Before pregnancy
If you have diabetes, pregnancy must be planned. Start communication with a gynecologist endocrinologist at least six months before conception and try to achieve a stable compensation for diabetes.
Types of diabetes and lifestyle
Diabetes mellitus is a chronic increase in sugar (glucose) in the blood and urine.
- There are the following types of diabetes:
1. Diabetes of the first type is insulin-dependent. For some reason, insulin in the body is not produced by itself, as a result, glucose is not processed. Too low level of glucose in the blood called hypoglycemia, too high - hyperglycemia. When hyperglycemia is necessary to monitor the presence of ketone bodies in the urine. Proper nutrition and balanced physical activity, constant monitoring of blood sugar level can make the life of a patient with type 1 diabetes mellitus as close as possible to normal.
2. Diabetes of the second type is not associated with insulin. Usually occurs in people over 40 years of age with excessive body weight.
3. Pancreatic diabetes. Develops in those who have a pancreas affected, responsible in the body for the secretion of insulin.
4. The so-called diabetes mellitus of pregnant women, or gestational diabetes mellitus (HSD). This is a violation of carbohydrate metabolism, which occurs or is first recognized during pregnancy. In about half of cases, GDD passes after birth without a trace, and in half - develops into type 2 diabetes.
The main conditions are the compensation of diabetes and the absence of serious complications (chronic renal failure, ischemic heart disease, proliferative retinopathy with fresh hemorrhages on the fundus, etc.). Against the background of decompensation of diabetes, it is dangerous to get pregnant: high blood sugar can prevent proper placement of the fetal internal organs, which occurs mainly in the first trimester of pregnancy. In addition, a miscarriage may occur. It is recommended to undergo a comprehensive medical examination in advance: like any other woman, it will not be impossible to check for infections transmitted predominantly through sexual intercourse, consult a neurologist, a cardiologist (this is mandatory for a diabetes experience of more than 10 years), an oculist - to undergo examination of the vessels of the fundus, with the pupil dilated. Do ultrasound of the thyroid gland and visit the endocrinologist. If necessary, also visit the nephrologist and go to the consultation in the office "Diabetic Stop". The following laboratory tests should be performed:
♦ glycated hemoglobin;
♦ microalbuminuria (UIA);
♦ a clinical blood test;
♦ biochemical blood test (creatinine, total protein, albumin, bilirubin, total cholesterol, triglycerides, ACT, ALT, glucose, uric acid);
♦ the general analysis of urine;
♦ Assessment of the glomerular filtration rate (Reberg's test);
♦ Urine analysis for Nechiporenko;
♦ Urine culture for sterility (if necessary);
♦ evaluation of thyroid function (tests for TTG free T4, AT to TPO).
During pregnancy
Pregnancy in women with SD-1 has a number of characteristics. People with diabetes know their blood sugar levels, but they do not always know that during pregnancy, the sugar level should be well below this norm. The rule for pregnant women with diabetes should be regular measurement of blood glucose level - at least 8 times a day. In the first trimester of pregnancy, hypoglycemia is possible: the risk of increasing arterial pressure in the mother, violations of blood flow in the vessels of the placenta and fetus, violations of the heart rhythms in the mother and in the fetus, fetal hypoxia. A woman can lose consciousness and even fall into a coma. Signs of hypoglycemia: headache, dizziness, hunger, impaired vision, anxiety, frequent palpitations, sweating, trembling, anxiety, confusion. If you experience any of the above, you should check the blood sugar. If this is not possible, you need to stop any physical activity, take quick-digestible carbohydrates (12 grams is 100 ml of juice or a sweet soda, or 2 pieces of sugar, or 1 table, a spoonful of honey). After this, you must eat slowly digestible carbohydrates (12-24 g - a piece of bread, a glass of yogurt, an apple). A high level of sugar in the blood of the mother can lead to the development of the child's pathology, such as diabetic fetopathy. It can be too fast or slow growth of the fetus, polyhydramnios, swelling of soft tissues. A newborn can suffer from respiratory and neurologic disorders, hypoglycemia. Elevated blood sugar can "hiccup" the child and later endocrine or neurological disorders in adolescence. To avoid such consequences, during pregnancy planning and all 9 months of waiting, be constantly in touch with the doctor. With increased blood sugar, you should cancel any physical activity and check the urine for ketone bodies (this can be done using test strips sold at the pharmacy), and then use the recommendations of your gynecologist-endocrinologist in case of glycemia. Keep a diary where you record the measurements of sugar, the amount of carbohydrates, the composition of food, the dose of insulin. Do not forget to watch how you gain weight, and measure blood pressure. It is necessary to monitor the presence of ketone bodies in the urine and about their availability immediately inform your doctor. It may be necessary to measure the volume not only of the drunk, but also of the excreted fluid (diuresis). Even with compensated diabetes during pregnancy, it is difficult to achieve a stable level of sugar in the blood.
