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:
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: