Diabetes and pregnancy of
Diabetes - the disease which is characterized by insufficiency in an insulin organism (the hormone of a pancreas which is responsible for a glucose exchange) when the pancreas develops small amount of this hormone. Before childbirth at the women sick with diabetes began to apply insulin as medicine, was a rarity. Pregnancy came only at 5% of women and threatened their life, pre-natal mortality of a fruit reached 60%. Treatment by insulin allowed the vast majority of the women sick with diabetes, to have children. Though pre-natal mortality of a fruit is possible also at rational tactics of treatment and conducting pregnancy, its probability can be considerably reduced. Therefore for the woman sick with diabetes, it is very important to prepare for pregnancy under supervision of the doctor - the endocrinologist and to continue supervision throughout all pregnancy.
Who is included into “risk group“?
can think Of predisposition of women to a disease of diabetes in the following cases:
- if both parents of the woman are sick with diabetes,
- if her uniovular twin - the diabetic, if earlier at the woman children with body weight more than 4500 g were born
- if the woman has obesity,
- if it had habitual abortions,
- at a mnogovodiya,
- at a glyukozuriya (detection of sugar in urine).
that the woman has diabetes most often happens it is known even before pregnancy, but diabetes can be shown for the first time during incubation of the kid.disease Symptoms
impact on all types of a metabolism. At a lack of this hormone digestion of glucose is broken, its disintegration what increase of level of glucose in blood (hyperglycemia) - the main symptom of diabetes is result of increases.
Patients with diabetes complain of dryness in a mouth, I am eager, consumption of the increased amount of liquid (more than 2 l), plentiful urination, the increased or lowered appetite, weakness, weight loss, a skin itch, especially in a crotch, a sleep disorder. At them it is expressed tendency to pustulous diseases of skin, a furunkuleza.laboratory researches, first of all definition of amount of sugar in blood are necessary for
For diagnosis of diabetes. The diagnosis “diabetes“ can be made at glucose level in the blood taken on an empty stomach from a vein it is higher than 7,0 mmol/l or in the blood taken from a finger it is higher than 6,1 mmol/l. Such level is also called a hyperglycemia.
the Suspicion on existence of diabetes arises at glucose level in blood on an empty stomach within 4,8 - 6,0 mmol/l. Then carrying out more difficult glyukozotolerantny test is necessary - this test allows to investigate reaction of an organism to introduction of additional amount of glucose. At an initial hyperglycemia the diagnosis is clear, and the test does not need to be carried out. It is necessary to define sugar in blood at the beginning of pregnancy weekly, and by the end of pregnancy - 2 - 3 times a week.
the Second important indicator of diabetes is detection of sugar in urine (glyukozuriya), but at simultaneous existence of a hyperglycemia (increase of level of sugar in blood). Glyukozuriya without hyperglycemia quite often occurs at healthy women and carries the name “glyukozuriya of pregnant women“. This state is not a symptom of an illness.the Expressed diabetes breaks
not only a carbohydrate, but also fatty exchange. At a decompensation of diabetes the ketonemiya appears (increase in blood of quantity of products of a fatty exchange - ketone bodies, including acetone), and acetone is found in urine.
At steadily normal level of sugar in blood and normalization of the glyukozotolerantny test is considered that diabetes is in a condition of compensation.
Diabetes proceeds with defeat of many bodies and systems of an organism: small vessels of eyes, kidneys, skin, muscles, nervous system, zheludochno - an intestinal path suffer.by
the disease of eyes - the diabetic retinopathy which is followed by the progressing visual acuity falling, hemorrhage in a retina and menacing with a blindness is Especially dangerous. Damage of kidneys is shown by increase of arterial pressure, availability of protein in urine, hypostases, deterioration in sight, a chronic renal failure (the violation of the internal environment of an organism caused by irreversible death of tissue of kidneys) which in this case develops earlier, than at other diseases of kidneys. Diabetes promotes emergence and other renal pathology which is especially connected with an infection: pyelonephritis, cystitis. At diabetes weakening of immune system is observed that, perhaps, is one of the reasons of frequent bacterial complications.Diabetes affects with
also genitals. At women spontaneous abortions, premature birth, pre-natal death of a fruit are noted.
