Gestational diabetes

A strong increase in blood sugar levels during pregnancy is called gestational diabetes. As a rule, after childbirth, the condition is normalized, and the sugar level returns to normal.

The high blood sugar level of a pregnant woman can trigger a number of health problems for both the woman and the fetus. For example, a child may be born large, which is fraught with problems during vaginal delivery, as well as with high blood sugar levels. But after completing a course of specific therapy, pregnant women may well control their blood sugar levels and give birth to a healthy baby.

Women who have had gestational diabetes during pregnancy are more likely to develop type 2 diabetes. Therefore, preventive measures should be taken: maintain a healthy weight, stick to a healthy diet and increase physical activity.

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Statistics

The prevalence of gestational diabetes reaches 9.2%.

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Causes of Gestational Diabetes

During pregnancy, the placenta is formed in the uterus, which serves as a link between the mother and the baby. It is the channel through which the fruit receives water and food. The placenta produces hormones that prevent insulin from controlling the level of sugar in the mother’s blood, so her body has to produce more of it. When the pancreas of a pregnant woman cannot produce enough insulin, gestational diabetes develops.

The pancreas produces a hormone - insulin, which helps to properly use sucrose from food. With such a well-coordinated work, the level of sugar in the blood is maintained normal. During pregnancy, the placenta produces hormones that interfere with the work of insulin, so there is insulin resistance. A pregnant woman develops diabetes when the pancreas is unable to produce enough insulin to maintain normal blood sugar levels. 

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Risk factors for gestational diabetes

• pregnancy after the age of 25;
• history of gestational diabetes;
• the birth of a large child in the breach (more than 4.5 kg);
• You were born weighing more than 4.5 kg;
• familial predisposition for type 2 diabetes (parents, siblings);
• passive lifestyle before pregnancy;
• obesity (body mass index more than 30 or higher);
• Racial or ethnic factors: Hispanics, Native Americans, Asians, African Americans, and Pacific Islanders are at risk of developing diabetes;
• polycystic ovary syndrome;
• dark eruptions on the back, neck;
• taking corticosteroids;
• symptoms that foreshadow the development of diabetes;
• history of severe pregnancy in the past.

[11], [12], [13]

Symptoms of Gestational Diabetes

Gestational diabetes does not cause any symptoms, so a woman should be tested to confirm her diagnosis from 24 to 28 weeks of gestation. Sometimes there are surprises, and pregnant women are just at a loss - how, they have diabetes? Gestational diabetes can cause a number of problems with the health of the mother and the unborn child, so it is important to get tested on time to make sure everything is in order.

It often happens that a pregnant woman observes a number of symptoms of another type of diabetes, but does not know about the disease.

Symptoms of another type of diabetes:

• increased thirst
• increased urination
• increased hunger
• blurred vision

During pregnancy, women already experience increased urination and eat more than usual, so they often do not pay attention to these symptoms.

Most women learn about gestational diabetes at 24-28 weeks of gestation, and then only by blood tests. When diagnosed, you should change your lifestyle, namely, adhere to a healthy diet and diet and systematically exercise. These measures will help control blood sugar levels. The longer the gestation period, the more the woman's body produces hormones that prevent insulin from maintaining a healthy level of sugar in the blood of a woman, and, consequently, increases the risk of developing gestational diabetes. If a healthy diet and exercise do not contribute to the normalization of blood sugar levels, the doctor recommends injecting insulin. If a pregnant woman is diagnosed with diabetes, this does not mean that the disease will be transmitted to the child. In most cases, healthy babies are born to women with gestational diabetes. If you manage to control blood sugar levels, there is no cause for concern, since the likelihood of developing problems during pregnancy or childbirth is the same as in the absence of gestational diabetes. In rare cases, the following health problems may occur, both in the mother and in the child:

• high blood pressure due to late toxicosis;
• large child weight (excess glucose contributes to better growth of the fetus and fat accumulation, so a large child may be injured during vaginal delivery; if the child’s weight exceeds 4.5 kg, a cesarean section is recommended);
• after birth, excess insulin provokes a sharp drop in sugar in the baby’s blood, which is not safe for his health; in such cases, glucose is additionally administered; newborns may also have low calcium levels, high bilirubin and high red blood cells.

