Pregnancy and diabetes

Pregnancy. Whether there is an occasion to address to the endocrinologist?
A normal pregnancy is without a doubt a joyful period for a woman. Nevertheless, it is worth monitoring a number of endocrine parameters that will allow you not to miss thyroid dysfunction and gestational diabetes mellitus in the early stages.

Gestational diabetes mellitus is a disorder of carbohydrate metabolism that first appeared during pregnancy. This is a special type of diabetes mellitus, when blood sugar does not fit into the norm, but does not meet the criteria for overt diabetes mellitus. A feature of gestational diabetes is that it “passes” after childbirth.

Pregnancy and diabetes

Why does the disease occur?
Pregnancy is a physiological state of insulin resistance (decrease in sensitivity to your own insulin), which in itself is already a factor in a possible increase in blood sugar. Therefore, the level of blood glucose should be investigated and correctly assessed in all pregnant women without exception. The doctor also takes into account whether a woman is at risk for a violation of carbohydrate metabolism. These patients require close monitoring.

Who is at risk?
At risk are:

overweight women
women who have had gestational diabetes in the past
women over 30 years of age
women whose closest relatives (mother, father, brothers, sisters) have diabetes mellitus.
Why is gestational diabetes dangerous?
First of all, any type of diabetes is life-threatening, and gestational diabetes is no exception. This is an insidious disease that may not manifest itself for some time, but pose a threat to the mother and fetus / newborn.

And even if the pregnancy and childbirth ended safely and gestational diabetes mellitus “passed”, endocrinologists understand that both the child and the mother are at risk for the development of obesity, overt diabetes mellitus, and cardiovascular diseases throughout their entire life.

How to detect gestational diabetes?
First of all, to detect this disease, it is necessary to determine the glucose in the venous blood plasma. Capillary blood, and even more so the assessment of sugar by a glucometer, is not suitable in such a difficult situation. Evaluation of blood glucose levels should be carried out in all pregnant women without exception and repeatedly during pregnancy. For routine assessment, blood sampling is carried out strictly on an empty stomach (at least 8 and not more than 14 hours of fasting before the study).

So, if fasting plasma sugar (in this case, a single determination is sufficient) ≥5.1 mmol / l, but

In case of doubt in the diagnosis, at the gestational age of 24-26 weeks (in exceptional cases up to 32 weeks), a standard test with a load of 75 g of glucose is performed. This test is absolutely safe for the pregnant woman and the fetus within the specified time frame. If 1 hour after taking the glucose solution, blood sugar is ≥10 mmol / l, and after 2 hours ≥ 8.5 mmol / l, a diagnosis of gestational diabetes is established.

The second parameter to think about when pregnancy occurs is the function of the thyroid gland. Be sure to check the level of TSH. At the same time, the upper limit of the norm for this indicator in the first trimester of pregnancy is determined as 2.5 mU / l, and in the second and third as 3.0 mU / l (and not “as it is written in the form up to 4.94”). If the level of TSH does not fit into the target, the issue of prescribing thyroxine, a thyroid hormone, is necessarily discussed with the patient. This is necessary because uncompensated hypothyroidism during pregnancy poses a threat to the proper laying of the nervous system and the development of the fetal brain. The correct step would be to assess the level of free T4, and the level of antibodies to TPO in the first trimester of pregnancy.

What other diabetes can occur during pregnancy?
Of course, no one is immune from the development of overt diabetes mellitus, incl. and during pregnancy. If fasting plasma glucose is detected ≥7 mmol / l, or during the day (regardless of food intake) ≥11.1 mmol / l, and the woman has clinical manifestations of hyperglycemia (dry mouth, thirst, frequent urination), a diagnosis is made explicit (manifest) diabetes mellitus and its type is determined.

How to treat gestational diabetes?
If a disease is detected, diet therapy is prescribed, against which the blood glucose level is assessed for two weeks. In the absence of compensation for carbohydrate metabolism (target glycemic levels are discussed in person in consultation with a doctor), insulin therapy is prescribed for the period of pregnancy.

What about after childbirth?
With gestational diabetes mellitus after childbirth, insulin therapy is canceled, but the issue of assessing the state of carbohydrate metabolism will need to be returned in 1.5-2 months.

In conclusion, I would like to say that there are many parameters that need to be assessed during pregnancy, and what we have just talked about is only a small part of the list. It is more correct, having learned about such a happy event in the life of every woman as pregnancy, to contact an endocrinologist for a discussion

the necessary examination plan and discussion of treatment, if necessary.

In order for your pregnancy to proceed most safely for you and your child, in our Polyclinic EXPERT we offer the necessary examination to clarify the function of the thyroid gland and the state of carbohydrate metabolism during this very important period.

If deviations of indicators from the norm adopted for pregnant women are detected, it is necessary to consult an endocrinologist with a mandatory discussion of the results of the examination and clarification of further tactics for managing pregnancy.