Dangerous complication of pregnancy are comas. Can develop ketonemichesky (other name - diabetic) and hypoglycemic a coma at which the patient faints. Lump violations of a diet (excess or insufficient consumption of carbohydrates) and an insulin dose inadequate to blood glucose level - overestimated or insufficient can be the reasons.
are Distinguished by 3 severity of diabetes:
- of degree (easy) : the hyperglycemia on an empty stomach is less than 7,7 mmol/l; normalization of level of sugar in blood can be reached by means of one diet.
- degree (average) : the hyperglycemia on an empty stomach is less than 12,7 mmol/l; for normalization of level of sugar in blood there is not enough diet, treatment by insulin is necessary.
- degree (heavy) : the hyperglycemia on an empty stomach is more than 12,7 mmol/l, vascular defeats of bodies are expressed, there is an acetone in urine.
of Feature of a course of a disease at pregnant women
during pregnancy the course of diabetes significantly changes. It is possible to allocate several stages of these changes.
- In 1 trimester of pregnancy improvement of a course of disease happens, glucose level in blood decreases, and it can lead to development of a hypoglycemia. Therefore the dose of insulin is reduced on 1/3. by
- With of 13 weeks of pregnancy observes deterioration in a course of disease, growth of a hyperglycemia that can lead to a coma. The dose of insulin needs to be increased.
- With of 32 weeks of pregnancy and before childbirth perhaps again improvement of a course of diabetes and emergence of a hypoglycemia. Therefore the dose of insulin is reduced by 20 - 30%.
- In labor considerable fluctuations of level of sugar in blood happen; the hyperglycemia under the influence of emotional influences (pain, fear) or a hypoglycemia as a result of the done physical activity, exhaustion of the woman can develop.
- After the delivery sugar in blood quickly decreases and then gradually raises, to 7 - 10 - mu to day of the postnatal period reaching that level that was before pregnancy.
Due to such dynamics of pathological process the woman is hospitalized for correction of doses of insulin in the following terms of pregnancy:
- in the first weeks as soon as pregnancy is diagnosed, for an assessment of weight of a course of disease and careful compensation of diabetes;
- 20 - 24 of week when the course of disease worsens;
- in 32 weeks for compensation of diabetes and the solution of a question of term and a method of a rodorazresheniye.
Pregnancy adversely influences the course of diabetes.
vascular diseases Progress, in particular the diabetic retinopathy is diagnosed for 35% of patients, diabetic damage of kidneys promotes accession of a gestoz - complications of pregnancy, the shown increase of arterial pressure, emergence of hypostases, protein in urine, to repetition of exacerbations of pyelonephritis.
Pregnancy at the women sick with diabetes, proceeds with a large number of serious complications. Gestoz develops at 30 - 70% of women. It is shown mainly by increase of arterial pressure and hypostases, but also severe forms of a gestoz up to an eklampsiya are frequent (convulsive attacks with loss of consciousness). At a combination of a gestoz and diabetic damage of kidneys danger to mother`s life sharply increases as the renal failure owing to considerable deterioration in function of kidneys can develop. Mertvorozhdayemost frequency at a gestoza at patients with diabetes makes 18 - 46%.
Spontaneous interruption of pregnancy happens at 15 - 31% of women in 20 - 27 weeks of pregnancy or earlier. But at implementation of careful supervision and treatment threat of a spontaneous abortion does not exceed that at healthy women. Premature birth is frequent, the women sick with diabetes, seldom wears to the term of childbirth. 20 - 60% of pregnant women can have an abundance of water. At a mnogovodiya often diagnose malformations of a fruit and a mertvorozhdayemost (for 29%). The pre-natal death of a fruit occurs usually in 36 - 38 weeks of pregnancy. It happens to a thicket at a large fruit, displays of diabetes and a gestoza. If abundance of water and malformations of a fruit are diagnosed during pregnancy, then, perhaps, doctors will raise a question of a rodovozbuzhdeniye in 38 weeks.