Gestational diabetes usually goes away after childbirth. But if he was diagnosed during this pregnancy, it may appear again during subsequent pregnancies, moreover, the risk of developing type 2 diabetes increases. According to data, more than half of women after diabetes were diagnosed with type 2 diabetes.

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Diagnostics of gestational diabetes

Almost all pregnant women are tested from 24 to 28 weeks. If your doctor suspects that you may have this disease, he will prescribe a diagnosis much earlier.

Gestational diabetes is diagnosed with two blood tests. One - after one hour from the moment of drinking a small cup of sweet drink. If the blood sugar level is very high, you need to do another longer 3-hour glucose test. If the blood sugar level is still above normal, the doctor makes a diagnosis - gestational diabetes.

Almost all pregnant women are tested for gestational diabetes between 18 and 28 weeks of gestation. But if the doctor thinks that you belong to a high-risk group, you will be tested much earlier.

Gestational diabetes is determined using the oral glucose tolerance test. A woman drinks a small amount of a sweet drink and after an hour the blood sugar level is checked. If it is very high, another three-hour glucose tolerance test should be done. It provides fasting for 3 hours (you can drink only water), and then use a small amount of a sweet drink. Blood sugar levels are checked every hour for at least three hours. If two or more of these tests showed high sugar levels, the doctor diagnoses gestational diabetes.

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Diagnosis during pregnancy

With gestational diabetes, the attending physician measures the pressure of the pregnant woman during each visit. In addition, he will prescribe various tests and diagnostics to determine the health status of the child and the mother.

• Ultrasound. Diagnosis helps determine the need for additional insulin, as well as determine the weight, age, health, and size of the abdominal cavity of the fetus. According to the results of ultrasound, the doctor is prescribed treatment. If the child is too large, the doctor will prescribe insulin. Remember that not always ultrasound correctly determines the child's weight and developmental abnormalities.
• Non stress test (when monitoring fetus). During movement, the reaction of the fetal cardiovascular system is observed. Sometimes the doctor prescribes an analysis each month for glycated hemoglobin (the average blood sugar level over time).

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Diagnosis during labor

During labor, the doctor carefully monitors the health of the pregnant woman and child, namely:

• monitoring fetal heartbeat (to determine the status of the child);
• blood sugar test (every few hours);

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Postpartum diagnosis

After giving birth, a woman needs to take a blood test for sugar several times. During the first few hours after birth, the newborn also takes blood for sugar. One of three days after giving birth you will have to starve and take an oral glucose tolerance test. It is more likely that gestational diabetes will pass after childbirth, but since you are at risk for developing type 2 diabetes, you need to take an oral glucose tolerance test 6 weeks after delivery and have a blood test for sugar after fasting once a year. Sometimes the doctor recommends an additional test for glucose tolerance at normal or slightly elevated blood sugar levels.

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Early detection of the disease

During the first visit to the doctor, after you know that you are pregnant, the doctor will determine the risk of developing gestational diabetes. If earlier during a previous pregnancy you gained a lot of extra pounds, you were diagnosed with high blood sugar, you had a family predisposition to type 2 diabetes and you found sugar in the urine, the doctor will immediately prescribe testing and diagnosis.

Most women are tested for gestational diabetes between the 24th and 28th week of pregnancy. [ 10 ] You may not need this testing if:

• You got pregnant before age 25;
• You have not been diagnosed with gestational diabetes before;
• no family member has type 2 diabetes;
• Your body mass index is less than 25;
• You do not belong to ethnic groups that are at risk for developing diabetes (Hispanics, Asians, African Americans, and Pacific Islanders);
• You do not have polycystic ovary syndrome.

