body;
- excessive deposition of fat in the subcutaneous space;
- soft tissue swelling;
- difficulty breathing
- jaundice;
- vascular problems and blood viscosity.
If a pregnant woman is diagnosed with diabetes, then a doctor's recommendation must be followed for the normal course of a woman's labor. With such pathology, a woman is hospitalized at 37-38 weeks.
Even if childbirth does not occur, it is induced artificially, but only if the child is considered long-term. This avoids birth injuries.
Natural delivery is not always possible. If the child is too big, then doctors prescribe a cesarean section.
Prognosis and prevention
Adherence to the doctor's recommendations for gestational diabetes gives a favorable prognosis for pregnant women and children. If it is possible to maintain a normal blood sugar level, this will allow a woman to give birth and give birth to a healthy baby.
Avoiding gestational diabetes is not always possible, but you can still reduce your risk of developing the disease.
The following preventative measures will help:
- weight reduction to an acceptable mark;
- transition to the principles of proper nutrition;
- rejection of the so-called sedentary lifestyle and increase physical activity, if it does not threaten pregnancy;
- hospitalization as recommended by a physician.
Expectant mothers with HD often ask many questions: in what week they give birth, have a diagnosis, how to be after childbirth, and what should be the observation after childbirth, as well as the consequences for the child.
If gestational diabetes is diagnosed during the gestational period, this is not a reason to panic or terminate the pregnancy. Subject to certain principles of nutrition and adherence to medical prescriptions, a woman has every chance to give birth and give birth to a healthy baby without endangering her own health.
How is pregnancy with diabetes?
What should I do if pregnancy occurs with a diagnosis of diabetes or if pathology is detected during the gestation period? To answer this question, you need to learn more about the features of the course of the disease.
The methods of childbirth, and the consequences for mother and child. You will learn about this, as well as about the ways of treatment by reading this article.
Features of the course of pregnancy in diabetics
If a woman suffering from the disease before conception, then, regardless of the type of diabetes, the gestation period has such characteristic features:
- 1st quarter. At that point, the mother’s body produces hormones that contribute to glucose processing for successful fetal creation. Therefore, the need for insulin is reduced.
- 2nd quarter. The processes become less intense, so the amount of sugar in the blood rises quickly. You need to continue your hormone intake.
- 3rd quarter. It is necessary to determine the treatment regimen, as in the 1st period. A pancreatic enzyme is produced by the fetus.
In pregnant women, type 2 diabetes is less common, because the disease develops mainly after the age of 40, when the ability to conceive decreases.
Why can diabetes develop during pregnancy?
In some women, the disease can be diagnosed directly during the period of childbirth. To understand why this happens, you must first clarify the types of diabetes in pregnant women.
There are two variants of the disease:
- Gestational. The disease develops on the background of hormonal imbalance and manifests itself in the form of an increase in blood glucose. Usually, the problem is detected in the 2nd trimester according to the results of the diagnosis. Constant control of sugar is required, and sometimes insulin is prescribed. After the birth of a child, the indicators return to normal.
- Manifesto. It is the name of common type 1 or 2 diabetes mellitus, found during an examination of a pregnant woman. After diagnosis, it is necessary to register and take medication for life.
Factors and risk groups
Among the main factors influencing the development of diabetes during pregnancy:
- Heritage. If there are diabetics among the relatives, the risk of pathology increases.
- Immune disorders May affect pancreatic function and reduce enzyme synthesis.
- infections Another reason for insulin malfunction.
- Improper diet. Excess carbohydrates lead to an increase in the need for enzymes and the development of pathology.
- Hormonal disorders. During the period of carrying a child, a woman's body increases the production of hormones that can inhibit the action of insulin. As a result, sensitivity to its effects decreases.
The risk group may include:
- Overweight. Especially if the problem has been observed since adolescence.
- Older than 35 years. At a younger age, women are less likely to have complications.
- Transmitted pathology. If the diagnosis of gestational diabetes is diagnosed during the first pregnancy, the likelihood of its recurrence in the next pregnancy increases.
- Complications in pregnancy Large fetus, polyhydramnios, the presence of pathologies in the child, miscarriage, or stillbirth can lead to disease.
- Reproductive system problems. For example, a failed miscarriage in the past or a polycystic ovary.
symptomatology
Signs that indicate the development of diabetes are:
- Thirst. The woman is constantly thirsty. But even after drinking enough fluids, you feel dry in your mouth.
- Intense urination The frequency of going to the toilet increases, while the volume of urine is greater than the consumption of drinking.
- Fatigue. Even with small loads, a pregnant woman feels a decline in workability. There is a constant need for rest.
- Visual impairment. It gets dark in his eyes.
- Itching not only of the skin but also of the mucous membranes.
- Weight gain is faster than normal. At the same time, appetite decreases.
Read more about how body weight changes in the weeks of pregnancy.
As the disease progresses, the following are observed:
- states of unconsciousness;
- heartache;
- renal pathology;
- delayed healing of lesions;
- limb stiffness.
Diagnostic
Main diagnostic measures:
- Glucose measurement Analysis is mandatory for all pregnant women, including those who are aware of their problem. It is performed in the 2nd trimester on an empty stomach. Normally, the result is up to 5.1 mmol / l.
- Body measurements. You need to regularly measure your belly circumference, weight, and height, pelvic width. A sharp change in the parameters indicates the likelihood of developing pathology.
- Monitoring the condition of the fetus. It is performed for women with diabetes. With the help of ultrasound, the child's weight, his development, and the probability of complications are assessed. KGT allows you to monitor the fetal heart rate.
Women diagnosed with diabetes should see a doctor more often to diagnose possible complications, including damage to the circulatory and nervous systems.
Treatment
Similar principles of therapy are used for different types of diseases.
Medicines
Pregnant women who have diabetes before conception are advised to give up sugar-lowering pills and use only insulin of human origin.
It can be in two options:
- Short. It works quickly, but not for long. It is introduced after meals. Liproso.
- Medium. It allows you to maintain normal glucose levels between meals. Enough 2 injections a day. Humaine.
In addition to gestational diabetes, drug therapy is prescribed only in cases where non-drug methods do not produce the desired effect. Small doses of insulin are indicated. The treatment regimen is selected based on the individual characteristics of the pregnant woman.
Diet
For any type of diabetes, it is important to follow a healthy diet:
- Fractional eating. It is necessary to make 5-6 meals a day and divide the food into small, equal portions.
- Monitor your carbohydrate intake. Their largest number - about 40% - should be included in breakfast. Eat porridge and bread.
- Avoid damage. Avoid fast food, preservatives, and chemical additives. Animal fats should not be more than 10% of the diet.
- Calorie control The optimal daily dose is 2000 Kcal. If you are overweight, you should reduce the norm by another 300-500 units.
- Combine diet and insulin injections. It is best to eat 1.5 and 5 hours after the injection, as well as in the morning after waking up and in the evening before bed.
- Adherence to BJU rules. Consume about 200 g of carbohydrates, 60 g of fat, and protein per day - based on 1 g per 1 kg of body weight.
- Eat healthy food. These include lean meats, garden fruits, garden vegetables, and grains.
- Cook properly. Cooked, baked, or cooked foods are better absorbed. You cannot eat fried and smoked. Reject semi-finished products.
- Monitor toxicosis. To do this, use dried fruit or biscuit biscuits.
- Choose foods low in carbohydrates. Zucchini, cabbage, cucumbers, and beans are useful in that there are few calories and enough important substances.
- Natural vitamins. Get the necessary body elements mainly from food. The use of special complexes for diabetes is not recommended, because it can increase glucose.
- Way of drinking. To remove toxins, the body needs about 8 glasses of fluid a day. It can be purified water, decoctions, or stewed fruit without added sugar.
In addition, you must leave:
- sour cream;
- some fruits, including grapes, bananas, figs, and persimmons;
- baking and sweets;
- sauces;
- sausage shop;
- lamb.
Physical activity
Regardless of the type of pathology, women are shown to perform special exercises.
The advantages are as follows:
- weight control;
- consumption of excess glucose;
- improved metabolism;
- tissue oxygen saturation.
The following types of activities are displayed:
- Walks. Walk slowly for about 2 hours a day.
- Swimming pool. Swimming, water aerobics.
- Gymnastics. It is better to consult with a coach who will choose the complex individually.
Exercises you can do:
- On your fingertips. Place a chair in front of you. Use the backrest as support. Stretch out well, trying to stand on your toes. Make about 20 lifts.
