Pregnancy with diabetes mellitus: how sugar affects the bearing of a child and how to prevent the development of complications

If there is an insulin deficiency in the body, diabetes mellitus occurs.

Previously, when this hormone was not used as a medicine, women with this pathology had practically no chance of childbirth. Only 5% of them could become pregnant, and the fetal mortality rate was almost 60%!

In modern times, diabetes in pregnant women has ceased to be a fatal threat, since insulin treatment allows most women to carry and give birth without complications.

Statistics

The problem of pregnancy complicated by diabetes mellitus (DM) is constantly in the center of attention of endocrinologists and obstetricians, since it is associated with frequent complications in the perinatal period and threatens the health of the expectant mother and child.

According to statistics, in our country, type 1 and type 2 diabetes is diagnosed in 1-2% of women in labor. In addition, a distinction is made between pregestational (1% of cases) and gestational diabetes (or GDM). 

The peculiarity of the latter disease is that it develops only in the perinatal period. GDM complicates up to 14% of pregnancies (world practice). In Russia, this pathology is detected in 1-5% of patients.

“12817”] The number of pregnant women with diabetes has been steadily increasing in recent years. The number of successful births in such patients is also growing. According to statistics, diabetes is detected in 2-3 pregnant women out of 100. A quarter of patients with GDM require insulin therapy.

Pregnancy diabetes, as GDM is often called, is diagnosed in obese women with poor genetics (relatives with conventional diabetes). As for diabetes insipidus in women in labor, this pathology is quite rare and accounts for less than 1% of cases.

Reasons for the appearance

The main reason is weight gain and the beginning of hormonal changes in the body.

Tissue cells gradually lose the ability to absorb insulin (become rigid).

As a result, the available hormone is no longer sufficient to maintain the required amount of sugar in the blood: although insulin continues to be produced, it cannot perform its functions.

Pregnancy with existing diabetes mellitus

Women should be aware that taking anti-sugar drugs is contraindicated for them during pregnancy. All patients are prescribed insulin therapy.

As a rule, in the first trimester, the need for it decreases slightly. In the second, it increases by 2 times, and in the third, it decreases again. At this time, you must strictly follow the diet. It is undesirable to use all kinds of sweeteners.

For gestational diabetes, a protein-fat diet is recommended. It is important not to eat very fatty foods: sausages and lard, high-calorie milk. Reducing carbohydrate foods in a pregnant woman’s diet will reduce the risk of developing an oversized fetus.  

To reduce the glycemic values ​​in the perinatal period, it is recommended to eat a minimum of carbohydrates in the morning. It is necessary to constantly monitor blood counts. Although mild hyperglycemia during pregnancy is not considered a dangerous condition, it is best avoided.

“12817”] With type 2 diabetes and GDM, reasonable physical activity (light exercise, walks) is shown to help improve glycemic values.

Pregnant women with type 1 diabetes may also have hypoglycemia. In this case, it is necessary to be regularly monitored by an endocrinologist and gynecologist.

How does the disease affect the bearing of the fetus?

Sugar disease aggravates the course of pregnancy. Its danger is that glycemia can provoke: at an early stage – malformations in the development of the fetus and spontaneous abortions, and at a later stage – polyhydramnios, which is dangerous for a relapse of premature birth.

A woman is prone to diabetes if the following risks are present:

• dynamics of vascular complications of the kidneys and retina;
• ischemia of the heart;
• the development of preeclampsia (toxicosis) and other complications of pregnancy.

Babies born to such mothers often have a large weight: 4.5 kg. This is due to an increased supply of maternal glucose to the placenta and then to the baby’s blood.

In this case, the fetal pancreas additionally synthesizes insulin and stimulates the growth of the baby.

During pregnancy, diabetes manifests itself in different ways:

• for 1 trimester, the attenuation of pathology is characteristic: blood glucose levels decrease. In order to prevent hypoglycemia at this stage, the dose of insulin is reduced by a third;
• diabetes progresses again from the 13th week of pregnancy. Hypoglycemia is possible, so the dose of insulin is increased;
• at 32 weeks and until delivery, the course of diabetes improves, glycemia may appear, and the insulin dose is again increased by a third;
• immediately after childbirth, blood sugar first decreases and then increases, reaching its prenatal levels by the 10th day.