Childbirth not always proceeds safely for mother and a fruit from - for the large sizes of the last causing traumatism - both maternal, and children`s.the Frequency of postnatal infectious complications at patients with diabetes is significantly higher than
, than at healthy women. The insufficient lactation is observed.
From - for deteriorations in a course of disease during pregnancy and increase in frequency of complications of pregnancy not all women having diabetes can transfer pregnancy and childbirth safely. Pregnancy is contraindicated:
- at diabetic mikrangiopatiya (defeat of small vessels of various bodies),
- at insulinrezistentny forms of an illness (when treatment by insulin does not help),
- at a disease of diabetes of both spouses (danger of a hereditary disease of the child is big),
- at a combination of diabetes and a Rhesus factor - the conflict (a state at which erythrocytes a Rhesus factor - a positive fruit collapse the antibodies developed in an organism a Rhesus factor - negative mother),
- at a combination of diabetes and active tuberculosis,
- in the presence in the past at the woman of the repeated still births or children who were born with malformations.
If pregnancy proceeds safely, diabetes is compensated, childbirth has to be timely and is carried out in natural patrimonial ways. At insufficiently compensated diabetes or at the complicated course of pregnancy carry out a premature rodorazresheniye in 37 weeks. Quite often patients with diabetes have a need of an operational rodorazresheniye by Cesarean section.
Children at the women sick with diabetes, are born large at the expense of fatty tissue (weight more than 4500 g, height of 55 - 60 cm). The diabetic fetopatiya is characteristic of them: puffiness, cyanosis (cyanotic coloring of skin), a crescent-shaped face (the roundish person from - for features of adjournment of fat), excess adjournment of fat, immaturity. These children adapt in the early postnatal period much worse that is shown by development of jaundice, considerable loss of body weight and its slow restoration. Other extreme - a fruit hypotrophy (small body weight) - meets at diabetes in 20% of cases.Congenital malformations are observed by
by 2 - 4 times more often than at normal pregnancy. Risk factors of their emergence at diabetes are bad control of diabetes before conception, illness duration over 10 years and diabetic pathology of vessels. It is impossible to exclude also the genetic reasons. Assume that already at the earliest stages of pregnancy the hyperglycemia breaks formation of bodies. By 5 times more often than at healthy women, children with heart diseases are born, it is frequent with damages of kidneys, a brain and intestinal anomalies. Malformations incompatible with life meet in 2,6% of cases.
Prenatal violations of development manages to be revealed by special researches.
the Risk of development of diabetes in posterity at a disease of diabetes of one of parents makes 2 - 6%, they are 20%.
Treatment of diabetes
the Woman sick with diabetes has to
even before pregnancy under supervision of the doctor reach full compensation of diabetes) and to support this state throughout pregnancy.
