Diabetes mellitus and unplanned pregnancy. Pregnancy Diabetes Pregnancy and Type 1 Diabetes

Depending on the individual characteristics of the pregnant woman and the course of fetal development, childbirth with diabetes develops in different ways.

Diabetes is a disease associated with an insufficient amount of insulin in the human body. The pancreas is responsible for this hormone.

More recently, doctors prohibited women with diabetes from becoming pregnant and having children. The progress of medicine does not stand still, thus the situation has completely changed and allows women with type 1 and 2 diabetes to give birth to children. In this case, the disease is not transmitted to the child. The risks are too low if the mother has type 1 diabetes, the transmission rate is no more than 2%. If the father is sick with this ailment, then the risk rises to 5%. If both parents get sick, the risk rises to 25%.

The main contraindications for pregnancy and childbirth

Type 1 and 2 diabetes puts a serious strain on the organs of a woman's body. This can threaten not only the pregnant woman, but also the fetus. Today it is not advisable to become pregnant and give birth to people who have:

Insulin-resistant diabetes prone to ketoacidosis.
Untreated tuberculosis.
Conflicting rhesus.
Some types of heart disease.
Severe renal failure.

Varieties of diabetes

There are three types of diabetes:

The first type is called insulin-dependent. It mainly develops only in adolescents.
The second type is called non-insulin dependent, often found in people over 40 years old with a large body weight.
Gestational diabetes occurs, occurs only during pregnancy.

The main signs of diabetes during pregnancy

If diabetes appears during pregnancy, it is almost impossible to detect it immediately, as it proceeds slowly and is not expressed in any way. The main features include:

Fatigue.
Increased feeling of thirst.
Significant weight loss.
High pressure.

Usually, few people pay attention to these symptoms, since they are suitable for almost any pregnant woman. As soon as the patient came to the gynecologist, and he revealed a pregnancy, he necessarily prescribes to take urine and blood tests, the results of which can reveal the presence or absence of diabetes.

What are the dangers of type 1 and 2 diabetes in pregnant women?

It is worth knowing that gestational diabetes, type 1 or 2 for a pregnant woman, can entail a number of undesirable consequences, namely:

The appearance of gestosis (high blood pressure, the appearance of protein in the urine, the appearance of edema.)
Polyhydramnios.
Violation of blood flow.
Fetal death.
Congenital malformations in a child.
Mutation in a child.
Changes in kidney function.
Deterioration of vision in a pregnant woman.
Significant increase in fetal weight.
Violation in the vessels.
Late toxicosis.

Rules for the management of pregnancy and childbirth in type 1 diabetes

If a woman in labor has diabetes, she should be under the constant supervision of specialists throughout the entire period. This does not mean that a woman should be hospitalized. You just need to constantly visit doctors and monitor blood glucose levels.

Type 1 diabetes mellitus is quite common and is detected in people as early as childhood. During pregnancy, this disease is rather unstable and there is wall damage, metabolic disorders and carbohydrate metabolism disorders.

Basic rules for managing pregnancy in diabetes:

Ongoing visits by designated specialists.
Strict adherence to all doctor's advice.
Daily monitoring of blood sugar levels.
Continuous monitoring of urine ketones.
Strict adherence to diet.
Taking insulin in the required dosage.
Undergoing examination, which includes a hospital stay under the supervision of doctors.

A pregnant woman is admitted to the hospital in several stages:

The first hospitalization is mandatory for up to 12 weeks, as soon as the doctor has identified a pregnancy. This procedure needed to identify possible complications and subsequent health threats. A complete examination is carried out. On the basis of which, the issue of maintaining the pregnancy or terminating it is decided.
The second hospitalization takes place for up to 25 weeks for re-examination, to identify complications and possible pathology. And also for adjusting the diet, the use of insulin. An ultrasound scan is prescribed, after which the pregnant woman undergoes this examination weekly to monitor the condition of the fetus.
The third hospitalization is carried out at 32-34 weeks so that doctors can accurately determine the due date. In this case, the woman remains in the hospital until the birth.

If any complications are found during pregnancy, then childbirth is carried out artificially by the cesarean method. If the pregnancy was calm, there were no pathologies, then the birth will take place naturally.

Proper management of pregnancy and childbirth in type 2 diabetes

As in the previous case, the pregnant woman should regularly be under the supervision of a doctor, attend all prescribed appointments and follow the doctor's advice.

In addition to all the above obligations, it is also necessary with this disease to measure the hemoglobin level every 4-9 weeks, and take urine for analysis to detect the presence of infections in the body.

Gestational diabetes

Pregnant women can be prone to gestational diabetes caused by hormonal changes. This problem occurs in about 5% of pregnant women, at 16-20 weeks. Previously, the disease cannot appear, since the placenta has not been fully formed.

This temporary effect lasts only during pregnancy. After childbirth, all abnormalities disappear. If a woman who has gestational diabetes during pregnancy wants to become pregnant again, the problem may recur.

The due date is scheduled no later than 38 weeks. With gestational diabetes mellitus, labor is more likely to take place naturally. The child tolerates such childbirth perfectly.

The caesarean section is used in the presence of obstetric indications. It can be hypoxia, large size of the fetus, a narrow pelvis in a pregnant woman, and others. In order for the birth to go well, it is necessary to consult a doctor on time and follow all the necessary recommendations.

If a woman acquired gestational diabetes during pregnancy, then after giving birth, no later than 5-6 weeks, it is necessary to take a blood test for sugar levels.

The main signs of diabetes mellitus include:

Constant urge to urinate.
Constant itching.
Dryness of the skin.
The appearance of boils.
Increased appetite with intense weight loss.

General advice on pregnancy in type 1 and type 2 diabetes, depending on the duration

In the first trimester, you need to constantly monitor your sugar level. At this stage, the level almost always decreases, so the dosage of insulin should be less than usual.
In the second trimester, the dosage should be increased and a balanced diet should be followed.
In the third trimester, glycemia appears, so the dose of insulin must be reduced.