Some pregnant women are not at risk of developing gestational diabetes, and therefore they do not need to be tested. Experts disagree on whether all pregnant women should be tested in this way. But still, for safety reasons, most attending physicians recommend this.

[28], [29], [30], [31], [32], [33], [34], [35], [36], [37],

After childbirth

Despite the fact that gestational diabetes will pass after the birth of a baby, it may reappear during the next pregnancy. In addition, often in such cases (more than half of women) after gestational diabetes develops a little later, type 2 diabetes. The doctor will tell you how you need to check your blood sugar for some time. After 6–12 weeks after birth and after breastfeeding have ceased, a glucose tolerance test should be taken. If the results are normal, then you need to donate blood every three years to blood sugar levels after a certain period of fasting. Even if the sugar level is kept within the normal range, one should not forget about the possibility of developing diabetes. Eat a healthy diet and diet and get active in sports. The use of birth control pills containing progesterone and progestin does not apply to factors that trigger the development of type 2 diabetes.

Consult your gynecologist for the most appropriate contraceptives. If you plan to have a baby, you need to be tested for diabetes before pregnancy and at an early period.

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Treatment gestational diabetes

Many women manage to keep their blood sugar levels under control through exercise and changes in diet and diet. These measures are also the prevention of gestational diabetes during pregnancy in the future, and over time - type 2 diabetes. In addition, you need to constantly check your blood sugar levels at home and regularly visit a doctor. In some cases, women additionally injected insulin, which adds to the lack of insulin produced by the body.

The diagnosis of gestational diabetes sounds scary, but in most cases, women with such a diagnosis give birth to healthy children. A pregnant woman herself should take care of the normal course of pregnancy. Treatment of gestational diabetes includes a healthy lifestyle, that is, a woman must adhere to a healthy diet and diet and exercise regularly, as well as constantly monitor blood sugar levels.

The doctor will develop a special treatment plan for you. There is no need to eat special foods, but you need to change what, when and how much you eat. In addition, you should sign up for training for pregnant women. A healthy lifestyle is the key to a successful pregnancy and childbirth, as well as preventing the development of diabetes in older age. When you begin to introduce these changes in life, you will learn a lot about your body and learn how to recognize its reaction to food intake and exercise. You will be pleasantly surprised at the improvement of well-being and a surge of energy.

During pregnancy

Treatment for gestational diabetes during pregnancy includes:

Balanced diet. Once the tests have confirmed gestational diabetes, you need to consult a nutritionist who will develop a healthy eating plan. They will tell you how to limit the amount of carbohydrates consumed in order to control blood sugar levels and recommend recording everything that you eat throughout the day (to follow the weight trend).

Regular exercise. Try to do the exercises at least 2.5 hours a week. You can actively move 5 days a week for 30 minutes or divide this time by 10 minutes during the day. Continuous moderate activity during pregnancy helps the body process insulin and maintain normal blood sugar levels. If you were in a passive lifestyle before pregnancy, consult your doctor about what is the best place to start. Walking and swimming is the best choice for a pregnant woman, but you can also sign up for special training for pregnant women.

Monitoring blood sugar levels. An important part of the program to combat gestational diabetes is the systematic monitoring of blood sugar levels. At home you need to check it up to 4 times a day (before breakfast and after an hour after a meal). If you inject insulin, you need to do tests 6 times a day (before and after an hour after meals). Frequent control of blood sugar sometimes seems like a debilitating exercise, but the realization that its level is within the normal range will help calm down and discard all negative thoughts.

Monitoring the development and growth of the fetus. The doctor may recommend to follow the movement of the fetus, and also appoint an ultrasound. If the weight of the fetus is higher than normal, you should inject insulin. With the introduction of insulin, you should pass a non-stress test (to monitor the fetal heart rate during movement). Remember that ultrasound and non-stress test is prescribed in the last days of pregnancy, even when insulin is not given.

