Gestational diabetes of
In pregnancy chronic diseases can become aggravated or appear signs of problems unknown earlier. Gestational diabetes can become such problem.
According to classification of World Health Organization, “gestational diabetes“ is the diabetes revealed during pregnancy and also violation of tolerance to the glucose (perceptions of glucose an organism) which is also revealed during this period. The reduced sensitivity of cages to own insulin is its reason (insulinorezistentnost) which is connected with high content in blood of hormones of pregnancy. After the delivery sugar level most often comes back to blood to norm. However it is impossible to exclude probability of development during pregnancy of diabetes of the first and second type. Diagnosis of these diseases is carried out after childbirth.
In the analysis of the data obtained as a result of multiple researches, doctors came to a conclusion that more, than at 50% of the pregnant women having gestational diabetes later during life true diabetes develops.
What risk factors of development of GSD?
- the Excess weight, obesity
- Diabetes at the immediate family
- Age of the pregnant woman more than 30 years
- the Burdened obstetric anamnesis: the Previous child was born
- weight more than 4000 grams
- of GSD in the previous pregnancy
- Chronic not incubation (early and late abortions) Mnogovodiye`s
- the Still birth
- Malformations at the previous children
What gestational diabetes is dangerous?
Gestational diabetes in the majority of clinical situations develops in the range from 16 till 32 weeks of pregnancy. The violations of a carbohydrate exchange revealed earlier, as a rule, speak about earlier unnoticed pregestatsionny (“doberemenny“) diabetes.
Of course, about chronic diseases to know before pregnancy better, and then an opportunity will compensate them as much as possible. For this reason of the doctor strongly recommend to plan pregnancy. In respect of preparation for pregnancy the woman will pass all main inspections, including on detection of diabetes. If violations of a carbohydrate exchange are revealed, the doctor will appoint treatment, will make recommendations, and future pregnancy will safely proceed, and the kid will be born healthy.
the Main condition of conducting the pregnancy complicated by diabetes (both gestational, and other its forms) - maintenance of level of glucose of blood within norm (3,5 - 5,5 mmol/l). Otherwise mother and the kid appear in very difficult conditions.
What threatens mother? Premature birth and still births are possible. The risk of development of a gestoz (at diabetes develops more often and earlier - till 30 weeks), a gidramniona and consequently, fetoplatsentarny insufficiency and a hypotrophy of a fruit is high. Development of diabetic ketoacidosis (a state at which sharp increase of level of glucose and concentration of ketone bodies in blood is noted), infections of a genital tract which are registered twice more often is possible and become the reason of infection of a fruit and premature birth. Perhaps also progressing of mikroangiopatiya from the outcome in violations of sight, functions of kidneys, violations of a blood-groove on vessels of a placenta and others. At the woman weakness of patrimonial activity which in combination with clinically narrow a basin and large a fruit will make inevitability a rodorazresheniye by Cesarean section can develop. At the women sick with diabetes, infectious complications in the postnatal period meet more often.
of Feature of a carbohydrate exchange between mother and the child are that
of Danger to the kid that the fruit receives glucose from mother, but does not receive insulin. Thus, the hyperglycemia (excess amount of glucose) especially in the first trimester when the fruit has still no own insulin, provokes development of various malformations of a fruit. After 12 weeks when in an organism of future kid the insulin is produced, the giperinsulinemiya which threatens with development of asphyxia and traumatism in labor, respiratory frustration (a respiratory distress - a syndrome) and hypoglycemic conditions of newborns develops. whether
the way to prevent these difficulties Is? Yes. The main thing - knowledge of a problem and its timely adjustment.
At first diagnostics...
the First point of diagnosis of gestational diabetes is the assessment of risk of its development. At statement of the woman on the account a number of indicators, for example, such as age and the pregnant woman`s weight, the obstetric anamnesis (existence of gestational diabetes is estimated at a maternity welfare unit during last pregnancies, the birth of children weighing more than 4 kg, a still birth and others), the family anamnesis (presence of SD at relatives) and so on. Such table is filled in:
|the Age of the woman is more senior than 30 years||Yes/no||yes||Less than 30|
|of SD 2 types at close relativesyes||is not present||there is no|
|of GSD in the anamnesis||yesthere is no||there is no|
|the Broken tolerance to glucose||yesthere is no||there is no|
|of Glyukozuriya in vremyapredshestvuyushchy or td does not have a dannoyberemennost >||yes||Yes/no|
|Gidramnion and the large fruit to a vanamnezaYes/no||yes||is not present|
|the child weighing more than 4000 Birth gil a still birth in the anamnesis||Yes / is not present||yesthere is no|
|the Fast increase of weight in vremyadanny pregnancy||Yes/no||yesthere is no|
|Excess weight (> td do not have 20% of ideal) >||Yes||yes|
Will pay attention to the Child Weighing More than 4 Kg Birth parameter. It is included in an assessment of risk of development of gestational diabetes not casually. The birth of such kid can demonstrate development in the future of both true diabetes, and gestational. Therefore, in the future the moment of conception needs to be planned and to constantly control sugar level in blood.Having determined by
risk of development of diabetes, the doctor chooses maintaining tactics.
the Scheme of diagnosis of gestational diabetes (the file in the ppt format - 330KB)
the Second step - blood sampling for the purpose of determination of level of sugar that has to be made several times for pregnancy. If at least once the content of glucose exceeded 5 mmol/l, conduct further examination, namely the glyukozotolerantny test.