Preventive measures for type 1 and 2 diabetes mellitus in pregnant women

Typically, gestational diabetes is stopped by dieting. At the same time, it is highly not recommended to sharply reduce the calorie content of products. The daily diet should be: 2500-3000 kcal. It is best to eat in portions and often (5-6 times a day).

The diet should include fresh fruits and vegetables, and not contain:

Sweets (sweets, rolls, pies, etc.) i.e. easily digestible carbohydrates. Since they contribute to high blood sugar levels.
Fatty foods (fats, oils, fatty meats, cream).
Refined sugar.
Salty food.

Diabetes diet

Since the main reason for the development of type 1 and 2 diabetes in pregnant women is a lack of insulin, the use of easily digestible carbohydrates is highly undesirable. The main components of the diet:

Drink plenty of fluids.
A pregnant woman needs to drink at least 1.5 liters of purified water per day. Do not use sweet syrups, carbonated drinks with and without dyes, kvass, yoghurts with various fillings. Any alcoholic drinks.

Fractional food.
A pregnant woman with type 1 and type 2 diabetes must eat at least 5 times a day in small portions. Protein foods should be consumed separately from carbohydrate foods. For example, if you have pasta with chicken for lunch, then with diabetes you should first eat pasta with stewed vegetables at lunchtime, and for an afternoon snack, chicken with fresh cucumber.

Vegetable salads can be eaten with any meal. It is recommended to eat fruits with carbohydrate foods.
Soups and other first courses.
Second courses.

Chicken, lean fish, beef or lamb are suitable as main courses. Vegetables can be in any diet.

Fermented milk products (sour cream, cottage cheese).
Snack (low-fat pate, ham, cheese).
Hot drinks (warm milk tea).
Rye or diabetic bread.

To measure blood sugar, a pregnant woman must have a glucometer, with which she can measure the data herself and adjust the dosage of insulin. Normal blood sugar is 4 to 5.2 mmol / liter on an empty stomach and not higher than 6.7 mmol / liter a few hours after eating. If your blood sugar does not drop during the diet, doctors will prescribe insulin therapy.

It is worth noting! Pregnant women should not take medicated tablets to lower blood sugar levels. They can adversely affect the development of the fetus. For the correct delivery of the dosage of insulin, the pregnant woman must be admitted to the hospital. All of the above points can be avoided if all preventive measures of diabetes mellitus are productively carried out.

Factors that can cause type 1 and type 2 diabetes in a woman

The pregnant woman is over 40 years old.
Relatives suffer from diabetes mellitus.
A pregnant woman is of a non-white race.
Being overweight before pregnancy.
Smoking.
A previously born child weighs more than 4.5 kilograms.
The previous birth ended in the death of the child for unknown reasons.

In pregnant women with type 1 and type 2 diabetes, childbirth is somewhat different than usual. To begin with, the birth canal is prepared by puncturing the amniotic bladder and injecting hormones. It is imperative that an anesthetic medicine is administered to a woman before starting the process.

In the process, doctors closely monitor the baby's heartbeat and the mother's blood sugar. If labor subsides, oxytocin is administered to the pregnant woman. When the sugar level is high, insulin is given.

If after the cervix has opened and the medicine has been injected, but the labor has subsided, doctors may use forceps. If hypoxia occurs in the fetus before the uterus opens, delivery is carried out by cesarean section.

No matter how the delivery goes, the chance of having a healthy baby is very high. The main thing is to monitor your health, visit doctors and follow their recommendations.

Newborn activities

After birth, the baby is provided with resuscitation measures, which depend on the condition and maturity of the baby, the methods that were used during childbirth.

In newborn babies who were born to women with diabetes mellitus, signs of diabetic fetopathy are very often noted. Such children need special care and supervision by specialists.

The principles of neonatal resuscitation are as follows:

Preventing the development of hypoglycemia.
Close monitoring of the child's condition.
Syndrome therapy.

In the first days of life, it is very difficult for a child with diabetic fetopathy to adapt. Some disorders may occur: significant weight loss, the development of jaundice, and others.

After the baby is born, of course, every mother wants to breastfeed him. It is in human milk that contains a huge amount of nutrients and nutrients that have a beneficial effect on the growth and development of the baby. Therefore, it is so important to keep lactation as much as possible.

Before breastfeeding a baby, the mother should consult with an endocrinologist. He will prescribe a specific dosage of insulin and make dietary recommendations at the time of feeding. It is very common for women to have a drop in blood sugar during the feeding period. To avoid this, you must drink a mug of milk before starting feeding.

Conclusion

Pregnancy and childbirth in women with diabetes is a major step. Therefore, it is very important to constantly visit specialists, follow their recommendations and independently monitor your health. Eat more vitamins, breathe in the fresh air and move more. And also do not forget about a balanced diet.

Take care of yourself and be healthy!

Children are happiness, and you can't argue with that. And when does this happiness come completely unexpectedly? And instead of the expected one strip - two? And such changes are not included in the plans for the near future? And still everyone is talking about the compulsory planning of pregnancy with diabetes!

This news initially causes only fear and anxiety. Unplanned pregnancies are much more common than you think. According to official statistics, more than 30% of pregnancies in Russia are unplanned, but, most likely, this percentage is much higher, because it is very difficult to calculate the real figure. We will not discuss the moral and ethical aspects of this emotional dilemma. We will discuss why this is happening and what to do if you nevertheless decided to keep the pregnancy, no matter what life circumstances.

Why does this happen?

Many modern methods of contraception are highly effective, but not 100% effective. Therefore, sometimes there are "mistakes". In addition, according to all the same statistics, contraception is used and correctly used by only 25-30% of people of reproductive age. Therefore, the most common reason "Unplanned" pregnancy is the lack of contraception for various reasons in general or its misuse. It turns out that a pregnancy is not planned, but at the same time nothing is done in order to avoid it.

