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Gestational diabetes mellitus for pregnancy causes. Gestational diabetes: What are the symptoms and what threatens the pregnant and child? Symptoms and diagnostics

When pregnancy, girls often experience hormonal bursts, as a result of which the metabolism is disturbed and the gestational diabetes (GSD) appears, which is also called gestosis. This happens even among the very young female representatives, diagnose the ailment with a standard examination in 2 trimester.

In pregnant women, the gestational type of diabetes after childbirth passes, but it is dangerous for the child with his complications and the earlier the first signs of the disease will be discovered, the less the consequences will be for the kid. It is worth noting that an empty stomach of blood test with this form of diabetes usually within the normal range, but 2 hours after meals, its level increases significantly as in humans in prediaboy state. This phenomenon occurs due to improper perception by the glucose organism and to confirm or refutate their fears of doctors prescribe a glucose-bearing test (GTT).

In pregnant women, the disease usually does not manifest themselves and diagnosed after the tests for the sugar content, but sometimes certain symptoms are accompanied.

Signs of GSD:

• Severe thirst;
• Constant dryness in the oral cavity;
• Frequent urination;
• Prostration;
• Exposure to infectious diseases;
• Reducing visual acuity.

Gestational diabetes mellitus for pregnancy usually disappears after childbirth, so the mother he will not be able to harm something particularly, but for the child the disease is dangerous, and to avoid consequences, you need to follow the symptoms that occur. In addition, doctors recommend that women do not forget about the time specified by a specialist for testing, since they will show the presence or absence of pathology.

Gestational diabetes in pregnant women is a serious threat to the health of the baby!

Risk group

Regardless of whether there are signs of this type of diabetes during pregnancy or not, women should understand what he threatens them and in time to pass tests on the sugar content in the blood. In this case, the disease can be avoided, but for this you need to find out whether the girl in the risk group is:

• Excess weight;
• After 16-20 years, the woman began to turn extra kilograms without much reasons;
• The decision to give birth after 30 years;
• Hereditary predisposition;
• During the first pregnancy, the DVI was diagnosed or in the past childbirth, the child was born with a weight of more than 4 kg;
• Metabolic dysfunction of ovaries (polycystic).

Causes of gestational diabetes

Diabetes appears due to weak production or perception of the hormone of the pancreas (insulin). Because of this, the level of blood sugar increases, and doctors call such a state of hyperglycemia. In a normal state, insulin serves to move glucose into the cells of the body and so it gets energy, but if it does not respond to a hormone, then the sugar concentration becomes greater, and this is dangerous for a person. Over time, the walls of the vessels will begin to collapse, they will be blocked because of what the permeability will break.

Sugar diabetes in pregnant women arises due to hormonal changes in the body of a woman, so when the reason is eliminated, it will be possible not to worry about whether the disease passes after childbirth or not.

It is important to remember that the pathological process begins due to an increase in the concentrate of some hormones, for example, estrogen and progesterone, as a result of which the resistance to insulin is growing.

In general, such a process is natural, as the fetus need more glucose in order to grow, but not every pancreas can withstand so high load for 9 months. For this reason, pregnant women often appear this type of diabetes.

Diagnosing alert

Gestational diabetes is most often diagnosed by about 25-27 weeks of pregnancy, since it was in this time interval that the doctors prescribe a glucose-bearing test. For the beginning, girls will make blood test on an empty stomach, and then give some sugar and after 2 hours they will make a re-test. The last fence of the material will be completed after another hour to secure the result of the survey. Gestational diabetes during pregnancy has such indicators:

• Empty stomach 5.1 mmol / l;
• 2 hours after the test on the GTT 10 mmol / l;
• Control indicator 8.5 mmol / l.

It is worth noting that during this period the girls have an empty stomach sugar usually not raised, so the main information will give its indicator after GTT. In addition, it is necessary to know how to prepare for the surcharge:

• It is not necessary to be specifically prepared, sit on exhaustive diets and train, it is necessary to do everything as always and three days before the blood supply is powered according to your daily diet;
• Blood fence is performed on an empty stomach, that is, 8 hours before anything is prohibited. As for drinks, you can drink water as much as you like;
• When an empty stomach was commissioned, it is necessary to drink a glass of diluted glucose and repeat the procedure after two hours.

Influence of the GSD on the kid

Sugar diabetes, which began during pregnancy will have consequences for the child. Due to illness, the fruit will grow faster, so during childbirth there may be complications related to the child too developed shoulder belt. This situation often leads to injuries and is especially dangerous for a child. For this reason, the doctors of drugs cause premature childbirth to avoid complications, but not always the fruit is ready for them, so the baby can be born premature or it can be lost.

There are other consequences of this pathology, for example, a child may have problems with a respiratory system. This is due to the fact that the gestational diabetes of the mother is able to influence the development of a shortage of a surfactant (surfactant) in the lungs in the kid. Slows out the production of this substance insulin, which in the blood of the mother has an excessive amount due to the increased level of sugar. Treatment of such syndrome in a child is mainly carried out in special clocks (incubators) and, if necessary, artificial ventilation of the lungs is used.

In addition, gestational diabetes is the cause of such a symptom as a diabetic fetopathy, which means low blood sugar concentration (hypoglycemia). At the time of the doctor cuts the umbilical umbilical cord, the glucose drops sharply, but the insulin produced by the pancreas of the child needs more time to come to normal indicators. Such children need a special approach, and 2-3 hours after childbirth, they need to feed glucose, gradually reducing its quantity. If the birth was premature or the child does not want it, then this process is performed intravenously. Over time, the level of insulin will come to normal and such actions will not be required, but if you ignore such a moment, neurological problems will begin with the age of the kid. In addition, there is sometimes lagging in mental development.

It is impossible not to note the chronic lack of magnesium and calcium in the child if the mother had gestational diabetes. It is necessary to take care of the saturation of a young organism by these elements, otherwise the baby is waiting for complications in the future, for example, liver disease, heart or neuralgia.

Course of therapy

Diabetes of pregnant women is not a sentence and can reduce its impact on the fruit with a diet and physical exercise. For this reason, mothers are advised to correct their diet according to these rules:

• On a day, it is necessary to make at least 5 meals and portions must be small;
• It is necessary to make a menu for a week, and the products are selected by the glycemic index (GI), which has a scale from 0 to 100. What it will be less, the longer the feeling of satiety remains and sugar will increase less, so its indicator should not exceed 70;
• If doctors diagnosed gestational diabetes, then from their diet, you need to try to remove food with fast carbohydrates, such as confectionery, flour products and potatoes (due to starch);
• It is necessary to measure the sugar level 1-2 hours after each meal and the glucometer is ideal for this;
• By drawing up its daily menu, you need to watch that there is no more than 45% of carbohydrates in food and up to 30% of fats. As for products with a large protein concentrate, they can be actually without restrictions (up to 60%);
• With such a disease, it will be useful to use a large number of rough fiber, as it helps to reduce blood sugar;
• Pregnant women are recommended to use more fruits and vegetables to replenish the supply of nutrients. In addition, it will not hurt to drink a vitamin complex.