- Push-ups. A lightweight version for pregnant women needs a wall. Stand at a distance of 2 steps, rest your arms, and do movements similar to the usual push-ups.
- With the ball. Take a small ball. Sit on a chair and place the ball on the floor next to you. Touch the foot and try to roll on the surface. Change foot.
Possible complications
The development of pathology is fraught with difficulties.
For the mother
In the case of gestational diabetes, the following are noted:
- abortions This is due to an increased tendency to develop infections as well as multiple hormonal disorders.
- Gestosis. Symptoms develop mainly in the late stages of gestation and can be dangerous, until the termination of pregnancy and coma in women. There is swelling, a change in blood pressure, and the release of protein in the urine.
- Vascular lesions. Suffering eyes, kidneys, placenta. This is due to a sharp increase in glucose concentration.
- Complications of childbirth. Delayed process, tears, and tissue damage bleeding.
- Impaired blood circulation. It is caused by the thickening of blood vessels.
- Development of diabetes. A woman who has had pathology during pregnancy has a higher risk that the disease will become chronic in the future.
As a result of other forms of diabetes, the following can be further detected:
- Risk of purulent complications. It develops due to delayed tissue healing.
- Increased need for surgical intervention. More frequent cesarean section surgery.
- Infertility. Problems with conception can also be noticed.
Read the following article about the effect of age on pregnancy.
Child
In most cases, children whose mothers suffered from diabetes while carrying them have complications:
Great weight. The weight of children can exceed 4 kg. They are born large, with a thick layer of subcutaneous adipose tissue. At the same time, the internal organs remain small, sometimes underdeveloped. This problem occurs in almost 100% of pregnant women who had diabetes before conception.
- Changing skin color. At birth, children have a more saturated red color of integrity.
- Congenital malformations. Almost all body systems can be affected. Suffer:
- nervous (delayed emotional and mental development);
- heart failure);
- digestive
- bones (fragility, underdevelopment of the spine);
- genitourinary (kidney problems).
More often children are born with a mirror arrangement of organs.
- Lung underdevelopment. It is observed 5 times more often than normal. The production of a substance that protects lung tissue is reduced.
- Lowered blood sugar. The indicator may be below 1.7 mmol / L. Children look lethargic, inhibited, and have no innate reflexes.
- Hypoxia. It is an oxygen deficiency syndrome, which is a particularly severe case that can cause fetal death.
- Injuries. Very often there is a mismatch between the width of the mother’s pelvis and the child’s head (shoulder area). This is fraught with complications such as collarbone fractures, damage to the vessels of the cervical region, and traumatic brain injuries.
As a rule, the procedure takes place in a regular ward under the supervision of a doctor.
Women with gestational diabetes usually give birth two weeks prematurely to reduce the risk of complications. Glucose levels are constantly monitored during the procedure. Urgent administration of short-acting insulin may be needed.
For diabetics, the natural birth process takes the following features:
- amniotic fluid puncture and administration of the required dose of insulin;
- the doctor must constantly monitor the activity of the fetal heart, monitor the amount of sugar;
- often the process is accompanied by a weakening of labor, so oxytocin may be needed;
- in severe cases, obstetric forceps are used.
In case of serious complications, a cesarean section is urgently needed. An anesthesiologist and a surgeon should be present at the birth.
Indications for surgery are:
- sharp worsening of diabetes symptoms;
- bleeding
- overweight fetus;
- excess sugar;
- hypoxia in the child;
- narrow pelvis in the mother.
Postpartum period
Recovery after childbirth depends on the type of diabetes and follows:
- Diabetes before pregnancy. After childbirth, a woman is prescribed a slightly reduced dose of insulin, because the processes that take place in the body help maintain normal glucose levels.
- It is very important to abandon sugar-lowering drugs, as they can interfere with breastfeeding. During breastfeeding, sugar control is solely due to insulin.
- Gestational diabetes. Sometime after birth, a woman's condition returns to normal. Before that, you should visit a doctor regularly and follow all the necessary recommendations.
Children born to women with diabetes often need urgent hospitalization and constant medical supervision.
prevention
- Particular attention should be paid to ways to prevent diabetes in pregnant women:
- Weight control When planning a pregnancy, you should take into account the normalization of body weight.
- Monitoring your health. High blood pressure can lead to problems in the future.