Of course, an “unplanned” pregnancy is not the best scenario and, as the name implies, not the most expected, especially for women with diabetes. But remember that such a pregnancy does not at all mean that the child will necessarily have health problems, and the mother will spend the entire pregnancy in a hospital. Many of you know that when your glucose levels are high at conception / early dates pregnancy increases the risk of congenital malformations. However, with the technology available today, many women keep their blood glucose levels within target values \u200b\u200bduring the first weeks of an unplanned pregnancy. But even if you feel anxious about the fact that in the early stages blood glucose was out of the norm, do not forget that your task is not to worry about what happened, but to act and reach your target blood glucose values \u200b\u200bas quickly as possible now. ... The future healthy baby is the biggest motivation to lead a healthy lifestyle, and for women with diabetes, it is also very careful to control blood glucose.

So:

Start with more frequent blood glucose measurements (at least 5 times a day - on an empty stomach, 1 hour after breakfast, lunch and dinner, before bedtime) and keeping a self-monitoring diary

Eat Familiar Foods You Are Confident In Carbohydrate Counts

Make an appointment with your endocrinologist and gynecologist as soon as possible

Find your medical documents (hospital discharges, the latest expert opinions, laboratory data). Be sure to look when you donated glycated hemoglobin and what is its value

Make a list of questions about what to expect during pregnancy, read the available information on this topic

Some diseases are a contraindication to fertilization and bearing a child. Pregnancy with type 1 diabetes is not prohibited, but a woman should carefully monitor her health, regularly take glucose tests and be monitored by doctors. If you do not listen to the doctor's recommendations and ignore your condition, then complications of type 1 diabetes mellitus during pregnancy are possible, which can harm the mother's health and endanger the life of the unborn baby.

Features of the disease

Type 1 diabetes mellitus in pregnant women is a complex autoimmune disorder. With such a pathology, the work of the pancreas is disrupted, as a result of which a deviation in the work of beta cells is noted. In this case, the woman is constantly fixed in the blood fluid. If type 1 diabetes mellitus is ignored during pregnancy, then serious complications are possible, in which the vessels, kidneys, retinas and the peripheral nervous system are affected.

Planning a pregnancy with type 1 diabetes

Pregnancy planning for type 1 diabetes begins six months before, a woman first takes all the necessary tests and undergoes instrumental examinations. If complications of diabetes mellitus are identified, a woman is recommended to undergo a therapeutic course and consult with specialists. Before pregnancy, it is necessary to normalize blood sugar levels.

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If normal blood sugar levels (5.9-7.7 mmol / l) persist for 3 months, then doctors allow the woman to become pregnant.

Moreover, throughout the entire period of gestation, a diet is followed and glucose in the blood fluid is controlled. Also, an important point when carrying a healthy child is the condition of the father. If the future dad has type 1 or 2 diabetes mellitus, then the likelihood of genetic transmission of pathology to the fetus increases significantly.

Symptoms

Constant thirst should alert a pregnant woman.

A woman with type 1 diabetes mellitus, when carrying a child, has the same symptoms as other people with a similar problem:

constant desire to drink;
the smell of acetone from the mouth;
increased daily amount of urine excreted;
poor wound healing;
dryness and peeling of the skin.

In the first trimester, the likelihood of high blood sugar increases significantly, which can trigger hyperglycemia. In the 2nd trimester, there is a risk of hypoglycemia with a rapid drop in blood sugar. Also, with type 1 diabetes mellitus, there is a constant desire to eat, so a woman should be especially careful to monitor weight gain. The table shows the basic norms for weight gain, taking into account the duration of pregnancy.

Possible complications

A pregnant woman with type 1 diabetes is likely to develop complications. Serious consequences for the life of the mother and the health of the unborn baby are possible. Among the main dangers are the following:

the likelihood of termination of pregnancy;
the development of congenital abnormalities in the fetus;
the development of severe hypoglycemia;
diseases of the genitourinary system;
early childbirth, as a result of which the baby will be born prematurely;
delivery by cesarean section.

With a significant amount of toxins in the body of a pregnant woman, negative influence on the development of the fetus. Often, such an impact leads to the termination of pregnancy or the birth of a baby with anomalies. Also, with type 1 diabetes mellitus, a pregnant woman may experience kidney pathologies, up to the complete cessation of the functioning of the organ. In this case, there is a threat not only to the life of the fetus, but also to the expectant mother.

Complications of the disease in the expectant mother are dangerous for her and the child.

If the doctor identifies many negative factors during pregnancy, then an emergency termination of pregnancy is performed, regardless of the gestational age.

Diagnostic procedures

In order for the entire period of bearing the baby and the delivery to go safely and without complications, the woman should regularly visit doctors and take the necessary tests. Every day, a pregnant woman should control the content of blood sugar and ketone bodies in urine with test strips. All the results obtained are recorded in the plate. Every month you should consult an endocrinologist. If complications are suspected, the doctor may prescribe a general urine test and check the female body for creatinine and biochemical parameters.

Pregnancy management

Diet food

With type 1 diabetes mellitus, it is extremely important to observe proper nutrition and control weight gain. It is strictly forbidden to abruptly gain or lose weight in pregnant women with type 1 diabetes. A woman refuses fast carbohydrates or significantly reduces their amount in the daily diet. These include juices, candy, cookies, and other foods. Important when drawing up diet food adhere to the rules of the ratio of fats, proteins and carbohydrates - 1: 1: 2. You should eat fractionally, in small portions, up to 8 times a day.

Medication

The amount of insulin consumed in each trimester of pregnancy varies.

During gestation, the need for insulin changes slightly: the dosage of drugs is adjusted for each trimester. In the first trimester, the doctor lowers the insulin dose, and in the second, it can be increased. In the second trimester, the dosage of drugs may increase to 100 units. Also, the endocrinologist will individually select long and short-acting drugs for each pregnant woman.

