Diabetes mellitus during pregnancy
May 11, 2018
Diabetes mellitus is a disease that is based on a deficiency in the body of the hormone insulin. At the same time there is a metabolic disorder and pathological changes in the whole body. With insulin deficiency, the use and utilization of glucose is disrupted, as a result of which the level of it in blood and urine rises. This is the main diagnostic sign of diabetes.
The diagnosis of diabetes mellitus is made on the basis of laboratory tests, at a glucose level in the blood, taken on an empty stomach, above 7.0 mmol / l or in blood taken from a finger, above 6.1 mmol / l. This level is called hyperglycemia.
Recently, the number of women waiting for a child with this pathology is increasing. Pregnancy in itself is a diabetogenic factor, i.e., increases the risk of developing diabetes. More often than not, it is known that a woman is sick, before pregnancy, but sometimes the disease can appear for the first time during the gestation period.
Suspected diabetes in pregnant women is necessary if there is frequent urination, even in the third trimester, increased appetite, dry mouth, thirst, weight loss, increased blood pressure, weakness, itching of the skin. Such patients have a tendency to pustular skin diseases, furunculosis.
Women who are overweight, have an inherited predisposition, at the age of 30 or older, and those who have had previous pregnancies wrong are most prone to the disease. It is recommended to take an analysis for the level of blood sugar between the 24th and 28th weeks of pregnancy.
Diabetes often increases the likelihood of spontaneous miscarriage. A dangerous complication is coma, the cause of which may be a violation of diet, improper use of insulin, inadequate or excessive. However, with careful monitoring, control of blood sugar level with
diet help, pregnancy can proceed correctly, and the baby is born healthy.
A characteristic feature is the birth in a woman with diabetes of a large child, with a mass of more than 4500 g and an increase of 55-60 cm.
However, not always an increase in the level of sugar indicates the presence of a pregnant woman in the disease. There may be a temporary appearance of a small amount of sugar in the urine, which passes after a while and is not detected during repeated studies. There is also a special form of diabetes of pregnant women, which occurs soon after its end, usually within 2-12 weeks after childbirth.
A future mother who has diabetes mellitus should be observed by an endocrinologist throughout her pregnancy. At the beginning of it, the blood sugar level is determined daily, at the end - 2-3 times a week.
During pregnancy, a woman must be hospitalized in a hospital three times:
1) the first time as soon as the pregnancy is diagnosed, for the purpose of examining and compensating for diabetes;
2) the second time for a period of 20-24 weeks;
3) the third time in 32 weeks, to prepare for childbirth.
The basis of treatment is a rational diet in combination with adequate insulin therapy. The diet should contain a reduced amount of carbohydrates( 200-250 g), fats( 60-70 g) and a sufficient number of proteins( 1-2 g) per 1 kg of body weight. It is very important to consume the same amount of carbohydrates daily. Fully excluded from the diet are sugar, candy, honey, ice cream, chocolate, cakes, sweet drinks, semolina and rice porridge. To eat better often, in small portions, preferably 8 times a day. The diet should be nutritious, provide the body with all the necessary vitamins and microelements.
The dose of insulin, the number of injections and the time of administration of the drug are prescribed and monitored by a physician. Unlike tableted hypoglycemic drugs, the use of insulin during pregnancy is safe, it does not have a damaging effect on the fetus.
Walking is recommended as a physical activity.
The choice of the method of delivery is decided individually by the obstetrician-gynecologist and depends on the course of pregnancy and the presence of concomitant obstetric pathology. If the period of bearing of the child runs without complications, diabetes mellitus is under control, in the compensation stage, the birth should be timely and conducted through the natural birth canal. When:
1) insufficiently compensated diabetes;
2) complicated pregnancy;
3) the presence of any concomitant diseases, - perform premature delivery at 37 weeks, if necessary by caesarean section.
It is known that in diabetes mellitus the metabolism of sugar is disturbed in the body. Its first sign is the presence of sugar in the urine. Diabetes mellitus is dangerous in pregnancy for both the mother and the baby. With the development of medicine, this danger has significantly decreased, and the infant mortality rate has almost halved. But nevertheless, diabetes complicates the course of pregnancy with toxicosis of the second half( more often occurring in severe form), high water, fetal diseases and even the possibility of his death in the last weeks of pregnancy.
A woman with diabetes mellitus can give birth to a child without complications, if it is observed by the doctor and clearly follow the prescribed treatment and regimen. Probably, at some period of pregnancy, hospitalization( and even repeated) will be required in order to reduce the negative impact of the disease on the course of pregnancy with the help of diet and medication. At the end of pregnancy, a future mother, who is sick with diabetes, is usually hospitalized. Most often, a cesarean section is performed, since the child is large( more than 4 kg).As a rule, these children are fragile and can suffer at birth through the natural birth canal. Sometimes a woman does not even know that she has diabetes, and the disease is diagnosed during examination during pregnancy. But in most cases, diabetes is known in advance. Before deciding on pregnancy, the expectant mother should consult an endocrinologist and gynecologist in order to decide on the possibility of bearing and the birth of a healthy child with her disease. Pregnancy is contraindicated in women who have diabetes mellitus in severe form, with diabetes mellitus in both spouses( there is a danger of hereditary diabetes, congenital malformations in the child).Diabetes mellitus can be suspected if there were diabetics in the family or a very large or dead child was born.