In connection with such a complex dynamics of the course of diabetes, a woman is hospitalized.

Diagnostics

Diabetes mellitus is considered established if, according to the results of laboratory tests, blood glucose values ​​(on an empty stomach) are 7 mmol / L (from a vein) or more than 6.1 mmol / L (from a finger).

If diabetes is suspected, a glucose tolerance test is prescribed.

Another important symptom of diabetes is urinary sugar, but only in combination with hypoglycemia. Sugar disease disrupts fat and carbohydrate metabolism in the body, provoking ketonemia. If the glucose level is stable and normal, diabetes is considered compensated.

Possible complications

The perinatal period with diabetes mellitus is associated with multiple complications.

The most common is spontaneous abortion (15-30% of cases) at 20-27 weeks.

There are also late toxicosis associated with the patient’s kidney pathologies (6%), urinary tract infection (16%), polyhydramnios (22-30%) and other factors. Gestosis often develops (35-70% of women).

If renal failure is added to this pathology, the likelihood of stillbirth increases sharply (20-45% of cases). Half of women in labor may have polyhydramnios.

Pregnancy is contraindicated if:

• there is microangiopathy;
• insulin treatment does not work;
• both spouses have diabetes;
• combination of diabetes and tuberculosis;
• in the past, the woman had repeated stillbirths;
• diabetes is combined with Rh-conflict in mother and child.

With compensated diabetes, pregnancy and childbirth go well. If the pathology does not disappear, the question is raised about premature delivery or caesarean section.

“12817”] Today, mortality among women in labor with diabetes is very rare and is associated with an extremely poor state of blood vessels.

With diabetes in one of the parents, the risk of developing this pathology in the offspring is 2-6%, in both – up to 20%. All of these complications worsen the prognosis of normal childbirth. The postpartum period is often associated with infectious diseases.

Treatment principles

It is very important to remember here that a woman with diabetes should be seen by a doctor even before pregnancy. The disease must be fully compensated for as a result of competent insulin therapy and diet.

The patient’s nutrition must be consistent with the endocrinologist and contain a minimum of carbohydrate foods and fats.

The amount of protein foods should be slightly overestimated. Be sure to take vitamins A, C, D, B, iodine preparations and folic acid.

It is important to monitor the amount of carbohydrates and correctly combine meals with insulin preparations. Various sweets, semolina and rice porridge, grape juice should be excluded from the diet. Watch your weight! During the entire period of pregnancy, a woman should not gain more than 10-11 kilograms.

Allowed and prohibited foods for diabetes

If the diet does not work, the patient is transferred to insulin therapy. The dose of injections and their number are determined and controlled by the doctor. For mild diabetes, herbal medicine is indicated. Pregnant women are advised to do small physical activity in the form of walking.

“12817”] Antidiabetic drugs (pills, not insulin), which treat non-insulin-dependent diabetes mellitus, are contraindicated in pregnant women. The fact is that these drugs penetrate the cells of the tissue of the placenta and harm the baby (form various malformations).

All of these measures apply to women with type 1 diabetes. Type 2 diabetes and gestational diabetes are less common among women in labor.

Pregnancy management

In order to maintain the pregnancy, it is necessary to fully compensate for the diabetes mellitus.

Since the need for insulin in different perinatal periods is different, the pregnant woman needs to be hospitalized at least three times:

• after the first visit for medical help;
• the second time at 20-24 weeks. During this time, the need for insulin is constantly changing;
• and at 32-36 weeks, when late toxicosis often joins, which is a great danger to the development of the fetus. Hospitalization in this case can be resolved by a cesarean section.

Continuing pregnancy is possible if the fetus develops normally and in the absence of complications.

Most doctors consider delivery at 35-38 weeks optimal. The method of delivery is strictly individual. Caesarean section in patients with diabetes occurs in 50% of cases. In this case, insulin therapy does not stop.

Babies born to such mothers are considered premature. They need special care. In the very first hours of a child’s life, all the attention of doctors is directed to the prevention and fight against glycemia, acidosis, viral infections.

“12817”] In the intervals between inpatient treatment, a pregnant woman should be constantly monitored by her endocrinologist and obstetrician in order to correctly determine the time of delivery.