When the third trimester of pregnancy begins, the need for insulin decreases again. Also, the emotional state of the woman and other factors that are important to consider before administering a dose of the drug affect the glucose level. It is better for a woman with type 1 diabetes to avoid emotional upheavals, as they increase the amount of glucose, which leads to complications. If a woman is not able to control emotions, then the doctor prescribes mild sedative drugs to calm the nervous system.

Pregnancy is an exciting and vibrant state in a woman's life, but it requires a significant exertion of all the forces of the body. During pregnancy, all types of metabolism are activated, and if there is some kind of metabolic disease, then its course can change unpredictably. Carbohydrate metabolism during gestation is the topic of our article today. We will tell you how pregnancy proceeds against the background of type 1 and 2 diabetes mellitus, how it threatens the mother and the fetus, and how to deal with it.

In Russia, the prevalence of type 1 and 2 diabetes mellitus among pregnant women is 0.9–2%. Among the disorders of carbohydrate metabolism in pregnant women, the following forms are distinguished:

1. Diabetes that a woman had before pregnancy (pre-gestational diabetes):

- type 1 diabetes mellitus
- type 2 diabetes mellitus
- other types of diabetes mellitus: pancreatogenic - after suffering from pancreatitis, pancreatic necrosis; damage to the pancreas with medications; diabetes induced by infections: cytomegalovirus, rubella, influenza virus, viral hepatitis B and C, opisthorchiasis, echinococcosis, cryptosporodiosis, giardiasis.

2. Gestational diabetes mellitus (GDM). GDM is a disorder of carbohydrate metabolism that developed during this pregnancy, its severity varies, the prognosis and treatment are also different.

When pregnancy with diabetes is contraindicated:

1) The presence of progressive complications of diabetes mellitus (proliferative retinopathy, nephropathy with a decrease in creatinine clearance, that is, with impaired renal filtration function), this poses a danger to the mother's life.

2) Insulin-resistant and labile forms of diabetes mellitus (diabetes, which is poorly corrected with insulin, there are often jumps in blood sugar levels, urine acetone and hypoglycemic conditions are present).

3) The presence of diabetes in both spouses.

4) The combination of diabetes mellitus and Rh sensitization of the mother (Rh - negative mother and Rh - positive fetus).

5) The combination of diabetes mellitus and active pulmonary tuberculosis.

6) Antenatal fetal death (especially repeated) and / or the birth of children with malformations against the background of compensated diabetes. In this case, it is necessary to consult a geneticist for both spouses.

Pregnancy and type 1 diabetes

Type 1 diabetes is an autoimmune disease endocrine system, which is manifested by an increase in blood sugar levels, due to absolute insufficiency of insulin.

The inheritance of type 1 diabetes mellitus is about 2% if the mother is sick, about 7% if the father is sick and about 30% if both parents are sick.

Symptoms of type 1 diabetes:

Symptoms of type 1 diabetes in pregnant women are the same as outside of pregnancy. But in pregnant women, fluctuations in carbohydrate metabolism can be more pronounced, in the first trimester the risk of hyperglycemia (high blood sugar) increases, in the second, on the contrary, hypoglycemia (lowering blood sugar below normal values).

Diagnostics

1. Blood glucose level. In pregnant women, the norm is up to 5.1 mmol / l. Preparation and delivery of the analysis does not differ from non-pregnant women. Blood sugar is measured in the venous blood in the morning on an empty stomach. In order to control glycemia, blood is taken several times a day, this is called the glycemic profile.

2. Sugar and acetone of urine. These indicators are determined by each visit to the antenatal clinic, along with the general indicators of urine.

3. Glycated hemoglobin (Hb1Ac). The norm is 5.6 - 7.0%.

4. Diagnosis of complications. Complications of diabetes are polyneuropathy (nerve damage) and angiopathy (vascular damage). Among angiopathies, we are interested in microangiopathies (damage to small vessels).

Diabetic nephropathy is a lesion of the small vessels of the kidneys, which gradually leads to a decrease in their filtration function and the development of renal failure. During pregnancy, the burden on the kidneys increases and the risk of infection is increased. And therefore, urine control is also performed every visit to the antenatal clinic.

Deterioration of the kidney condition can be a contraindication for carrying a pregnancy, an indication for hemodialysis (artificial kidney device) and premature delivery (risk to the mother's life).

Diabetic retinopathy is a lesion of the small vessels of the retina. Pregnancy in a patient with diabetes mellitus should be planned, also because sometimes it is necessary to carry out laser coagulation of the retina before pregnancy in order to reduce the risk of retinal detachment. Late stages of retinopathy are a contraindication to independent childbirth (you cannot push, as there is a high risk of retinal detachment), and sometimes to gestation.

5. Also, all women with diabetes undergo a general examination, according to which a conclusion is made about their health.

General blood analysis.
- General analysis of urine (urine protein).
- Biochemical blood test (total protein, albumin, urea, creatinine, direct and indirect bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase).
- Coagulogram (indicators of blood clotting).
- Analysis of daily urine for protein.

6. Diagnostics of the fetus:

Ultrasound + Dopplerometry (to assess the correct development of the fetus, weight, compliance with the term, presence of defects, amount of water and blood flow activity)

Cardiotocography (CTG) to assess fetal cardiac activity, movement and uterine contractile activity

Complications of type 1 diabetes for the mother:

1) An unstable course of diabetes mellitus, an increase in hypoglycemic conditions (a sharp decrease in blood sugar up to a hypoglycemic coma), episodes of ketoacidosis (an increase in acetone in the blood and urine, an extreme manifestation is ketoacidotic coma).

2) Worsening of the course of diabetes and the progression of vascular complications, up to the threat of loss of vision or a sharp decrease in kidney function with the need for hemodialysis (artificial kidney).