Systematic visits to the doctor. A pregnant woman with gestational diabetes should regularly come for a consultation with a doctor. During the visits, the doctor will measure blood pressure and prescribe a urine test. A woman talks about how often and what she eats, how much time she is actively moving and how much she has gained weight. In addition, the doctor analyzes the blood sugar level, which is determined at home.

Introduction of insulin. The first thing to do with gestational diabetes is to change the diet and diet, as well as regular exercise. But if after a lifestyle change, the blood sugar level is significantly different from the norm (high), the doctor may prescribe insulin. It will help keep blood sugar within the normal range and is considered harmless to the fetus.

As a rule, you cannot starve during pregnancy. Doctors usually consider it normal when a pregnant woman gains 12 kg, but for obesity or obesity, the doctor may recommend eating less and, consequently, gaining less weight. Large women are more prone to high blood pressure and the development of late toxicosis of pregnancy.

If possible, breastfeed the baby. Breastfeeding is the prevention of obesity and diabetes in a child, but during breastfeeding one should not forget about monitoring blood sugar levels.  

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Childbirth

Most women with gestational diabetes give birth vaginally, so a single diagnosis of gestational diabetes is not a medical indication for a cesarean section. If the doctor believes that the child will be born large, he will prescribe an ultrasound to determine the exact weight and size of the fetus. With a large fetus weight, the doctor decides to stimulate labor for 38 weeks and plans a cesarean section.

• During labor and delivery, the mother and child are under the supervision of a physician.
• Blood sugar is checked every hour or two. When the level is high, insulin is injected into the vein, while at low it is glucose.
• Monitoring the fetal heart rate and its health status. If the child is large and fetal distress is observed, the doctor prescribes a cesarean section.

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After childbirth

After giving birth, you and your baby will still be under the supervision of specialists.

• Blood sugar levels will be measured every hour (usually it returns to normal).
• The child will also take a blood test for sugar. If you had a high level of sugar during pregnancy, then the baby’s body will produce an increased amount of it several hours after birth. Sometimes this leads to hypoglycemia (low blood sugar). In this case, the child is given sweet water or is given intravenous glucose.
• A child may have a low calcium content, high bilirubin and an increased number of red blood cells.

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Drug treatment of gestational diabetes

For most women with gestational diabetes, it is enough to switch to a healthy diet and an active lifestyle in order to normalize blood sugar levels. If this is not enough, and if the fetus is gaining weight more than the norm, you need to enter insulin. The doctor will tell you in detail how to do this.

Insulin is the only approved medication for the treatment of gestational diabetes, which is used if the body of a pregnant woman can not control blood sugar levels with a healthy diet and regular exercise. The amount of insulin administered depends on the weight of the woman and the duration of the pregnancy. In some cases, the body needs more insulin in the last weeks of pregnancy, because the placenta produces more hormone that inhibits insulin. Sometimes a woman is hospitalized until the sugar level returns to normal. In type 2 diabetes, Glyburide is prescribed, which in rare cases is also used in the case of gestational diabetes.  

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Insulin for gestational diabetes

Insulin is usually produced by the pancreas. Its dosage form helps the body process glucose. It can not be taken orally because the stomach acid destroys it even before it enters the blood. Different types of insulin are produced depending on the speed and duration of its action: fast / long / medium duration of action.

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Packaging

Insulin is produced in small glass jars, covered with rubber caps, containing 1000 units. It is also produced in cartridges - syringe pens with special needles. Each package contains detailed instructions for use.

How to take insulin?

Insulin is injected under the skin, and sometimes into the vein, but only in a medical facility.

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Insulin action

Insulin lowers blood sugar levels, helping glucose reach cells and be used as energy. Sometimes women with gestational diabetes need to take two types of insulin - fast and medium action. Long-acting insulin is not recommended during pregnancy. Short-acting insulin lowers blood sugar levels and ceases action. Then long-acting insulin begins to act. The combination of short-acting and long-acting insulin helps maintain blood sugar levels within the normal range before and after meals.

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Why is it used?