If necessary, the doctor can refer you to:
♦ Dopplerography - using ultrasound, blood flow is checked in the umbilical cord, placenta and in the fetus;
♦ cardiotocography - it is checked whether the fetus has oxygen starvation (hypoxia).
Evaluation of the effectiveness of insulin therapy is carried out using a study of fructosamine (a compound of albumin blood protein with blood glucose). In the third trimester of pregnancy, the doctor will invite you more often than before. This is due to the fact that it is at this time that the risk of complications associated with diabetes increases. Gestational diabetes mellitus differs from gestosis of pregnant women. The reason for its appearance is reduced sensitivity of cells to their own insulin. According to European scientists, the prevalence of GDD is from 1 to 14% among healthy women. In the risk group - pregnant women with overweight, with a history of obstetric anamnesis. Take a blood test for sugar and a blood test with glucose load. If the indices are normal, the second time the test is carried out at the 24-28th week of pregnancy.
Childbirth
Many pregnant women with diabetes can give birth independently, if there are no additional reasons for cesarean section and obstetric contraindications for natural childbirth. Polyhydramnios, gestosis and urogenital infections can lead to premature birth. The most common complication in childbirth in patients with diabetes mellitus is prenatal discharge of amniotic fluid.
After childbirth
Most often, moms are afraid that their baby will also have diabetes. If the father of the child does not have this disease, then the probability of developing diabetes in a baby is about 3-5%. If the father suffers from diabetes, the risk is estimated as much as 30%. In this case, it is recommended to do genetic tests before pregnancy. Newborns need special care. Often babies are born with obesity, but with underdeveloped lungs. In the first hours of life, respiratory disorders, as well as central nervous system damage, acidosis, blood glucose levels should be avoided; to conduct a heart examination. In newborns, excessive body weight, swelling of the skin, enlargement of the liver and spleen can be noted. Infants from mums with SD-1 are poorly adapted and therefore often suffer from jaundice of newborns, toxic erythema, lose more weight after birth and restore it more slowly. But everything is surmountable!
Vanyusha was born by cesarean section at 37 weeks. His mother Ole was 29 years old when his son was born. Four and a half years later a woman gave birth to a daughter. Nothing special? Perhaps - if only at the time of the birth of the first child Olya did not have a diabetic experience of 19 years! The main problem for women who want to have children can be diabetes mellitus type 1 (SD-1). Doctors are afraid for the life of mother and child and are not always ready to take responsibility for conducting a problem pregnancy. So it happened with Olya, who did not find first support from doctors. Olya says: "I have a reliable support - my husband. It was he who went with me to all the consultations, looked for all kinds of articles, he considered all the doses of insulin, weighed me pieces of bread for sandwiches to work and in general very strictly followed my diet. Calmed my flashes of hysterics, woke me at night, sometimes every hour to measure the level of glucose, repaired me with juice if necessary and so on. Thousands of such little things, and take into account all of them - that was the most difficult for me. "With this approach, one can avoid negative consequences for the mother and baby.The main task of endocrinologists and midwives should be to ensure stable compensation of carbohydrate metabolism at all stages - from conception to birth.