Gestational diabetes mellitus

Nine months after conception are the responsible and intense period in life of future mother. The growing fruit demands a lot of energy, microelements and nutrients. Because of it pregnancy is the state which is strongly influencing a metabolism of the woman. Gestational insulin resistance is considered one of manifestations of these changes.

Both the liver, and muscles, and fatty tissue become a little sensitive to pancreas hormone - insulin. In unfavorable conditions it can lead to increase in sugar in blood and to development of a diabetes mellitus. Diabetes at pregnant women comes to light at inspection in clinic for women. For the analysis on term up to 24 weeks a venous blood (sugar or glycated hemoglobin is defined) undertakes, on later term "the sugar curve" is carried out.

Until recently any for the first time the revealed increase in sugar of blood during pregnancy was considered as a gestational diabetes mellitus.

Modern ideas of gestational diabetes

Now there is the Russian national consensus "A gestational diabetes mellitus: diagnosis, treatment, puerperal observation". This document is the management for all doctors, including endocrinologists and obstetricians-gynecologists. According to this management at the woman during pregnancy both the gestational diabetes mellitus, and manifest can be established. And the manifest diabetes mellitus is diagnosed at higher figures of sugar of blood. Such diagnosis indicates that increase in sugar is connected not only with pregnancy, and after the delivery carbohydrate metabolism is not normalized.

The gestational diabetes mellitus can be considered as a temporary state and to count on improvement after the child's birth. Thus, establishment of the diagnosis gestational diabetes is considered more favorable. However even slight increase of sugar of blood during pregnancy is dangerous to the woman and a fruit. At children whose mothers did not receive sufficient treatment, defects of internals can develop, the mass of the child at the birth is considered also very characteristic more than 4 kg. The large fruit is exposed to big danger in labor. For the woman the gestational diabetes mellitus can be a harbinger of serious violations of carbohydrate metabolism further.

Diagnosis of a disease

Diagnosis is based on symptoms of a gestational diabetes mellitus and laboratory indicators. The norm recognized value of sugar of a venous blood on an empty stomach to 5,1 mm/l. If blood sugar from a vein keeps within a prmezhutok from 5,1 to 7,0 mm/l, then doctors interpret results as a gestational diabetes mellitus. If the result is higher than 7,0 mm/l, then the diagnosis of a manifest diabetes mellitus is made.

Risk factors of a gestational diabetes mellitus

Prevalence of a gestational diabetes mellitus grows both in Russia, and in the world. Frequency of a disease averages 7%. Most possibly increase in sugar of blood during pregnancy at women is more senior than 30 years having excess body weight and relatives, suffering from a diabetes mellitus 2 types.

Symptoms of a gestational diabetes mellitus

Increase in sugar of blood at this disease quite insignificant therefore the expressed complaints at pregnant women arise rather seldom. Sometimes there are a thirst and the speeded-up urination, a xeroderma. Rather often the woman has hypostases, a bystry set of weight, an infection of uric ways.

Treatment of a gestational diabetes mellitus at pregnancy

The pregnant woman needs regular observation at the obstetrician-gynecologist, the therapist or the endocrinologist. It is necessary to measure blood sugar by the glucose meter daily. The first medical measure is the diet. Besides, at once recommend an adequate exercise stress (walking, swimming). In two weeks insulin can be added to treatment. The indication to insulin is the remaining high level of sugar of blood. Also data of ultrasonic examination of a fruit can become the reason of purpose of insulin. Most often the pregnant woman enters genetically engineered insulin in the intensified mode.

It means that injections of hormone will be made repeatedly during the day. Antihyperglycemic tablets at pregnancy are strictly prohibited as they exert negative impact on a fruit. Hospitalization in a hospital at identification of a gestational diabetes mellitus is not considered obligatory. Also there are no reasons to carry out Cesarean section or early delivery at this diagnosis without existence of obstetric complications. The main measure at gestational diabetes the diet is considered.

Diet at a gestational diabetes mellitus

Food of the pregnant woman has to be regular and fractional. During the day it is necessary to eat 4-6 times food in the small portions. It is important to exclude all sweet, that is simple carbohydrates: sucrose, glucose, fructose. These substances most quicker increase sugar level in blood. From products simple carbohydrates contain in a large number in all confectionery. The diet at a gestational diabetes mellitus assumes refusal of honey, fruit juice, bananas, grapes, dried fruits and all sweet products. Except carbohydrates, in food also fats, first of all, of animal origin are limited. Fats are very rich with calories, so, influence increase in body weight.

Vegetables, cereals, low-fat dairy, meat and fish products have to become a diet basis at a gestational diabetes mellitus. Bread needs to be limited to 50 grams a day. Preference should be given to grades with addition of bran or from coarse flour. It is better to use rice, macaroni, semolina porridge seldom. It is desirable to eat potatoes boiled, stewed, but not fried. Soups have to be on a vegetable or low-fat beef-infusion broth. Addition to each meal of vegetables in a crude or boiled look is shown. Salads it is impossible to dress with mayonnaise, sour cream, vegetable oil. During the day it is not necessary to abuse salt, coffee, tea. It is better to minimize canned food, semi-finished products in a diet.

Puerperal observation of women with gestational diabetes

Right after childbirth to all women with a gestational diabetes mellitus insulin is cancelled if it was used. While the patient is in a maternity home, to her several times control blood sugar. Usually, in the very first days after delivery carbohydrate metabolism is normalized completely. However the woman should be observed at the endocrinologist at the place of residence. To avoid a diabetes mellitus 2 types, it will be necessary to keep further to a hypocaloric diet, to reduce body weight to norm, to expand physical activity.

Blood sugar monitoring procedure on an empty stomach or a sugar curve in 6-12 weeks after the delivery is important. Planning of the following pregnancy should be carried out together with the obstetrician and the endocrinologist. At the child whose mother suffered from a gestational diabetes mellitus at pregnancy, development of disturbances of carbohydrate metabolism is probable too. Therefore the pediatrician has to be informed on this complication of pregnancy.