Gestational diabetes is temporary pathology and an organism over time comes back to the norm after delivery, since the concentration of hormones will return to valid indicators. If the concentration of sugar does not decrease even when complying with a strict diet and engage in sports, the doctors recommend to make insulin injections quickly after eating. Such a solution will help stabilize blood glucose levels.

If many of us have heard about conventional diabetes, then with what is gestational diabetes, few people are familiar. Gestational Dubet is an increase in the level of glucose (sugar) in the blood, which was first revealed during pregnancy.

The disease is not so common - only 4% of all pregnancies - but, just in case, you need to know about it, if only because this disease is far from harmless.

Sugar diabetes during pregnancy can negatively affect the development of the fetus. If it appears on the early timing Pregnancy, the risk of miscarriage increases, and, even worse - the appearance of congenital malformations in the kid. Most often, the most important organs of the crumbs are the heart and brain.

Gestational diabetes started in the second third trimesters Pregnancy becomes the cause of repenting and excessive growth of the fetus. This leads to hyperinsulinemia: after childbirth, when the child will not receive such a number of glucose from the mother, the sugar indicators in its blood are reduced to very low marks.

If this disease does not reveal and not treated, it can lead to development diabetic Fethopathy - complication of the fetus, developing due to impairment of carbohydrate exchange in the mother's body.

Signs of diabetic fetopathy in a child:

• large size (weight of more than 4 kg);
• violation of body proportions (thin limbs, big belly);
• tissue swelling, excessive deposits of subcutaneous fat;
• jaundice;
• respiratory disorders;
• hypoglycemia of newborns, increased blood viscosity and risk of blood cloves, low content of calcium and magnesium in the blood of a newborn.

How does gestational diabetes mellitus occur during pregnancy?

During pregnancy in the female body, it is not just a hormonal splash, but a whole hormonal storm, and one of the consequences of such changes is violation of body tolerance to glucose - Someone is stronger, someone is weaker. What does this mean? The blood sugar level is high (above the upper limit of the norm), but still not so much so that the diagnosis of sugar diabetes can be diagnosed.

In the third trimester of pregnancy, as a result of new hormonal rearrangements, gestational diabetes can develop. The mechanism of its occurrence: the pancreas of pregnant women produces 3 times more insulin than the rest of the people - in order to compensate for the specific hormones on the level of sugar contained in the blood.

If it does not cope with this feature with an increasing concentration of hormones, it appears such a phenomenon as gestational diabetes mellitus during pregnancy.

Risk group of gestational diabetes mellitus during pregnancy

There are some risk factors that increase the likelihood that the woman during pregnancy will develop gestational diabetes. However, the presence of even all of these factors does not guarantee that diabetes will still arise - in the same way as the absence of these adverse factors, does not guarantee 100% protection against this disease.

1. Excessive body weight observed in a woman before pregnancy (especially if the weight exceeded the norm by 20% or more);
2. Nationality. It turns out that there are some ethnic groups in which gestational diabetes is observed much more often than others. These include negros, latino, indigenous Americans and Asians;
3. High level of sugar based on urine analysis;
4. Violation of the body tolerance to glucose (as we have already mentioned, the sugar level is higher than the norm, but not so much to diagnose "diabetes");
5. Heredity. Diabetes is one of the most serious hereditary diseases, its risk increases if someone from the close relatives on your line was diabetic;
6. Preceding the birth of a large (over 4 kg) of a child;
7. Previous appearance of a stillborn child;
8. You have already diagnosed "gestational diabetes" during previous pregnancy;
9. Multi-way, that is, too much amniotic waters.

Diagnosis of gestational diabetes

If you have discovered several signs related to the risk group, report this to the doctor - you may appropriate an additional examination. If nothing bad is detected, you will pass another analysis with all other women. All other pass screening examination On gestational diabetes between the 24th and 28th week of pregnancy.

How would this happen? You will be offered to make an analysis called the "oral test of body tolerance to glucose". It will be necessary to drink a sweetened fluid containing 50 grams of sugar. After 20 minutes there will be a less pleasant stage - taking blood from Vienna. The fact is that this sugar is quickly absorbed, after 30-60 minutes, but individual readings differ, namely, this is interested in doctors. Thus, they find out how well the body is capable of metabolizing the sweet solution and absorb glucose.

In the event that there will be a number 140mg / dl (7.7mmol / l) in the form "Results of Analysis" or above, it is already high level. You will make another analysis, but this time - after a few hours of fasting.

Treatment of gestational diabetes

Life from diabetics, just say, not sugar - both in the direct, and figurative sense. But this disease can be controlled if you know how to clearly follow medical instructions.

So, what will help cope with historical diabetes during pregnancy?

1. Control of blood sugar levels. This is done 4 times a day - an empty stomach and 2 hours after each meal. Perhaps you will also need additional checks - before meals;
2. Urine tests. It should not have ketone bodies - they indicate that diabetes is not controlled;
3. Compliance with the special power regime that the doctor will inform you. We will consider this question below;
4. Reasonable physical exertion on the advice of the doctor;
5. Control over body weight;
6. Insulin therapy as needed. On the this moment during pregnancy, only insulin is allowed as an antidiabetic preparation;
7. Control of blood pressure.

Diet with gestational diabetes

If you have detected gestational diabetes, you will have to reconsider your power mode - this is one of the conditions for the successful treatment of this disease. Usually, diabetes is recommended to reduce body weight (this contributes to increasing insulin resistance), but pregnancy is not time for weight loss, because the fruit must receive all the nutrients they need. It means that the calorie content should be reduced, without reducing its nutrition.

1. Eat in small portions 3 times a day and 2-3 times snack at the same time. Do not skip meals! Breakfast should consist of carbohydrates by 40-45%, the last evening snack should also contain carbohydrates, approximately 15-30 gr.

2. Avoid roasted and fat, as well as products rich in easily driving carbohydrates. These include, for example, confectionery, as well as baking and some fruits (banana, persimmon, grapes, cherry, figs). All these products are quickly absorbed and provoke the rise of blood sugar levels, there are few nutrients in them, but many calories. In addition, to level their high glycemic effect, it takes too much insulin that in diabetes is a non-disabilities.