The doctor will recommend the introduction of insulin, if diet and exercise do not contribute to the normalization of blood sugar levels, which is necessary for the health of the mother and baby. Usually, gestational diabetes goes away after childbirth, and insulin is no longer needed.

Insulin efficacy

Today, insulin is the only approved agent that is prescribed for gestational diabetes.

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Side effects

As a result of insulin administration, hypoglycemia (low blood sugar level) may appear.

Sugar falls very quickly - for 10-15 minutes as a result of:

• excess insulin dose;
• introducing it into the muscle and not fatty tissue;
• skipping meals;
• excessive physical exertion without proper nutrition;
• drinking alcohol, especially on an empty stomach (any amount of alcohol during pregnancy is considered dangerous to the health of the child);
• taking medications that lower sugar (some OTC drugs tend to lower blood sugar levels, so before you buy any drug, you should consult with your doctor).

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What should I think?

Taking insulin should meet your needs. The development of side effects and the action of insulin depend on many factors:

• places for insulin administration: if you inject into muscle tissue, and not into adipose tissue, insulin will act very quickly;
• the amount of insulin injected: excess dosage is fraught with a strong decrease in blood sugar;
• combinations of insulin types: the drug acts faster if you take only fast-acting insulin;
• Whether physical exercises were done before the drug was injected: if an injection is made into the muscle tissue that was in tension during the workout, the drug will enter the blood faster.

Women with gestational diabetes need to check blood sugar levels up to 6 times a day (before meals and an hour after meals).

Check the expiration date of the drug and watch when the next bottle is opened. After 30 days, take the next vial and discard the remaining insulin.

Store the insulin box according to the instructions.

Treatment of gestational diabetes at home

The successful course of pregnancy depends on you. Gestational diabetes, like other type of diabetes, cannot be cured only with medication. Your doctor and nutritionist will advise you on how to change your lifestyle in order to cope with the disease. Possession of all the information about this disease is the first step to a healthy pregnancy. If you know how nutrition and exercise affect blood sugar levels, you can control it yourself and, therefore, prevent many problems in the future.

Home treatment for gestational diabetes involves a healthy diet, regular exercise and constant monitoring of blood sugar levels.

Healthy diet

A healthy diet and diet will help keep blood sugar levels in the normal range. Once you have been diagnosed with gestational diabetes, you should immediately consult with a nutritionist who will develop a special nutrition plan for you. You will be recommended to record everything you eat in order to control weight. A nutritionist will also teach you how to count and distribute consumed carbohydrates throughout the day.

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Regular exercise

Constant moderate activity during pregnancy helps the body use insulin better, which helps control blood sugar levels. Often, with gestational diabetes, simply exercising and eating healthy foods is enough. Try to be moderately active at least 2.5 hours a week. You can practice 30 minutes 5 days a week or distribute the load several times for 10 minutes every day.

If you were leading a passive lifestyle before pregnancy, talk to your doctor about how best to start playing sports. For pregnant women, for example, cycling in the prone position will do. You can enroll in a special sports group for pregnant women or start to visit the pool.

If an active and healthy lifestyle contributes to the normalization of blood sugar levels, there is no need to inject insulin. If the doctor still recommends insulin, during exercise you should always have on hand sweet products of quick action in case of symptoms of low blood sugar. In this case, you need to stop exercising, check blood sugar levels and have a snack.

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Blood sugar test

An integral part of treating gestational diabetes is controlling blood sugar levels. Every day, you need to do a sugar test 4 times (in the morning before breakfast and after one hour after each meal). If you inject insulin, you should monitor your sugar level 6 times a day (before and one hour after meals). Frequent control of blood sugar sometimes seems like a debilitating exercise, but the realization that its level is within the normal range will help calm down and discard all negative thoughts.

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Other important points

If a healthy diet and an active lifestyle do not contribute to the normalization of blood sugar levels, the doctor will recommend injecting insulin.

