Gestational diabetes – a special form of diabetes which develops at women during pregnancy because of a hormonal imbalance. The main symptom of this disease is increase in level of glucose in blood after meal and preservation of an indicator is normal on an empty stomach. Gestational diabetes poses a threat for a fruit as can become the reason of development of congenital anomalies of heart and brain. For the purpose of early detection of pathology test for tolerance to glucose is shown to women during 24-28 weeks. Treatment of gestational diabetes assumes observance of a diet, work-rest schedule, in hard cases insulin therapy is appointed.
Gestational diabetes or diabetes of pregnant women – the disease developing owing to violation of carbohydrate exchange in the woman's organism against the background of insulin resistance (lack of a susceptibility of cages to insulin). In obstetrics such pathology is diagnosed approximately for 3-4% of all pregnant women. Most often primary increase in level of glucose in blood is defined at patients whose age makes less than 18 or more 30 years. The first symptoms of gestational diabetes usually appear in 2-3 trimester and independently disappear after the child's birth.
Sometimes gestational diabetes becomes the reason of development of diabetes 2 types at women after the delivery. Similar is observed approximately at 10-15% of patients with such diagnosis. According to researches of scientists, gestational diabetes is diagnosed more often for female black representatives. Danger of a disease to a fruit is that because of increase in glucose in mother's blood the organism of the kid begins to produce insulin actively. Therefore after the birth such children are inclined to decrease in level of sugar in blood. Besides, gestational diabetes promotes rapid increase in mass of a fruit during pre-natal development.
Reasons of gestational diabetes
Etiopatogenez of gestational diabetes is authentically not found out. Scientists assume that the disease develops owing to blocking of production of enough insulin hormones which are responsible for the correct growth and development of a fruit. At pregnancy the organism of the woman needs bigger amount of glucose which is required not only for mother, but also for the kid. There is a compensatory increase in production of insulin. These factors become the main reason for gestational diabetes. Against the background of disorder of functions of β-cells of a pancreas increase in level of pro-insulin is noted.
The autoimmune diseases promoting destruction of a pancreas and, as a result, decrease in production of insulin can become the reason of gestational diabetes. At patients whose relatives suffer from any form of diabetes the risk of development of this pathology increases twice. One more frequent cause of infringement – obesity as it already assumes violation of exchange processes in an organism of future mother. Gestational diabetes can arise if on early terms of pregnancy the woman had viral infections which promoted disorder of work of a pancreas.
The women suffering from a syndrome of polycystous ovaries inclined to addictions – to smoking, the use of alcoholic and narcotic substances get into risk group on development of gestational diabetes. The burdening factors are the birth of a large fruit, a still birth, abundance of water in the anamnesis, gestational diabetes at the previous pregnancies. The high risk of developing of pathology is noted at patients is younger 18 and 30 years are more senior. In addition the unbalanced food assuming the use of a large number of the products rich with bystry carbohydrates can provoke violation development.
Symptoms and diagnosis of gestational diabetes
Gestational diabetes has no specific symptomatology. The main symptom of pathology is increase in concentration of glucose in blood that before pregnancy at the woman was not observed. This violation is most often diagnosed for patients after the 20th week of incubation. In addition at gestational diabetes excessive increase in body weight of the patient (more than 300 g a week), strong feeling of thirst, increase in a daily diuresis can be observed. Also patients complain of a loss of appetite, quickly arising fatigue. From a fruit the bystry gain of weight, the wrong proportions of parts of a body, excess adjournment of fatty cellulose can become a sign of development of gestational diabetes.
The main method of detection of gestational diabetes is blood test on determination of level of glucose. The obstetrician-gynecologist directs all women at registration on pregnancy to this analysis. Patients at whom at blood test, taken from a finger, the amount of glucose made 4,8-6,0 mmol/l, from a vein – 5,3 to 6,9 mmol/l enter into risk group of development of gestational diabetes. If there are such indicators, to the woman the test with loading glucose which allows to reveal disorders of carbohydrate exchange at early stages is appointed.