3. If you are sick in the morning, Keep an cracker or dry salt cookies on your bedside table and eat a few pieces before getting out of bed. If insulin is treated, and in the morning it is sick - make sure you know how to deal with a low level of blood sugar.

4. Do not use products fast cooking . They undergo pre-industrial processing in order to reduce their preparation time, but their influence on the increase in the glycemic index is greater than that of natural analogues. Therefore, exclude sublimated noodles from the diet, soup "in 5 minutes" from the bag, fast food cereal, sublimated potato mashed potatoes.

5. Pay attention to fiber-rich foods: porridge, rice, pasta, vegetables, fruits, bread from whole cereals. This is true not only for women with gestational diabetes - every pregnant should eat 20-35 Gy of fiber per day. What is so useful for diabetics? It stimulates the intestinal work and slows down suction of excess fat and sugar in blood. More products rich in fiber contains many necessary vitamins and minerals.

6. Saturated fats in the daily diet should not be more than 10%. And in general, eat fewer products containing "hidden" and "visible" fats. Exclude sausages, sausages, sausages, bacon, smoked, pork, lamb. Lean meat varieties are much more preferable: turkey, beef, chicken, as well as fish. Clean all the visible fat from meat: fat from meat, and from the bird - the skin. Prepare all gently: cook, bake, prepare for a pair.

7. Prepare food not for fat, and on vegetable oil, but it should not be too much.

8. Drink at least 1.5 liters of fluid per day (8 glasses).

9. Your body has any such fatslike margarine, butter, mayonnaise, sour cream, nuts, seeds, cream cheese, sauces.

10. Tired of bans? There are such products that you can there are no limit - They contain few calories and carbohydrates. These are cucumbers, tomatoes, zucchini, mushrooms, radishes, zucchini, celery, salad, clad beans, cabbage. Eat them in the main methods of food or as snacks, better - in the form of salads or boiled (boil the usual way or a pair).

11. Make sure your body is provided with the whole complex of vitamins and mineralsnecessary for pregnancy: ask your doctor if you do not need additional intake of vitamins and minerals.

If dietherapy does not help, and blood sugar remains at a high level or at a normal level of sugar in the urine constantly detecting ketone bodies - you will be prescribed insulinotherapy.

Insulin is administered only injecting method, since it is a protein, and if you try to conclude it in the tablet, it will completely collapse under the influence of our digestive enzymes.

Disinfectants are added to insulin preparations, so do not wipe the skin with alcohol before injection - alcohol destroys insulin. Naturally, you need to use one-time syringes and follow the rules of personal hygiene. All other subtleties of insulin therapy will tell you the attending physician.

Physical exercises in pregnant gestational diabetes

Consider do not need? On the contrary, they will help keep well-being, support muscle tone, to recover faster after delivery. In addition, they improve insulin effect and help not gain excess weight. All this helps to maintain the optimal level of blood sugar.

Engage in the usual types of active activities that like you and please: walking, gymnastics, water exercises. No loads on the belly - about favorite exercises "on the press" yet will have to forget. It is not necessary to deal with those sports that are fraught with injuries and drops - horse riding, cycling, skating, skiing, etc.

All loads - for well-being! If they felt bad, pains appeared at the bottom of the abdomen or in the back, stop and skip.

If you pass insulin therapy, it is important to know that hypoglycemia may occur during physical exertion, since physical activity and insulin reduce the amount of blood sugar. Check the blood sugar level before and after training. If you started going an hour after eating, you can eat a sandwich or an apple after class. If from the moment of the last meal has passed more than 2 hours, it is better to eat up to workout. Be sure to take juice or sugar in case of hypoglycemia.

Gestational diabetes and childbirth

Good news: after childbirth, gestational diabetes, as a rule, it takes place in diabetes mellitus only in 20-25% of cases. True, the births themselves because of this diagnosis may be complicated. For example, due to the already mentioned cropping of the fetus, the child may born very large.

Many, perhaps, would like the "hero", but the large size of the child may be a problem in battles and childbirth: in most such cases, it is carried out, and in the case of a relatives in natural way there is a risk of the injury of the baby's shoulders.

With gestational diabetes children born with reduced level Sugar in the blood, but it is fixable just feeding.

If the milk is not yet, and the browser is not enough to the child, the child is remembered by special mixtures to raise the level of sugar to normal. Moreover, the medical staff constantly controls this indicator, measuring the level of glucose quite often, before feeding and 2 hours after.

As a rule, no special measures to normalize the level of sugar in the blood of the mother and child will not need: the child, as we have already said, sugar comes to normal due to feeding, and in the mother - with the output of the placenta, which is the "annoying factor", because Molds hormones.

First after childbirth we'll have to post For meals and periodically measure the level of sugar, but over time everything should normalize.

Prevention of gestational diabetes

100% guarantees that you will never come across gestational diabetes no - it happens that women, most indicators falling into a risk group, premensenev, are not ill, and on the contrary, this disease happens to women who seem to have no No backgrounds.

If during the previous pregnancy you already had a gestational diabetes, the probability of its return is very high. However, you can reduce the risk of developing gestational diabetes during pregnancy, maintaining your weight in the norm and not gaining too much in these 9 months.

Support at the safe level sugar in the blood will help and physical exertion - provided that they are regular and do not give you discomfort.

You also have the risk of developing a permanent form of diabetes - type 2 diabetes mellitus. We will have to be careful and after delivery. Therefore, it is unwanted by the reception of drugs that increase insulin resistance: nicotine acid, glucocorticoid preparations (they include, for example, dexamethasone and prednisone).

Please note that some contraceptive pills can increase the risk of diabetes - for example, progestin, but this does not apply to low-base combined drugs. In the choice of means of contraception after childbirth, follow the recommendations of the doctor.

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Content

Pregnant woman sometimes gets a diagnosis of gestational diabetes, which has unpleasant consequences for a child. The disease occurs even in people with excellent health, previously not experiencing problems with high glucose in the blood. It is worth learn more about the signs of diseases provoking factors and risks for the fetus. Treatment is appointed by a doctor, and its results are carefully monitored before delivery.

What is gestational diabetes

Otherwise, diabetes of pregnant women is called gestational (GSD). It occurs when entering the fetus, it is considered "prediabet." This is not a complete disease, but only a predisposition to incomplete to simple sugars. Gestational diabetes in pregnant women is considered an indicator of the risk of the present disease of the second type. The disease can disappear after the birth of the baby, but sometimes develops further. To prevent it, prescribe treatment and careful examination of the body.

