Gestational diabetes mellitus – a violation of carbohydrate metabolism associated with the onset of pregnancy. Critical terms of its development are 24-28 weeks. This is explained by the fact that with the increase in the gestation period, the level of counterinsulin increases (partially blocks the action of insulin) hormones, which produces the placenta, so to maintain normal blood sugar increases secretion insulin pancreas. With increasing duration, the need for insulin increases, because the placenta produces more hormones.
This process is compensated by increased insulin production. Against the backdrop of a sharp decline in the activity of a pregnant woman, increased calorie content, weight gain, there is a pronounced insulin resistance (a decrease in the sensitivity of tissues to insulin). In the presence of factors – hereditary predisposition to diabetes, obesity, the secretion of insulin is not enough to overcome insulin resistance. This leads to a hyperglycemia and diabetes mellitus is established for pregnant women.
Most often, it has no clinical manifestations characteristic of diabetes mellitus 1 or 2 type (thirst, frequent urination, itching, weight loss). Pregnant women have obesity and rapid weight gain, and only with high glycemic numbers can there be a characteristic complaint.
Elevated sugar in pregnancy, revealed at least once, requires repeated examinations and follow-up by an endocrinologist. Stable maintenance normoglycemia is the prevention of many complications during pregnancy.
One of the features of diabetes in pregnant women is that it is often not recognized, so it is important to actively detect this disease among women who have risk factors. In a group of low-risk women, testing with a loading oral 75 g glucose is not carried out. High-risk groups include women with severe obesity, diabetes mellitus in relatives, and violations of carbohydrate metabolism outside of pregnancy.
The diagnosis of diabetes in pregnancy is established if the values glikemii: on an empty stomach exceed 5, 37 mmol / l, through 1 after meal – 10 mmol / l, through 2 h – 8,6, through 3 h – 7,8 mmol / l. If the fasting is detected more than 7 mmol / L, and in case of random testing – more than 11, as well as confirmation of these values every other day, the diagnosis is established and glucose loading tests are not required.
Treatment is aimed at achieving throughout the pregnancy a stable compensation for carbohydrate metabolism. At the first stage, diet and exercise doses are prescribed.
Diet in gestational diabetes provides for:
- Exclusion of simple carbohydrates (confectionery, honey, sugar, jam, jams, sweets, sweet fruit and fruit juices, syrups, ice cream, sweet pastries, white bread).
- Complex carbohydrates (cereals, corn, potatoes, vegetables, fruits, pasta, legumes) should not exceed 40-45% of daily calorie content. It is necessary to use them evenly in 3 basic and 3 additional meals. Such a diet prevents hungry ketosis. Fasting is contraindicated.
- High protein content (1,5 g / kg weight).
- Enrichment of the diet with vitamins, fiber and minerals.
- Moderate restriction of fats, which serves as prevention of weight gain.
- Limitation of salt content and consumption cholesterol.
- The use of potatoes, because it is a highly starched product.
- Macaroni products.
- Cooked carrots and beets – they have a high glycemic index and cause a significant increase in glucose levels.
The food is characterized by a moderate decrease in energy value due to the restriction of simple carbohydrates and fats in the diet. However, protein, trace elements and vitamins, necessary for the full development of the fetus, must necessarily be present in sufficient quantity. Do not restrict the use of fluid, if it is not contraindicated. Cooking should be steamed, baking or stewing is also used. If you follow a diet for a pregnant woman, it is important to control the sugar level 4 times a day (on an empty stomach and after meals in 1,5-2 hours).
If, following a diet for 2 weeks, normal values of glycemia can not be reached, insulinotherapy. Signs of macrosomia (large fetus) with ultrasound, availability diabetic fetopathy, an increase in insulin in the amniotic fluid also serves as an indication for the appointment of insulin therapy.
Oral hypoglycemic drugs prescribed for pregnant women are contraindicated because they have a teratogenic effect and stimulate increased secretion of insulin in the fetus. After giving birth, there is a chance of normalizing the sugar level, however, the diet should be observed at least 2-3 months after birth. A part of women in the future can develop diabetes type 2.
Nutrition in gestational diabetes mellitus in pregnant women includes:
- Black and gray bread, pastry from coarse flour. The amount of bread depends on the level of glucose and is discussed with the doctor – usually no more than 200 g per day.
- The first dishes on a weak and low-fat meat or vegetable broth. In the diet must predominate vegetable first dishes: borsch, cabbage soup, okroshka on kefir (kvass is excluded), mushroom soup, light soups with meatballs. Potatoes in them can be present in small quantities.
- Vegetables with a low content of carbohydrates (eggplant, all kinds of cabbage, pumpkin, zucchini, cucumber, lettuce, patissons), which are used in raw or stewed. Potatoes are allowed with restriction (usually no more than 200 g per day for all meals). According to the permission of the doctor, depending on the level of sugar, carrots and beets can be included in the diet in a boiled form.
- Legumes, of which give preference to lentils, soybeans and green beans.
- Carbohydrate sources with a lot of fiber: whole grains, bread and whole grain breads, homemade pastries with bran, whole grain cakes. Cereals (pearl barley, buckwheat, millet, oatmeal, wheat, brown rice). If you have used pasta, you should reduce the amount of bread. All white cereals (semolina, rice) are excluded.
- Low-fat varieties of meat, fish (pike perch, hake, pollock, blue whiting, saithe, pike), poultry. Meat and fish dishes for calorie reduction are cooked in boiled or baked form.
- Eggs up to 3-4 pieces per week in cooked form or omelettes, steamed.
- Low-fat dairy products and sour-milk drinks should be present in the daily diet. Bold cottage cheese is better to eat in a natural way, faint cheese (fat content up to 30%) can also be in the diet daily. Sour cream is used as an additive to dishes.
- Unsweetened fruit, sweet and sour berries. Excluded: grapes and bananas.
- Vegetable fats – for filling ready meals.
- Vegetable juices, chicory soluble, weak tea without sugar, decoction of dogrose, coffee with milk.