3) Complications of pregnancy: the risk of preeclampsia, the threat of termination of pregnancy, premature outpouring of water is increased, polyhydramnios, placental insufficiency, frequent urinary tract infections, recurrent vulvovaginal infections (candidiasis and others) are characteristic.

4) Abnormalities of labor (weakness of labor; shoulder dystocia, that is, stuck fetal shoulders in the birth canal, which entails injuries to the mother and fetus, acute fetal hypoxia during childbirth).

5) Birth trauma (tissues are less elastic, often affected by a fungal infection, in combination with a large fetus, this leads to perineal tears).

6) The risk of operative delivery increases. Due to the large size of the fetus, childbirth is often performed by caesarean section. Often women with diabetes are operated on as planned and earlier than at 39 - 40 weeks. If by 37 weeks the baby already weighs more than 4000 grams, then further prolongation of pregnancy will lead to an increase in the number of complications. Such patients must be delivered in a planned manner, having previously adjusted the dose of insulin (together with an endocrinologist).

7) The frequency of postpartum purulent-septic complications (postpartum endometritis) increases.

Complications of type 1 diabetes mellitus for the fetus:

1) Diabetic fetopathy or embryophetopathy (100% chance). Diabetic fetopathy is a characteristic complex of disorders that is caused by a combination of several factors (persistent hyperglycemia, chronic fetal hypoxia and other metabolic disorders inherent in diabetes mellitus).

In the above picture, there are two babies next to them, on the right with normal weight, and on the left with diabetic fetopathy.

The concept of diabetic fetopathy includes a set of clinical criteria:

Large body weight and length at birth (macrosomia).
- Puffiness and blueness - purple color of the skin, mainly of the face after birth (the face is of the cushingoid type, this is the case in adults and children who receive treatment with prednisolone and other glucocorticoid hormones). Intrauterine fetal hypotrophy is possible, however, in this case, there is a change in the face according to the cushingoid type.

Morphofunctional immaturity.
- Respiratory distress syndrome due to impaired surfactant synthesis.
- Congenital heart defects, cardiomegaly up to 30% of cases.
- Other congenital malformations.
- Hepatomegaly and splenomegaly (enlargement of the liver and spleen).
- Impaired postnatal adaptation in 80% of newborns: clinical symptoms of hypoglycemia, hypocalcemia and hypomagnesemia (according to laboratory data, there may be muscle cramps, impaired swallowing)

Macrosomia of the fetus.

Macrosomia is literally translated from Latin as “big body”. Excessive intake of sugars in the blood of the mother, and therefore the fetus, leads to the overweight of the baby and it weighs more than 4000 grams, the body length is more than 54 cm.

Large fruit is a fruit weighing from 4000 gr. up to 5000 gr.
The giant fruit is a fruit weighing more than 5000 grams.

Macrosomia of the fetus is not always caused by diabetes mellitus, the cause may be high growth and large constitution of both parents, Beckwith-Wiedemann syndrome (a congenital disease characterized by very rapid growth, asymmetric body development, an increased risk of cancer and some congenital anomalies), obesity in the mother (even in the absence of type 2 diabetes).

Congenital malformations.

Most often, the central nervous system (brain and spinal cord), the heart (heart defects, cardiomegaly, that is, a significant increase in the heart with a decrease in its contractile function), the skeletal system, the gastrointestinal tract (small descending bowel syndrome, atresia of the anus) and the genitourinary tract (aplasia kidneys, doubling of the ureters and others). Also among children from women with diabetes mellitus, the phenomenon of reverse ("mirror") arrangement of organs is significantly more common.

There is a syndrome of caudal regression or caudal dyskinesia (absence or underdevelopment of the sacrum, coccyx, less often of the lumbar vertebrae, incomplete development of the femoral bones).

Defects develop due to damage to the yolk sac in early pregnancy (4-6 weeks), which develops against the background of hypoxia caused by hyperglycemia. If a woman approaches pregnancy prepared, with normalized blood glucose and glycated hemoglobin levels, then this risk can be minimized.

Morphofunctional immaturity.

Despite the large weight, babies with diabetes can be born immature, primarily the lungs. With excess glycemia, the synthesis of surfactant in the body is disrupted.

A surfactant is a fat-like substance that is located inside the pulmonary vesicles (which have not yet expanded in a child and do not look like bubbles) and, as it were, lubricates them. Thanks to the surfactant, the pulmonary vesicles (alveoli) do not collapse. This is especially important when it comes to a newborn. The alveoli should expand and not fall further from the first breaths. Otherwise, respiratory failure and a condition called "respiratory distress - neonatal syndrome" or "respiratory distress syndrome" (SDS) rapidly develop. To prevent this urgent and serious condition often carry out the prevention of SDR with dexamethasone intramuscularly, under the influence of the hormone the synthesis of surfactant is accelerated.

Hypoglycemia in a newborn.

A decrease in blood sugar in the first 72 hours in full-term newborns is less than 1.7 mmol / L, in premature infants and babies with delayed development - less than 1.4 mmol / L, pallor, skin moisture, anxiety, irritated cry, attacks of apnea (episodes of long delay breathing), and then a sharp lethargy, weakening of sucking, nystagmus ("tracking" rhythmic movements of the eyes, which are not controlled and directed in one direction), lethargy up to hypoglycemic coma.

After 72 hours, a hypoglycemic state is considered to be a decrease in blood sugar less than 2.2 mmol / L. This condition is subject to intensive treatment in a hospital setting.

2) Fetal hypoxia (the state of constant oxygen starvation in the fetus, which entails various complications, read more in our article "Fetal hypoxia"). Fetal hypoxia also causes a state of polycythemia, that is, blood clotting, an increase in the number of all blood cells. This leads to the formation of microthrombi in small vessels, and can also lead to prolonged jaundice of the newborn.