The cause of the development of the disease is the weak reaction of the body to its own insulin produced by the pancreas. The violation appears due to a hormonal background failure. The factors of the occurrence of gestational type diabetes are considered:

• excess body weight, metabolic disorders, resource;
• hereditary predisposition to common diabetes in the population;
• age after 25 years;
• previous births ended with the birth of a child from 4 kg of weight, with broad shoulders;
• anamnesis has already been the GSD;
• chronic unbearable;
• multi-way, stillbirth.

Effect on pregnancy

Negative is considered the effect of sugar diabetes for pregnancy. A woman suffering from the disease receives the risk of spontaneous abortion, late gestosis toxicosis, fetal infection and multi-way. On the health of Mother GSD during pregnancy is able to affect as follows:

• the development of hypoglycemic lack, ketoacidosis, preeclampsia;
• complication of vascular diseases - nephro-, neuro- and retinopathy, ischemia;
• after childbirth, a full-fledged disease appears in some cases.

What is dangerous gestational diabetes for a child

No less dangerous are the consequences of gestational diabetes for a child. With increasing sugars in maternal blood, the child's growth is observed. This phenomenon is associated with overpressure is called macros, it falls on the third trimester of pregnancy. The sizes of the head and brain remain normal, and large shoulders can cause problems with the natural passage by generic paths. The violation of growth leads to early childbirth, injury to female organs and a child.

In addition to macrosomia, leading to the immaturity of the fetus and even death, the DOS is carrying the following implications for the child:

• congenital malformations;
• complications at the first weeks of life;
• the risk of first degree diabetes;
• painful obesity;
• breathing disorder.

Sugar standards for gestational diabetes in pregnant women

Prevent the development of dangerous disease can help knowledge of sugar standards in gestational diabetes in pregnant women. Doctors recommend women in the risk group to continuously monitor glucose concentration - before eating, after an hour after. Optimal concentration:

• on an empty stomach and at night - at least 5.1 mmol / liter;
• after an hour after food - no more than 7 mmol / l;
• the percentage of glycated hemoglobin - up to 6.

Signs of diabetes in pregnant women

Gynecologists allocate the following initial signs of diabetes in pregnant women:

• increase in body weight;
• frequent volumetric urination, the smell of acetone;
• severe thirst;
• fast fatiguability;
• lack of appetite.

If diabetes are not controlled by pregnant women, then the disease can cause complications with a negative forecast:

• hyperglycemia - sharp jumps of sugars;
• confusion of consciousness, fainting;
• high pressure, pain in the heart, stroke;
• defeat kidney, ketonuria;
• reducing the functionality of the retina eye;
• slow healing of wounds;
• fabric infections;
• friend numbness, loss of sensitivity.

Diagnosis of gestational diabetes

Having reveaning the risk factors or symptoms of the disease, doctors carry out the operational diagnosis of gestational diabetes mellitus. Blood donated on an empty stomach. The optimal levels of sugar content fluctuate in the limits:

• from the finger - 4.8-6 mmol / l;
• from veins - 5.3-6.9 mmol / l.

Analysis on diabetes mellitus during pregnancy

When the previous indicators are not stacked, they carry out glucose-beaded analysis on diabetes mellitus during pregnancy. The test includes two dimensions and needs a patient survey rules:

• for three days before analyzing, do not change the power mode, stick to the usual physical exertion;
• during the night to the test, nothing is recommended, the analysis is made on an empty stomach;
• blood is taken;
• for five minutes, the patient takes a solution of glucose and water;
• two hours later, blood sample is still taken.

The diagnosis of the manifesticity (manifest) GSD is raised according to the established criteria for the concentration of glucose in the blood in three laboratory samples:

• from the finger on an empty stomach - from 6.1 mmol / l;
• from veins of an empty stomach - from 7 mmol / l;
• after the adoption of the glucose solution is over 7.8 mmol / l.

Having determined that the indicators are normal or low, doctors prescribe a test again in a period of 24-28 weeks, because the level of hormones increases. If you have to analyze before - the DOS can not be revealed, and later - it is no longer possible to prevent the emergence of complications from the fetus. Some doctors conduct research with different amounts of glucose - 50, 75 and 100. Ideally, it is necessary to make glucose-beaded analysis when planning conception.

Treatment of gestational diabetes in pregnant women

When laboratory samples showed the GDS, the treatment of diabetes mellitus is prescribed during pregnancy. Therapy is:

• proper nutrition, dosing of carbohydrate food, increasing proteins in the diet;
• normal physical activity, it is recommended to increase;
• constant glycemic control of sugars in the blood, ketone decay products in the urine, pressure;
• in case of chronic high concentration of sugar, insulin therapy is appointed in the form of injections, in addition to it, other drugs are not prescribed, because sugarpponent pills adversely affect the development of the child

With what sugar are prescribed insulin during pregnancy

If gestational diabetes during pregnancy is durable, and sugar is not reduced, insulin therapy is assigned to prevent the development of fetopathy. Insulin is also taken under normal sugar testimony, but when revealing excessive growth of the fetus, swelling of its soft tissues and multi-way. The injection of the drug is prescribed for the night and on an empty stomach. Accurate reception routing Find out an endocrinologist after consultation.

Diet with pregnant breeding diabetes

One of the items of treating the disease is a diet with gestational diabetes, which helps to hold normal sugar. There are rules how to reduce sugar during pregnancy:

• exclude from the menu sausages, smoked, fatty meat, give preference to a lean bird, beef, fish;
• culinary processing of food should include baking, cooking, pair use;
• eat dairy products with a minimum fatness percentage, refuse butter, margarine, fatty sauces, nuts and seeds;
• without restrictions allowed to use vegetables, greens, mushrooms;
• eat often, but little, every three hours;
• daily caloric content should not exceed 1800 kcal.

Gengetation Diabetes

So that the proposal of gestational diabetes has passed normally, the prescriptions of the doctor should be performed. Danger for a woman and baby can become macros - then natural labor is impossible, the Caesarean section is prescribed. For mother, childbirth in most situations mean that diabetes mellitus during pregnancy is no longer dangerous - after the release of the placenta (irritating factor), the danger passes, and the full-fledged disease is developing in a quarter of cases. A month and a half after the birth of the baby, the amount of glucose should be measured regularly.

Video: Gestational diabetes mellitus during pregnancy

Attention! The information presented in the article is familiarized. Article materials do not call for independent treatment. Only a qualified doctor may diagnose and give recommendations on treatment based on individual features Specific patient.