Women suffering from diabetes mellitus often have irregularities in the menstrual cycle: irregularity, amenorrhea, early onset of menopause.
Modern methods of treatment with insulin in combination with a physiologically complete diet allow normalizing the functions of the sex glands.
Sometimes pregnancy serves as a trigger, allowing to identify a woman's diabetes. The prevalence of this disease among pregnant women is 0.5%, and this number increases yearly.
In different terms of pregnancy, diabetes in women is not the same. In the first half and in the last 6-7 weeks before childbirth, and also immediately after childbirth, the condition of the patients usually improves. The blood glucose level decreases, the sensitivity of tissues to insulin increases, which can lead to the development of hypoglycemia. Deterioration of the course of the disease is observed usually from the 13th week of pregnancy. At this time, the amount of sugar in the blood begins to increase, which can lead to a coma. From the 32nd week of pregnancy and until the birth, it is possible to improve the course of diabetes and the appearance of hypoglycemia, which is associated with the effect of fetal insulin on the mother's body, as well as with increased fetal glucose intake through the placenta from maternal blood. During childbirth there are significant fluctuations in blood glucose levels, but more often develop hyperglycemia and acidosis. This happens under the influence of the physical work done and the emotional experiences of the woman. After giving birth, the blood glucose level decreases rapidly and then gradually rises.
The course of pregnancy in diabetes mellitus is accompanied by a number of features: pregnancy is often interrupted, resulting in either late miscarriage or premature birth;the second half is often complicated by toxicosis, which is difficult to treat. The most serious complication is fetal death, usually occurring in recent weeks.
One feature has long been noticed: pregnant women with diabetes mellitus often have large children. The large size and weight of the fetus affect the duration of labor, cause weakness in labor and therefore often result in surgical intervention. Another 70-100 years ago, at birth or in the post-natal period, every second woman died. Only the use of insulin in combination with a full-fledged diet dramatically reduced mortality.
Children born to mothers with diabetes often suffer from congenital pathology. Most often, the fetus affects the central nervous system, liver, cardiovascular system, there is swelling of the anterior abdominal wall and limbs. Such newborns need special care. In the first hours of life, attention should be paid to identifying and fighting respiratory disorders, hypoglycemia, acidosis and CNS damage.
If a woman has diabetes, then there is always a dilemma in front of her - is it possible to plan pregnancy and future childbirth. She should remember the following rules:
• it is worth to abstain from pregnancy if remission is not achieved in the treatment of diabetes mellitus;
• for five to six months before conception, a woman should undergo an examination with an endocrinologist.
Every woman should know that pregnancy is contraindicated in the following cases:
• if there is diabetes in both spouses;
• the presence of insulin dependence in the mother;
• combination of diabetes mellitus and active form of tuberculosis;
• combination of diabetes mellitus and various Rh factor in spouses;
• death or birth of children with anomalies of development in the anamnesis;
• progressive vascular complications of diabetes mellitus( fresh hemorrhages in the retina, diabetic nephropathy with manifestations of renal failure and arterial hypertension).
In the event of an unplanned pregnancy, it is recommended to discontinue it if the patient's age is over 38 years, and if the blood sugar and urine sugar level is constantly on high numbers and decreases with difficulty.
Eating pregnant, with diabetes, should be full. Particular attention should be given to the amount of vitamins in the diet and with their lack of treatment, vitamin preparations should be added.2-3 months before the birth, it is necessary to register in the maternity institution where it is planned to give birth.
Place the woman in the maternity ward in advance, 7-10 days before the expected date of delivery. On the day of delivery, insulin should not be discontinued. Insulin should be given in divided doses, every 6-8 hours and give carbohydrates in the form of sweet tea, compote, jelly, etc.
The significant decrease in blood sugar level observed in the first days after birth and the decrease in urinary sugar release usually does not require a reduction in the amount ofinsulin. In the diet, you need to introduce an additional amount of carbohydrates to normalize the process of milk production.
In order to prevent possible hypoglycemia or shortness of breath in a newborn, several drops of 40% glucose solution should be injected into the mouth every few hours after birth within 2-3 hours during 2-3 hours. During the first 24 hours after birth, 40% glucose should also be added to breast milk in a ratio of half of the glucose solution to one part of the milk, which is given every 2 hours.
Breast milk of a mother suffering from diabetes mellitus is not a contraindication for a child's nutrition. Breastfeeding mothers and newborns should be under the supervision of an endocrinologist and pediatrician.
The food of nursing mothers should contain enough carbohydrates, proteins, fats, vitamins and mineral salts.
The usual course of diabetes as a result of rational treatment makes it possible for the nursing mother to feel well, maintain weight, have enough milk, and as a result the child develops normally. At the end of the feeding period, the mother is transferred to regular doses of insulin and a corresponding diet.