3) Birth traumatism. A clinically narrow pelvis is a discrepancy between the size of the fetus and the size of the mother's pelvis. Due to the peculiarities of the constitution of the fetus in diabetes mellitus, most often the shoulder girdle does not correspond, there is a complication of childbirth, which is called "shoulder dystocia". The shoulders of the fetus get stuck in the birth canal for more than 1 minute and cannot make the required turn. The second stage of labor is delayed, and this is fraught with birth trauma to the mother and fetus.

Threat of dystocia to the fetus:

Fractures of the shoulder and / or clavicle
- damage to the brachial plexus,
- damage to the vessels of the spinal cord in the cervical region,
- traumatic brain injury,
- asphyxia (suffocation) of the fetus,
- Intranatal fetal death.

Treatment of type 1 diabetes during pregnancy

During pregnancy, we try to limit the use of pharmaceuticals as much as possible, but this does not apply to insulin. The lack or insufficient dose of insulin is a risk to the life and health of both the mother and the baby.

During pregnancy, all the same insulin preparations are used as in the usual management of patients with type 1 diabetes. Even if you already have a well-chosen insulin administration schedule, it needs correction during pregnancy. Carbohydrate metabolism during pregnancy is unstable, it depends on the changing needs of the fetus, as well as on the time when the fetal pancreas begins to function.

I trimester - a tendency to hypoglycemic conditions.

Reduced insulin requirements by 10 - 20%
- the risk of ketoacidosis increases (early toxicosis, vomiting of a pregnant woman)

II trimester - synthesis of hormones by the placenta (progesterone, placental lactogen).

Insulin resistance increases
- an increase in the need for insulin (2 - 3 times)

III trimester - by 36 weeks the function of the placental complex gradually fades away

Decreases the need for insulin
- increased risk of hypoglycemia

Childbirth is a high risk of hypoglycemia due to high psycho-physical activity.

The selection of drugs, doses and administration scheme should be carried out by a doctor - an endocrinologist and no one else! With an optimally selected treatment regimen, you are able to bear a healthy baby and maintain your health.

Prevention of complications

Prevention consists in regular monitoring by specialists (joint management of the patient by an obstetrician - gynecologist and endocrinologist) and adherence to a specialized diet.

Observation

All women with pre-gestational diabetes who are planning to have a baby should be seen by an endocrinologist 5 to 6 months prior to the expected conception. The degree of diabetes compensation, the presence and severity of complications are being clarified, educational trainings on self-control of glycemia are conducted (School of Diabetes).

Together with an endocrinologist, the patient consults an obstetrician - gynecologist to decide on the possibility of carrying a pregnancy.

A pregnant woman with diabetes mellitus must be hospitalized in the endocrinology department at a certain time, if the condition worsens unscheduled.

First hospitalization at 4-6 weeks. It is performed in the event that a woman has not been examined before pregnancy or the pregnancy is spontaneous and unplanned, the same issues are solved as with pre-gravid preparation (compensation, complications and the possibility of gestation), or if complications of pregnancy have arisen in the early stages.

Second hospitalization at 12-14 weeks, when insulin requirements decrease and the risk of hypoglycemia increases.

Third hospitalization at 23-24 weeks of pregnancy: correction of insulin doses, control of the course of angiopathy (urine protein, microalbuminuria, examination of the fundus, etc.), identification and treatment of complications of pregnancy (threat of premature birth, polyhydramnios, recurrent infections of the genitourinary tract), fetal monitoring (ultrasound, dopplerometry)

Fourth hospitalization at 30 - 32 weeks: correction of insulin doses, control over the course of diabetic complications, control of the fetus (III screening ultrasound, dopplerometry, CTG), general examination (general blood and urine tests, biochemical blood test, blood coagulation assessment), according to indications, the prevention of the syndrome of respiratory disorders of the fetus is carried out with dexamethasone (if there is a threat of premature birth), the choice of the method of delivery and preparation for delivery

Diet

The diet of a pregnant woman, in this case, is the same as for all patients with diabetes. It is necessary to monitor the sufficient amount of protein and calorie intake.

Forecast

The more the mother's carbohydrate metabolism is compensated by the time of pregnancy and during pregnancy, the lower the risk of all the listed complications, or their less significant and dangerous severity.

Pregnancy with type 2 diabetes

Type 2 diabetes is a disease in which the cells in the body are insensitive to insulin. The pancreas is not damaged in this disease, the production of insulin can be completely normal, but in some cells of the body (primarily in fat cells) receptors (sensitive points on the cell membranes) to insulin are damaged. Thus, insulin resistance is formed, that is, the cells are insensitive to insulin.

Insulin is produced, but it cannot contact the cells and help them absorb glucose. The pathophysiological mechanism of damage to blood vessels and nerves due to hyperglycemia here will be the same as in type 1 diabetes mellitus.

Most often, type 2 diabetes is accompanied by overweight, up to morbid (painful) obesity. Excess weight, in addition to a violation of carbohydrate metabolism, also provokes an increased load on the cardiovascular system and joints. Also, being overweight or overweight during pregnancy increases the risk of thrombophlebitis and varicose veins.

Symptoms

Complaints are very similar to those of type 1 diabetes. But unlike type 1 diabetes mellitus, there is no decrease in body weight, even, on the contrary, due to frequent bouts of hunger, the patient eats a much larger amount of food than necessary. And bouts of hunger can occur due to surges in insulin levels. The body produces the right amount, the cells do not perceive it, the level of insulin increases even more. Some of the cells still remain sensitive to insulin, higher doses of it can reach them, blood glucose drops sharply and a feeling of "wolfish" hunger arises. During an attack of hunger, a woman eats a large amount of food, and, as a rule, easily digestible (simple carbohydrates in the form of bread, sweets and other confectionery, since hunger is really unmanageable and there is no time to cook healthy food for herself) and then the mechanism closes in the form of a "vicious circle ".