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With diabetes mellitus 1 or 2 familiar, many people directly or indirectly. But few people heard about the third variety of sweet illness. It is gestational diabetes mellitus, which is diagnosed only in a woman when having tolerated the long-awaited kid.

The reasons for the appearance, the impact on the development of the fetus and the state of the mother, the diagnosis methodology, how to treat gestational diabetes during pregnancy should be known to every woman ininthlete.

The difference between gestational diabetes from other species

Violation of the indicators of the blood sugar rate always testifies to diabetes. It is only important to determine the type of this disease. If 1 type is, mostly, the disease of the young, and 2 type is the result of the wrong mode of nutrition and lifestyle, then the 3 kind of illness may appear only in a woman, and only during pregnancy. More precisely, it can be diagnosed in this piquant position.

The specificity of gestational diabetes is such that glucose jumps occur until the kid appears on the light.

In the future, a woman can live familiarly and not fear for her health. But there is no complete guarantee of a positive outcome if the future mammy will not comply with the recommendation of the doctor.

Diabetes in pregnant women occurs due to hormonal changes that are the norm in most cases. The mechanism of the natural process is as follows:

1. After fertilization of the egg increases the activity of progesterone - a hormone, which is on guard of the preservation of the fetus and its prosperous development. This hormone partially blocks insulin production. But the pancreas, getting a signal of a deficit, begins to produce it in more and may be overwhelmed. Hence the signs of diabetes.
2. Placenta leads its work, rebuilding internal life future momSo that the baby is correctly formed, scored the right weight and was born safely.
3. In pregnancy, overestimated levels of cholesterol and glucose levels are admissible, because it is required to provide energy, two organisms, are moms and kids.

But gynecologists have a medical scale, which determines that during pregnancy can be considered the norm, and what is worth calling pathology.

And there are cases with sugar content and insulin in a pregnant woman.

At a certain period, elevated numbers in the analysis do not cause anxiety, but if the content of sugar or insulin in the blood is higher than the permissible, that is, it is a reason to assume the development of pregnant diabetes. Due to the increased production of hormones, a failure in the absorption of glucose or insulin insulin lack of insulin has occurs.

Diagnosis period of gestational diabetes

Despite the fact that the percentage ratio of pregnant women without pathology and future mothers with gestational diabetes is small (about 5% of 100), there is a pattern of how the hormonal failure can develop. Twenty-two weeks - this period when the gynecologist can diagnose the first changes in screening, which is prescribed pregnant women. The activity of the placenta is enhanced to preserve the intrauterine life and the full development of the fetus.

If the patient has no preliminary complaints or symptoms pointing to the belonging to the risk group, screening is carried out in the period of 24-28 weeks. On an empty stomach of veins take blood and check its composition.

With an elevated level of glucose, the pregnant woman is guided by an additional analysis - a test for the ratio of the cells of the body to insulin, the ability to absorb glucose. The patient is offered to drink a liquid containing 50 grams of sugar. After a certain interval, intravenous blood fence make and study as far as glucose is learned.

The liquid is usually converted to useful glucose and absorbed by cells for 30 minutes or an hour. But in violation of the metabolism process, the indicators will be far from standards. The figure is 7.7 mmol / l - this is a reason for the appointment of another blood fence, only after a few hours of fasting.

Such testing allows you to accurately determine the presence of a woman with a diabetes during pregnancy.

There is a circumstance when gestational diabetes is determined at the initial stage of pregnancy. Hidden diseases of the pancreas, the initial stage of carbohydrogen exchange failure can be enhanced by hormonal changes in pregnant women. Therefore, when registering with the female consultation, the future mother needs to be detailed to tell about any diseases.

Applicants for diabetes during pregnancy

There are some criteria for which a gynecologist understands that a pregnant patient is in a risk group, an enhanced observation of the general state of a woman and the fetus is required. Ladies preparing for pregnancy or already waiting for a crumb, will be worthwhile to pay attention to it.

• The presence of diagnosis "Diabetes" has someone in a related line.
• Excessive weight in the future mother is even conceived. If the body mass index exceeds the allowed rate by 20%, then it is better to pay attention to the diet and physical exertion to reduce the likelihood of malcose by cells.
• The age of the future mother. It is believed that after 30 years in the body of a woman there are processes that may affect pregnancy. To this age it is possible to break the tolerance of cells to insulin. Having such a problem before conception, the lady risks to get even greater insensitivity of the cells.
• Previous pregnancy ended with miscarriage, fret of the fetus and the birth of a dead baby.
• The weight of the woman itself when her birth was 4 kg and more.
• Previous children were born with a mass mass of more than 4 kg.
• Multiple throughout the cycle of pregnancy.
• During the urine examination, increased sugar rates were discovered.
• Gestational diabetes was already put at previous pregnancies, but after childbirth did not develop into a serious illness.

If a woman's history is at least one of the listed factors, the health control of the patient and the development of pregnancy should be reinforced.

But it is not necessary to think that only those ladies who have precursors of gestational diabetes fall into the risk group. Cases are often diagnosed at one hundred percent health of the future mother. The birth and development of a new life is a complex process that can violate any rules of medicine and nature.

What is dangerous gestational diabetes

Diabetes in pregnant women - the phenomenon is rare, but not giving a reason to the woman belongs to this skeptical. If there is an imbalance into the absorption of glucose by the body of the mother and baby, serious problems will appear:

• In the early time, pregnancy can stop developing. The fetus comes oxygen starvationThe cells will not receive the necessary energy for development. The result may be miscarriage or fetal fetal.
• For late development The embryo diabetes will receive excess glucose, which usually contributes to the rapid weight gain. The child intrauterine can gain weight more than 4 kg. This will affect the ability of the embryo to turn around so that the root separation is without complications. If the kid in the birthplace will enter the boom or legs, complications may be serious, up to death or violation of brain activity.
• In the kids after the appearance of the level of sugar is usually lowered, which requires greater attention of the doctors for the health of the newborn.
• Sometimes, the deviations in the assimilation of glucose lead to the development of intrauterine pathologies of the fetus - the development of the brain, the respiratory system, the formation of the pancreas. The insufficiency of maternal insulin can provoke the kid intensifying the function of the pancreas, which is not ready for this. From here there are problems with the development of enzymes after the birth of crumbs.
• The woman has a non-compatible diabetes causes prisons. The blood pressure increases, strong swelling occurs, work is disturbed vascular system. A child may experience oxygen and nutritious starvation.
• Gestational diabetes is closely related to the formation of a large number of accumulating waters (multi-water), which gives discomfort both mom and embryo.
• Thirst and abundant urination can also be provoked by a high level of glucose.
• Hyperglycemia enhances the risk of genital infections in pregnant women due to the decline in local immunity. Viruses, bacteria can get into labor pathways, get to the placenta and lead to the infection of the crumbs. A woman will need additional therapy that can affect the course of pregnancy.
• Insulin insufficiency in the body of the mother can cause ketoacidosis - a serious disease that can enter a woman in a diabetic to whom. The child often dies intrauterine.
• Due to the reduction in the process of glucose utilization in the usual way, the kidney and the circulatory system are experiencing a larger load. There is a renal failure or a strongly reduced acuity of sight.

