Diabetes is a big problem for healthcare in many countries. Gestational diabetes is diagnosed in about 5%-20% of pregnant women. Pregnancy is a period when it is possible to determine the presence of diabetes through screening and to change the eating behavior not only of a pregnant woman, but also of the whole family.
Screening for gestational diabetes in Russia is mandatory during pregnancy. A diabetes test, or glucose tolerance test (GTT), is performed between 24 and 28 weeks of pregnancy.
What is gestational diabetes?
This is diabetes, which exists only during pregnancy. It is characterized by elevated blood glucose levels and a lack of insulin. Insulin is a hormone that is produced by the pancreas and promotes the penetration of glucose into cells. As pregnancy progresses, the need for insulin increases, gestational diabetes occurs when the pancreas is unable to increase insulin secretion anymore, which leads to an increase in blood glucose levels in the mother and fetus.
Consequences of gestational diabetes
Increased glucose levels or hyperglycemia can lead to fetal macrosomia (large fetus). At the same time, the size of the head and brain remain within the normal range, but a large shoulder girdle can cause difficulties in passing through the birth canal, which increases the risk of birth trauma. Immediately after childbirth, there is a threat of a sharp decrease in the level of glycemia in the fetus, the appearance of jaundice.
Children born to mothers with gestational diabetes may have breathing problems. The risk of diabetes and obesity in a child increases in adulthood.
The risk of hypertension in late pregnancy and preeclampsia increases for the mother, as well as the likelihood of cesarean delivery (due to the high weight of the fetus and the risk of injury to the mother and child).
As a rule, gestational diabetes disappears immediately after childbirth. But in 30-50% of cases, it reappears after a while and does not disappear anymore. A balanced diet and diet can prevent the onset of diabetes in pregnant women.
Risk factors for gestational diabetes (GD)
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Heredity and eating habits.
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Ethnically at risk are Latin Americans, Asians, and Africans.
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Age over 35, overweight, low physical activity.
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A history of fetal macrosomia.
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A history of gestational diabetes (the risk of GD increases significantly in subsequent pregnancies).
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The presence in the family of patients with type 2 diabetes mellitus.
Gestational diabetes can be diagnosed in pregnant women who are not at risk.
Diagnosis of gestational diabetes
For diagnosis, a glucose tolerance test is performed using 75 g of glucose.
The study is performed on an empty stomach, and the meal break before the study should be at least 8 hours.
The first blood sampling is performed on an empty stomach, after which it is necessary to drink glucose. Then 2 more blood samples are taken with an interval of one hour.
Diagnostic criteria (norm indicators):
- fasting glucose - less than 5.1 mmol/l,
- after 1 hour - up to 10.0 mmol/l,
- after 2 hours - up to 8.5 mmol/L.
Exceeding at least one indicator indicates the presence of gestational diabetes.
What should I do if gestational diabetes is detected?
When gestational diabetes is detected, the patient first receives dietary recommendations. It is necessary to keep a food diary and monitor glycemia before meals and an hour after meals at least 3 times a day.
It is recommended to exclude "fast" carbohydrates from the diet: pastries, sweets, bananas, grapes.
Physical activity plays a significant role in the complex of measures for the treatment of gestational diabetes. About 150 minutes of physical exercise per week or 30-45 minutes sessions 3-5 times a week are recommended. If physical activity was not practiced before pregnancy, it is necessary to start gradually, under the supervision of a specialist. Recommended types of physical activity: swimming, walking, dancing, yoga. If, following all the recommendations, the glycemic level does not return to normal, insulin therapy may be prescribed. Such patients are under the supervision of an endocrinologist.
After giving birth, it is necessary to take the diabetes test again after 6-12 weeks.
Breastfeeding is recommended for all women, including patients with gestational diabetes.
The best way to prevent diabetes is to eat a carbohydrate-restricted diet. Focus on protein-rich foods and natural healthy fats, instead of foods rich in carbohydrates that increase the risk of diabetes. A low-carb diet is contraindicated for women during pregnancy, but it is great after the end of the breastfeeding period. Exercise is also useful for preventing type 2 diabetes.
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