When the test is considered positive? At test with loading of 50 g of glucose the assessment of level of a glycemia is made on an empty stomach and in 1 hour. In case glucose on an empty stomach exceeds 5,3 mmol/l, and in 1 hour value above of 7,8 mmol/l, then purpose of the test from 100 g of glucose is necessary.the Diagnosis of gestational diabetes is exposed to
if glucose on an empty stomach - more than 5,3 mmol/l, in 1 hour - is higher than 10,0 mmol/l, in 2 hours - it is higher than 8,6 mmol/l, in 3 hours - it is higher than 7,8 mmol/l. Important: increase only one of indicators does not give the grounds for statement of the diagnosis. In this case the test needs to be repeated once again in 2 weeks. Thus, increase of 2 and more indicators testifies to diabetes.
of the Rule of test:
- In 3 days prior to inspection the pregnant woman is on food, usual for herself and adheres to physical activity, usual for herself
- the Test is carried out in the morning on an empty stomach (after night starvation not less than 8 hours).
- After blood test capture on an empty stomach the patient has to drink the glucose solution consisting of 75 grams of the dry glucose dissolved in 250 - 300 ml of water within 5 minutes. Repeated sample of blood for determination of level of sugar of blood is taken in 2 hours after loading by glucose.
Normal values of a glycemia:
- a glycemia on an empty stomach - 3,3 - 5,5 mmol/l;
- a glycemia before meal (bazalno) 3,6 - 6,7 mmol/l;
- a glycemia in 2 hours after food of 5,0 - 7,8 mmol/l;
- a glycemia before withdrawal to a dream of 4,5 - 5,8 mmol/l;
- a glycemia in 3. 00 5,0 - 5,5 mmol/l.
If results of research meet standard, then repeatedly the test is carried out on 24 - 28 week of pregnancy when the hormonal background changes. On earlier terms of GSD often does not come to light, and establishment of the diagnosis after 28 weeks not always prevents development of complications in a fruit.
However pregnant women face not only high rates of sugar in blood. Sometimes blood test “shows“ a hypoglycemia - the low content of sugar in blood. Most often the hypoglycemia develops at starvation. During pregnancy glucose consumption by cages amplifies and therefore it is impossible to allow long breaks between meals and it is impossible “to go“ on the diet directed to weight loss at all. Also sometimes in analyses it is possible to meet boundary values which always demonstrate always higher risk of development of an illness therefore it is necessary to control strictly blood indicators, to adhere to recommendations of the doctor and to keep to the diet appointed by the expert.
Several words about treatment
to the Pregnant woman who faced diabetes needs to be seized a technique of independent control of a glycemia. In 70% of cases gestational diabetes is corrected by a diet. Production of insulin happens, and there is no need for an insulinoterapiya.
Basic principles of a dietotherapy:
- the Daily diet needs to be divided between carbohydrates, fats and proteins - 35 - 40%, 35 - 40% and 20 - 25% respectively.
- Caloric content in the conditions of excess weight has to make 25 kcal on 1 kg of weight or 30 - 35 kcal on 1 kg with a normal weight. To the women having excess weight recommendations about its decrease or stabilization are made. It is necessary to reduce food caloric content with special attention, without undertaking drastic measures.
- From the daily menu are excluded by digestible carbohydrates, that is any sweets. whether
to the healthy woman Should sound alarm if she wants some sweet?“ The love to sweet“ has to guard if in analyses there are changes. But anyway it is necessary to adhere to recommendations about food and not to go to far in sweet or still something. It is necessary to remember what to eat ““ the thicket wants something sweet from desire just to regale. Therefore “sweet“ it is possible to replace with fruit.
- to Reduce amount of the consumed fats, having enriched a diet with cellulose (fruit and vegetables) and proteins to 1,5 g/kg.
it (is corrected) by the attending physician.
Gestational diabetes so is called not only because demonstrates (is shown) during pregnancy. Other its feature consists that its signs disappear after the delivery. However if the woman had gestational diabetes, the risk of development true increases by 3 - 6 times. Therefore supervision over the woman and after the delivery is important. In 6 weeks carrying out research of a condition of a carbohydrate exchange of mother is after the delivery obligatory. If changes are not revealed, control of 1 times in 3 years is appointed, and at violation of tolerance to glucose - issue of recommendations about food and supervision once a year.In this case all subsequent pregnancies have to be planned by