Listed consequences and complications in the presence of gestational diabetes occur only due to the inaction of pregnant. If you approach temporary inconveniences with knowledge and compliance with the recommendations of the gynecologist, you can normalize pregnancy.

Gestational diabetes must be controlled

Such a feature in pregnant women is no innovation for medicine. Despite the fact that the causes of the occurrence of pathology precisely when carrying the baby are not determined by 100%, the mechanism of compensation for sugars and the relief of the life of a woman was studied and worked out. You need to trust a gynecologist and comply with a number of rules:

1. The first task of the patient to normalize the blood glucose level. As with any form of diabetes, it will help proper nutritionwhich is built to exclude or reduce simple carbohydrates in the diet.
2. But the food in a pregnant woman in any case should be complete in order not to deprive the crumb of nutrients, the right fats, vitamins, proteins. You need to diversify the menu, but monitor the glycemic index of products.
3. Moderate physical activity has a positive effect on insulin production and prevents the deposition of excess glucose into fat.
4. Permanent diagnosis on blood glucose levels. You need to buy a glucometer and measure the indicators 4 times a day. The doctor will tell more about the monitoring methodology.
5. Endocrinologist and nutritionist should be connected to pregnancy. If psychological bursts are observed in a woman, you can consult with a psychologist.

The sensitive attitude of the future mother to his health will help to normalize the carbohydrate process and approach childbirth without complications.

Nutrition in gestational diabetes

When receiving a woman with diabetes, a doctor has no time for detailed nutritional consultation. General installations or directions to a nutritionist are given. But the pregnant woman itself can develop a power mode and a list of permissible products, if you study information on how people with diabetes mellitus 1 and 2 feed. The only exception is the fact that the benefits of food should be not only for mom, but also for the fetus.

• The emphasis must be made on the observance of the food intake interval. Main portions use 3 times (breakfast, lunch, dinner). In the intervals there must be snacks up to 3-4 times.
• Energy value is also important because two organisms eat at once. Excessive consumption of carbohydrates is replaced by proteins (from 30 to 60%), useful fats (30%), fiber (up to 40%).
• Power must be complex, any monoda and starvation is excluded. Porridge, soups, salads, meat, fish dishes should be the basis. The snacks use vegetables, fruits, allowed desserts, low fat milk products.
• Bakery products, cakes, sweets, some fruits, pasta, potatoes should be canceled for the entire period of pregnancy. Even rice may be prohibited due to a high glycemic index.
• When choosing products in the store, you need to pay attention to the composition, energy value, to study in advance and draw up a list of croup, vegetables, a low glycemic index fruit.
• Dishes should not be difficult not to create loads on the pancreas and do not deceive themselves.
• It is necessary to change the method of cooking food. You can not fry, preserve products. Any fast food is eliminated to which pregnant women are often not indifferent. Semi-finished products from the discharge of dumplings, sausages, sausages, a boiler and other mass production products should remain on the shelves. Close to be solidarity in refusal to not injure already wounded women during pregnancy.
• Attention should be paid to frozen vegetable cocktails, which will allow you to make food to the ambulance hand and give a lot of use. The range is large, but you need to monitor the correctness of the storage of goods.

If at first there are difficulties with the right menu with gestational diabetes in pregnant women, you can focus on the recipes of soups, salads, second dishes, desserts for diabetics 1 and 2 types. Moms who collided with a similar diagnosis are often combined on the forums and share their recipes.

The diet in this case does not have differences by the type of sweet illness, because it is focused on the normalization of carbohydrate exchange in the body of the mother and the fetus.

A nutritionist or an endocrinologist will necessarily give a consideration on the calories of food. The daily rate should not exceed the figure of 35-40 kcal per 1 kg of the weight of pregnant. Suppose that the weight of a woman is 70 kg, then the total daytime diet must have an energy indicator from 2,450 to 2,800 kcal. It is advisable to keep a diary so that by the end of the day it was not possible whether disorders were allowed.

Menu option for pregnant women with gestational diabetes

Meeting Stage / Day of the Week	PN	T.	Cf.	Th	PT.	Sat	Sun
Breakfast	buckwheat porridge on water, 1 toast with butter, herbal tea b / s	oatmeal on milk, boiled egg, black b / s tea	Omelet with chicken boiled breast and vegetables, tea b / s	cottage cheese casserole, branch of rosehip b / s	oatmeal on water, low fatty cheese or curd, slice of rye bread, weak coffee.	wrench porridge on meat broth, toast, herbal tea	rice on water with vegetables or greens, a piece of rye bread, low-fat cheese, weak unsweetened coffee.
2nd breakfast	baked apple, water	orange, low-fat yogurt	vegetable seasonal salad, seasoned with lemon juice or vegetable oil.	fruit salad made of permitted list, seasoned with low-fat yogurt without filler.	cottage cheese casserole, water	Cheese with a piece of oat loaf, unsweetened tea.	drinking yogurt.
Dinner	Vegetable soup with chicken meatballs, a piece of boiled chicken breast, Vegetables, compote from dried fruit.	Fish soup, boiled brown rice, low-fat fish for a couple, boiled beet salad, tea.	Borsch on veal without potatoes, boiled buckwheat with calf calf, compote.	Chicken soup with noodles without potatoes, vegetable stew, herbal tea	Pea turkey soup, lazy cabbage rolls with stuffing from turkey in the oven, Kissel.	Shrimp soup with vegetables, squid stuffed with vegetables and baked in the oven, freshly squeezed vegetable juice.	Rollers on non-large beef, stewed cabbage, boiled beef, berry mole b / s
Afternoon person	small handful of nuts	curd cheese, a piece of whole grain bread	baked apple (any fruit from the list)	assorted raw vegetables on season	dried fruits from permissible	yogurt	vegetable Salad
Dinner	boiled cabbage (color, broccoli), baked fish, tea	stuffed turkey pepper with 15% sour cream, tea	vegetable stew, low-fat cheese, fresh fruit juice	valtine pilaf, vegetable salad, tea	salad of seafood, tea.	turkey baked in the oven with vegetables, berry morse	boiled potatoes with fresh cabbage salad
Late dinner	Kefir 200 ml	Ryazhenka 200 ml	Low-fat cottage cheese 150	Bifox 200 ml	Drinking yogurt	Cheese, toast, green tea	Milkshake

This is an option of the approximate menu for every day for pregnant women, having a history of gestational diabetes. The diet can be more diverse, it all depends on the season and personal taste preferences. If there is a sense of hunger between planned meals, you can drink ordinary water with small sips. In the diet should be up to 2 liters of ordinary water, not counting other liquid products.

