Gestational diabetes mellitus during pregnancy

What is glucose and why does the body need it? Glucose (dextrose) plays a very important role in the human body, since it is a universal source of energy, a nutrient and an antitoxic agent. Dextrose is directly involved in the metabolic process that constantly occurs in the human body. What is the importance of glucose during pregnancy? The presence of a monosaccharide is essential to ensure normal growth and development of the fetus. However, it should be remembered that an excess of any component does not bring positive results.

Where is glucose found?

Glucose is found in many foods:

• fruits
• berries
• sweets
• honey
• sugar
• some cereals
• beans
• vegetables and other products.

The amount of monosaccharide content in each of them is completely different. For example, 1 kg of sugar contains 999.8 grams of glucose, and 1 kg of white cabbage contains 167 grams. Therefore, you should remember that some foods should be consumed in moderation due to their high glucose content. Of course, the body of the expectant mother and her child needs glucose, but only in regulated quantities. It not only provides the body with energy, but also helps the normal functioning of the heart, liver, relieves stress and removes toxins.

The human body is designed in such a way that it is able to regulate blood sugar levels on its own. Thanks to special hormones, this process is controlled at the intracellular level. The main hormone responsible for reducing the concentration of glucose in the blood is called insulin. For various reasons, the process of regulating the level and concentration of dextrose may be disrupted, which can provoke a pathological process and the development of a complex disease. That is why pregnant women need to carefully monitor not only the general condition of the body, but also the sugar level throughout pregnancy.

When is glucose needed during pregnancy?

Why is glucose solution given to pregnant women? Indications for dextrose monohydrate therapy for pregnant women are:

• low fetal weight;
• low sugar levels;
• intestinal infection;
• experienced state of shock;
• water balance disturbance;
• low blood pressure;
• myocardial or liver dysfunction.

Often, women during pregnancy are prescribed a combination of drugs: vitamin C + glucose (dropper). Why is this procedure recommended? The introduction of these two drugs strengthens the body of the expectant mother, synchronizes the work of various systems, and reduces the risk of miscarriage.

How to determine your sugar level?

The concentration of the monosaccharide in the blood can be determined using a biochemical blood test, urine test, or using a glucometer. Almost every clinic and hospital does a comprehensive blood test, including blood sugar levels. There is neither time nor desire to go to the hospital often, so expectant mothers often use a modern device called a glucometer, for example Diacont or OneTouch.

This high-tech device is designed to independently measure blood sugar levels and diagnose the state of carbohydrate metabolism. The analysis should be carried out exclusively on an empty stomach or some time after eating (7-8 hours). The fact is that the concentration of glucose increases sharply after the entry of fats, carbohydrates or proteins into the human body. Therefore, it is not advisable to carry out diagnostics right away; the indicators will be distorted.

The level of glucose concentration in the blood of a woman carrying a child can range from 3.1 to 6.6 mmol/l. Pregnant women very often experience temporary hyperglycemia (increased levels of dextrose in the body), which is evidence of insufficient insulin. Scientists believe that pathological changes occur due to a double load on the pancreas and a decrease in the amount of essential amino acids.

During the period of bearing a child, you need to be extremely careful about glucose concentration indicators. At this time, a woman is most at risk of developing diabetes.

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While expecting a baby, expectant mothers are constantly prescribed various laboratory tests, so based on their indicators, the condition of the mother and child can be monitored, and appropriate measures can be taken in a timely manner.

Glucose testing is prescribed to pregnant women more often than others, and this is no coincidence. During pregnancy, gestational diabetes often develops, which can lead to serious complications. Therefore, it is simply necessary to monitor your blood sugar levels throughout your pregnancy.

Glucose is vital for us; it is a universal source of energy. It is involved in all metabolic processes and is the only “fuel” for the brain. After sweet food enters the body, insulin is released into the blood by the pancreas, which allows glucose to enter the cell. Pregnancy is characterized by significant hormonal fluctuations, and insulin concentrations also often change. This can lead to diabetes.

A sugar test is prescribed in the early morning on an empty stomach. You should not consume sweets for 12 hours beforehand. You are allowed to drink water. Optimal values: from a finger: 3.3 – 5.5 mm/l, from a vein – 4.0 – 6.4 mm/l. A false positive result can occur due to an unstable emotional state typical of expectant mothers. If the numbers are high, you should calm down and retake the test again.