• Do not try to lose weight during pregnancy, if you have been large before. Just consult with your doctor how much you can gain a kilogram during pregnancy.
• The doctor may recommend monitoring the movement of the fetus to see if the number of tremors has decreased. As a rule, the fetus begins to move for 18 weeks and moves several times a day. If it seems to you that you have not felt movement for a long time, lie down on your left side for 30 minutes or longer. If there is no movement, contact your doctor.
• If you inject insulin, insulin levels can drop to a critical limit. Although this is rarely the case for gestational diabetes, a pregnant woman should be aware of the symptoms of low blood sugar and have sweet, quick-acting foods on hand.

What should be taken into account?

In most cases, the blood sugar level of a pregnant woman returns to normal within a few hours after giving birth. If you have already been diagnosed with gestational diabetes, there is a risk of it recurring during the next pregnancy. The possibility of developing type 2 diabetes at an older age is also not excluded. The transition to a healthy lifestyle during pregnancy (and its subsequent observance) is the prevention of diabetes and the guarantee of health. If you are concerned about the health of your child or your child, consult your doctor.

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Gestational diabetes: when to ask for help?

Immediately call an ambulance if a woman who injects insulin:

• loss of consciousness or symptoms of low blood sugar that do not go away after taking a sweet drink or food;
• has low blood sugar (less than 50 milligrams per deciliter);
• it becomes sleepy and lethargic, while the blood sugar level is less than 60 milligrams per deciliter (after the measures taken to increase).

Go to the doctor if you have gestational diabetes and:

• You notice that the child starts to move less or stops moving altogether;
• You inject insulin without consulting a doctor about how to control low blood sugar levels;
• Your blood sugar level does not rise to more than 60 milligrams per deciliter after taking steps to raise blood sugar levels;
• It is difficult for you to control blood sugar levels; at the same time, if you inject insulin, you also need to change the diet and diet;
• You have been ill for 2 days or more (except for cases of a cold) and have been vomiting or diarrhea for 6 hours; You associate weakness and thirst with rising blood sugar levels;
• You followed the doctor’s recommendations, but you didn’t feel better; sugar level is 150 milligrams per deciliter.

You should also see a doctor if you suspect symptoms of high blood sugar: increased thirst, urination more often than usual, increased hunger and blurred vision

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Observation

For a period of time, you observe the progress of symptoms. If you feel better, you will not need to undergo treatment. When worsening, the doctor will decide what to do. If you are pregnant and are at risk of developing gestational diabetes or are experiencing its symptoms, you can’t hesitate - you need to seek medical help. Observation is also not advisable if you inject insulin and still experience low blood sugar symptoms that do not go away after the measures taken.

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Who to contact if you have gestational diabetes?

Specialists who diagnose and treat gestational diabetes:

• family doctor with experience in treating gestational diabetes;
• obstetrician-gynecologist.

If you need to inject insulin, you can consult with an endocrinologist or a perinatologist. After consulting these specialists, you can return to your doctor. If you are diagnosed with gestational diabetes, you should also consult a nutritionist who can help you adjust your diet and diet.

Prevention of gestational diabetes

Sometimes the development of gestational diabetes cannot be prevented. But still, you can reduce the risk of its development, maintaining a healthy weight, and not gaining a lot of extra pounds during pregnancy. Systematic exercise will help maintain blood sugar levels within the normal range.

Once you have been diagnosed with gestational diabetes, there is a high risk of it recurring in the future and developing type 2 diabetes. One of the basic principles for preventing gestational diabetes is to support a healthy weight.

If you have had gestational diabetes in the past, avoid medications that are insulin resistant (nicotinic acid and glucocorticoids: prednisone and dexamethasone). Birth control pills containing estrogen and progestin (low dosage) do not increase the risk of developing type 2 diabetes.

A child born to a woman with gestational diabetes is at risk for developing type 2 diabetes and obesity. Breastfeeding prevents the child from gaining excess weight. Teach your child as they mature to a healthy diet and exercise, which is the prevention of the development of type 2 diabetes.

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