In the treatment of gestational diabetes, the diet is not enough, if the lifestyle is generally passive. The energy must be consumed, oxygen must come into the body in sufficient quantities, unacceptably the weakening of the abdominal muscles and other parts of the body.

Physical activity improves the production and absorption of insulin, the excess glucose will not be able to transform into fat.

But the lady in the "special status" should not run into the sports club to get this load. It is enough to make everyday hiking, visit the pool or sign up for a special fitness for pregnant women.

Sometimes compensated sugar accounted for using insulin injections. In such a situation, it is necessary to remember that active physical exertion can minimize the level of glucose and hormone in the blood, which leads to hypoglycemia.

Sugar monitoring should be both before training and after it. With you, you need to take some snack to fill the deficit. Sugar or fruit juice will be able to prevent the effects of hypoglycemia.

Childbirth and postpartum period in gestational diabetes

To get pregnant, even a woman sick diabetes mellitia can take birth to a kid and give birth to Long before conception.

Therefore, in diabetes, which occurred during pregnancy, there are no contraindications for the delivery. The main thing is that the preliminary stage is not complicated by patient inaction.

If pregnancy proceeds on a specific algorithm, the attending physician pre-prepares a special mammy to the generic process.

The main risk in such kinds is a large fruit that can lead to complications. Usually recommended caesarean section. In practice, independent childbirth is allowed if there is no gestosis in a pregnant woman or the situation did not deteriorate in the last days.

Monitor the overall state of both women and the future kid. In the hospital, the pregnant woman comes earlier than ladies without such a complication. The gynecologist disclaims the direction with a mark of clauses of 38 weeks, but in reality the process can begin at 40 weeks and later, if there are no complications on ultrasound and analyzes.

Stimulate the contractions begin only in the absence of natural, if pregnant stands over a period.

Cesarean cross-section is necessarily not for all women with a diagnosis of gestational diabetes, but only at risk for the fetus and for the feminine. If there is a special branch for the delivery of people with diabetes, then the gynecologist, with all the testimony, will send the patient in such an institution.

After childbirth, the baby may have a low level of sugar, but it is compensated by power. Medical therapy is usually not required. The baby is under special observation and is diagnosed on the absence of pathology due to gestational diabetes at mom.

In a woman after the release of the placenta, the condition is normalized, the jumps of sugar levels are not observed. But you should not neglected the diet, which they held before childbirth, at least in the first month.

The subsequent pregnancy is better planning no earlier than 2 years so that the body is recovered and has no more serious pathologies. But before conception, you need to go through a full examination and warn the gynecologist about the fact of complications in past pregnancy.

Marina Pozdeev on violation of tolerance to glucose, manifesting during pregnancy and why gestational diabetes mellitution

About 7% of all pregnancies are complicated by gestational diabetes (GSD), which is more than 200 thousand cases in the world annually. Along with the arterial hypertension and premature gods, the GSD refers to the most frequent complications of pregnancy.

• Obesity increases the risk of developing gestational diabetes during pregnancy at least twice.
• The glucose-bearing test should be carried out by all pregnant women on the 24-28 week of pregnancy.
• If the level of glucose in an empty stomach plasma exceeds 7 mmol / l, they are talking about the development of manifest diabetes.
• Oral saccharifying drugs in the DOS are contraindicated.
• The DOS is not considered an indication to the planned caesarean section and even more so for early delivery.

Pathophysiology of the consequences of gestational diabetes and influence on the fruit

Starting from the earliest time of pregnancy, the fruit and the forming placenta need a large amount of glucose, which is continuously fed to the fetus using protein conveyors. In this regard, the utilization of glucose during pregnancy is significantly accelerating, which helps to reduce its level in the blood. Pregnant women tend to develop hypoglycemia between meals and during sleep, as the fruit gets glucose constantly.

What is dangerous gestational diabetes during pregnancy for a child and mother:

As pregnancy progressing, the sensitivity of tissues to insulin is steadily decreased, and insulin concentration compensatory increases. In this connection, the basal level of insulin increases (on an empty stomach), as well as the concentration of insulin-stimulated with glucose-beaded test (the first and second phases of the insulin response). With increasing gestational period, insulin elimination of blood flow increases.

In case of insufficient developing insulin, pregnant women develop gestational diabetes, which is characterized by increased insulin resistance. In addition, it is characterized by an increase in the content of the preinselulin in the blood, which indicates the deterioration of the function of beta cells of the pancreas.

Risk factors GSD

The risk assessment of the development of the GDS should be made in the first visit of a pregnant woman to the Akuster-Gynecologist about pregnancy. There are factors that increase the risk of developing GDS at least twice, this is:

• excess body mass and obesity (body mass index (BMI) above 25 kg / m2 and above 30 kg / m2);
• an increase in body weight after 18 years by 10 kg;
• age of pregnant older than 40 years (compared to women aged 25-29 years);
• belonging to the Mongoloid race (compared to the European).

In addition, the probability of GSD increases smoking, a sedentary lifestyle, genetic predisposition to diabetes diabetes (SD) of the 2nd type. IN last years Information appeared, testifying that lowness can be associated with the GDS. More likely the likelihood of insulin resistance during pregnancy in women with disturbed glucose tolerance (NTH); Patients suffering from polycystic ovarian syndrome, as well as arterial hypertension.

Risk factors associated with pregnancy are distinguished. Thus, the probability of the development of the GDM significantly increases with multiple pregnancy (twice during pregnancy double and 4-5 times - triple), as well as with a quick increase in weight during pregnancy. The use of beta-adrenobloclars or corticosteroids to prevent the threat of premature genera increases the risk of 15-20% and more.

The risk factors of the GSD associated with the obstetric history include:

• GSD with previous pregnancies;
• glucosuria (during the present or previous pregnancy);
• large fruit in history and / or hydramnion;
• anamnesis.