- Proper nutrition. Eating healthy foods can help reduce the risk of many diseases.
- Regular inspections. During the period of the child's birth, pass all tests on time, and follow the doctor's recommendations. Sometimes you have to lie down for preservation to be under the constant supervision of a doctor.
- Rejecting bad habits. Toxins that accumulate in the body during smoking and alcohol consumption inhibit the work of the pancreas.
Women diagnosed with diabetes should follow the recommendations to avoid complications:
- Preparing for pregnancy. A few months before conception, you should ensure that your treatment regimen allows you to keep your glucose levels within normal limits. Also, a woman takes blood tests, urine tests, and hormone tests to make sure her body can handle the load.
- Learn about the risks of developing a child's diabetes. To do this, you can consult an expert in the field of genetics. It will explain the risk that a child will be born with pathology just in case.
- Explain the contraindications. Some women are strongly discouraged from having a child.
Pregnancy is not possible if observed:
- kidney problems
- gastro enteropathy;
- coronary heart disease;
- probability of rhesus conflict;
- infections
- the presence of the disease in both parents;
- severe diabetic complications.
The risks and contraindications for pregnancy in the case of diabetes were described by an expert in the presented video:
Diabetes is not a sentence for a woman who has a child. Timely detection of the problem, proper choice of treatment regimen, and method of application will help reduce the risk. This increases the chances of having a healthy child.
Diabetes and Pregnancy
Diabetes
More recently, most doctors have categorically not recommended that women with diabetes get pregnant and give birth. What tricks did not have to go to future mothers to save the child, and yet very often the pregnancy ended in miscarriage, intrauterine fetal death, or the birth of a child with diabetic disorders in growth and development.
Decompensation of diabetes before or during pregnancy has sometimes led to dire consequences for women’s health. Lack of means for self-control, lack of awareness about women, and poor quality of equipment did not allow for timely medical care. As a result, the woman lost the opportunity to have a child forever.
Features of the course of pregnancy in diabetes
A joint study by obstetricians and endocrinologists proved that diabetes is not an absolute obstacle to the birth of a healthy baby. The health of the baby is negatively affected by high blood sugar, not the disease itself.
So, for a favorable pregnancy, you need to maintain a normal glycemic level. Modern means of self-control and insulin administration contribute to this success.
There are fetal monitoring devices that allow you to monitor any changes, so the probability of having a practically healthy child in a woman with diabetes today is not lower than in any other woman without metabolic disorders.
However, some difficulties and problems, in this case, cannot be avoided, so it is necessary to closely monitor the health of the pregnant woman.
First of all, a pregnancy with high sugar should only be planned, especially if there is no regular monitoring of sugar levels. From the moment of pregnancy to recognition usually takes 6-7 weeks, during which time the fetus is almost completely formed.
The brain, spine, intestines, and lungs are laid, and the heart begins to beat, pumping blood normally for mother and child. If the mother’s glucose levels increased multiple times during that period, it inevitably affected the baby.
Hyperglycemia causes metabolic disorders in the developing body, leading to errors in the laying of the child's organs. In addition, the onset of pregnancy with elevated sugar is always associated with the rapid development and progression of diabetic complications in mothers. Therefore, such a "sudden" pregnancy is fatal not only for the child but also for the woman herself.
The ideal sugar curve should look like this:
- on an empty stomach - 5.3 mmol / l;
- before meals - 5.8 mmol / l;
- one hour after a meal - 7.8 mmol / l;
- two hours after meals - 6.7mmol / l.
preliminary preparation
3-6 months before the proposed conception, you need to take special care of your health and completely control your blood sugar - use a glucometer every day and achieve complete compensation for the disease.
Any case of severe hyperglycemia or ketonuria is detrimental to the health of a woman and a possible child. The longer and better the compensation before conception, the greater the likelihood of a normal course and termination of pregnancy.
Those with type 2 diabetes will need to move from measuring urine sugar to more informative studies. In some cases, your doctor may advise you to temporarily (until the end of breastfeeding) switch from sugar-lowering tablets (which may harm the fetus) to insulin injections.
Even before conception, it is necessary to consult with many experts, because even a successful pregnancy is always a great burden on the body, and you need to know how it will affect your health.
If a woman is forced to take any medications (even vitamin complexes), it is necessary to ask the doctor in advance if they can adversely affect the fetus and with what they can be replaced.