Also for definition of functionality of a pancreas and risk of formation of gestational diabetes routinely to all pregnant women on the term of 24-28 weeks the oral tolerance test to glucose is appointed. In the beginning blood test from a vein on an empty stomach then the woman has to drink 75 g of the glucose divorced in 300 ml of water is made. 2 hours later blood sampling repeat. The diagnosis "gestational diabetes" is established if the first indicator of level of glucose makes more than 7 mmol/l, the second – more than 7,8 mmol/l. for its confirmation of the pregnant woman appoint one more analysis in several hours on the same day.
Treatment of gestational diabetes
At gestational diabetes treatment is carried out in out-patient conditions. First of all, the patient is recommended to reconsider a diet. The diet is directed to decrease in level of glucose in blood therefore the woman should exclude the products containing bystry carbohydrates from the menu: confectionery, starchy vegetables. Fruit need to be used moderately and not really sweet. Under a ban at gestational diabetes there are fat and fried dishes, fast food, store sauces, fancy bread. It is possible to replace these products with cabbage, mushrooms, vegetable marrows, bean, greens. Besides, at gestational diabetes it is necessary to include in the menu low-fat fish and meat, grain, cereal porridges, macaroni of firm grades, vegetables. Once a week it is possible to allow presence at a diet of red fish.
Making a diet for the pregnant woman with gestational diabetes, it is important to provide sufficient intake of the vitamins and minerals necessary for the correct growth and development of a fruit. Carbohydrates have to make 45% of diet value, fats – 30%, proteins – 25%. At gestational diabetes of the pregnant woman it is necessary to eat small portions, but it is frequent – 3 main meals and 2-3 having a snack. It is necessary to prepare easily acquired dishes, optimal variants – boiled products, on couple, baked. The drinking mode assumes the use not less than 1,5 l of liquid a day.
Moderate physical activities are recommended to patients with gestational diabetes. They allow to support an organism in a tone, warn an excessive set of body weight. Besides, exercises promote increase in activity of insulin that is important at gestational diabetes. Physical activity assumes gymnastic activity, pedestrian walking, swimming. It is necessary to avoid sharp movements, exercises directed to muscle work of an abdominal tension. Level of loading is defined by endurance of the woman and is established by the doctor.
The woman with gestational diabetes daily has to control glucose level in blood, measurements are taken on an empty stomach and in 60 minutes after each meal. If a dietotherapy in total with physical exercises do not give positive effect, to the patient with gestational diabetes insulin pricks are appointed. The dosage of medicine is defined by the expert. Conducting pregnancy at such diagnosis is continued up to 38-40 weeks. Rodorazresheniye is most often carried out by Cesarean section as the fruit has the big sizes that poses a threat of development of complications at natural development of patrimonial process.
At gestational diabetes the child is born with the lowered glucose level in blood, however the indicator returns to normal at usual feeding by breast milk or the adapted mixes. Surely control concentration of sugar in blood of mother and child. After the delivery the woman with gestational diabetes has to keep some time to the diet appointed during pregnancy and to measure glucose level to avoid development of diabetes 2 types. As a rule, indicators come back to norm in the first months after the birth of the kid.
Forecast and prevention of gestational diabetes
In general at gestational diabetes the forecast for mother and the child favorable. At such disease there is a risk of development of a macrosomia – the excessive growth of a fruit, and also increase in body weight of the woman. At a macrosomia the brain of the child keeps the natural sizes, and the humeral belt increases. These consequences of gestational diabetes can become the reason of injuries during natural childbirth. If on ultrasonography reveal a large fruit, the doctor can recommend a premature rodorazresheniye that also constitutes a certain danger as, despite the big sizes, the kid remains insufficiently mature.
Prevention of gestational diabetes consists in planning of pregnancy and control of body weight. The woman has to eat, refuse addictions properly. Surely it is necessary to adhere to active lifestyle as moderate physical activities allow to reduce probability of development of gestational diabetes. It is important that exercises were regular and did not bring the pregnant woman of discomfort.