Diabetes mellitus type 2, as already mentioned, goes along with obesity and insulin is produced in sufficient quantities at first. But then the constant stimulation of the pancreas to produce large amounts of insulin depletes the beta cells (specialized cells in the pancreas that produce insulin). When beta cells are depleted, there is already a secondary insulin deficiency. The difference between these conditions is in the treatment. In the second case, insulin is vital.

Diagnostic measures are the same as for type 1 diabetes mellitus. It is also necessary to determine the blood glucose level, glycated hemoglobin, undergo a general examination plan (see above), as well as consultations of specialist doctors (primarily an ophthalmologist).

The consequences for the mother and fetus in type 2 diabetes are the same as in type 1 diabetes, because they are all consequences of long-term high blood sugar and in this case it is not so important for whatever reason.

Treatment of type 2 diabetes during pregnancy

But the treatment for type 2 diabetes mellitus may differ from type 1. Before pregnancy, the patient received drugs that lower blood sugar and affect weight (contribute to weight loss) and / or adhere to a special diet.

It makes no sense to list the drugs used to treat type 2 diabetes BEFORE pregnancy, because they are all contraindicated DURING pregnancy.

With the onset of pregnancy, the question of transferring the patient to insulin or (at the very beginning of the course of diabetes and obesity no more than I-II degrees) to a diet is decided. The translation is carried out by an endocrinologist under the close supervision of sugars and the general condition of the woman.

The diet for type 2 diabetes is the same as for type 1.

Prevention of complications

Self-monitoring of blood sugar is a guarantee that you will always be aware of what is happening in the body and will be able to inform your doctor in time. Do not spare money to purchase a glucometer. It's a smart double investment in your baby's and your health. Sometimes the course of type 2 diabetes during pregnancy is unpredictable and you may need to switch to insulin temporarily at any time. Don't miss this moment. Measure blood sugar at least in the morning on an empty stomach and once a day, 1 hour after eating.

Forecast

Just like type 1 diabetes, the more your sugar metabolism is compensated, the more favorable the pregnancy outcome will be and the less your own health will suffer.

Pregnancy against the background of other forms of diabetes (much rarer) follows the same rules. The need for insulin is determined by an endocrinologist.

A subsequent pregnancy for a woman with any type of diabetes is recommended no earlier than 1.5 years later.

Diabetes mellitus of any type is a disease that is becoming a way of life. It is very difficult to come to terms with the need to introduce into your daily routine from 1 to 5 - 6 injections of insulin per day, especially if this need arose suddenly during this pregnancy. But you have to accept this in order to preserve your health and the ability to bear and give birth to a baby. The more disciplined you are with your diet, dosing schedule, and self-monitoring, the better your chances of success. And your obstetrician-gynecologist together with an endocrinologist will help you with this. Take care of yourself and be healthy!

Obstetrician-gynecologist A.V. Petrova

Type 1 diabetes mellitus is a serious pathology in which there is partial or complete dysfunction of the pancreas, as a result of which the body begins to experience a deficiency in insulin and loses the ability to process sugar that enters it with food. Because of this, it is believed that type 1 diabetes and pregnancy are completely incompatible things. But is it? And is there an opportunity for a woman with such a disease to become a happy mother?

General information

Diabetes mellitus is not a complete contraindication to pregnancy. But if a woman wants to give birth to a healthy child, she needs to prepare in advance. And this should be done not 1-2 weeks before conceiving a child, but for at least 4-6 months. So, there are certain conditions in diabetes where pregnancy is not recommended. And these include:

unstable health;
frequent exacerbations of type 1 diabetes, which can adversely affect the development and formation of the fetus;
high risks of having a child with disabilities;
a high probability of spontaneous miscarriage in early pregnancy and the onset of premature birth.

With the development of T1DM, the process of glucose breakdown is disrupted. The consequence of this is the accumulation of a large amount of toxic substances in the blood, which are also transmitted through the bloodstream to the fetus, provoking the development of various pathologies in it, including diabetes mellitus.

Sometimes a sharp exacerbation of diabetes ends badly not only for the child himself, but also for the woman. For this reason, when there are high risks of such problems, physicians, as a rule, advise to terminate the pregnancy, and in the future not to try to give birth to a child on their own, as all this may end badly.

Quite often, pregnancy with type 1 diabetes mellitus gives complications to the kidneys. If a woman has a sharp deterioration in their functionality in the first trimester, then she, as in the previous case, is recommended to terminate the pregnancy, since if the kidney function continues to deteriorate, this can lead to the death of both the woman herself and her child.

It is for these reasons that pregnancy and type 1 diabetes are considered incompatible. However, if a woman takes care of her health in advance and achieves stable compensation for the disease, then she has every chance of giving birth to a healthy child.

Weight gain

In T1DM, carbohydrate metabolism is impaired not only in a pregnant woman, but also in her unborn child. And this, first of all, affects the weight of the fetus. There are great risks of developing obesity in him even in the prenatal period, which, of course, will negatively affect labor. Therefore, when a woman with diabetes finds out about her interesting situation, she needs to carefully monitor her weight.

There are certain rates of weight gain that indicate the normal course of pregnancy. And they are:

the first 3 months, the total weight gain is 2-3 kg;
in the second trimester - no more than 300 g per week;
in the third trimester - about 400 g per week.

Strong weight gain during pregnancy increases the risks of developing pathologies in the fetus

In total, a woman should gain 12-13 kg during her entire pregnancy. If these norms are exceeded, then this already indicates high risks of developing pathologies in the fetus and the occurrence of serious complications during childbirth.

And if the mom-to-be notices that her weight is growing rapidly, she must absolutely go on a low-carb diet. But this can be done only under the strict supervision of a doctor.

Features of the course of pregnancy in type 1 diabetes

In order to bear a healthy and strong baby, doctors do not advise women to take any medications during pregnancy. But since with type 1 diabetes in the body there is an acute shortage of insulin, medication is indispensable.