What is impossible in gestational diabetes mellitus? In the GSD, it is necessary to limit the amount of energy consumed per day. Changes in the diet should be directed to the transition to fractional nutrition (for example, three main meals and three "snacks"). Carbohydrates should be no more than 50% of the diet, with the content of fats and proteins of 25%.

According to the standards of the American Diabetic Association of 2013, a woman belongs to the category of high risk of GSD development when it has identiced at least one of the criteria: obesity; burdened heredity; GSD in history; glucosuria; Polycystic ovarian syndrome in history.

The low risk of the development of the GDG is said if a woman meets all the following criteria: age under 25 years; Normal weight before pregnancy; to belong to ethnic group with a low probability of development of the SD; lack of relatives of the first line suffering from the SD; Lack of NTH in history; Lack of burded obstetric anamnesis.

Women who do not fall into the category of high and low risk have a moderate risk of developing the GDS.

Diagnosis of gestational diabetes: indicators and norm

In 2012, experts of the Russian Association of Endocrinologists and experts of the Russian Association of Obstetrician-Gynecologists adopted the Russian national consensus "Gestational diabetes mellitus: diagnostics, treatment, postpartum observation" (hereinafter - Russian National Consensus). According to this document, the DVF is detected as follows:

1 phase

with the first handling of pregnant

• blood plasma glucose on an empty stomach, or
• glycated hemoglobin (Methodology certified in accordance with the National Glycohemoglobin Standartization Program NGSP and standardized in accordance with the reference values \u200b\u200btaken in DCCT - Diabetes Control and Complications Study), or

plasma glucose at any time of the day, regardless of food intake.

2 phase

on the 24th-28th week of pregnancy

• All pregnant women, including those who have not been detected in carbohydrate exchange in early terms, is carried out oral glucose-bearing test (PGGT) on the 24-28 week of pregnancy. The optimal period is 24-26 weeks, but PGTT can be carried out up to 32 weeks of gestation.

IN different countries PGTT is carried out with different glucose loads. The interpretation of the results can also be somewhat different.

In Russia, PGTT is carried out with 75 g of glucose, and in the United States and many EU countries a diagnostic standard is recognized as a test from 100 g of glucose. The American Diabetic Association confirms that the first, and the second version of the PGTT have the same diagnostic value.

According to the Russian national consensus in the Russian Federation, the criterion for setting the diagnosis of gestational diabetes is the indicators of glucose content in an empty stomach plasma of more than 7 mmol / l, and 2 hours after glucose load more than or equal to 7.8 mmol / l.

Interpretation of PGTT can carry out endocrinologists, gynecological obstetricists and therapists. If the test result testifies to the development of the manifest diabetes, pregnant is immediately sent to the endocrinologist.

Maintaining patients with GSD

Within 1-2 weeks after the diagnosis is established, the patient shows observation by gynecologists, therapists, general practitioners.

Rules for the oral glucosotolerant test (PGTT)

1. The test is carried out against the background of ordinary nutrition. At least for three days before the study, at least 150 g of carbohydrates should flow.
2. The latter before studying meals must contain at least 30-50 g of carbohydrates.
3. The test is carried out on an empty stomach (8-14 hours after meals).
4. Drinking water before analyzing is not prohibited.
5. During the study, it is impossible to smoke.
6. During the test, the patient should sit.
7. If possible, the day before and during the study it is necessary to eliminate the reception of drugs capable of changing blood glucose. These include polyvitamins and gland preparations, which include carbohydrates, as well as corticosteroids, beta blockers, beta-adreminimetics.
8. PGTT should not be carried out:
   • with early toxicosis of pregnant women;
   • if necessary in strict bed mode;
   • against the background of an acute inflammatory disease;
   • with exacerbation of chronic pancreatitis or a suspended stomach syndrome.

Individual correction of the diet, depending on the mass of the body and the growth of a woman. It is recommended to completely eliminate easily durable carbohydrates and limit the amount of fats. Food should be distributed evenly on 4-6 receptions. In moderate quantities, non-ball sweeteners can be used.

For women with BMI\u003e 30 kg / m2, the average daily calm must be reduced by 30-33% (approximately 25 kcal / kg per day). It has been proven that such a measure allows you to reduce hyperglycemia and plasma triglycerides.

1. Aerobic exercise: walking at least 150 minutes a week, swimming.
2. Self-control of the main indicators:
   • the level of glucose in the capillary blood is an empty stomach, before meals and 1 hour after meals;
   • the level of ketone bodies in the urine in the morning on an empty stomach (before bedtime or at night it is recommended to additionally take carbohydrates in the amount of about 15 g at ketoneuria or ketonemia);
   • blood pressure;
   • fetal movements;
   • body mass.

The preparations of sulfonylurea (glibenklamide, glymepiride) penetrate a placental barrier and can have a teratogenic effect, therefore do not apply under the GDG.

• Impossibility to achieve the target level of glucose in blood plasma
• Signs of diabetic phtopathy on ultrasound (indirect evidence of chronic hyperglycemia)
• Uzi-signs of the diabetic fetopathy of the fetus:
• large fruit (abdominal diameter is greater than or equal to 75 percentile);
• hepatoslenomegaly;
• cardiomegaly and / or cardiopathy;
• dual-circuit head;
• swelling and thickening of the subcutaneous fat layer;
• thickening of the cervical fold;
• for the first time identified or increasing multi-way, with a diagnosis of the DVM (if other reasons are excluded).

When appointing insulin therapy, the endocrinologist (therapist) and an obstetrician gynecologist are pregnant.

Treatment of gestational diabetes in pregnant women: selection of pharmacotherapy

Control the GES helps a modification of lifestyle, in particular, an increase in physical exertion. Cells muscular fabric Initially, glycogen reserves are used to obtain energy, however, as activity increases, they are forced to consume blood purulezos, so that its level falls. Exercise also contribute to the increase in the sensitivity of muscle cells to insulin. In the long term, physical activity reduces the risk of the development of the GDS during re-pregnancies.

Oral hypoglycemic drugs during pregnancy and lactation are contraindicated!

• category B (adverse effects on the fetus were not detected in animal studies, adequate and controlled research on pregnant women were not conducted);
• category C (adverse effects on the fetus were identified in animal studies, the research on pregnant women were not conducted).

• all drug insulin preparations for pregnant women must be appointed with an indispensable indication of the trade name;
• hospitalization in the detection of DVS is not obligatory and depends on the availability of obstetric complications;
• The DOS is not considered an indication to a planned caesarean cross section or early delivery.

List of sources

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