Most of the contraindications for pregnancy that occur with diabetes can be eliminated if you take it seriously. Decompensation of the disease, inability to self-control glycemia, and concomitant genitourinary infections are completely overcome.
But, unfortunately, there are still absolute contraindications associated with diabetes, coronary heart disease, renal failure (with proteinuria, arterial hypertension, elevated blood creatine levels), and severe gastroenteropathy (gastroparesis, diarrhea).
Once all manifestations of diabetes have been compensated and the medical examination is completed, you will need to be patient and get family support before you can start talking to your gynecologist about canceling contraception.
After that, you can buy home pregnancy tests, and as soon as one of them shows a positive result, you should immediately go to the doctor to confirm the fact of pregnancy with a blood or urine test for chorionic gonadotropin
How to avoid complications
During the entire period of pregnancy - from the first day to the time of birth - the condition of the future mother is constantly monitored by an endocrinologist and a gynecologist-obstetrician.
The choice of doctor should be approached very seriously: the observation of a highly qualified specialist will reduce the likelihood of serious health problems. Carrying a child with diabetes has some features that should not be forgotten.
The most important in terms of fetal health can be considered 1 trimester of pregnancy - from 1 to 12 weeks. At this point, two tiny cells give life to a new person, and his health and vitality depend on how this happens.
Constant monitoring of stable blood sugar levels will allow all vital fetal organs to form properly. Self-control is equally vital for the growth and development of the placenta.
The expectant mother should remember that the body is now working in a new unusual way. In the early stages of pregnancy, insulin sensitivity increases, which will require a temporary reduction in normal doses.
In this case, acetone in the urine may occur even with a slight increase in glucose (already at 9-12 mmol / l). To prevent hyperglycemia and ketoacidosis, you will need to use glucometers much more often 3-4 times a day.
Many women experience nausea and vomiting in the first trimester, but women with diabetes, in this case, must pass a urine test for acetone. If vomiting is profuse and frequent, prevention of hypoglycemia will be needed.
Regular sugary drinks and, in severe cases glucose injections. In the first months, a visit to the gynecologist should be at least once a week in a normal state, and daily in any emergency.
The period of 13 to 27 weeks is considered the most pleasant - the toxicosis has remained in the past, and the body has adapted to the new condition and is full of strength.
But at about week 13, the baby's pancreas begins to work, and if the mother has sugar, the baby will release too much insulin in response, leading to the development of diabetic telepathy (all kinds of growth and developmental disorders). After birth, such a baby has the inevitable hypoglycemia due to the cessation of the flow of "sweet" maternal blood.
By week 20, insulin dosing will again need to be adjusted, as the adult placenta begins to secrete the counter-hormonal hormones needed for child development, reducing the effects of the insulin a woman takes.
During pregnancy, the need for insulin can increase by 2 or more times, there is nothing wrong with that, but on the first day after birth, everything will return to normal.
In no case can you choose the doses yourself - the danger is too great; only an endocrinologist can do it quickly and accurately, you just have to visit him more often than usual.
At week 20, the woman was sent for an ultrasound examination for signs of a congenital fetal abnormality. At the same time, you need to visit the optometrist again.
A control ultrasound is performed every two weeks for the entire third trimester. The final stage of pregnancy will require a higher calorie intake (to provide the baby with everything it needs) and an increase in bread units.
By week 36, the woman must be hospitalized in the pathology department of pregnant women to prevent complications, and the method of delivery is chosen. If all is well, including the size and position of the fetus, perform a normal natural birth. Indications for cesarean section are:
- fetal hypoxia;
- big fruit;
- pregnancy complications in women;
vascular complications of diabetes.
If at the time of birth, the future mother has not developed any complications, and the sugar level does not exceed the allowable limits, the birth is as good as in any healthy woman, and the baby is no different from its peers.
Sample test list for the correction of diabetic (and any other) disorders:
- consultation with an endocrinologist;
- a complete examination by a gynecologist and thorough treatment of genitourinary infections (if any);
- examination by an ophthalmologist (with the obligatory examination of the fundus), if necessary - burning of the affected vessels of the fundus to avoid rupture and bleeding;
- a comprehensive study of renal function;
- consulting neurologists, cardiologists, and therapists.
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