Important! The need for insulin during pregnancy changes in every trimester, therefore, it is necessary to carry out injections or take special medications strictly according to the scheme prescribed by the doctor!

As a rule, in the first trimester of pregnancy, the body does not experience an acute shortage of insulin, so many women during this period can easily do without medication. But this does not happen in all cases. Therefore, all women suffering from diabetes should constantly monitor their blood glucose levels. In the event that a systematic increase in indicators is noted, this should be immediately reported to the attending physician, since insulin deficiency in the first 3 months of pregnancy can provoke the development of secondary diseases and the appearance of serious consequences.

During this period, it is not recommended to resort to insulin injections, as they can provoke the opening of severe vomiting (due to toxicosis), in which the body loses many useful micro- and macroelements, including carbohydrates, used as energy. A deficiency of nutrients can also lead to the development of pathologies in the fetus or to spontaneous miscarriage.

Insulin injection dosage is adjusted every 2-3 months of pregnancy

From the 4th month of pregnancy, the need for insulin increases. And it is during this period that there is an urgent need for insulin injections. But it should be understood that a pregnant woman is responsible not only for her own health, but also for the health of her unborn child, so she needs to strictly follow all the doctor's prescriptions.

Insulin injections should be given on a schedule at regular intervals. After setting them, eating is mandatory. If, after the administration of insulin, carbohydrates do not enter the body, this can lead to hypoglycemia (a sharp decrease in blood sugar levels), which is no less dangerous than hyperglycemia (an increase in blood sugar outside the normal range). Therefore, if a woman has been prescribed insulin injections, she needs to constantly monitor her blood glucose levels to avoid serious consequences.

In the third trimester, the need for insulin may decrease, but this increases the risk of hypoglycemia. And since the symptoms of this condition are often sluggish during pregnancy, you can easily miss the moment of lowering blood sugar. And in this case, you also need to regularly use the meter and record the results in a diary.

Taking blood for sugar from a pregnant woman should be carried out regularly

It should be noted that if a woman makes every effort and stabilizes her condition even before pregnancy, she has every chance of giving birth to a healthy and strong child. The opinion that when a pregnant woman has diabetes she will have a sick baby is wrong. Since scientists have repeatedly conducted studies on this matter, which have shown that diabetes is transmitted from woman to child in only 4% of cases. The risks of developing diabetes in a fetus increase dramatically only when both parents are ill with this disease at once. Moreover, the probability of its development in a baby in this case is 20%.

When is hospitalization required?

Diabetes mellitus poses a serious threat to the health of a pregnant woman and her unborn child. And to prevent the development of complications, doctors often hospitalize such women to make sure that there is no threat.

Typically, the first time hospitalization occurs at the moment when a woman with diabetes is diagnosed with pregnancy. In this case, they take all the necessary tests from her, check her general health and consider whether the pregnancy should be terminated or not.

If the pregnancy continues, the second hospitalization occurs at 4-5 months. This is due to a sharp increase in insulin requirements. In this case, doctors are trying to stabilize the patient's condition, thereby preventing the occurrence of complications.

The last hospitalization occurs around 32 to 34 weeks of gestation. The patient is fully examined and the question of how the childbirth will occur - naturally or by cesarean section (it is used if the fetus is obese) is decided.

Important! Additional hospitalizations are indicated only with a sharp deterioration in the patient's condition or the development of pathologies in her unborn child.

It is believed that the most dangerous condition in pregnancy is uncompensated diabetes. Its development very often leads to various complications, for example:

miscarriage in early pregnancy;
gestosis;
toxicosis in the last months of pregnancy, which is also dangerous;
premature birth.

Gestosis - dangerous conditionaccompanied by toxicosis, edema and high blood pressure

For this reason, women with uncompensated diabetes are hospitalized almost every month. The development of gestosis is especially dangerous for them. This condition can provoke not only spontaneous miscarriage or premature opening of labor, but also fetal death in the womb, as well as provoke bleeding and the development of secondary diseases in a woman that can lead to disability.

Moreover, uncompensated diabetes often leads to polyhydramnios. And this condition significantly increases the risks of developing pathologies in the fetus, since with high water its nutrition is disturbed, and the pressure on it increases. As a result, the fetus has impaired cerebral circulation, and the work of many internal organs... This condition is manifested by constant malaise and strange dull pains in the abdomen.

It is important to know

A woman suffering from type 1 diabetes should understand that the health of her unborn child depends on her state of health. Therefore, before becoming pregnant, she needs to prepare her body for this event. To do this, she needs to undergo a medical course of treatment, lead a healthy lifestyle, engage in moderate physical activity and, of course, pay special attention to your diet.

Proper nutrition in diabetes allows you to achieve stable normalization of blood sugar and avoid the onset of hypoglycemia or hyperglycemia. It should be noted that after the onset of pregnancy, the introduction of insulin does not give such quick results, since carbohydrates after the birth of a new life in the body are broken down much more slowly.

Proper nutrition prevents the exacerbation of the disease and the development of various pathologies in the fetus.

And in order to prepare the body for the fact that it will somehow have to do without insulin, injections need to be given much less often, especially morning hours... It is advisable to set up an injection one hour before eating.

If, after the administration of insulin, a woman has hypoglycemic attacks, she needs to eat more easily digestible carbohydrates. If she tolerates injections normally, then products containing simple carbohydrates should be discarded. These include a variety of sweets and pastries. Fruit juices, smoothies and sodas are also undesirable for diabetes.

A doctor should tell in more detail about the diet that a woman planning to become a mother should follow in the near future. It should be understood that each organism has its own individual characteristics, therefore, dietary restrictions are also individual in nature. It is important to strictly follow all the doctor's recommendations, then the chances of giving birth to a healthy and strong child will increase several times.