the Basic principle of treatment of diabetes during pregnancy - aspiration to full compensation of a disease by an adequate insulinoterapiya in combination with a balanced diet.the Diet of the pregnant women sick with diabetes is surely coordinated by
with the doctor - the endocrinologist. It contains the reduced amount of carbohydrates (200 - 250), fats (60 - 70 g) and normal or even the increased amount of proteins (1 - 2 g on 1 kg of body weight); power value - 2000 - 2200 kcal. At obesity the subhigh-calorie diet is required: 1600 - 1900 kcal. It is very important to consume the same amount of carbohydrates daily. Meal has to coincide on time with the beginning and the maximum effect of insulin therefore the patients accepting the combined insulin preparations (the prolonged and simple insulin) have to receive the products rich with carbohydrates, in one and a half and 5 hours after insulin introduction, and also before going to bed and when awakening. The use of quickly soaking up carbohydrates is forbidden: sugar, candies, jam, honey, ice cream, chocolate, cakes, sweet drinks, grape juice, semolina and rice porridges. At pregnant women with diabetes without obesity such diet contributes to normalization of body weight of newborns. Food of the pregnant woman having diabetes has to be fractional, 8 times a day are desirable. During pregnancy sick with diabetes has to put on weight no more than 10 - 12 kg., vitamins A, groups B, C, and D, folic acid (400 mkg a day) and potassium iodide are necessary for
In a diet of the pregnant women sick with diabetes (200 mkg a day).If in 2 weeks of treatment by a diet at least twice figures of glucose turn out
raised, pass to an insulinoterapiya. Too rapid growth of a fruit even at the normal level of sugar in blood is also the indication for treatment by insulin. The insulin dose, quantity of injections and time of introduction of a preparation are appointed and controlled by the doctor. In order to avoid lipodistrofiya (lack of hypodermic cellulose in places of injections it is necessary to enter insulin into the same place not more often than 1 time in 7 days.At easy forms of diabetes phytotherapy application is admissible
. A number of plants possesses hypoglycemic properties. For example, it is possible to make bilberry leaves (60 g) in boiled water liter, to insist 20 min., to filter to drink 100 ml of 4 - 5 times a day, it is long, under blood sugar control. It is possible to use the following collecting: 5 g of pods of haricot without seeds, 5 g of leaves of bilberry, 5 g of cut oat straw, 3 g of a linen seed, 2 g of the crushed root of a burdock to mix, fill in 600 ml of boiled water, to boil 5 min., to insist 20 min., to filter. To drink 50 ml of 6 times a day 4 - 6 months.Krom of a diet and insulin sick diabetes physical activity is useful to
; in this case the working muscles consume glucose and content of sugar in blood decreases. Foot walks are recommended to pregnant women as physical exercises.Patients with diabetes have to use
for self-checking glyukometry, diagnostic strips, however it is impossible to make the diagnosis of diabetes on the basis of these researches since they are insufficiently exact.
Everything described above belongs to diabetes 1 - go type is diabetes which arises at young age, at it formation of insulin in a pancreas is always broken. Occur at pregnant women diabetes 2 much less often - go type and diabetes of pregnant women.
Diabetes 2 - go type arises at people 30 years are more senior, it is frequent against aboutzhireniye. At this form of diabetes the condition of bodies of reproduction is almost not broken. However the risk of development of diabetes in posterity is very big. The women sick with diabetes 2 - go like, as a rule, give birth at the full-term pregnancy.to
Anti-diabetic means (not insulin) in the form of tablets which treat diabetes 2 - go type are contraindicated to pregnant women: they pass through a placenta and have the damaging effect on a fruit (causing formation of malformations of a fruit) therefore at diabetes 2 - go type to pregnant women also appoint insulin.
Diabetes of pregnant women occurs at 4% of women. This form of diabetes develops in pregnancy time, passes soon after its termination. It develops at corpulent women in the presence of diabetes at relatives. On its existence can specify the burdened obstetric anamnesis (a spontaneous abortion, a still birth, abundance of water, the birth in the past of large children). This form of diabetes by means of special test on tolerance to glucose comes to light, is more often in 27 - 32 weeks of pregnancy. Diabetes of pregnant women disappears in 2 - 12 weeks after the delivery. Within the next 10 - 20 years at these women diabetes as a chronic disease quite often develops. Pregnancy at diabetes of pregnant women proceeds the same as at diabetes 2 - go type.
About 25% of women with diabetes of pregnant women need an insulinoterapiya.
Pregnancy - serious test for health of the woman having diabetes. Its safe end requires scrupulous implementation of all recommendations of the doctor - the endocrinologist.