A value below 3.3 mm/l can also be dangerous. Glucose is necessary for the baby for the development of the nervous system, so a strong decrease should not be allowed.

If a pregnant woman has donated blood several times, and each time the sugar level is more than 5.5 mm/l, then in the 2nd trimester a glucose tolerance for a more accurate diagnosis.

You need to be prepared to perform this analysis. For 3 days, the patient needs to eat 140 g of pure carbohydrates per day. You should not eat any food 12 hours before blood collection. You are allowed to drink plain water.

On the day of the study, the patient is asked to drink a sweet solution containing 80 g of pure glucose. The concentration is measured immediately and then every 60 minutes twice.

If there are no violations, after 2 hours glucose levels should be below 7.8 mm/l. At a level of 7.8 to 11.1 mm/l, impaired tolerance is diagnosed, and from this point on the patient should be closely monitored.

There are situations when a tolerance test is carried out even with normal sugar levels:

• Obesity (before and during pregnancy);
• Increased glucose in previous pregnancies, large fetus;
• Family history of diabetes mellitus.

However, this test is contraindicated if you have the following conditions:

• Pathology of the liver and gall bladder;
• Diseases of the pancreas in the acute stage;
• Peptic ulcers of the gastrointestinal tract;
• Infectious diseases;
• Severe toxicosis.

It should be noted that the study is informative before the onset of the third trimester. Carrying it out after 30 weeks is not advisable.

If a pregnant woman has a persistent increase in glucose, then she should purchase a glucometer - a device for measuring sugar at home. Test strips must be stored under proper conditions to avoid false results.

Constant monitoring of blood sugar in pregnant women will help prevent the development of complications in mother and baby and ensure the normal course of labor.

How to protect yourself and your child?

At 6-7 months of pregnancy, experts advise women to undergo a specialized oral glucose tolerance test. This unique testing allows you to most accurately determine the body's response to glucose. It is carried out in several stages:

• 50 grams of glucose is taken orally. After taking the monosaccharide, the main indicators of blood sugar levels are diagnosed. If after an hour they exceed 7.6 mmol/l, then a similar 3-hour test is prescribed.
• Not 50, but 100 grams of glucose are taken again. Measurements are taken 3 times: after 1 hour, 2 hours and 3 hours. The first indicator should not exceed 10 mmol/l, the second – 9.2 mmol/l, the third – 8 mmol/l. If the indicators are the same or higher, then this indicates impaired glucose tolerance. As a rule, a woman with such indicators is given a disappointing diagnosis - type 2 diabetes. The attending physician prescribes comprehensive treatment, including a strict diet and drug therapy.

How to do the test

The analysis includes 3 stages:

Stage 1

• half an hour before taking the test, the expectant mother needs to completely relax;
• A medical professional takes venous blood and immediately sends it to the laboratory.

These data make it possible for the doctor to diagnose “gestational diabetes” (sugar above 5.0 mmol/l). If the indicators are contradictory, then the second stage is carried out.

Stage 2

The woman is given a sugar solution to drink (75 g of dry glucose is dissolved in a glass of warm water). The pregnant woman drinks it within 5 minutes and remains in a sitting position for about an hour. When the time is up, blood sampling is repeated.

Stage 3

After a couple of hours, blood is taken again. And the doctor either confirms or does not confirm the diagnosis.

What is the main cause of glucose intolerance?

The main cause of glucose intolerance is insulin resistance. This process is characterized by a disruption in the metabolic mechanism's response to insulin, which leads to the development of diabetes mellitus. Scientists around the world are still arguing about why some people experience this disorder and others do not. Since not all medications can be used during pregnancy, the first thing that is recommended is a strict diet. The diet is developed by a specialist taking into account the weight, calorie content of foods and the daily intake of nutrients for the normal development of the child and the condition of the mother. Naturally, nutrition is selected individually, but the general dietary standards include: about 55-60% - proper carbohydrates, 25-30% - normal fats, 12% - 20% - proteins. On a daily basis, you need to measure your blood sugar levels in two ways: on an empty stomach and no earlier than an hour after eating. If blood sugar levels decrease, treatment is limited only to diet. Drug treatment (insulin therapy) is prescribed only if diet does not help and blood glucose levels do not decrease or increase.

The dosage is also determined individually after consultation with your doctor. Type 2 diabetes mellitus is classified as a complex endocrine disease, and occurs in women not at the initial stage of gestation, but at 6-8 months of pregnancy, which complicates treatment. The disease is caused by hormonal imbalance, poor diet or obesity. Type 2 diabetes mellitus in rare cases causes pathogenic development of the fetus or termination of pregnancy. But, like any complex disease, it can affect the genetic level. In 70% of cases, the baby is born completely healthy, and the mother’s blood sugar level is normalized. But still, in 30% of women, the indicators remain unchanged, and the disease can progress.

To prevent yourself and your child from developing diabetes, you need to eat right from the first trimester of pregnancy, move more, breathe fresh air, monitor your weight and get a charge of positive emotions.

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Contraindications to GTG

The sugar solution is too sweet and not every pregnant woman can drink it without experiencing an attack of nausea. Therefore, if the expectant mother has toxicosis, then such a test is not performed.

There are also a number of contraindications:

• peptic ulcers;
• liver dysfunction;
• acute stomach;
• late stages of pregnancy (above 32 weeks);
• chronic and inflammatory processes.

The first testing is carried out at 16-18 weeks. The second study is 24-28 weeks. If necessary, testing is carried out in the third trimester, but no later than 32 weeks.

Alternative Methods

Many women do not agree to undergo a GTG test. Since not everyone can tolerate it, and most women experience nausea, dizziness and weakness. Therefore, there is an alternative option for detecting gestational diabetes. This is the calculation of glycated hemoglobin.

The analysis shows blood sugar saturation over the past 3 months. In gestational diabetes, glycated hemoglobin is at the level of 6-6.5%.

You can also use a home glucometer to determine blood sugar, which allows you to quickly and easily set your glucose level. Glycemic levels are usually measured on an empty stomach, after a night's sleep.

Causes of Gestational Diabetes

The exact mechanism of the disease is still not completely clear.
Doctors are inclined to believe that the hormones responsible for the proper development of the fetus block the production of insulin, which leads to disruption of carbohydrate metabolism. During pregnancy, more glucose is required for both the woman and the baby. The body compensates for this need by suppressing insulin production. There are other possible causes of gestational diabetes, such as autoimmune diseases that destroy the pancreas. In principle, any pancreatic pathology can increase the risk of diabetes during pregnancy.

Preventing Gestational Diabetes

Unfortunately, there are no 100% effective measures that would protect against this disease.
But the more useful habits a woman develops before pregnancy, the easier pregnancy and childbirth will be:

• From the first days of pregnancy, eat healthy foods: choose foods high in fiber and low in fat. Focus on vegetables and whole grains. Strive for variety and watch portion sizes.
• Stay active. Try to devote 30 minutes to sports every day. Take daily walks, ride a bike, or go swimming.
• Plan your pregnancy at a healthy weight and don't gain more than recommended. Excessively rapid weight gain can increase the risk of gestational diabetes.

Although there is no universal protection against GDM, you can reduce your risk of developing it through a healthy lifestyle.
The most important thing is to detect the problem in time and prevent it from developing. Author:

Baktyshev Alexey Ilyich, General Practitioner (family doctor), Ultrasound Doctor, Chief Physician

The dangers of diabetes during pregnancy

This pathological condition threatens the health of both mother and child.
Even before birth, the fetus begins to actively produce insulin to compensate for the increased glucose in the mother’s blood. Such children are prone to low blood sugar from birth, and they have a higher risk of obesity and type II diabetes in adulthood. Gestational diabetes increases the risk of high blood pressure, as well as preeclampsia, a severe form of preeclampsia. It manifests itself as headaches, nausea, vomiting, blurred vision, lethargy, drowsiness or insomnia. This is one of the most severe disorders during pregnancy, affecting the central nervous system.

Another alarming factor is that diabetes during pregnancy contributes to rapid weight gain in the baby during the prenatal period (macrosomia). This causes difficulties during childbirth and poses a threat to the mother. A child over 4 kg is considered large. These babies have a higher risk of birth injuries and are more likely to require a caesarean section. Due to the large size of the fetus, early delivery may be required. At the same time, the risk of premature birth is high.

Also, high sugar in pregnant women increases the risk of cardiovascular and nervous pathologies of the fetus, increases the risk of respiratory distress syndrome in the baby (a condition that makes breathing difficult) and generally increases the frequency of complications during pregnancy and childbirth.